A Factorial Approach to Improve Treatment Adherence and Systolic Blood Pressure

NCT ID: NCT05106790

Last Updated: 2022-05-17

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

1440 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-07-01

Study Completion Date

2023-09-15

Brief Summary

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In Pakistan, poor medication adherence is a key operational factor in the prevalence of uncontrolled hypertension. Mobile phone treatments based on technology are at the forefront and are a reasonably low-cost strategy for combating the latest health concerns associated with poor adherence. On the other hand, conservative approaches to counseling are also found effective. This study will look at how a mHealth-based strategy and an educational-led peer counseling intervention can help hypertensive patients with coronary artery disease lower their systolic blood pressure.

Detailed Description

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In Pakistan, hypertension is a serious public health concern. Hypertension affects 18.9% of teenagers over the age of 15 and 33% of adults over the age of 45; however, only around 3% of hypertensive individuals have their blood pressure regulated to 140/90 mm Hg or lower. The majority of hypertensive patients are found to have blood pressure that is out of control. The majority of those undergoing therapies were judged to be non-compliant. According to the study, adherence to cardiac medications ranged from 27 to 77 percent, while adherence to stroke medications was around 68 percent. According to a recent study, 37.7% of patients did not take their antihypertensive medication as advised.

Interventions to help hypertensive patients in controlling blood pressure show potential to alter their behavior and lead to better outcomes, but delivering them at a cheap cost is difficult. Although evidence is scarce, several trials examining clinical interventions utilizing conventional health education support while others employing a mobile health strategy, both showed significant results. For a low-resource country, we built cost-effective models that are integrated with clinical care for patients with hypertension. The goal of this trial is to assess the effectiveness of mHealth intervention with clinical educational support and educational support with peer counseling to improve blood pressure control in hypertensive patients when compared to standard care.

Conditions

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Treatment Adherence and Compliance

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

It's a 12-month factorial design, intention-to-treat, four-arm, double-blinded, multicentre, pragmatic randomized controlled trial with an intervention to assess the efficacy of mHealth and education support with peer counseling to improve treatment adherence and lower systolic blood pressure in hypertensive patients in three teaching hospitals in Lahore, Pakistan.
Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

DOUBLE

Investigators Outcome Assessors
Double-blinded

Study Groups

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Standard care arm

The first group will be on standard care as usually being practiced in hospitals.

Group Type NO_INTERVENTION

No interventions assigned to this group

Ed-counseling arm

The second group will receive monthly educational support ( booklets) with peer counseling sessions in addition to standard care.

Group Type ACTIVE_COMPARATOR

Educational support with peer counseling

Intervention Type BEHAVIORAL

This group will receive peer counseling therapy sessions will be led by doctors who specialize in hypertension. Patients and their families will be the focus of the sessions. Face-to-face sessions will take roughly 25-30 minutes. Patients will receive spoken and written instructions based on their abilities during these sessions. The counseling sessions are geared toward overcoming both general and personal obstacles. The educational component will be delivered through smart booklets. Information on hypertension, blood pressure self-monitoring, and frequent systolic blood pressure (SBP) tests, as well as body weight and serum cholesterol values, are included in the instructional support. Food control, exercise therapy, and hypertension problems and their management will also be explored as non-pharmacological therapeutic approaches.

mHealth

The third group will receive daily written and voice reminders, and once weekly an education-led video in addition to standard care.

Group Type ACTIVE_COMPARATOR

mHealth intervention

Intervention Type BEHAVIORAL

This group will receive mHealth intervention will include daily written and voice messages, and once weekly an educational-led video. This intervention module will be delivered through "WhatsApp".

Combined arm

The fourth group will receive educational support (booklets)and counseling sessions every month, daily written and voice reminders, and once weekly an education-led video in addition to standard care.

Group Type ACTIVE_COMPARATOR

mHealth intervention and Educational support with peer counseling

Intervention Type BEHAVIORAL

This group will receive both Educational support (Smart booklets) with peer counseling sessions on a monthly basis and mHealth intervention will include daily written and voice reminders, and once weekly an educational led video.

