Designing a text messaging program to increase adherence to medication for the secondary prevention of cardiovascular disease

Background: Cardiovascular medication for secondary prevention has been shown to be effective. However, cardiovascular patients have poor medication adherence, the consequences of which include premature death, recurrence risk, hospitalization, and high financial cost for the healthcare system. Behavioral interventions based on text messaging technology are a promising strategy to improving adherence in medications. In low-middle income settings there is no high-quality evidence of a behavioral program delivered by SMS; hence we describe the development, message content, and the program design of the intervention for improving adherence to cardiovascular medication. Methods: We used the model reported by Abroms and colleagues for developing and evaluating text messages-based interventions. This model describes a process in which the intervention created is based on theory and evidence, the target audience is involved to ensure the intervention is engaging and useful, and there is a focus on implementation from the outset. Results: Our main result was the design of the program, which consisted of a twelve-month structured intervention based on Transtheoretical Model of Behavior Change. We wrote and validated clusters of texts messages targeting each stage of the model. Each message went through an examination process including the evaluation of former cardiovascular patients, experts and the team research personnel. Another important result was an understanding of patients perceptions of their experience of cardiovascular disease, barriers to accessing healthcare in Colombia and the use of mobile technology for health. Conclusions: An SMS intervention has the potential to be an acceptable and effective way of improving adherence to medication in patients with cardiovascular disease. This paper describes the development and content of one such intervention.