Add on digital cartoon video versus paper based counselling for medication adherence in hypertensive patients followed at a referral hospital in Yaoundé (Cameroon) : a randomized control trial. (e-Adherence study)

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Abstract Introduction: Treatment adherence is one of the milestones in the care of hypertensive patients, with as potential educational tools new technologies of information and communication. This study aimed to evaluate the add on effect of a digital Cartoon educative video on the therapeutic observance of patients followed up in the General hospital Yaoundé compared to standard of care. Method: We conducted a randomized simple blind clinical trial at the cardiology unit of the Yaoundé General Hospital, over a 6 months period from 1st March to 30th August 2022. We enrolled 110 patients and randomized them in blocs of 4 creating two groups of 57 and 53, respectively without (group 1) and with (group 2) intervention. Pre-intervention treatment adherence was assessed using the Morisky Medication Adherence Scale (MMAS). In the standard group (G1) we did standard paper based clinical counselling including oral advice and in the intervention group (G2) with did the same and added a digital cartoon video containing exactly the same message with images and audio. The primary outcome was medication adherence after three months. Results: The mean age in group 1(paper) was 56.65±10.98 years and 56.42±10.46 years in group 2 (paper + video), without any significant difference. The two groups were similar regarding the proportion of females (36.8% in G1 and 49.3% in G2), and the educational levels. According to the Morisky medication adherence scale,before the intervention, the proportions of patients with good, medium and low treatment adherence in group 1 and 2 were respectively 7%, 25.6%, 67.4%, and 5.1%, 43.6%, 51.3%, without any statistical difference. After interventions, the proportion of patients presenting a good observance moved from 7 to 11% in group 1(paper), and 5.1 to 20%in the group 2( paper + video), respectively. The intragroup variation of treatment adherence in the intervention group (before-after) tended to be significant with a p-value = 0.0572, while this p-value was 0.712 in the standard group. Conclusion: Our results provide an insight on how digital cartoon videos can help to have an add-on effect on treatment adherence of hypertensive patients, with a clinical significance.

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