Adherence results: Stage One

Experimental condition (group A)

Overall adherence for group A in the first stage was 92%

Group A missed very few pills and took their pills at the scheduled times, or within one hour of it.

Control condition (group B)

Overall adherence for group B in the first stage was 71%

Two participants in group B did not start the study. The remaining participants missed very few pills except TMR07 who displayed poor adherence (missing 10 of 14 pills).

In general, the participants in the non-intervention (control) group were more relaxed about their pill schedule with two of three stating that they took their Tic-Tac out of the scheduled time on several occasions. Participant TMR01 frequently took their medication 2-3 hours late, but overall still finished the prescription.

Were the groups adherent?

Overall, the participants in the experimental group performed better with an average adherence of 92% compared to 71% for the control condition.

Using 80% as the measure of adherence (World Health Organization, 2003) while reviewing the results at a group level, Group A (experimental condition) were adherent, whilst group B (control condition) was not.

Opinions on the experience

Some participants stated when interviewed that the further along they were in the study, the more difficult they found it to take their Tic-Tac’s because the novelty had worn off. The motivation to take the placebo wanes when there was no longer the enthusiasm of its ‘newness’. This correlates with my assumption that patients find it harder to remember and take their medication once their symptoms begin to abate, or as previous research has shown when they are symptom-less (Miller, 1997).

Four participants (two in each group) stated that they may have behaved differently if they were taking real medication.

Occasions when participants found it more difficult to take their Tic-Tac

There was no consistency in the times of the day participants found it more difficult to take their Tic-Tac’s. Some found it more difficult in the morning, some more difficult in the evening. The general consensus was that the most difficult times were when they were busy, e.g. busy at work, or out in the evening.

A slight trend can be found  towards the end of the study week where more participants stated that they found it  “hard to do” compared to the beginning of the study.

However, counter to the trend, a surprising number stated that the last day of the study was “easy to do”.  One participant stated their reason as;

New week. More focused.

This coincided with the last day of the study being a Monday and could explain this unexpected change.

Insights from the experimental condition group (Group A)

Reasons for non-adherence

• Forgetting their phone whilst out during the time they were supposed to take their Tic-Tac
• Being asleep at the time they were supposed to take their Tic-Tac
• Being on the tube therefore not having any signal to receive the text message

Opinions on the SMS reminder

• TMR06 and TMR09 stated that they liked the countdown message within the SMS of how many pills were left before the prescription was complete
• TMR03 stated that the SMS served the purpose in helping to remember to take the Tic-Tac
• Some participants mentioned that they stopped reading the messages but hearing their phone buzz signalled that it was time to take the Tic-Tac
• One participant stated that getting the phone alert took the responsibility away for taking the Tic-Tac. The same participant noted that they would’ve forgotten their Tic-Tac twice. By the end of the week, they began to rely on the phone alert
• All participants said there were occasions that they didn’t remember to take until prompted. If they hadn’t received the message would have forgotten on these occasions.

Interesting comments

Participants expressed that the most negative aspects of the SMS reminder were;

Doesn’t work when I’m not in a mobile signal area

Can’t differentiate from any other type of text message

Sometimes text messages are not always noticed unless phone is felt or heard

The message was sometimes annoying

Took away my responsibility for my recovery via medication

 

Positive aspects of the SMS reminder;

It reminded me to take my medication

I could not forget to take my medication even at difficult times such as during an event eg theatre

[Useful for] being reminded during a busy day

Not having to rely on boxed instructions

Information on days left of the course

You can’t fail to forget to take it and it’s discreet

 

How the SMS reminder could have been better;

Maybes a date applied to the message so no room for telecommunications error.

Opinion’s on performance

Took it one hour late as woke up late. I was aware that it was not real medication. Would have been more strict if it was.

TMR03

Insights from the control condition group (group B)

Reasons for non-adherence

• Being out
• Other things on their mind, not seen as a priority

In general, the participants in the non-intervention (control) group were the most relaxed about their pill schedule. Participant TMR01 took their medication 2-3 hours late on several occasions, but overall still finished the prescription.

Opinions on the experience

Took a couple after lunch because knew wouldn’t remember so thought I’d make up for it.

TMR07

For example either taking a pill out of schedule or missing a pill instead of double-dosing as they did in the study, depending on how they felt it would affect their treatment. Two participants double-dosed when they were, or knew they would be busy at another time in the day. Such activity affected the pill count results, however, these occasions have not been discounted as the participants stated that with real medication they would prefer to finish the course rather than worry about the time they took the medication.

Interesting comments

Totally forget, I was out all day

TMR07

 

Almost always took medication up to 1 hour late

TMR05

Further work

Participant TMR07 had the worst performance of all. It will be interesting to see how they perform under the experimental condition; whether the intervention improves their adherence.

In the next stage of the study, I will also probe participants who were often late taking their medication to see what effect the alternate condition has on their tardiness.

Future work

Thoughts for future experiments include devising a more complex experiment where the participants are required to take 3 or more pills per day or a mixture of medication.

Differentiating pill reminder messages from other messages, potentially through the use of sound.

 

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