Adherence Apps Research Articles

Adapting technology-based HIV prevention and care interventions for youth: lessons learned across five U.S. Adolescent Trials Network studies.

U.S. sexual and gender minority youth experience individual, interpersonal, and structural-level barriers to HIV prevention and care. Innovative, youth-driven approaches to mobile and electronic interventions that support use of new biomedical prevention, testing, and treatment options may address these barriers. Adapting evidence-based interventions for youth must balance core intervention components with responsiveness to the distinct needs of end-users. The UNC/Emory Center for Innovative Technology (iTech) adapts and evaluates technology-based interventions for youth living with or at risk for HIV. We analyzed formative research (focus groups and individual usability sessions) across five iTech studies: two apps promoting HIV testing and pre-exposure prophylaxis (PrEP), one app promoting behavioral risk reduction and PrEP, one PrEP adherence app, and one mobile-optimized website for increasing viral suppression, with the aim of informing best practices for technology-based intervention development. Each study presented prototypes of adapted mHealth interventions to samples of their target end-user population for use and/or evaluation. One hundred and thirty-eight youth across seven geographically diverse sites provided feedback during the intervention adaptation process. We found high interest in and acceptability of all five intervention prototypes. Cross-study themes included: (I) Desire for multiple privacy protections (e.g., password, fingerprint) to keep HIV status, sexual identity, and sexual behavior confidential. (II) Strong but varied preferences for the look and feel of platforms. Imagery should be discrete but representative. Participants valued customizable platforms and positive themes, motivational language, and humor. Youth wanted information presented using multiple modalities (e.g., text, video, image) to increase engagement. (III) Youth preferred engagement features and functions consistent with familiar platforms (e.g., Snapchat, Instagram). Gamification features that resulted in tangible versus virtual rewards were predicted to increase engagement. Intervention messaging functions were perceived as useful; customization was desired as a way to control frequency, mode (e.g., SMS, in-app message, push notification), and content. (IV) Youth voiced varied preferences for platform content including: featuring young role models from the lesbian, gay, bisexual, transgender, queer and/or questioning (LGBTQ) community, incorporating mental health resources, and maintaining a holistic health-focus (not HIV-centric). We found high acceptability and consistent feedback in youths' evaluations of these mHealth interventions; divergence was most commonly found in preferred content versus features and functions. Identifying broadly accepted aspects of mHealth interventions for youth supports the feasibility of adaptation (versus de novo creation) and should guide the focus of future formative research phases. Continued research is needed to better understand how to balance usability preferences with finite resources for customization.

Digital Medication Adherence Support: Could Healthcare Providers Recommend Mobile Health Apps?

Adherence to prescribed medication is suboptimal in 50% of the chronic population, resulting in negative medical and economic outcomes. With the widespread use of mobile phones worldwide, medication adherence apps for mobile phones become promising medication adherence aids thanks to simplicity, user-friendliness, and accessibility for the public. Yet, until today, there is insufficient evidence in favor of using mobile health (mHealth) apps to increase medication adherence. This study aims to develop a methodology for scientific and end-user (patient) mHealth evaluation (a) to identify medication adherence apps search terms, (b) to evaluate identified apps based on scientific criteria, and (c) to report best smartphone apps evaluated by patients. Search terms were identified via literature review and expertise. Firstly, an online questionnaire was developed to identify frequently used search terms by recruited patients. Related medication adherence apps were identified and selected using predefined inclusion criteria. Secondly, identified apps were evaluated thanks to a scientific evaluation method and a created online questionnaire for patient feedback. Recruited patients were invited to test and evaluate the selected apps. Out of 1,833 free-of-charge and 307 paid apps identified, only four free-of-charge and three paid apps remained included in the study after eligibility criteria. None of the selected app reached a high score. Looking at the overall scores, Medisafe (59%), MyTherapy (56%), and Meds on time (44%) received the highest scores in the scientific app evaluation. In the patient evaluation, Dosecast (3.83 out of five points), Medisafe (3.62), and SwissMeds (3.50) received the highest scores. None of the apps in this research has undergone a process for certification, for example, CE marking, through a notified body. Security and data protection aspects of existing apps highly contribute to these low evaluation scores through little information on patient's data processing and storage. This might be corrected through the introduction of General Data Protection Regulation (GDPR) in the European Economic Area (EEA) and more scrutiny through regulatory bodies in the EU/EEA and the USA. None of the applications should be recommended by healthcare providers. In addition, clinical studies with chronic patients are necessary to measure long-term app impacts.

