• Users Online: 415
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Ahead of print Browse Articles Search Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
Year : 2019  |  Volume : 10  |  Issue : 1  |  Page : 200

Effect of training through short message service on compliance and mean blood pressure of hypertensive patients

Department of Community Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Date of Submission18-Nov-2017
Date of Acceptance25-Feb-2018
Date of Web Publication27-Nov-2019

Correspondence Address:
Reza Rouzbahani
Department of Community Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijpvm.IJPVM_507_17

Rights and Permissions

Background: Hypertension has been one of the early mortality and morbidity in human societies. Training and consequently compliance increase will lead to improve treatment progress and disease control. The study aimed at the effect of training through short message service (SMS) on blood pressure mean and compliance scale in hypertensive patients. Hypertension control is essential to prevent early mortality. Methods: This study is a randomized controlled clinical, uni-center, single-blinded. The study was managed in a health-care center subordinated to Medical University of Isfahan, Iran, in 2017. Sampling was a convenient method therefore the researchers implemented it for 188 hypertensive patients who were allocated randomly into two groups: SMS group and control group. First, all patients filled the compliance questionnaire, and their blood pressure was measured. Afterward, the intervention group would be texting daily for 1 month containing a training text. During 1 and 2 months after intervention, all patients' blood pressure will be measured, and then the questionnaire had been filled 2 months after intervention, again. Results: Systolic blood pressure mean decreased from 136.23 ± 15.91 to 121.70 ± 14.43 and diastolic blood pressure mean decreased from 91.95 ± 8.24 to 86.64 ± 7.86 in the intervention group according to analysis of variance through repeated measurement and is significantly different in comparison with control group (P < 0.001). Compliance scale increased from 72.95 ± 7.65 to 85.40 ± 5.62 based on dependent t-test which was significantly different with the control group (P < 0.001). Conclusions: SMS training would be an effective method to control hypertension.

Keywords: Compliance, hypertension, short message service, training

How to cite this article:
Movahedi M, Khadivi R, Rouzbahani R, Tavakoli-Fard N. Effect of training through short message service on compliance and mean blood pressure of hypertensive patients. Int J Prev Med 2019;10:200

How to cite this URL:
Movahedi M, Khadivi R, Rouzbahani R, Tavakoli-Fard N. Effect of training through short message service on compliance and mean blood pressure of hypertensive patients. Int J Prev Med [serial online] 2019 [cited 2021 Jul 23];10:200. Available from: https://www.ijpvmjournal.net/text.asp?2019/10/1/200/271853

  Introduction Top

Hypertension is one of the most important reasons of early mortality and morbidity due to cardiovascular disease that can be prevented.[1],[2] It alone is the essential factor of morbidity worldwide. To control and treat hypertension, it is necessary to change lifestyle as well as using drug treatment.[1],[3] A healthy lifestyle to reduce blood pressure includes sufficient physical activity, stress management, losing weight, and a healthy diet such as taking less salt and fat, using less tobacco, decreasing alcohol drinking, and having more fruit, vegetables, and grains.[4],[5]

Most of the hypertensive patients have been controlled insufficiently across the world.[2],[6] Inadequate training and lack of following patients, which are the responsibilities of health cares, led to the absence of patients' compliance and adherence routinely in longterm. They are two of major factors in uncontrolled hypertension. Considering the aforementioned factors and low information of people on the issue, training in hypertensive patients is one of the most effective approach to control the disease.[3],[7]

The aim of implementing training programs is to promote awareness, establish a positive trend, and to enable continuous appropriate function in healthy behavior.[8] Compliance to proper management of chronic disease is fundamental to accomplishing enhanced health results, quality of life, and profitable health care. Chronic diseases are gradually spreading worldwide, and the effect of noncompliance is growing more and more.

Cell phones are used increasingly in health care and public health practice (mHealth) aimed at patients' communication, monitoring, and training to facilitate compliance managing chronic diseases.[9] One of the practically effective method for changing behavior is texting short message service (SMS) through cell phones due to availability across the world, being cheap, and quick access. The study offers a summary on intervention of behavior change for managing and preventing disease with the help of SMS.[10] The current study researchers found some similar studies such as increase in the compliance of patients undergoing hemodialysis,[11] improvement of the quality of ambulatory care in patients with arterial hypertension,[12] promotion of self-control in asthmatic patients,[13] and compliance increase in patients with bioprosthetics heart valves.[14] The study aimed at the effect of training through SMS on blood pressure mean and compliance scale in hypertensive patients due to the importance of hypertension control and prevention from mortality and morbidity because of hypertension.

