Testing the Effectiveness of a Novel Intervention to Improve Medication Adherence in Stroke Survivors

NCT07414732 — Not applicable, Recruiting, 150 participants, Massachusetts General Hospital

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The "Savvy for Stroke Survivors" Study: Testing a Novel Tool to Help Stroke Survivors Take Their Medication

RegistryNCT07414732
StatusRecruiting
PhaseNot applicable
Study typeInterventional; randomized, parallel, masking: none, health services research
Enrollment150 (Estimated)
SponsorMassachusetts General Hospital (Other)
ConditionsStroke, Intracerebral Haemorrhage, Ischemic Stroke, TIA (Transient Ischemic Attack)
InterventionsSavvy Medication Adherence Intervention (Behavioral)
Datesstart 2026-03-31, primary completion 2027-04-30 (estimated), completion 2027-04-30 (estimated), first posted 2026-02-17, last updated 2026-05-20
Locations2 sites in United States

Related Papers Related Patents Related Grants Related Experts
All trials for Stroke All trials for Intracerebral Haemorrhage All trials of Savvy Medication Adherence Intervention

-Summary

The goal of this study is to test if Savvy, a multimodal intervention (consisting of psychological exercises, a weekly pill organizer, and a text message reminder system) can improve medication adherence in stroke survivors.

The main questions it aims to answer are:

* Can the Savvy tool improve medication adherence in stroke survivors compared to usual care?
* Does the use of the Savvy tool lead to better blood pressure control after a stroke?

The investigators will compare the use of the Savvy intervention to a control group that receives usual care, including a package of educational materials.

The study consists of the following components:

* Participants will receive the Savvy intervention or usual care. The intervention package consists of short psychological exercises over the phone, a weekly medication organizer to support daily medication intake, and text message reminders to take medication and refill the medication box. Participants in the control group will receive usual care, including educational materials about the importance of blood pressure and medication.
* All participants will receive a free home blood pressure monitor and will be requested to measure their blood pressure at certain time points during the study.
* Participants will be enrolled in the study for 6 months and will have virtual follow-up calls at 3 and 6 months.

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+Detailed description

The investigators will conduct a randomized controlled trial to evaluate the preliminary efficacy of the Savvy intervention, an intervention incorporating psychological strategies and practical tools to improve medication adherence and blood pressure control among stroke survivors.

A total of 150 stroke survivors will be enrolled and followed longitudinally for a duration of 6 months. Stratified randomization will be performed in a 1:1 ratio for the Savvy intervention and control group.

The intervention group will receive the Savvy intervention and a free BP monitor to support their medication intake. The control group will also receive the free BP monitor, as well as access to educational materials about blood pressure management. All participants will complete study assessments at baseline, and at 3 and 6 months of enrollment.

+Arms and interventions

ArmTypeInterventionsDescription
Control GroupNo interventionThe control group will receive access to educational materials about the importance of blood pressure control and medication adherence, along with a home blood pressure monitor.
Savvy GroupExperimentalBehavioral: Savvy Medication Adherence InterventionThe intervention group will receive the Savvy intervention to support medication adherence, consisting of psychological exercises, a weekly pill organizer, and a text messaging reminder system. Additionally, the intervention group will receive the same educational materials and home blood pressure monitor as the control group.
  • Savvy Medication Adherence Intervention (Behavioral): The intervention group will receive the Savvy intervention to support medication adherence, consisting of psychological exercises, a weekly pill organizer, and a text messaging reminder system. Additionally, the intervention group will receive the same educational materials and home blood pressure monitor as the control group.

+Outcome measures

Primary outcomes

  • Self-Reported Medication Adherence [6 months]: The primary outcome is self-reported medication adherence using the validated Medication Adherence Report Scale (MARS-5). The MARS-5 scores ranges from 5-25; higher scores indicate better adherence.

Secondary outcomes

  • Blood Pressure Improvement [3 and 6 months]: Defined as the proportion of patients who achieved a 10-mmHg reduction in systolic blood pressure
  • Blood pressure control [3 and 6 months]: The proportion of participants achieving a blood pressure of <130/80mmHg
  • Self-Reported Medication Adherence at 3 months [3 months]: Self-reported medication adherence measured using the Medication Adherence Report Scale (MARS-5) at 3 months. Scores range from 5-25; higher scores indicate better adherence.