Interventions

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Educational support with peer counseling

This group will receive peer counseling therapy sessions will be led by doctors who specialize in hypertension. Patients and their families will be the focus of the sessions. Face-to-face sessions will take roughly 25-30 minutes. Patients will receive spoken and written instructions based on their abilities during these sessions. The counseling sessions are geared toward overcoming both general and personal obstacles. The educational component will be delivered through smart booklets. Information on hypertension, blood pressure self-monitoring, and frequent systolic blood pressure (SBP) tests, as well as body weight and serum cholesterol values, are included in the instructional support. Food control, exercise therapy, and hypertension problems and their management will also be explored as non-pharmacological therapeutic approaches.

Intervention Type BEHAVIORAL

mHealth intervention

This group will receive mHealth intervention will include daily written and voice messages, and once weekly an educational-led video. This intervention module will be delivered through "WhatsApp".

Intervention Type BEHAVIORAL

mHealth intervention and Educational support with peer counseling

This group will receive both Educational support (Smart booklets) with peer counseling sessions on a monthly basis and mHealth intervention will include daily written and voice reminders, and once weekly an educational led video.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Participants with age 21 to 70 years
* Participants who have been registered as hypertensive with comorbidity of coronary artery disease in the Outpatient Departments (OPDs) of one of the three public teaching hospitals in Lahore, for at least last one month
* Participants on antihypertensive drugs
* The participants with stable coronary artery disease who are treated in an outpatient setting
* Participants who are willing to sign a written informed consent form, must have a smartphone with the WhatsApp application installed and be able to read Urdu/English.
* Participants with smartphones and have internet access

Exclusion Criteria

Participants who suffer from some type of malignancy and require adjustment of drugs

* Participants with any biological condition that makes it difficult for them to read write, communicate or hear phone calls
* Participants in hypertensive emergency blood pressure \>220/120 mmHg
* Participants with pregnancy(self-reporting)
* Participants in their period of lactation
Minimum Eligible Age

21 Years

Maximum Eligible Age

70 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Universiti Putra Malaysia

OTHER

Sponsor Role lead

Responsible Party

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Arshed Muhammad

PhD studentship

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Arshed MUHAMMAD

Role: PRINCIPAL_INVESTIGATOR

UPM

Locations

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Victoria Hospital

Bahawalpur, Punjab Province, Pakistan

Site Status

Sheikh Zayed Hospital Rahim Yar Khan

Rahim Yar Khan, Punjab Province, Pakistan

Site Status

Jinnah Hospital

Lahore, , Pakistan

Site Status

Punjab Institute of Cardiology

Lahore, , Pakistan

Site Status

Rehmatul-lil-Almeen Institute of Cardiology

Lahore, , Pakistan

Site Status

Sheikh Zayed, Hospital

Lahore, , Pakistan

Site Status

Countries

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Pakistan

Central Contacts

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Arshed MUHAMMAD, MBBS,MPH

Role: CONTACT

+923337474464

Maaz Arif Muhammad, MBBS

Role: CONTACT

00923481816881

Facility Contacts

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Arshed MUHAMMAD

Role: primary

+923337474464

Arshed MUHAMMAD, MBBS

Role: primary

+923337474464

Arshed MUHAMMAD

Role: primary

+923337474464

Arshed MUHAMMAD, MBBS

Role: primary

00923337474464

Kiran Mehwish, MBBS

Role: backup

00923150228348

Arshed MUHAMMAD, MBBS

Role: primary

+923337474464

Maaz Arif Muhammad, MBBS

Role: backup

00923481816881

References

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NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19.1 million participants. Lancet. 2017 Jan 7;389(10064):37-55. doi: 10.1016/S0140-6736(16)31919-5. Epub 2016 Nov 16.

Reference Type BACKGROUND
PMID: 27863813 (View on PubMed)

Lewington S, Clarke R, Qizilbash N, Peto R, Collins R; Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002 Dec 14;360(9349):1903-13. doi: 10.1016/s0140-6736(02)11911-8.