KEPT-app trial: a pragmatic, single-blind, parallel, cluster-randomised effectiveness study of pelvic floor muscle training among incontinent pregnant women: study protocol

IntroductionPelvic floor muscle training (PFMT) strongly recommended to incontinent pregnant women. The Kegel Exercise Pregnancy Training-app trial is a multicentre cluster-randomised study aims to assess the effectiveness and its cost-effectiveness...

Evaluating Perspectives of a Smartphone Medication Application in the Adolescent and Young Adult Oncology Population: A Qualitative Study

Purpose: Medication adherence research involving adolescent and young adult (AYA) oncology patients has consisted of small, retrospective studies demonstrating poor adherence rates. Technology plays an active role in attempt to improve medication adherence. There is a growing body of literature investigating the role of smartphone applications (apps). We hypothesized a medication phone app, MedActionPlan Pro (MPP), leads to perceived improvement in medication adherence. Methods: Thirty AYA oncology patients actively receiving treatment (AYA defined as 15-30 years) at Nationwide Children's Hospital were enrolled. Participants downloaded the MPP app on their smartphone for 3 months, during which time participants were provided text messages and alerts to encourage medication adherence. Post-app use, participants completed semi-structured interviews. Interviews were audio-recorded, transcribed, and independently coded to determine consensus thematic content. Results: Thirty AYA oncology participants (16 male), median age 17.5 (range: 15-30 years), participated in the study, with 22 participants (55% male) with a median age of 18 years (range: 15-30 years) participated in the final qualitative survey interview. Participants reported positive views about app utilization and perceived improved medication adherence. Additional themes included perceived decreased forgetfulness, improved organization, and identified customization for medications within the app was most important to AYAs. Conclusion: AYA oncology patients reported improvement in perceived medication adherence utilizing MPP and identified several features they thought would lead to improved medication adherence. These findings, integrated with previous literature, support the further need to investigate the utility of medication adherence apps that fit the unique needs of AYA oncology patients.

On-site multi-component intervention to improve productivity and reduce the economic and personal burden of neck pain in Swiss office-workers (NEXpro): protocol for a cluster-randomized controlled trial

BackgroundNon-specific neck pain and headache are major economic and individual burden in office-workers. The aim of this study is to investigate the effect of a multi-component intervention combining workstation ergonomics, health promotion information group workshops, neck exercises, and an app to enhance intervention adherence to assess possible reductions in the economic and individual burden of prevalent and incident neck pain and headache in office workers.Methods/designThis study is a stepped wedge cluster-randomized controlled trial. Eligible participants will be any office-worker aged 18–65 years from two Swiss organisations in the Cantons of Zurich and Aargau, working more than 25 h a week in predominantly sedentary office work and without serious health conditions of the neck. One hundred twenty voluntary participants will be assigned to 15 clusters which, at randomly selected time steps, switch from the control to the intervention group. The intervention will last 12 weeks and comprises workstation ergonomics, health promotion information group workshops, neck exercises and an adherence app. The primary outcome will be health-related productivity losses (presenteeism, absenteeism) using the Work Productivity and Activity Impairment Questionnaire. Secondary outcomes are neck disability and pain (measured by the Neck Disability Index, and muscle strength and endurance measures), headache (measured by the short-form headache impact test), psychosocial outcomes (e.g. job-stress index, Fear-Avoidance Beliefs Questionnaire), workplace outcomes (e.g. workstation ergonomics), adherence to intervention, and additional measures (e.g. care-seeking). Measurements will take place at baseline, 4 months, 8 months, and 12 months after commencement. Data will be analysed on an intention to treat basis and per protocol. Primary and secondary outcomes will be examined using linear mixed-effects models.DiscussionTo the authors’ knowledge, this study is the first that investigates the impact of a multi-component intervention combining current evidence of effective interventions with an adherence app to assess the potential benefits on productivity, prevalent and incident neck pain, and headache. The outcomes will impact the individual, their workplace, as well as private and public policy by offering evidence for treatment and prevention of neck pain and headache in office-workers.Trial registrationClinicalTrials.gov, NCT04169646. Registered 15 November 2019 - Retrospectively registered.

