Effect of text messages designed to change contact lens compliance: A randomised controlled trial.

Purpose: Contact lens behaviours such as poor hand and lens hygiene are common and are associated with increased risk of microbial keratitis. Evidence for health promotion strategies to address this gap is required. The trial examined the effectiveness of a customised text-messaging intervention on compliance, discontinuation rate and wearer satisfaction in contact lens wearers.
Methods: The parallel group, double masked, randomised clinical trial was pre-registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12621001719820). Contact lens wearers were recruited using social media and optometry partners in clinical practice. Participants (n = 76) received the intervention and usual care. The control group (n = 75) received usual care. Intervention text messages (range 56-76) were customised, provided education, reminders, and motivation and were delivered over six months. Outcomes were validated self-report online surveys for compliance (0-100), satisfaction (0-100) and discontinuation (Y/N), at 3 months and 6 months. Secondary outcomes were intervention feasibility and acceptability.
Results: Participants mean age was 38 years, 105/151 (70 %) female and 83 % completed the trial (intervention 60/76, control 65/75). The intervention group demonstrated better compliance than control with an adjusted between-group-difference at 3 months of 5.2, 95 % confidence interval (CI), 1.6-8.7, P = 0.004 and at 6 months 3.9, 95 % CI 0.2-7.6, P = 0.04. This difference in compliance is clinically significant, equivalent to a single change in a behaviour such as starting to handwash or ceasing overnight wear. There was no adjusted between-group-difference in satisfaction at 3 months (0.8, 95 % CI -4.3-6.0, P = 0.75) or at 6 months (-0.4, 95 % CI -5.7-4.9, P = 0.89). Few participants (7/151, 4.6 %) discontinued contact lens wear (3 intervention, 4 control). The messages were delivered successfully (98 %), at A$11 per participant. Participants reported appropriate message content (75 %), language (80 %) and delivery timing (97 %).
Conclusion: This customised text message intervention was a feasible and acceptable method for improving contact lens compliance.
Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: NC was awarded a UNSW Scientia Fellowship and AS was supported by a PhD Scientia Scholarship. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. All authors attest that they meet the current ICMJE criteria for authorship. Authors AS, KF and LK indicate no financial disclosures or conflicts of interest. NC has previously received an educational grant from Alcon, honoraria from the British Contact lens Association (UK) and Optometry Virtually Connected, and travel grants from Standards Australia, and Australian Vision Convention (QLD/NT).
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