The SMS-Adherence Support Trial (StAR) mHealth initiative involving members from Oxford University, the Chronic Disease Initiative for Africa (CDIA) at the University of Cape Town (UCT) and the South African Medical Research Council (SAMRC) is successfully helping patients living with hypertension manage their disease.
According to the SAMRC, 6.2 million people in SA have high blood pressure and 3.2 million have unacceptably high levels, heightening the risk of heart attacks and strokes.
The StAR programme began in 2009 when a team consisting of Oxford Professor of General Practice, Andrew Farmer, Professor of Endocrinology and Diabetes at UCT and head of the CDIA, Naomi Levitt, and epidemiologist and medical doctor, Kirsty Bobrow, started working together to try and find an innovative solution to help patients manage their disease.
Professor Lionel Tarassenko of Oxford Institute of Biomedical Engineering bought funding for the project from the Wellcome Trust and the Engineering and Physical Sciences Research Council.
The team realised an mHealth solution that could run on a feature mobile phone would be the ideal solution because of SA’s strong mobile network coverage. “It seemed evident that we could use this network in healthcare, simply to send text messages, automatically and on a wide scale,” said Professor Farmer.
By working with patients with high blood pressure and primary care clinic staff in the Western Cape, a library of suitable messages in English, Afrikaans and Xhosa with the correct tone was compiled to be used as text prompts and reminders. The programme was then tested at a large clinic serving the Langa and Bonteheuwel townships.
Regarding the importance of the programme, Dr Bobrow said: “It’s important that we keep you in care, keep you on medication and keep your blood pressure controlled. How do you get people to stay in care? How do you get them to come back and to keep coming back? You need to remind them to come back, improve the experience they have at the clinic, and have people think about their clinic as a caring space.”
Professor Farmer added: “The SMS-messages have a wide range. They can be prompts to collect your medicine or to take it regularly. Others focus on worries people may have about side-effects. Or we can suggest what to talk about with their families about illness – many people are reluctant to. Sometimes we just wish them Happy Birthday.”
A DPhil student, David Springer, set up the system to handle data from patients and work out what message to send them and when, based on very little extra input from the clinic. “I adapted an app for the clinic to collect all the data. So we had all the information about patients’ medical health records accessible by this module, which is all we needed to send the texts,” said Springer.
The team is currently nearing the end of a trial involving 1300 patients, and from it Professor Farmer noted that “it’s clear that people found using the system very helpful. We have stayed in contact with 97% of patients, which in itself demonstrates how people felt this was relevant.”