Tailoring Tofacitinib Oral Therapy in Rheumatoid Arthritis: The TuTORApp-A Usability Study.

Objective: To create a mobile application able to help patients follow medical treatments properly. Methods: We designed and developed a custom Android/iOS App to remind patients of the pharmaceutical drugs to be taken, of the visits and exams to attend, and to detect their compliance with their personal therapeutic plan. In this paper we describe the App development, UX/UI design, Gamification. TuTOR is an Android and iOS application designed to remind patients of the drugs to be taken, giving them all the information related to their therapeutic plans in a simple and non-invasive way. Thanks to a dedicated back-office, specially designed to meet specific medical information needs, the App can also help physicians detect their patients’ compliance with their treatments and modify prescriptions in real time. The App also ensures a state-of-the-art approach to data security and privacy protection. The main feature of TuTOR is the smart therapy assistant, which features dedicated alarms to remind users of taking their prescription drugs. Thanks to the automatic synchronization with a local database, the alert system works even without connection to the Internet. Particular attention was paid during the App’s design process: we looked to create an intuitive interface to ensure absolute ease of use, with state-of-the-art visual design aimed at maximizing user experience. Other relevant features include the App’s ability to givevisual evidence of the most important drugs to be taken and its note-taking feature, which gives patients the possibility to note down indications on why a specific drug was skipped. The App also keeps track of upcoming medical exams, laboratory tests, and visits on a devoted calendar. It also helps patients by listing therapy contacts, such as physicians’ phone numbers, and indicates all medical references by showing, for example, locations of relevant clinics and pharmacies on a map. Thanks to specific visual progress indicators and an innovative gamification approach, the App encourages users to faithfully follow therapy guidelines. With TuTOR, assessing the therapy’s state of completion is quick and easy.Thanksto the privacy-by-design approach used, all data managed by the system is compliant with the European Privacy Regulation and it is not available to third parties. Expected results: A mobile App for medication adherence might increase objectively and subjectively measured adherence.

App for buprenorphine adherence moves forward

A pilot study published in the Journal of Addiction Medicine last month paves the way for more clinical investigations of an application developed by Emocha Health. We talked to the CEO, Sebastian Seiguer, and to the primary investigator and lead author of the study, Judith Tsui, M.D., M.P.H., about how the app works.

Usability and Utility of a Mobile App to Improve Medication Adherence Among Ambulatory Care Patients in Malaysia: Qualitative Study.

BackgroundTo date, several medication adherence apps have been developed. However, the existing apps have been developed without involving relevant stakeholders and were not subjected to mobile health app guidelines. In addition, the usability and utility of these apps have not been tested with end users.ObjectiveThis study aimed to describe the usability and utility testing of a newly developed medication adherence app—Med Assist—among ambulatory care patients in Malaysia.MethodsThe Med Assist app was developed based on the Theory of Planned Behavior and the Nielson usability model. Beta testing was conducted from March to May 2016 at a primary care clinic in Kuala Lumpur. Ambulatory care patients who scored ≥40% on the electronic health literacy scale, were aged ≥21 years, and were taking two or more long-term medications were recruited. Two rounds of in-depth interviews were conducted with each participant. The first interview, which was conducted upon participant recruitment, was to assess the usability of Med Assist. Participants were asked to download Med Assist on their phone and perform two tasks (register themselves on Med Assist and enter at least one medication). Participants were encouraged to “concurrently think aloud” when using Med Assist, while nonverbal cues were observed and recorded. The participants were then invited for a second interview (conducted ≥7 days after the first interview) to assess the utility of Med Assist after using the app for 1 week. This was done using “retrospective probing” based on a topic guide developed for utilities that could improve medication adherence.ResultsUsability and utility testing was performed for the Med Assist app (version P4). A total of 13 participants were recruited (6 men, 7 women) for beta testing. Three themes emerged from the usability testing, while three themes emerged from the utility testing. From the usability testing, participants found Med Assist easy to use and user friendly, as they were able to complete the tasks given to them. However, the details required when adding a new medication were found to be confusing despite displaying information in a hierarchical order. Participants who were caregivers as well as patients found the multiple-user support and pill buddy utility useful. This suggests that Med Assist may improve the medication adherence of patients on multiple long-term medications.ConclusionsThe usability and utility testing of Med Assist with end users made the app more patient centered in ambulatory care. From the usability testing, the overall design and layout of Med Assist were simple and user friendly enough for participants to navigate through the app and add a new medication. From the participants’ perspectives, Med Assist was a useful and reliable tool with the potential to improve medication adherence. In addition, utilities such as multiple user support and a medication refill reminder encouraged improved medication management.