  Methods Top

This study is a randomized controlled clinical trial, uni-center, single-blind study implemented on hypertensive patients in a health-care center subordinated to Medical University of Isfahan, Iran, in 2017. Inclusion criteria were as follows: hypertensive patients (with systolic blood pressure mean is equal to or higher than 140 mm Hg or diastolic blood pressure mean is equal to or higher than 90 mm Hg), 30-year-old or above, being literate, able to work with a cell phone, able to read the Persian SMS, signed informed consent form, and being officially satisfied to include in the study. The sampling method was a convenient one.

First, 200 people were selected in a convenient method among the hypertensive patient's list, identified, and registered from hypertensive national program screening. Afterward, these patients were allocated randomly into two groups using table of random numbers: SMS group and control group. Then, 12 patients were excluded from the study because of their dissatisfaction; therefore, the sample size became 188 patients with intervention group (97 people) and control group (91 people) (response rate = 94%). Before intervention, the patients' demographics were recorded such as age, gender, education, occupation, and systolic and diastolic blood pressures, and then, the self-made 18-question questionnaire was applied to measure compliance and its reliability was calculated 0.77 through Cronbach's alpha. Its validity was investigated, and the content and face validities were suitable. To evaluate the content validity, the questionnaire had been read by five experts involving an internist, cardiologist, social community physician, and two health education professionals. Researchers evaluated face validity, and the questionnaire had been filled by 20 hypertensive patients. The questionnaire questions have been scored based on five-choice scales including always, mostly, sometimes, hardly, and never. The questions with the positive meaning load take a score of 5 for the answer “always” and 1 for “never;” in addition, the questions with negative meaning load take the reverse scores. The maximum score of questionnaire was 90 and the minimum one was 18.

During the study, both intervention and control groups were trained equally and monthly by caregivers one by one or in the group according to hypertensive patients' care protocol in health center. Besides all the foregoing methods, intervention group received a daily Persian SMS that included a training text on hypertension definitions, signs and symptoms, complications, control methods, suitable medicine taking, side effects and its benefits, and training a healthy lifestyle (including salt-taking decrease; doing suitable physical activities; having fruit, vegetables, fiber and grain; fat-taking decrease; suitable weight; smoking rehabilitation; anxiety decrease; right choice of oil; and losing weight). The researchers implemented the WHO [15] and up-to-date [16] papers to form the content of theses short messages. They have been sending through an online SMS panel regularly at 10 a.m.

ALPK2 CE0123 mercury sphygmomanometer was applied to measure the blood pressure. We put the lower board of the cuff approximately 2.5 cm above the antecubital crease. Palpating the radial artery with fingers, we inflated the cuff quickly until the radial pulse could not been felt. Then, we read the same pressure number illustrated on the manometer and added another 30 mm Hg that illustrates the maximum amount of cuff inflation. After deflating the cuff quickly and completely, we inflated the cuff for 15–30 s to target level and then deflated the cuff with the speed of approximately 2–3 mm Hg/s. Now, the systolic blood pressure was on the level, we could hear the sounds of at least two sequential beats; and the diastolic blood pressure was when we cannot hear the sounds. After two or more minutes, the measurement had been repeated and the readings had been averaged.[17] Before intervention, 1 and 2 months after intervention, all patients' blood pressures were measured. The compliance questionnaires were filled for all patients before intervention and 2 months after intervention in the end of research. Regularly, the derived data were recorded from blood pressure and patients' compliance scale in both control and intervention groups. The caregivers – measuring patients' blood pressure, explaining and filling the questionnaire, and analyzing the data – were unaware of the groups.

The derived data were analyzed on 0.05 level by SPSS 16 (the Statistical Package for Social Sciences) for Windows developed by SPSS Inc., Chicago IL, US. To describe the data, researchers applied descriptive indices including frequency, cumulative frequency, mean, and standard deviation. To compare and evaluate the age, gender, and occupation distribution in both control and intervention groups, the researchers used independent t-test; to evaluate patients' education they used Chi-square, and to evaluate compliance scale they applied dependent t-test. The current researchers applied to repeated measure ANOVA to evaluate people's blood pressure before intervention, 1 and 2 months after it. Finally, ANCOVA was used to adjust the effect of confounding factors in comparing blood pressure values between both intervention and control groups.

  Results Top

In the study, 188 hypertensive patients participated randomly in two intervention (97 people) and control groups (91 people), while 60.8% of them were females and 39.2% were males. The patients' age range was 36–93 years old while the mean age of intervention group was 59.67 ± 0.95 and control group was 58.68 ± 0.94. The rest of demographic features have been shown in [Table 1].
Table 1: A comparison of frequency distribution of hypertensive patients' demographic variation in control and intervention groups

Click here to view

Moreover, there was no significant difference in participants' age (P = 0.46), gender (P = 0.13), and occupation (P = 0.08), but in the view of education (P = 0.009), it was significantly different in both groups. Therefore, the significant demographic factor was considered as effective factor covariance in analysis.

