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Using Daily Text-Message Reminders to Improve Adherence With Oral Contraceptives: A Randomized Controlled Trial

Hou, Melody Y. MD, MPH; Hurwitz, Shelley PhD; Kavanagh, Erin MPP; Fortin, Jennifer MPH; Goldberg, Alisa B. MD, MPH

doi: 10.1097/AOG.0b013e3181eb6b0f
Original Research

OBJECTIVE: To estimate whether women receiving daily text-message reminders have increased oral contraceptive pill adherence compared with women not receiving reminders.

METHODS: This randomized controlled trial estimated whether there was an effect of daily text-message reminders on oral contraceptive pill adherence of new oral contraceptive pill users. Pill-taking was tracked for 3 months by an electronic monitoring device with wireless data collection. During the study period, participants assigned the intervention received a daily reminder text message. Eighty-two women were assigned randomly to detect a 1.6±2.0 pill difference (90% power, 5% α, 15% dropout).

RESULTS: Participants were 79% white, non-Hispanic, 99% high school graduates, and 99% nulliparous with a mean age of 22 years. Most reported condom use with past coital activity, and more than half reported prior emergency contraception use. The mean number of missed pills per cycle did not differ significantly between the groups: 4.9±3.0 for the text-message group and 4.6±3.5 for the control group (P=.60). The number of missed pills per cycle increased over the course of the study, but this pattern did not increase differentially between the groups. Adherence recorded by the electronic monitoring device indicated much poorer adherence than that recorded by patient diaries. Despite poor pill-taking, there were no pregnancies.

CONCLUSION: Daily text-message reminders did not improve oral contraceptive pill adherence. Although the lack of benefit may be attributed to the frequent use of alternative reminder systems in the control group, the rate of missed pills when measured objectively was still very high in both groups.



Daily text-message reminders do not improve adherence with oral contraceptives.

From the Boston University School of Medicine; the Planned Parenthood League of Massachusetts; and Brigham and Women's Hospital, Boston, Massachusetts.

Supported by a grant from an anonymous foundation.

Presented as a poster at the American College of Obstetricians and Gynecologists' 58th Annual Clinical Meeting, May 15–19, 2010, San Francisco, CA.

Corresponding author: Melody Y. Hou, MD, MPH, Department of Obstetrics and Gynecology, 850 Harrison Avenue–Yawkey, ACC 4th Floor, Boston, MA 02118; e-mail:

Financial Disclosure Dr. Hou was paid for board membership from Bayer HealthCare (January 22–24, 2009) and for travel expenses covered or reimbursed by Bayer HealthCare for this activity and received honoraria from Schering-Plough as an Implanon trainer. Dr. Goldberg received honoraria and payment for development of educational presentations (including service on speakers' bureaus) from Organon and as a speaker and trainer for Implanon.

© 2010 by The American College of Obstetricians and Gynecologists.