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Randomized Controlled Trial
. 2025 Mar 19;25(1):1070.
doi: 10.1186/s12889-025-22204-6.

Efficacy of short message service (SMS) intervention on medication adherence and knowledge of stroke prevention among clinic attendees at risk of stroke: a randomized controlled trial

Daniel Aigbonoga  1   2 , Boluwatife Adewale  3   4 , Joshua Igwilo  3 , Victoria Adeyeye  3 , Tobi Olajide  3   4 , Oluwatosin Olaniran  3 , Abiodun Akintayo  3 , Peter Aremu  3 , Faith Oluwadamilare  3 , Oluwafemi Popoola  3 , Adesola Ogunniyi  3   4
Affiliations
Randomized Controlled Trial

Efficacy of short message service (SMS) intervention on medication adherence and knowledge of stroke prevention among clinic attendees at risk of stroke: a randomized controlled trial

Daniel Aigbonoga et al. BMC Public Health. .

Abstract

Background: Stroke remains a leading cause of long-term disability and mortality worldwide, particularly in low- and middle-income countries where suboptimal management of modifiable risk factors such as hypertension and diabetes mellitus are prevalent. Poor medication adherence, a critical barrier to effective risk management, is widespread in Nigeria, with adherence rates below 50% in patients with chronic illnesses. This study evaluates the efficacy of a 12-week short message service (SMS)-based intervention in improving medication adherence, knowledge, and prevention practices among hypertensive and diabetic patients attending the Medical Outpatient Clinic at the University College Hospital, Ibadan, Nigeria.

Methodology: A single-center randomized controlled trial was conducted with 150 participants aged 18 years and above and had a documented clinical diagnosis of hypertension and/or diabetes mellitus and currently being treated with a prescribed medication. The intervention group received bi-daily SMS reminders on medication adherence, lifestyle modifications, and stroke prevention, alongside standard care. The control group received standard care only. Outcomes assessed included change in medication adherence, knowledge, stroke prevention practices, and quality of life. A p value of 0.05 was used.

Result: The prevalence of hypertension and diabetes were 90.0% and 20.7% respectively; 16 individuals (10.7%) had comorbidity of hypertension and diabetes. There was a 14.7% increase in the proportion of participants with a high medication adherence in the intervention arm whereas the control arm had a 2.7% increase. This 5 times relative increase in proportion was however not statistically significant. The study showed a significant effect of the intervention on participants knowledge of stroke prevention (t = 3.339, p = 0.001). There was no significant impact of the intervention on self-rated health scores (t = 0.132; p = 0.896).

Conclusion: The SMS intervention significantly improved stroke prevention knowledge and showed a non-significant trend towards better medication adherence. Baseline motivational and cultural factors likely influenced outcomes, underscoring the need to address behavioral, cultural and economic barriers. This scalable telehealth model warrants further exploration to optimize adherence in resource-limited settings.

Clinical trial registration: This study was registered on the 25th July and approved on 25th of August 2023 by the Pan African Clinical Trials Registry (PACTR) with unique identification number: PACTR202308767234235. The findings from this study are presented in accordance with the Consolidated Standards of Reporting Trials (CONSORT) statement.

Keywords: Diabetes mellitus; Hypertension; Medication adherence; Randomized controlled trial; Short message service (SMS) intervention; Stroke knowledge.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Ethical approval was obtained from the University of Ibadan and University College Hospital Joint Ethical Committee with assigned number: UI/EC/22/0465. The study has also been approved by the Chairman of the Medical Advisory Committee of the University College Hospital, Ibadan. We ensured that the research was carried out in accordance with the World Medical Association Declaration of Helsinki on Ethical Principles for medical research involving Human Subjects. Informed consent was obtained from study participants. This study is registered and approved by the Pan African Clinical Trials Registry (PACTR) with unique identification number: PACTR202308767234235. The approval date is 25 Aug 2023. This is in accordance with the recommendations of the International Committee of Medical Journal Editors (ICMJE). Consent for publication: Not applicable. This manuscript does not contain any individual person’s data in any form (including individual details, images, or videos). Competing interests: The authors declare no competing interests. Abbreviations: Not applicable.

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