Cloud-based multi-media systems for patient education and adherence: a pilot study to explore patient compliance with colonoscopy procedure preparation

ABSTRACT Technology based patient education and adherence approaches are increasingly utilized to instruct and remind patients to prepare correctly for medical procedures. This study examines the interaction between two primary factors: patterns of patient adherence to challenging medical preparation procedures; and the demonstrated, measurable potential for cloud-based multi-media information technology (IT) interventions to improve patient adherence. An IT artifact was developed through prior design science research to serve information, reminders, and online video instruction modules to patients. The application was tested with 297 patients who were assessed clinically by physicians. Results indicate modest potential (43.4% relative improvement) for the IT-based approach for improving patient adherence to endoscopy preparations. Purposively designed cloud-based applications hold promise for aiding patients with complex medical procedure preparation. Health care provider involvement in the design and evaluation of a patient application may be an effective strategy to produce medical evidence and encourage the adoption of adherence apps.

A Medication Adherence App for Children With Sickle Cell Disease: Qualitative Study.

BackgroundYoung people with sickle cell disease (SCD) often demonstrate low medication adherence and low motivation for effectively self-managing their condition. The growing sophistication of mobile phones and their popularity among young people render them a promising platform for increasing medication adherence. However, so far, few apps targeting SCD have been developed from research with the target population and underpinned with theory and evidence.ObjectiveThe aim of this study was to develop a theory-and-evidence-based medication adherence app to support children and adolescents with SCD.MethodsThe Behavior Change Wheel (BCW), a theoretically based intervention development framework, along with a review of the literature, 10 interviews with children and adolescents with SCD aged between 12 and 18 years, and consultation with experts informed app development. Thematic analysis of interviews provided relevant theoretical and evidence-based components to underpin the design and development of the app.ResultsFindings suggested that some patients had lapses in memory for taking their medication (capability); variation in beliefs toward the effectiveness of medication and confidence in self-managing their condition (motivation); a limited time to take medication; and barriers and enablers within the changing context of social support during the transition into adulthood (opportunity). Steps were taken to select the appropriate behavioral change components (involving behavior change techniques [BCTs] such as information on antecedents, prompts/cues; self-monitoring of the behavior; and social support) and translate them into app features designed to overcome these barriers to medication adherence.ConclusionsPatients with SCD have complex barriers to medication adherence necessitating the need for comprehensive models of behavior change to analyze the problem. Children and adolescents require an app that goes beyond simple medication reminders and takes into account the patient’s beliefs, emotions, and environmental barriers to medication adherence.

MON-148 Medication Adherence Mobile Apps And Diabetes Self Management Education/Support Guidelines

