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Effectiveness of a Behavior Change Wheel-Informed WeChat-Based Messaging Intervention to Improve Medication Adherence
Yong Fang1, Wenxiao Wu1, Dili Chen1
1Nursing Department, First Affiliated Hospital Zhejiang University, 79 Qingchun Road, Shangcheng District, Hangzhou City, 310053, China, 86 13867129329.
Background:
Medication nonadherence after percutaneous coronary intervention (PCI) remains a major barrier to secondary prevention. Prior SMS text messaging interventions have shown inconsistent results, often limited to reminders without addressing behavioral or psychological determinants.
Objective:
This study aimed to evaluate the effectiveness of a theory-informed, WeChat-based messaging intervention for improving medication adherence and patient-reported outcomes after PCI.
Methods:
A nonrandomized quasi-experimental parallel-group study was conducted from July 2022 to March 2023 at a tertiary hospital in Hangzhou, China. Patients were allocated by ward admission to the intervention or control group. The intervention comprised 12-week WeChat-based medication reminders and theory-informed messages mapped to capability, opportunity, and motivation-behavior model domains and behavior change techniques. The primary outcome was medication adherence measured using the 8-item Morisky Medication Adherence Scale (MMAS-8); secondary outcomes were medication beliefs, self-efficacy, and disease-specific health status measured using the Beliefs About Medicines Questionnaire (BMQ)-Specific, Self-Efficacy for Appropriate Medication Use Scale, and Seattle Angina Questionnaire (SAQ), respectively. Outcomes were assessed at baseline and 12 weeks by blinded assessors and analyzed using baseline-adjusted analysis of covariance based on the observed outcome data for all 92 participants. Sensitivity analyses included a per-protocol analysis restricted to the 87 participants who completed the full assigned care protocol and a difference-in-differences analysis comparing changes from baseline to 12 weeks between groups.
Results:
Of 180 patients screened, 92 (51.1%) were enrolled, of whom all completed the 12-week outcome assessment and 87 (94.6%) completed the full assigned care protocol. At 12 weeks, medication adherence was higher in the intervention group than in the control group (adjusted mean MMAS-8 score 7.40, SE 0.05 vs 6.22, SE 0.10; adjusted mean difference 1.18, 95% CI 0.96-1.40; P<.001). Secondary outcomes generally favored the intervention, including the BMQ necessity (adjusted mean difference 1.62, 95% CI 1.06-2.17) and concerns (adjusted mean difference -3.25, 95% CI -3.87 to -2.63) subscales, medication self-efficacy (adjusted mean difference 4.04, 95% CI 3.21-4.87), and the SAQ summary score (adjusted mean difference 6.13, 95% CI 4.72-7.53; P<.001 in all cases). SAQ treatment satisfaction did not differ significantly between groups (adjusted mean difference 0.40, 95% CI -2.02 to 2.82; P=.74). Both the per-protocol and difference-in-differences sensitivity analyses yielded findings consistent with the primary analysis, supporting the robustness of the results.
Conclusions:
A theory-informed, WeChat-based messaging intervention was associated with improvements in medication adherence, medication beliefs, self-efficacy, and disease-specific health status after PCI. Larger, adequately powered randomized trials with longer follow-up are needed to confirm these findings.