Abstract
Effective mobile health (mHealth) interventions have been developed to support patients with their medication use, however to date few are widely used in pharmacy practice. Normalization of an intervention is essential to have a population impact, which is defined as 'the process of getting a new intervention into routine practice'. The aim of this study was to assess the normalization potential of a complex mHealth intervention for adolescents with asthma (ADolescent Adherence Patient Tool; ADAPT) in community pharmacy practice. The Normalization Process Theory (NPT), a sociological action theory, was retrospectively applied to study the normalization potential of ADAPT. NPT explains factors that promote or hinder implementation, embedding, and integration of new interventions in clinical practice. Evaluation data (structured interviews and questionnaires) of 23 pharmacists who used the ADAPT intervention were used for this study. Pharmacists understood the purpose of the ADAPT intervention and were prepared to undertake the necessary work of implementation. However changes at different levels are needed to support full normalization, such as changes in the intervention itself and changes in the pharmacist's work flow. The potential for normalization could also be enhanced by the use of product champions and appropriate reimbursement guidelines, to ensure uptake of the intervention by other pharmacists. Support from professional bodies for the use of mHealth could also promote normalization. Normalization of mHealth is a complex continuous process. The ADAPT intervention has the potential to be normalized in community pharmacy practice, but full normalization would require changes in both daily pharmacy practice and reimbursement models.
Highlights
Suboptimal asthma control is common, i.e., around 50% of patients have uncontrolled asthma, mostly caused by medication non-adherence
This study describes all factors related to the normalization of a complex asthma mobile health (mHealth) intervention in the community pharmacy setting
The findings tentatively suggest that the ADolescent Adherence Patient Tool (ADAPT) intervention has the potential to become normalized in clinical practice as long as there is adequate financial reimbursement for the additional work required by pharmacists and sufficient investment in training and motivating pharmacists to use it
Summary
Suboptimal asthma control is common, i.e., around 50% of patients have uncontrolled asthma, mostly caused by medication non-adherence. Non-adherence rates are especially high during adolescence.[3] Mobile health (mHealth) interventions have the potential to support patients with their medication use, and can be in particular interesting for adolescents.[4,5] Medication intake behaviour is complex as it is affected by multiple unintentional (practical) and intentional (perceptual) barriers.[6] interventions with multiple components are more effective in improving medication adherence than those aimed at only one aspect of non-adherent behaviour.[7,8] Several mHealth interventions with multiple components have been developed and use of these interventions resulted in increased adherence rates, improved self-management, or improved health status.[9,10,11,12] hardly any of them are currently implemented in clinical practice. Objective: The aim of this study was to assess the normalization potential of a complex mHealth intervention for adolescents with asthma (ADolescent Adherence Patient Tool; ADAPT) in community pharmacy practice. The ADAPT intervention has the potential to be normalized in community pharmacy practice, but full normalization would require changes in both daily pharmacy practice and reimbursement models
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