Background: Medication adherence is a problem in the management of chronic diseases like Diabetes. As there are 325,000 mobile health apps in 2017, "medication adherence" mobile apps are now a subtype of this sector in the ehealth marketplace. More and more patients are using such apps to self manage their medication and disease management. Purpose: To evaluate free, medication compliance mobile apps in terms of the Diabetes Self Management Education/Support Guidelines Methods: We used Google Play Store to find the free medication adherence apps, ranging from 1 million to 50,000 downloads, for 2018. Android apps downloads are documented by Google Play whereas iPhone apps downloads are not available to the public. Inclusion criteria: apps that emphasized medication compliance. Exclusion criteria: apps with malfunctioning websites on a daily basis. Result: Ranked by most downloads to least number of downloads: 1) Pill Reminder and Medication Tracker by Medisafe (1 million downloads (DL)); 2)CareZone (1 million DL); 3) Medication Reminder & Pill Tracker (500,000 DL); 4)Dosecast (100,000 DL); 5) Med Help Pill Reminder (100,000 DL); 6) Alarm and pill reminder (100,000 DL); 7) Mango Health (100,000 DL); 8) Medicine time! (100,000 DL); 9) Mr. Pillster (100,000 DL) ;10) Medica (50,000 DL). 100% of the 10 apps have reminders and missed medication warnings. Other features included in the apps: rewards 1/10 ; HIPAA compliance 1/10; BP 6/10; FBS 6/10; HbA1c 2/10 ; weight 6/10; height 3/10; exercise 2/10; carb 2/10; 4/10 mood; 0/10 stress mgmt; BMI 1/10, lipids 1/10. Conclusion: Medication adherence apps are available to patients with smartphones. However, most of the current medication adherence apps do not track the important health parameters for diabetes management, according to the DSME/S guidelines such as FBS, HbA1C, weight loss, exercise, carb intake, stress management and BMI. We, as physicians, can use our knowledge to guide our diabetic patients in their judicious use of mobile health medication adherence apps.

Mobile Phone Apps Targeting Medication Adherence: Quality Assessment and Content Analysis of User Reviews.

BackgroundWith the accessibility and widespread use of mobile phones, mobile phone apps targeting medication adherence may be useful tools to help patients take medications as prescribed.ObjectiveOur objectives were to (1) characterize and assess mobile phone medication adherence apps guided by a conceptual framework on the focus of adherence interventions and (2) conduct a content analysis of Web-based reviews to explore users’ perspectives and experiences with mobile phone medication adherence apps.MethodsWe searched for mobile phone medication adherence apps using keyword searches in Apple and Android operating systems. We characterized all apps in terms of number of downloads, ratings, languages, cost, and disease target. We categorized apps according to 4 key features of (1) alerting to take medication, (2) tracking medication taking, (3) reminding to refill or indicating amount of medication left, and (4) storing medication information. We then selected representative apps from each operating system for detailed quality assessment and user testing. We also downloaded Web-based reviews for these selected apps and conducted a qualitative content analysis using an inductive approach involving steps of initial open coding, construction of categories, and abstraction into themes.ResultsWe identified 704 apps (443 from Apple and 261 from Android). The majority of apps across both operating systems had 1 or 2 features—specifically, 37.2% (165/443) and 38.1% (169/443) of Apple apps, respectively, and 41.4% (108/261) and 31.4% (108/261) of Android apps, respectively. Quality assessment and user testing of 20 selected apps revealed apps varied in quality and commonly focused on behavioral strategies to enhance medication adherence through alerts, reminders, and logs. A total of 1323 eligible Web-based reviews from these 20 selected apps were analyzed, and the following themes emerged: (1) features and functions appreciated by users, which included the ability to set up customized medication regimen details and reminders, monitor other health information (eg, vitals, supplements, and manage multiple people or pets), support health care visits (eg, having a list of medications and necessary health information in 1 app); (2) negative user experiences that captured technical difficulties (glitches, confusing app navigation, and poor interoperability), dosage schedule, and reminder setup inflexibility; and (3) desired functions and features related to optimization of information input, improvement of reminders, and upgrading app performance (better synchronization or backup of data and interoperability).ConclusionsA large number of mobile phone medication adherence apps are currently available. The majority of apps have features representing a behavioral approach to intervention. Findings of the content analysis offer mostly positive feedback as well as insights into current limitations and improvements that could be addressed in current and future medication adherence apps.

