Effective Interventions and Patient Perceptions on the Management of Medication Adherence: a focus on mHealth

Wiecek, Elyssa Katlin

Effective Interventions and Patient Perceptions on the Management of Medication Adherence: a focus on mHealth

Wiecek, Elyssa Katlin

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Publication Type:: Thesis
Issue Date:: 2021

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Field	Value	Language
dc.contributor.author	Wiecek, Elyssa Katlin
dc.date.accessioned	2021-10-06T00:50:25Z
dc.date.available	2021-10-06T00:50:25Z
dc.date.issued	2021
dc.identifier.uri	http://hdl.handle.net/10453/150854
dc.description	University of Technology Sydney. Graduate School of Health.	en_US.UTF-8
dc.description.abstract	𝗕𝗮𝗰𝗸𝗴𝗿𝗼𝘂𝗻𝗱 Medication non-adherence is highly prevalent globally with an estimated half of all patient’s non-adherent to their medications. Interventions to improve adherence have been widely evaluated, including variations in component composition, seeing modest improvements. A lack of understanding surrounding the effectiveness of individual components within interventions is implicated. Additionally, the Digital Age is the use of mobile phones to assist in management of health, yet evidence is lacking on their effectiveness and acceptability. This thesis aimed to explore and estimate the effect of component composition within medication adherence interventions as well as analyse a multicomponent mHealth intervention’s impact on adherence and acceptability. 𝗠𝗲𝘁𝗵𝗼𝗱𝗼𝗹𝗼𝗴𝘆 A series of discrete studies were undertaken: (1) a network meta-analysis of studies assessing the effectiveness of interventions and their components aimed at improving medication adherence; (2) evaluation of an innovative mHealth intervention utilising multiple components on sustaining optimal adherence; and (3) analysis of users’ acceptability of the mHealth app. 𝗥𝗲𝘀𝘂𝗹𝘁𝘀 The network meta-analysis identified 249 studies evaluating interventions to improve adherence over multiple periods of time. Multicomponent interventions were found to the be the most effective interventions at improving adherence over 10 months, with education in combination with technical and attitudinal components (OR 0.49, 95% CrI 0.27-0.88) and rewards in combination with technical interventions having the most effective odds ratio (OR 0.03, 95% CrI 0.01-0.13) against standard of care. The Perx mHealth app utilising rewards, technical components, education and attitudinal components revealed high rates of adherence, average at 87.6% (SD 16.9%), above an optimal adherence threshold standard of 80%, over 6 months. An analysis of 6,296 user reviews of the mHealth app discovered a highly accepted and appreciated tool for aiding the management of medication adherence. Users reacted positively to reminder and reward components specifically, though expected improvements within technical functionality issues and the frequency of rewards. 𝗖𝗼𝗻𝗰𝗹𝘂𝘀𝗶𝗼𝗻 Interventions to improve medication adherence have revealed modest improvements in effectiveness, with a continued need for multicomponent interventions to sustain long-term adherence. The evaluated mHealth intervention utilising multiple components highlighted an intervention able to sustain optimal adherence rates over time. User reviews recognised a highly desirable and accepted intervention. MHealth interventions should continue to be innovated and adopted as helpful tools in improving medication adherence but must be evidence-based and evaluated for their effect on health outcomes.	en_US.UTF-8
dc.format	Thesis (PhD)
dc.language.iso	en_US	en_US.UTF-8
dc.relation	https://opus.lib.uts.edu.au/bitstream/10453/150854/2/02whole.pdf
dc.rights	The author owns the copyright in this thesis including all reproduction and reuse rights for the work. The work may not be altered without the permission of the copyright owner. Attribution is essential when quoting or paraphrasing from this thesis.
dc.rights	au.edu.uts.lib/ppc
dc.rights	info:eu-repo/semantics/openAccess
dc.title	Effective Interventions and Patient Perceptions on the Management of Medication Adherence: a focus on mHealth	en_US.UTF-8
dc.type	Thesis
utslib.copyright.status	open_access	*

Abstract:

𝗕𝗮𝗰𝗸𝗴𝗿𝗼𝘂𝗻𝗱 Medication non-adherence is highly prevalent globally with an estimated half of all patient’s non-adherent to their medications. Interventions to improve adherence have been widely evaluated, including variations in component composition, seeing modest improvements. A lack of understanding surrounding the effectiveness of individual components within interventions is implicated. Additionally, the Digital Age is the use of mobile phones to assist in management of health, yet evidence is lacking on their effectiveness and acceptability. This thesis aimed to explore and estimate the effect of component composition within medication adherence interventions as well as analyse a multicomponent mHealth intervention’s impact on adherence and acceptability. 𝗠𝗲𝘁𝗵𝗼𝗱𝗼𝗹𝗼𝗴𝘆 A series of discrete studies were undertaken: (1) a network meta-analysis of studies assessing the effectiveness of interventions and their components aimed at improving medication adherence; (2) evaluation of an innovative mHealth intervention utilising multiple components on sustaining optimal adherence; and (3) analysis of users’ acceptability of the mHealth app. 𝗥𝗲𝘀𝘂𝗹𝘁𝘀 The network meta-analysis identified 249 studies evaluating interventions to improve adherence over multiple periods of time. Multicomponent interventions were found to the be the most effective interventions at improving adherence over 10 months, with education in combination with technical and attitudinal components (OR 0.49, 95% CrI 0.27-0.88) and rewards in combination with technical interventions having the most effective odds ratio (OR 0.03, 95% CrI 0.01-0.13) against standard of care. The Perx mHealth app utilising rewards, technical components, education and attitudinal components revealed high rates of adherence, average at 87.6% (SD 16.9%), above an optimal adherence threshold standard of 80%, over 6 months. An analysis of 6,296 user reviews of the mHealth app discovered a highly accepted and appreciated tool for aiding the management of medication adherence. Users reacted positively to reminder and reward components specifically, though expected improvements within technical functionality issues and the frequency of rewards. 𝗖𝗼𝗻𝗰𝗹𝘂𝘀𝗶𝗼𝗻 Interventions to improve medication adherence have revealed modest improvements in effectiveness, with a continued need for multicomponent interventions to sustain long-term adherence. The evaluated mHealth intervention utilising multiple components highlighted an intervention able to sustain optimal adherence rates over time. User reviews recognised a highly desirable and accepted intervention. MHealth interventions should continue to be innovated and adopted as helpful tools in improving medication adherence but must be evidence-based and evaluated for their effect on health outcomes.

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