Daily SMS did not improve adherence to oral contraceptive pills

You'd think that daily SMS (text messages) would improve adherence to pills, right? After all, many patients miss doses because they forget. So what happens if you randomize 82 women to either receive a daily SMS reminder or no SMS reminder?

Here's what the authors found:

METHODS: This randomized controlled trial estimated whether there was an effect of daily text-message reminders on oral contraceptive pill adherence of new oral contraceptive pill users. Pill-taking was tracked for 3 months by an electronic monitoring device with wireless data collection. During the study period, participants assigned the intervention received a daily reminder text message. Eighty-two women were assigned randomly to detect a 1.6±2.0 pill difference (90% power, 5% α, 15% dropout).

RESULTS: Participants were 79% white, non-Hispanic, 99% high school graduates, and 99% nulliparous with a mean age of 22 years. Most reported condom use with past coital activity, and more than half reported prior emergency contraception use. The mean number of missed pills per cycle did not differ significantly between the groups: 4.9±3.0 for the text-message group and 4.6±3.5 for the control group (P=.60). The number of missed pills per cycle increased over the course of the study, but this pattern did not increase differentially between the groups. Adherence recorded by the electronic monitoring device indicated much poorer adherence than that recorded by patient diaries. Despite poor pill-taking, there were no pregnancies.

CONCLUSION: Daily text-message reminders did not improve oral contraceptive pill adherence. Although the lack of benefit may be attributed to the frequent use of alternative reminder systems in the control group, the rate of missed pills when measured objectively was still very high in both groups.

Using Daily Text-Message Reminders to Improve Adherence With Oral Contraceptives: A Randomized Controlled Trial

Obstetrics & Gynecology: September 2010 - Volume 116 - Issue 3 - pp 633-640
Hou, Melody Y. MD, MPH; Hurwitz, Shelley PhD; Kavanagh, Erin MPP; Fortin, Jennifer MPH; Goldberg, Alisa B. MD, MPH

Click here to read the abstract.

Are you surprised by the results? I don't think SMS will be effective unless people are already using SMS on a regular basis. You could also build a feedback system so that the patient continues to receive an SMS reminder until the patient replies back indicating that he/she has taken the medication.