15. Positively Connected For Health (PC4H): Acceptability And Feasibility of A Digital Health Adherence And Engagement In Care Intervention For Adolescents And Young Adults Living With HIV

Adolescents and young adults (AYA) are disproportionately affected by HIV and fewer than half of AYA who are prescribed antiretroviral therapy (ART) achieve viral suppression. Digital interventions can be uniquely designed to provide support and feedback in real time as youth go about their daily lives in order to improve health literacy and ART adherence. The purpose of this study was to determine acceptability, feasibility, and preliminary efficacy of a digital health literacy workshop coupled with a medication adherence application (app) for AYA living with HIV over a 3-month period. Demonstration project (June 2017-July 2018) of AYA 14-34 years old in Philadelphia, PA linked to care at one of five health clinics who are HIV-positive, have an unsuppressed viral load (≥200 copies/ml), and/or have been out of care for ≥6 months last 24 months, and/or newly diagnosed with HIV in last 12 months. The eHealth Literacy Scale (eHEALS) was administered prior to the workshop and at the 3-month follow-up to compare confidence in navigating digital health information. Participant satisfaction was measured via electronic surveys immediately following the workshop and after 3 months of app usage. Self-reported adherence to antiretroviral therapy (ART), by visual analog scale (VAS) for past month adherence, and viral load from electronic health records were measured at baseline and 3-month follow-up. Descriptive analyses were performed and t tests for paired samples were used to compare baseline and 3-month outcomes. Analyses performed using SPSS 24. Participants (N = 41) at workshop/baseline were mean age 25.49 years (SD 4.65, range 17–34), and majority were male (73.17%), Black (73.17%), non-Hispanic/Latino (85.37%), and on ART (97.6%). Most participants (31; 75.61%) were retained at the 3-month study visit where all were still on ART and refilled ART at least once. Among 31 participants who completed eHEALs pre-workshop and 3-months post-workshop, confidence in navigating digital health information to make health decisions among respondents increased from 48.39% (15 agreed) to 70.97% (22 agreed). Of 41 participants at baseline, 92.68% (38) said the workshop helped them navigate and more likely use the app, and 85.37% (35) said the instructor knew the subject matter well. After 3 months of app usage (n=31), 61.29% (19) reported that the app helped them miss fewer doses of ART and 80.65% (25) thought the app made them more likely to call their healthcare provider with questions. Medication and appointment reminders with progress calendar were listed as the most useful app features. Self-report adherence improved (mean VAS baseline=75.19 and 3-month=89.27, p=0.02), but there was no significant difference in viral load (n=28; mean baseline=9473.36 and 3-months=7298.43, p=0.44). Study showed high satisfaction with a digital health literacy workshop and medication adherence app, high retention rates, improved confidence in digital health literacy, and self-reported adherence, but did not show significant viral load improvement over a 3-month period. PC4H is a feasible and acceptable digital health intervention for AYA living with HIV, but requires further study.

A Multi-step Usability Evaluation of a Self-Management App to Support Medication Adherence in Persons Living with HIV

PurposeAdherence to antiretroviral therapy is essential to HIV management and sustaining viral suppression. Despite simplified regimens, adherence remains difficult for certain persons living with HIV (PLWH). There is evidence to support the use of mHealth apps for effective self-management in PLWH; however, a medication adherence app with real-time monitoring for this population has not been developed and rigorously evaluated by PLWH. We developed a mHealth app (WiseApp) for HIV self-management to help PLWH self-manage their health. The purpose of this study was to evaluate the usability of the WiseApp. MethodsWe conducted a three-step usability evaluation using 1) a traditional think-aloud protocol with end-users, 2) a heuristic evaluation with experts in informatics, and 3) a cognitive walkthrough with end-users. During the cognitive walkthrough, we tested two devices (fitness tracker and medication tracking bottle) that were linked to the WiseApp. ResultsThe think-aloud protocol informed iterative updates to the app, specifically to make it easier to see different sections of the app. The heuristic evaluation confirmed the necessity of these design changes. The cognitive walkthrough informed additional updates and confirmed that overall, the app and the linked devices were usable for the end-users. ConclusionThe results of the cognitive walkthrough with both experts and end-users informed iterative refinements to the WiseApp and finalization of a mHealth app for PLWH to better self-manage their health.

A content analysis of smartphone apps for adolescent smoking cessation.

