Quick Take: Lay health supporters aided by mobile text messaging to improve adherence, symptoms, and functioning among people with schizophrenia in a resource-poor community in rural China (LEAN)

Schizophrenia is a significant cause of disability worldwide, and medication adherence remains poor in low- and middle-income countries. This is, in part, due to the scarcity and inefficiency of mental health resources. As such, there is broad consensus for collaborative community-based health care programs to increase medication adherence that involve low-cost methods, such as text messaging. However, technology-based interventions have shown conflicting results to-date, and have not included informal caregivers. In this randomized controlled trial, 278 patients from rural villages in China with schizophrenia were assigned to a free antipsychotic medication program (the 686 program, control group) or to the 686 program in addition to the LEAN program (Lay health supporters, E-platform, Award, and iNtegration; intervention group) for 6 months to study the impact on medication adherence over 30 days. The LEAN program featured recruitment of a lay health supporter (family member or volunteer), text messages containing medication reminders, health education, monitoring of early signs of disease relapse, awards and incentives, and facilitated linkage to primary health care. Medication adherence was primarily based on unannounced home-based pill counts. In the intention-to-treat analysis, medication adherence was found to be 27% greater in the intervention group (0.61) than in the control group (0.48) (adjusted mean difference (AMD) 0.12, 95% CI 0.03 to 0.22, p=0.013). Moreover, patients in the intervention group attended a higher proportion of scheduled clinical appointments (83%) than the control group (76%) (p=0.066). There was also a significant reduction in the risk of relapse in the intervention group (21.7%) as compared to the control group (34.2%) (RR 0.63, 95% CI 0.42 to 0.97). There was no statistically significant difference in patient functioning between the two groups measured by the World Health Organization Disability Assessment Schedule 2.0 (WHODAS) (mean WHODAS score 0.12 in the intervention group vs. 0.15 in the control group, AMD -0.03, 95% CI -0.07 to 0.01, p=0.117). Limitations of this study included the lack of generalizability due to the uniqueness of the 686 program and the fact that cost-effectiveness was not analyzed. In summary, this study suggests that interventions that combine low-cost technology with lay health supporters may increase medication adherence in patients with schizophrenia in resource-poor communities.

Click to read the study in PLOS Medicine

Image: PD

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