Reference Type BACKGROUND
PMID: 12493255 (View on PubMed)

NIPS/Pakistan and ICF NI of PS-. Pakistan Demographic and Health Survey 2017-18. 2019 [cited 4 Jan 2021]. Available: https://dhsprogram.com/publications/publication-fr354-dhs-final-reports.cfm

Reference Type BACKGROUND

Mahmood S, Jalal Z, Hadi MA, Orooj H, Shah KU. Non-Adherence to Prescribed Antihypertensives in Primary, Secondary and Tertiary Healthcare Settings in Islamabad, Pakistan: A Cross-Sectional Study. Patient Prefer Adherence. 2020 Jan 14;14:73-85. doi: 10.2147/PPA.S235517. eCollection 2020.

Reference Type BACKGROUND
PMID: 32021119 (View on PubMed)

Zhai P, Hayat K, Ji W, Li Q, Shi L, Atif N, Xu S, Li P, Du Q, Fang Y. Efficacy of Text Messaging and Personal Consultation by Pharmacy Students Among Adults With Hypertension: Randomized Controlled Trial. J Med Internet Res. 2020 May 20;22(5):e16019. doi: 10.2196/16019.

Reference Type BACKGROUND
PMID: 32432556 (View on PubMed)

Chan AW, Tetzlaff JM, Altman DG, Laupacis A, Gotzsche PC, Krleza-Jeric K, Hrobjartsson A, Mann H, Dickersin K, Berlin JA, Dore CJ, Parulekar WR, Summerskill WS, Groves T, Schulz KF, Sox HC, Rockhold FW, Rennie D, Moher D. SPIRIT 2013 statement: defining standard protocol items for clinical trials. Ann Intern Med. 2013 Feb 5;158(3):200-7. doi: 10.7326/0003-4819-158-3-201302050-00583.

Reference Type BACKGROUND
PMID: 23295957 (View on PubMed)

Bhide A, Shah PS, Acharya G. A simplified guide to randomized controlled trials. Acta Obstet Gynecol Scand. 2018 Apr;97(4):380-387. doi: 10.1111/aogs.13309. Epub 2018 Feb 27.

Reference Type BACKGROUND
PMID: 29377058 (View on PubMed)

Risser J, Jacobson TA, Kripalani S. Development and psychometric evaluation of the Self-efficacy for Appropriate Medication Use Scale (SEAMS) in low-literacy patients with chronic disease. J Nurs Meas. 2007;15(3):203-19. doi: 10.1891/106137407783095757.

Reference Type BACKGROUND
PMID: 18232619 (View on PubMed)

Strobl J, Cave E, Walley T. Data protection legislation: interpretation and barriers to research. BMJ. 2000 Oct 7;321(7265):890-2. doi: 10.1136/bmj.321.7265.890. No abstract available.

Reference Type BACKGROUND
PMID: 11021874 (View on PubMed)

Del Re AC, Maisel NC, Blodgett JC, Finney JW. Intention-to-treat analyses and missing data approaches in pharmacotherapy trials for alcohol use disorders. BMJ Open. 2013 Nov 12;3(11):e003464. doi: 10.1136/bmjopen-2013-003464.

Reference Type BACKGROUND
PMID: 24227870 (View on PubMed)

Montgomery AA, Peters TJ, Little P. Design, analysis and presentation of factorial randomised controlled trials. BMC Med Res Methodol. 2003 Nov 24;3:26. doi: 10.1186/1471-2288-3-26.

Reference Type BACKGROUND
PMID: 14633287 (View on PubMed)

Whelan DB, Dainty K, Chahal J. Efficient designs: factorial randomized trials. J Bone Joint Surg Am. 2012 Jul 18;94 Suppl 1:34-8. doi: 10.2106/JBJS.L.00243.

Reference Type BACKGROUND
PMID: 22810445 (View on PubMed)

Other Identifiers

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APUTRA

Identifier Type: -

Identifier Source: org_study_id

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