Effectiveness, Cost-effectiveness, and Acceptability of Phone Call and Video-based Interventions to Improve Adherence to Antihypertensive Medications

Hypertension prevalence in adults ranges between 19 percent and 55 percent in Ghana (Agongo et al., 2020). About half of the patients diagnosed with hypertension in Ghana exhibit signs of organ damage which occur as a result of poor control of blood pressure and late detection by the health system (Atibila et al., 2021). Despite the availability of effective treatment regimen and evidence of benefits of treatment, hypertension remains poorly controlled in Ghana as studies have reported control rates ranging from 24 percent to 42 percent (Sanuade et al., 2018).

The high prevalence of uncontrolled blood pressure has been attributed mainly to poor medication adherence (Boima et al., 2015). A study conducted by Abeasi et al. (2022) in the Upper East region indicated that about 60 percent of hypertensive patients were nonadherent to their medications. Also, another study (Adomako et al., 2021) reported non-adherence rates of 49 percent and 53 percent in two hospitals in the Ashanti region. These high rates of nonadherence thwart the efforts to control and manage hypertension.

With the increase in availability and uptake of mobile phones worldwide, mobile health technologies (mHealth) have been identified as promising strategies that can be used to remind, motivate and educate patients about their disease as well as medications to improve adherence to medications in patients with hypertension (Anglada-Martinez et al., 2015; Xiong et al., 2018). Ghana has the highest mobile penetration rate in Africa (Global System for Mobile Communications Association (GSMA), 2020) and as of 2021, there were over 40 million mobile connections in the country (Kemp, 2021). The widespread use of mobile phones provides a unique opportunity for clinicians to leverage mHealth to improve medication adherence as they are incorporated widely into daily life.

Studies that have utilized mHealth interventions to improve adherence to antihypertensive medications have mostly employed short message service (SMS)(Buis et al., 2017; Leon et al., 2015; Maslakpak & Safaie, 2016; Sartori et al., 2020; Varleta et al., 2017). The challenge with text messaging or SMS is that it is difficult to apply to every context, especially in Africa where the literacy level is reported to be low (Gee et al., 2015). Also, evidence suggests that individuals with lower levels of education may not open and read the messages (Saleh et al., 2018). There is also the likelihood that people may read the messages and may not understand them (Sartori et al., 2020). Additionally, text messaging restricts the number of characters that can be sent and hence, messages sent may lack details which makes them difficult to be understood (Schoenthaler et al., 2020). Other authors have noted that the content of the messages may become monotonous resulting in message fatigue and possible withdrawal from the study (Finitsis et al., 2014; Horner et al., 2017).

Other equally important alternatives such as phone calls and videos can overcome most of the challenges associated with SMS (Asante et al., 2020; Stanczyk et al., 2016). Existing evidence from the healthcare literature suggests that videos perform better than written words since words cannot convey facial expressions and body language (Schooley et al., 2015). Again the use of videos is useful for individuals who have less education, health literacy and motivation to take medicines as it does not necessitate extensive reading of numerous pages of written material (Ben-Zeev et al., 2018). The use of phone call based interventions also increases patients confidence in the information provided and allows them to receive immediate feedback on queries about their illness or medications (Son et al., 2020). There is a paucity of studies on use of phone call and video-based interventions in improving adherence to medications in hypertensive patients in the mHealth literature (Chun-Yun Kang, 2022).