Text messages little help in remembering the Pill

NEW YORK (Reuters Health) - A cell phone text message -- and the buzz or beep that signals its arrival -- may not help a woman remember to pop her birth control pill, a new study suggests.

The finding comes as a surprise to some researchers who have seen benefits of text message reminders for everything from keeping kids inhaling their asthma medicine to sunbathers applying sunscreen.

“We’ve been surprised at how big a factor reminders can be,” Dr. Joseph Kvedar, who is director for The Center of Connected Health in Boston and was not involved in the new study, told Reuters Health. “And it’s so simple.”

Since missed birth control pills account for about one in five of the 3.5 million unintended pregnancies in the U.S., Dr. Melody Hou of Boston Medical Center and her team were interested to see if text messages could help minimize this potentially costly forgetfulness too.

They randomly assigned 82 new oral contraceptive users, averaging 22 years old, to either receive a daily text message reminder to take their birth control pills or to receive no reminders but rather some encouragement at the study’s outset to use their own reminder tricks. (Hou and other members of her team received funding from makers of various birth control pills.)

During the three-month study, both groups missed a monthly average of about five pills, as recorded by an electronic monitoring device on the pill packs. Fortunately, none of the women got pregnant, report the researchers in the journal Obstetrics and Gynecology.

In both groups, the rate of missed pills was nearly double the average estimated by previous research, Hou’s group notes, hinting that adherence in the general population of Pill users may be overestimated.

Why was no difference seen between the groups in the current study, especially when the women receiving the reminders felt they were useful? The researchers suggest that alternative reminder systems, used by 68 percent of the participants who didn’t receive text messages, may have played a role.

“Oral contraceptives are special in that people who sign up for them are generally motivated for their desired effect,” added Kvedar, who led the sunscreen study and noted how that intervention, along with others such as hypertension drugs, might not carry as much obvious incentive.

“The control group was motivated and encouraged to find other ways of reminding themselves,” he said.

But as Kvedar also pointed out, the initial attention and enthusiasm that comes with being part of a study may have waned over time as evidenced by the decreased pill-taking over the course of the study.

And while this downward trend was evident in both groups, women who didn’t receive text messages forgot significantly more often as time went on. This may point to some benefit from the texts after all, he noted.

“We know from our own experience that if people are motivated and just can’t remember, then this is a wonderful application (for text messaging),” Kvedar said.

To improve the effectiveness of oral contraceptive reminders, Kvedar recommended customizing the content of the 160-character messages for each woman.

Dr. Santosh Krishna, of Saint Louis University School of Public Health, who was also not part of the new study, added that better communication strategies, privacy issues and language barriers should be considered when using the text message as a health tool.

She suggested as well that people could also use their own cell phones to set themselves “don’t forget to exercise” reminders, or alarms when going out to eat to encourage them to make healthier choices.

“We’re moving people to new levels of health behavior,” said Kvedar, “which is quite achievable with this technology because it is quite scalable and cheap.”

SOURCE: Obstetrics and Gynecology, September, 2010.