Automated telecommunication interventions to promote adherence to cardio-metabolic medications: meta-analysis of effectiveness and meta-regression of behaviour change techniques

ABSTRACT

Automated telecommunication interventions, including short message service and interactive voice response, are increasingly being used to promote adherence to medications prescribed for cardio-metabolic conditions. This systematic review aimed to comprehensively assess the effectiveness of such interventions to support medication adherence, and to identify the behaviour change techniques (BCTs) and other intervention characteristics that are positively associated with greater intervention effectiveness. Meta-analysis of 17 randomised controlled trials showed a small but statistically significant effect on medication adherence, OR = 1.89, 95% CI [1.51, 2.36], I² = 89%, N = 25,101. Multivariable meta-regression analysis including eight BCTs explained 88% of the observed variance in effect size (ES). The BCTs ‘tailored’ and ‘information about health consequences’ were positively and significantly associated with ES. Future studies could explore whether the inclusion of these and/or additional techniques (e.g., ‘implementation intentions’) would increase the effect of automated telecommunication interventions, using rigorous designs and objective outcome measures.

KEYWORDS:

• Medication adherence
• cardio-metabolic conditions
• interactive voice response
• text messaging
• meta-regression
• behaviour change techniques

Acknowledgements

We would like to acknowledge Dr Anna de Simoni for advising on the clinical outcomes. S. S. and A. K. designed the study. A. K. conducted all stages of the review, under the supervision of S. S. Both authors independently conducted data extraction and coding. A. K. drafted and S. S. provided substantial input in writing this manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit programme [grant number PB-PG-0215-36032]. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. The funder had no role in study design, data collection, data analysis, data interpretation, the writing of the manuscript, and decision to submit the manuscript for publication.