Adolescent cigarette smokers have an increased risk of sustained smoking into adulthood. Smartphone applications (apps) for smoking cessation are a promising treatment resource. However, research on apps for adolescent smoking cessation is limited. This study compared smoking cessation mobile apps targeting an adolescent audience with popular cessation apps for a general audience. Adolescent and general-audience apps were identified by searching the Google Play and Apple App Stores (November 2016). Two coders assessed each app for adherence to clinical practice guidelines for tobacco and adolescent-specific content (2016-2017) and developed a summary score that summed all adherence and adolescent content criteria. Eight adolescent apps were identified and compared with the top 38 general apps (as ranked by Apple and Google). Both general and adolescent apps commonly had adherence content related to developing a quit plan (general: 73.68 per cent; adolescent: 87.50 per cent) and enhancing motivation by describing the rewards of not smoking (general: 76.32 per cent; adolescent: 62.50 per cent). Adolescent-specific content such as peer influence on smoking was common in adolescent apps but not in general apps (general: 5.26 per cent; adolescent: 62.50 per cent). Adolescent apps had a higher general adherence content summary score [t (44) = 2.55, p = .01] and a higher adolescent content summary score [t (7.81) = 2.47, p = .04] than the general apps. On average, adolescent cessation apps included more adherence content and adolescent-specific content than general apps. Future research is needed to determine the extent to which adolescents engage with the adherence content available in these apps.

Paediatric use of medications and adherence apps: a qualitative analysis of the perspectives of children and parents

AbstractBackgroundThe number of children diagnosed with chronic medical conditions is increasing, with a high percentage struggling with medication adherence. Non‐adherence in children may lead to negative health outcomes. Parents are typically responsible for managing their child's medications. Medication adherence mobile apps are an innovative approach to address non‐adherence and actively engage children.AimThis study explored children's and parents’ perceptions of using medication adherence apps to facilitate self‐management.MethodsChildren (aged 7–17 years) taking one or more medications for a chronic condition and their parents were recruited from an outpatient pharmacy and adolescent clinic. Semistructured interviews were conducted with 8 children and 10 parents. An app interaction (guided and independent), followed by a brief questionnaire with the child was also administered. Interviews and interactions were audio recorded, transcribed and reviewed for accuracy. The technology acceptance model guided data collection and analysis. Prevalent codes were identified and thematic analysis was conducted.ResultsMost children were 12–17 years of age and most parents were 30–49 years of age. Parents and children received adherence apps as an innovative approach to the child's medication management. Nine themes emerged: ability to earn rewards for adherence; having security functionality to protect user information; customisable graphics and appealing colour schemes; medication‐specific information; ease of accessibility to mobile devices; sharing child‐friendly medication information; children's limited knowledge and involvement in medication management; and communication challenges with healthcare providers.ConclusionsAdherence apps incorporating user‐centred needs of children and educating them about chronic diseases and medication use may positively affect self‐care.

User acceptance of an app-based adherence intervention: Perspectives from patients taking oral anticancer medications.

BackgroundWidespread adoption by patients is imperative for the success of app-based interventions for enhancing adherence to oral anticancer medications. Patients' attitudes and beliefs should be evaluated to understand determinants of their acceptance and adoption of such interventions.ObjectiveTo identify factors that influence cancer patients' intention to adopt an app-based system for enhancing oral anticancer medication adherence.MethodsThis study was conducted as part of the usability evaluation of an app-based system for enhancing adherence. We followed the grounded theory approach employing audio-recorded face-to-face interviews for data collection from patients taking oral anticancer medications (n = 15) and caregivers of such patients (n = 3). Data analysis involved verbatim transcription of all interviews, coding of the transcripts and field notes, detailed memo writing, and constant comparative evaluation of emergent categories.ResultsA conceptual framework of facilitating and hindering factors for users' adoption intention for an oral anticancer medication adherence app was developed. Findings suggest that facing difficulties in maintaining adherence and patients' perceived superiority of the app over their current methods facilitate adoption intention. In contrast, having to pay, lack of language options and users' perception of low competence in using an app were the hindrance factors.ConclusionThis study showed that adoption of adherence apps could be explained by technology acceptance constructs, such as performance expectancy. Adoption intention was also facilitated by patients perceived vulnerabilities in maintaining adherence to their medications, which was a health behaviour construct. Implementation of app-based programs should address patients' perceived vulnerabilities and relative advantage of the app over their current methods. Clinicians and app developers should also consider the financial, technological and language barriers for end users.

