Mobile health: A carrot and stick intervention to improve medication adherence

摘要

Medication adherence is a critical element in promoting healthcare outcomes, especially for chronic medical conditions. However, due to several underlying factors, major challenges such as how to improve and maintain the required level of medication adherence still exist. We propose a novel mobile health-based intervention, we call Carrot and Stick, to promote medication adherence (MA) for patients with intentional and/or unintentional non-adherence. Drawing on Social Cognitive Theory, Social Exchange Theory, Goal-setting Theory, and people's dependency on smartphones, we develop a composite intervention using both positive and negative reinforcements, goal-setting, and social connections. The m-health intervention provides decision support to patients in their medication-taking process. With multiple intervention scenarios, healthcare professionals have baselines to adjust the intervention to meet patients' needs. We validate our design using analytical modeling and show that (1) high medication adherence is achievable by the composite intervention for single and multiple medications, (2) negative reinforcement (NR) leads to better MA outcomes in addition to positive reinforcement (PR), (3) the intervention can maintain effectiveness in the operational environment due to its adaptability, and, (4) the estimated healthcare savings are significant even for slightly improved medication adherence. Our research is the first to utilize NR in intervention design to enhance MA and to categorize patients based on elements derived from theories while providing technical and behavioral interventions for both unintentional as well as intentional non-adherence. The future work can address multiple different types of NR; development of DSS for patients, caregivers, and healthcare professionals; and, integration of other m-health interventions for creating sophisticated and highly effective personalized solutions.