Mobile phones help to beat hypertension
Out in the townships of South Africa’s Western Cape, unemployment can run at 44 per cent. Gang violence leaves people wary of being robbed on the way to a clinic appointment. There is a creeping rise in chronic lifestyle diseases. These include hypertension, now the leading cause of death and disability worldwide. According to the South African Medical Research Council, 6.2 million people in a population of 52 million have high blood pressure and 3.2 million have unacceptably high levels, heightening the risk of heart attacks and strokes.
Since 2009, Oxford Professor of General Practice Andrew Farmer, Professor of Endocrinology and Diabetes at the University of Cape Town and head of the Chronic Disease Initiative for Africa (CDIA) Naomi Levitt, and epidemiologist and medical doctor Kirsty Bobrow have been working together on making use of the mobile phone network to benefit health care in South Africa. South Africa’s mobile network has excellent coverage across the country and almost 90 per cent of the population, even in remoter areas, possesses a phone.
The result has been the SMS-Adherence Support (StAR) Trial, a partnership involving Oxford, the CDIA and the University of Cape Town (UCT) and the South African Medical Research Council (SAMRC). Professor Farmer and Dr Bobrow started working with patients with high blood pressure and primary care clinic staff in the Western Cape. Together, they compiled a library of messages suitable to be used as text prompts and reminders. The resulting intervention was then tested at one large clinic serving the Langa and Bonteheuwel townships.
Strong technical underpinning
The project was built on a strong technical underpinning. Professor Lionel Tarassenko, Head of the Department of Engineering Science, secured funding for the project from the Wellcome Trust and the Engineering and Physical Sciences Research Council, and brought on board a team of Biomedical Engineers, Thomas Brennan and David Springer, both Rhodes Scholars from South Africa.
David Springer set up a system that could handle data from patients and could work out what message to send them and when, running with very little extra input from the clinic. He said: “We set up a system that allowed the collection of patient information in the clinic, such as their blood pressure measurements, phone number and appointment schedule. This was uploaded to a medical record system, which then sent the texts automatically. Including the patient’s first name, and the name of their doctor in the texts really made them feel that they were getting individual care”.
Professor Farmer said: “The SMS-messages can be prompts to collect your medicine or to take it regularly. Others focus on worries people may have about side-effects. Or we can suggest what to talk about with their families about illness – many people are reluctant to. Sometimes we just wish them Happy Birthday”.
Tone is important, and the team consulted with patients and health care providers to make sure the right words were used in the different languages of the project, including English, Afrikaans and Xhosa. Travelling to the clinic is difficult for many, so appointment reminders were sent out two days in advance to give patients time to prepare.
More than five years on, the team is nearing the end of a trial involving 1300 patients. Professor Farmer said: “It’s clear that people found using the system very helpful. We have stayed in contact with 97 per cent of patients, which in itself demonstrates how people felt this was relevant”.
One major success of the project has been increasing research capacity in South Africa and strengthening the research links between Oxford and South African academic institutions.
There are plans to start new trials in Cape Town and Johannesburg in South Africa and in Lilongwe in Malawi, and also to see if the intervention could work with people with diabetes.
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