What can be learned from medication adherence apps?
Apps are often used to help patients adhere to medication regimen. Ample research has been done to identify what can make these apps effective. Therapists can learn from these studies how to improve adherence in family-centered practice. The behavioral modification and educational features that are being used in medication adherence are similar to what therapists are trying to do when encouraging clients and their family members to be more engaged in therapy beyond just coming to sessions.
So what can we learn from medication adherence apps?
Studies suggest that adherence-promotion is effective when it includes behavioral modification features or a mix of educational & behavioral modification approaches. Educational approach consists of providing information about the disorder / illness and the rationale for treatment. Behavioral modification includes a range of techniques such as goal setting, monitoring, reward based reinforcements, contingency contracting, problem solving and linking medication-taking with established family routines (Dean et al. 2010, Kahana et al. 2008).
In pediatric medication adherence, studies have also shown that many apps lack critical features knows to promote adherence, such as: the ability to track adherence (including reasons for in-adherence) and the ability to share with others such as with child’s therapist (Breland 2013, Dayer 2013). Studies have indicated that families that rely on app stores ranking and user reviews tend to follow apps’ popularities rather than evidence based strategies (Nguyen, 2016).
In a study published on Telemedicine and e-Health (Nguyen et al, 2016) that reviewed 101 apps, the authors suggest to check for the following behavioral modification features that together with the previous studies mentioned make the check list
Checklist for adherence promoting apps:
Track – does the app allow users track adherence over time?
Goals – does the app allow users to set goals?
Reinforcement – does the app provide reinforcement for logging adherence?
Problem-solving – does the app include a feature to promote problem solving related to adherence barriers (e.g. for pediatric therapy: alternative activities with similar effect)?
Sharing – does the app provide a mechanism for sharing history?
Routines – does the app link the desired adherence with established family routines?
Therapists and families today often use apps to assist in therapy. The prevalence of smartphones and increased usage make them ideal partners for managing most aspects of our lives, including health. But choosing or recommending apps that go beyond ‘popularity’ and have a strong evidence-base requires relying of literature reviews. Studies have researched the features that help promote adherence and recommend to check apps for the following TGR-PSR: Tracking, Goals, Reinforcement, Problem-Solving, Sharing, Routines. So next time you are looking at apps remember TGR-PSR.
Breland, J. Y., Yeh, V. M., & Yu, J. (2013). Adherence to evidence-based guidelines among diabetes self-management apps. Translational behavioral medicine, 3(3), 277-286.
Dayer, L., Heldenbrand, S., Anderson, P., Gubbins, P. O., & Martin, B. C. (2013). Smartphone medication adherence apps: potential benefits to patients and providers. Journal of the American Pharmacists Association, 53(2), 172-181.
Dean, A. J., Walters, J., & Hall, A. (2010). A systematic review of interventions to enhance medication adherence in children and adolescents with chronic illness. Archives of disease in childhood, 95(9), 717-723.
Kahana, S., Drotar, D., & Frazier, T. (2008). Meta-analysis of psychological interventions to promote adherence to treatment in pediatric chronic health conditions. Journal of pediatric psychology, 33(6), 590-611.
Nguyen, E., Bugno, L., Kandah, C., Plevinsky, J., Poulopoulos, N., Wojtowicz, A., … & Greenley, R. N. (2016). Is there a good app for that? Evaluating m-Health apps for strategies that promote pediatric medication adherence. Telemedicine and e-Health, 22(11), 929-937.
Oren Steinberg is co-founder of SensoryTreat, providing a carryover empowerment platform for pediatric therapists and caregivers of children with Autism and other developmental disabilities.