The comparative mean results have been presented on systolic and diastolic blood pressures before intervention and 1 and 2 months after intervention with control group [Chart 1], [Chart 2] and [Table 2].
Table 2: Systolic and diastolic blood pressure mean before and one and two months after intervention, and compliance scale before and after intervention in both study groups

Click here to view

The comparative mean results of compliance score before intervention and 2 months after intervention with control group are given in [Table 2].

  Discussion Top

The main purpose of the study was impact of training through SMS on blood pressure mean and the compliance scale in hypertensive patients. The results showed that implementing training SMS resulted in decreasing systolic and diastolic blood pressures and increasing compliance scale in hypertensive patients. The results depicted that using of training SMS resulted in decreasing systolic and diastolic blood pressure and increasing compliance in hypertensive patients. There were so many studies in this regard concurrent with the current study result.

Bobrow et al. had managed a survey entitled the impact of two SMS training methods interactively and noninteractively for 12 months on hypertensive patients. In noninteractive group, the researcher had a one-way communication with patients while in interactive group; patients were communicated reciprocally through asking their questions and interacting researcher without time limitations and 24 h. He concluded that systolic blood pressure in people who had received SMS in an noninteractive method decreased significantly in comparison with the control group.[18]

Carrasco et al. concluded from a study that receiving SMS by hypertensive patients would lead to decreasing blood pressure without alternative control program.[19] Maslakpak and Safaie had studied on hypertensive patients as follow: they applied six training SMS weekly during 3 months in a group and in another one, they used reminder cards during 3 months, afterwards they were compared with the control group. He concluded that there was a significant difference among the blood pressure of the three groups', but there was no significant difference between the group blood pressure who received SMS and the group who used reminding cards.[20]

Sedri et al. managed to conduct a survey on the impact of two training SMS methods for 3 months (interactive and noninteractive) on anticoagulant compliance in patients with prosthetic heart valves. After intervention, the scale mean of interactive group illustrated the most compliance under SMS effect in comparison with the other groups.[14] Peimani et al. studied the impact of SMS on self-care and some of diabetic patients' parameters. After 12 intervention sessions, the effectiveness scale mean increased significantly in the intervention group, but there was no significant difference in the HbA1c value.[21]

In Benhamou et al.[22] and Rami et al.,[23] there was no significant difference in HbA1c value in control and intervention groups after receiving training SMS. Different factors could have effects on the result of study, leading to ineffectiveness of training SMS on patients including patients' age, disease severity, other disease, sample size, study design, study strength, kind of intervention, and study duration.

According to the aforementioned study results and the current one, training through SMS can cause an increase in compliance scale and improve systolic and diastolic blood pressure mean in hypertensive patients.

The present training and follow-up method are more available, simpler, and less expensive than other methods; moreover, you can cover many patients in various geographical areas. There were some delimitations during the study including ad SMS blocking in spite of participants' satisfaction and signed form, in this case, the researchers sent SMS manually and through cell phone.

