Effectiveness of Mobile Text Messaging to Improve Schizophrenia Adherence, Symptoms and Functioning in a Resource-poor Community Setting: “LEAN” Randomized Controlled Trial

Abstract

Objective To evaluate the effectiveness of mobile text messaging to improve medication adherence, symptoms and functioning in community-dwelling people with schizophrenia in a resource-poor setting. Design Two-arm randomized controlled trial. Setting Rural communities of Hunan Province, China. Participants 278 randomly-selected community-dwelling villagers diagnosed with schizophrenia. Interventions Participants were randomized 1:1 into two groups. Both the intervention and control groups received a nation-wide community-based mental health program that provided free antipsychotic medications and clinician consultations. The intervention group also received text messages for medication reminders, health education and monitoring of early signs of relapses. The intervention was conducted from November 2015 to July 2016. Main outcome measures The primary outcome was the medication adherence (percentage of dosages taken) assessed by unannounced home-based pill-counts. The secondary outcomes included patient symptoms, functioning, relapses, and re-hospitalization due to schizophrenia. Results Medication adherence increased 27% from 0.49 in the control group to 0.63 in the intervention group (adjusted mean difference (AMD) 0.13 [95% CI 0.04 to 0.22]; p=0.004; effect size 0.35); The program showed less loss in functioning from 15% loss in the controls to 12% in the intervention (AMD -0.03 [95% CI -0.07 to 0.01]; p=0.117; effect size 0.17). No difference in severity of symptoms was found, however, there was substantial reduction in the risks of relapses (26 (21.7%) of 120 interventional participants vs. 40 (34.2%) of 117 controls; risk ratio 0.63 [95% CI 0.42 to 0.97]; NNT 8.0) and re-hospitalizations (9 (7.3%) of 123 interventional participants vs. 25 (20.5%) of 122 controls; risk ratio 0.36[95% CI 0.17 to 0.73]; NNT 7.6). Conclusions Texting patients and their family supervisors in a resource-poor community setting was more effective than a free-medicine program alone in improving medication adherence and patient functioning and reducing relapses and re-hospitalizations. Trial registration ChiCTR-ICR-15006053