A research project designing a personalised text message system to help more people take statins as advised and reduce their risk of heart attacks and strokes.
Project overview
Cardiovascular diseases (also called heart and blood vessel diseases) are some of the biggest causes of death in the UK. They cause about 170,000 deaths each year. That is about the same as everyone in a city like Oxford.
One big cause of these diseases is cholesterol, a fatty substance in the blood that can block blood vessels. Statins are medicines that bring cholesterol down, which lowers the chance of a heart attack or stroke. About 8 million people in the UK are prescribed statins, but many do not take them as advised. UK studies show that about one in three people often miss doses. Nearly half stop taking them at some point.
Why is this important?
Some groups find it even harder to take their statins, such as people from ethnic minority groups and people with low incomes. These groups are more likely to become ill, but there are often not many people from these groups included in research.
It is hard to help many people take their statins. Some ways of helping work well, but they cost a great deal of time and money, because they need a professional to spend time helping each patient, one person at a time. Other ways can reach many people at once. But they treat everyone the same. The problem is that people stop taking their statins, or miss them, for many different reasons. So one way for everyone does not work.
Developing a personalised approach
This project built a new way to help, using text messages. These messages can reach many people at once. But the messages are designed to be matched to what each person needs.
We used four kinds of evidence to build it:
- We reviewed and combined evidence from 70 studies around the world.
- We interviewed 17 patients from different backgrounds.
- 233 patients filled in a survey.
- We held eight workshops with 48 patients and 22 healthcare professionals.
Putting patients at the centre
We made sure to include people from ethnic minority and low-income groups in the interviews and workshops. Including them helped us hear about many different experiences and the problems people face. Three patients from different backgrounds were also part of our team the whole time. They reviewed the messages and helped make them easier to follow and more useful for everyone.
How the text message support works
The result was a set of 50 text messages that give simple tips and practical tools. They are based on what we know helps people take their medicines. Each person can choose what time of day they get the messages, and how often.
Some messages are tailored to different groups and people, and to their reasons for not taking statins. For example, some help those who take many other medicines and find it hard to remember them all, and others help those with side effects or trouble swallowing. Other messages are sent to everyone, as they deal with reasons that many people share, such as not knowing how statins work or why they were offered them.
People can also reply to some of the messages. They can say if they are taking their statins, get a reply, and tell us about any new problems.
GP surgeries invite patients prescribed statins to take part by text message. Before joining, patients answer a few quick questions. Their answers help us send the messages that matter most to them.
Early feedback
Fifteen patients tried out the messages for one month and told us what they thought. They said the messages were clear, short and kind and felt personal to them. Many felt more confident and reassured about taking statins, understood better why they take them, and remembered to take them on time. Almost everyone said they would recommend it to others. Patients also gave us ideas to improve the messages. For example, we could add messages that reassure people statins work for both men and women, and explain cholesterol in a little more detail.
Looking ahead
We now want to test the messages with more patients. If they work, even small changes could make a big difference. They could help stop heart attacks and strokes, giving many people a better chance of good health, and even save lives.
Learn more about the project through the resources below:
Project team:
This project is funded by the National Institute for Health and Care Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number NIHR205407) and carried out at the NIHR Patient Safety Research Collaboration: North West London.
The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
For any questions on this project, please contact Javiera Rosenberg or Dr Gaby Judah.