It is recommended to manage a study through interactive training SMS, social networking or email services to evaluate the impact on blood pressure mean and compliance scale in hypertensive patients. SMS is an effective training method to control blood pressure, and it can be used to train the patients in health-care centers.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014;311:507-20.  Back to cited text no. 1
Siadat ZD, Hasandokht T, Farajzadegan Z, Paknahad Z. Effects of multicomponent lifestyle modification on blood pressure control in health centers: Design of the study. J Res Med Sci 2013;18:308-13.  Back to cited text no. 2
Rakel RE, Rakel DP. Textbook of Family Medicine. 9th ed. Philadelphia (Pa): Elsevier Saunders; 2016.  Back to cited text no. 3
Integrated Chronic Disease Prevention and Control. Available from: http://www.who.int/chp/about/integrated_cd/en/index2.html. [Last accessed on 2017 Sep 05].  Back to cited text no. 4
World Health Day 2013: control Your Blood Pressure. Control Your Life: Diet, Nutrition and Hypertension. Available from: http://www.emro.who.int/world-health-days/2013/. [Last accessed on 2017 Aug 10].  Back to cited text no. 5
Whitworth JA; World Health Organization, International Society of Hypertension Writing Group. 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens 2003;21:1983-92.  Back to cited text no. 6
Hojatzadeh A, Samavat T. Manual Blood Pressure Measurements. Tehran: Ministry of Health and Medical Education of Iran; 2012. p. 3.  Back to cited text no. 7
Bruce DG. Davis WA. Cull CA. Davis TM. Diabetes education and knowledge in patients with type 2 diabetes from the community: The fremantle diabetes Study. J Diabetes Complications 2003;17:82-9.  Back to cited text no. 8
Hamine S, Gerth-Guyette E, Faulx D, Green BB, Ginsburg AS. Impact of mHealth chronic disease management on treatment adherence and patient outcomes: A systematic review. J Med Internet Res 2015;17:e52.  Back to cited text no. 9
Cole-Lewis H, Kershaw T. Text messaging as a tool for behavior change in disease prevention and management. Epidemiol Rev 2010;32:56-69.  Back to cited text no. 10
Estaji Z, Hejazi S, Tabarraie Y, Saedi M. The effects of training through text messaging via cell phones on the compliance of patients undergoing hemodialysis. JNKUMS 2016;8:203-13.  Back to cited text no. 11
Kiselev AR, Gridnev VI, Shvartz VA, Posnenkova OM, Dovgalevsky PY. Active ambulatory care management supported by short message services and mobile phone technology in patients with arterial hypertension. J Am Soc Hypertens 2012;6:346-55.  Back to cited text no. 12
Pedram Razi AH, Piroozmand N, Zolfaghari M, Kazemnejad A, Firoozbakhsh SH. Education of how-to-use peak flow meter and following up via SMS on asthma self-management. J Fac Nurs Midwifery Tehran Univ Med Sci (HAYAT) 2013;4:19-27.  Back to cited text no. 13
Sedri N, Asadi Noughabi AA, Zolfaghari M, Haghani H, Tavan A. Comparison of the effect of two types of short message service (interactive and non-interactive) on anticoagulant adherence of patients with prosthetic heart valves. J Nurs Educ 2014;2:1-11.  Back to cited text no. 14
Life Style and Hypertension; 2016. Available from: http://www.who.int/topics/en. [Last accessed on 2016 Feb 03].  Back to cited text no. 15
Life Style and Hypertension; 2016. Available from: http://www.uptodate.com/home. [Last accessed on 2016 Feb 15].  Back to cited text no. 16
Bickley LN, Szilagvi PG. Bates' Guide to Physical Examination and History Taking. 12th ed. CN: Wolters Kluwer Publication; 2017.  Back to cited text no. 17
Bobrow K, Farmer AJ, Springer D, Shanyinde M, Yu LM, Brennan T, et al. Mobile phone text messages to support treatment adherence in adults with high blood pressure (SMS-Text Adherence Support [StAR]): A single-blind, randomized trial. Am Heart Assoc 2016;133:592-600.  Back to cited text no. 18
Carrasco MP, Salvador CH, Sagredo PG, Márquez-Montes J, González de Mingo MA, Fragua JA, et al. Impact of patient-general practitioner short-messages-based interaction on the control of hypertension in a follow-up service for low-to-medium risk hypertensive patients: A randomized controlled trial. IEEE Trans Inf Technol Biomed 2008;12:780-91.  Back to cited text no. 19
Maslakpak MH, Safaie M. A comparison between the effectiveness of short message service and reminder cards regarding medication adherence in patients with hypertension: A Randomized controlled clinical trial. Int J Community Based Nurs Midwifery 2016;4:209-18.  Back to cited text no. 20
Peimani M, Rambod C, Ghodssi-Ghassemabadi R, Nasli Esfahani E. Effectiveness of short messages service-based intervention (SMS) on self-care in type 2 diabetes. IJDLD 2016;15:267-76.  Back to cited text no. 21
Benhamou PY, Melki V, Boizel R, Perreal F, Quesada JL, Bessieres-Lacombe S, et al. One-year efficacy and safety of web-based follow-up using cellular phone in type 1 diabetic patients under insulin pump therapy: The pumpNet study. Diabetes Metab 2007;33:220-6.  Back to cited text no. 22
Rami B, Popow C, Horn W, Waldhoer T, Schober E. Telemedical support to improve glycemic control in adolescents with type 1 diabetes mellitus. Eur J Pediatr 2006;165:701-5.  Back to cited text no. 23


  [Table 1], [Table 2]

This article has been cited by
1 Blood lead level monitoring related to environmental exposure in the general Iranian population: a systematic review and meta-analysis
Nahid Khoshnamvand,Nahid Azizi,Mohammad Sadegh Hassanvand,Mansour Shamsipour,Kazem Naddafi,Vahide Oskoei
Environmental Science and Pollution Research. 2021;
[Pubmed] | [DOI]
2 Elderly patients with hypertension self-perceived of aging status and compliance with medical behaviour
Wu Qing,Zhao Qi,Hu Yao,Jiang Xin,Hou Ying
Psychology, Health & Medicine. 2020; : 1
[Pubmed] | [DOI]


Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  In this article
Article Tables

 Article Access Statistics
    PDF Downloaded147    
    Comments [Add]    
    Cited by others 2    

Recommend this journal