Medication Adherence Apps: Review and Content Analysis.

BackgroundMedication adherence is an expensive and damaging problem for patients and health care providers. Patients adhere to only 50% of drugs prescribed for chronic diseases in developed nations. Digital health has paved the way for innovative smartphone solutions to tackle this challenge. However, despite numerous apps available claiming to improve adherence, a thorough review of adherence apps has not been carried out to date.ObjectiveThe aims of this study were to (1) review medication adherence apps available in app repositories in terms of their evidence base, medical professional involvement in development, and strategies used to facilitate behavior change and improve adherence and (2) provide a system of classification for these apps.MethodsIn April 2015, relevant medication adherence apps were identified by searching the Apple App Store and the Google Play Store using a combination of relevant search terms. Data extracted included app store source, app price, documentation of health care professional (HCP) involvement during app development, and evidence base for each respective app. Free apps were downloaded to explore the strategies used to promote medication adherence. Testing involved a standardized medication regimen of three reminders over a 4-hour period. Nonadherence features designed to enhance user experience were also documented.ResultsThe app repository search identified a total of 5881 apps. Of these, 805 fulfilled the inclusion criteria initially and were tested. Furthermore, 681 apps were further analyzed for data extraction. Of these, 420 apps were free for testing, 58 were inaccessible and 203 required payment. Of the 420 free apps, 57 apps were developed with HCP involvement and an evidence base was identified in only 4 apps. Of the paid apps, 9 apps had HCP involvement, 1 app had a documented evidence base, and 1 app had both. In addition, 18 inaccessible apps were produced with HCP involvement, whereas 2 apps had a documented evidence base. The 420 free apps were further analyzed to identify strategies used to improve medication adherence. This identified three broad categories of adherence strategies, reminder, behavioral, and educational. A total of 250 apps utilized a single method, 149 apps used two methods, and only 22 apps utilized all three methods.ConclusionsTo our knowledge, this is the first study to systematically review all available medication adherence apps on the two largest app repositories. The results demonstrate a concerning lack of HCP involvement in app development and evidence base of effectiveness. More collaboration is required between relevant stakeholders to ensure development of high quality and relevant adherence apps with well-powered and robust clinical trials investigating the effectiveness of these interventions. A sound evidence base will encourage the adoption of effective adherence apps, and thus improve patient welfare in the process.

MedAd-AppQ: A quality assessment tool for medication adherence apps on iOS and android platforms.

With the recent proliferation of smartphone medication adherence applications (apps), it is increasingly more difficult for patients and clinicians to identify the most useful app. To develop a quality assessment tool for medication adherence apps, and evaluate the quality of such apps from the major app stores. In this study, a Medication Adherence App Quality assessment tool (MedAd-AppQ) was developed and two evaluators independently assessed apps that fulfilled the following criteria: availability in English, had at least a medication reminder feature, non-specific to certain disease conditions (generic apps), free of technical malfunctions and availability on both the iPhone Operating System (iOS) and Android platforms. Descriptive statistics, Mann-Whitney U test, Pearson product moment correlation and Spearman rank-order correlation were used for statistical analysis. MedAd-AppQ was designed to have 24 items (total 43 points) categorized under three sections: content reliability (11 points), feature usefulness (29 points) and feature convenience (3 points). The three sections of MedAd-AppQ were found to have inter-rater correlation coefficients of 0.801 (p-value < .001) or higher. Based on analysis of 52 apps (27 iOS and 25 Android), quality scores ranged between 7/43 (16.3%) and 28/43 (65.1%). There was no significant difference between the quality scores of the Android and iOS versions. None of the apps had features for self-management of side effects. Only two apps in each platform provided disease-related and/or medication information. MedAd-AppQ can be used to reliably assess the quality of adherence apps. Clinicians can use the tool in selecting apps for use by patients. Developers of adherence apps should consider features that provide therapy-related information and help patients in medications and side-effects management.

Adherence app ‘has no impact on blood pressure control’

Adherence app ‘has no impact on blood pressure control’