OMG: Texting No Help 4 Adherence 2 The Pill

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Sending text messages to remind women to take their oral contraceptive pills doesn't seem to work, according to researchers.

A randomized trial involving 82 women at a Boston Planned Parenthood Clinic found that missed pills were common whether the women got the reminders on their cell phone or not, Dr. Melody Y. Hou of Boston University and colleagues reported.

In fact, daily adherence to oral contraceptive use fell similarly over time in both groups, Hou and co-authors wrote in the September issue of Obstetrics & Gynecology.

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Forgetfulness is often cited by women as a top reason for nonadherence, but no strategy has yet been proven to overcome it -- including group motivation, structured, peer, or multicomponent counseling, and intensive reminders of appointments, the researchers noted.

The current trial recruited new users of birth control pills at the Planned Parenthood clinic. The women were all sexually active and had all chosen the pill as their mode of contraception, and all of them had mobile phones with text-messaging capabilities.

The women were assigned to receive their choice of commercially-available oral contraceptive pills from an electronic monitoring device that reported missed pills in real time via wireless transmission.

Nearly two thirds of the women had been on the pill in the past, half of them having typically used some type of reminder system, such as a cell phone or clock alarm.

Roughly one third of the women randomized to get the daily text message reminders had previously used this kind of additional reminder system. But 68 percent of those in the control group used a similar system to remember to take their pills during the study. This high rate of reminders mimicking the study intervention could account for the lack of benefit of text-message reminders, the researchers suggested.

"Whether this use was the result of the extensive formal education or reproductive health knowledge of our study cohort, the counseling received, or study reactivity (in which participants may change their behavior simply in response to the fact that they are being studied) is unclear," Hou's group wrote in their paper.

But control group women using a reminder system outside the trial protocol weren't any less likely to forget taking their pills compared with those who didn't use any reminder system.

At the same time, the team noted that the women appeared to like getting text message reminders and to find them useful -- rating them a median of 8 on a scale on which 10 was "I would never remember without it."

Most of the women getting text-message reminders said they would at least consider continuing to use the system (86 percent) and would even be willing to pay a monthly fee for it (57 percent).

Every patient in both groups rated remembering to take the pill as highly important (median 10 on a scale in which 10 was "the most important thing she can do to prevent pregnancy").

Nevertheless, only 16 percent of women in the study had excellent adherence, defined as missing no more than one pill per cycle on average.

These adherent users weren't more likely to have been getting the text-message reminders and had no other distinguishing characteristics at the start of the study, except for higher baseline reported condom use.

"This suggests that there are some women who are excellent pill takers and are good candidates for oral contraceptive pill use and others who will have poor pill adherence even with reminder systems," and thus may be better candidates for methods considered "forgettable," such as intrauterine devices, the researchers wrote in the paper.

No pregnancies occurred during the three-month study despite a predicted 8 percent risk, possibly because of the low frequency of sexual activity among the participants or correct use of condoms and other backup methods when they missed pills, Hou and colleagues suggested.

The researchers cautioned that generalizability of the results may have been limited by the predominantly white, well-educated, population in the study.