Does electronic monitoring influence adherence to medication? Randomized controlled trial of measurement reactivity

Stephen Sutton (Lead Author), Ann Louise Kinmonth, Wendy Hardeman, Dyfrig Hughes, Sue Boase, A. Toby Prevost, Ian Kellar, Jonathan Graffy, Simon Griffin, Andrew Farmer

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Background: Electronic monitoring is recommended for accurate measurement of medication adherence but a possible limitation is that it may influence adherence. Purpose: To test the reactive effect of electronic monitoring in a randomized controlled trial. Methods: A total of 226 adults with type 2 diabetes and HbA1c ≥58 mmol/mol were randomized to receiving their main oral glucose lowering medication in electronic containers or standard packaging. The primary outcomes were self-reported adherence measured with the MARS (Medication Adherence Report Scale; range 5-25) and HbA1c at 8 weeks. Results: Non-significantly higher adherence and lower HbA1c were observed in the electronic container group (differences in means, adjusting for baseline value: MARS, 0.4 [95 % CI -0.1 to 0.8, p = 0.11]; HbA1c (mmol/mol), -1.02 [-2.73 to 0.71, p = 0.25]). Conclusions: Electronic containers may lead to a small increase in adherence but this potential limitation is outweighed by their advantages. Our findings support electronic monitoring as the method of choice in research on medication adherence. (Trial registration Current Controlled Trials ISRCT N30522359)

Original languageEnglish
Pages (from-to)293–299
Number of pages7
JournalAnnals of Behavioral Medicine
Issue number3
Early online date27 Feb 2014
Publication statusPublished - Dec 2014


  • Diabetes
  • Electronic monitoring
  • Measurement reactivity
  • Medication adherence

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