+Eligibility

Sex: All, ages: 18 Years to 99 Years

Inclusion criteria:

1. Participants must be between the ages of 18 years old and 99 years old at the time of consent.
2. Self-reported primary diagnosis of stroke (ischemic or hemorrhagic) within the past 12 months, without structural, traumatic or secondary causes (including aneurysm, arteriovenous malformation, or tumor).
3. Currently prescribed an antihypertensive regimen.
4. Currently less than optimal adherence to medication, defined as a score <25 on the Medication Adherence Report Scale (MARS-5).
5. Cognitively able to manage medications independently, defined as a score of >4 on the Six-Item Screener (SIS) for cognitive impairment.
6. Speaks English sufficiently to complete consent and study procedures.
7. Has access to a phone that can receive text messages and is able to participate in scheduled phone-based follow-up assessments.
8. Uses, or willing to start using, a single pharmacy chain for prescription refills and is willing to provide consent for the study team to contact the pharmacy to retrieve prescription refill data.
9. Willing and able to provide informed consent.

Exclusion criteria:

1. Prescribed a more than three scheduled daily medication doses.
2. Prescribed a complex medication regimen requiring more than five additional oral medications per dose time.
3. Diagnosed with secondary hypertension or other BP conditions not managed with standard oral antihypertensives.
4. Has upper extremity impairments or other physical limitations that prevent safe use of the medication box or BP monitor.
5. Lives in an environment where the medication organizer cannot be safely or consistently accessed, such as in temporary housing, shelters, or unstable living conditions.
6. Diagnosed with moderate-to-severe cognitive impairment, dementia, or active psychiatric instability that precludes informed consent or reliable participation.
7. Known allergy or contraindication to the materials used in the BP monitor or the medication box.
8. Participation in another intervention trial targeting medication adherence or BP control.
9. Planned relocation or anticipated unavailability for the 12-month study period.

+Locations (2)

FacilityCityCountryStatus
Massachusetts General HospitalBoston, MassachusettsUnited StatesActive not recruiting
Massachusetts General HospitalBoston, MassachusettsUnited StatesRecruiting

+Publications

  • Arima H, Chalmers J. PROGRESS: Prevention of Recurrent Stroke. J Clin Hypertens (Greenwich). 2011 Sep;13(9):693-702. doi: 10.1111/j.1751-7176.2011.00530.x. Epub 2011 Sep 2. PMID 21896153
  • Kleindorfer DO, Towfighi A, Chaturvedi S, Cockroft KM, Gutierrez J, Lombardi-Hill D, Kamel H, Kernan WN, Kittner SJ, Leira EC, Lennon O, Meschia JF, Nguyen TN, Pollak PM, Santangeli P, Sharrief AZ, Smith SC Jr, Turan TN, Williams LS. 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association. Stroke. 2021 Jul;52(7):e364-e467. doi: 10.1161/STR.0000000000000375. Epub 2021 May 24. No abstract available. PMID 34024117
  • Harris PR, Brearley I, Sheeran P, Barker M, Klein WM, Creswell JD, Levine JM, Bond R. Combining self-affirmation with implementation intentions to promote fruit and vegetable consumption. Health Psychol. 2014 Jul;33(7):729-36. doi: 10.1037/hea0000065. Epub 2014 Feb 3. PMID 24490648
  • Nolan RP, Feldman R, Dawes M, Kaczorowski J, Lynn H, Barr SI, MacPhail C, Thomas S, Goodman J, Eysenbach G, Liu S, Tanaka R, Surikova J. Randomized Controlled Trial of E-Counseling for Hypertension: REACH. Circ Cardiovasc Qual Outcomes. 2018 Jul;11(7):e004420. doi: 10.1161/CIRCOUTCOMES.117.004420. PMID 30006474
  • Wan LH, Zhang XP, Mo MM, Xiong XN, Ou CL, You LM, Chen SX, Zhang M. Effectiveness of Goal-Setting Telephone Follow-Up on Health Behaviors of Patients with Ischemic Stroke: A Randomized Controlled Trial. J Stroke Cerebrovasc Dis. 2016 Sep;25(9):2259-70. doi: 10.1016/j.jstrokecerebrovasdis.2016.05.010. Epub 2016 Jun 28. PMID 27371106
  • Ogedegbe GO, Boutin-Foster C, Wells MT, Allegrante JP, Isen AM, Jobe JB, Charlson ME. A randomized controlled trial of positive-affect intervention and medication adherence in hypertensive African Americans. Arch Intern Med. 2012 Feb 27;172(4):322-6. doi: 10.1001/archinternmed.2011.1307. Epub 2012 Jan 23. PMID 22269592

+Investigators