Effective behavioral intervention strategies using mobile health applications for chronic disease management: a systematic review Mobile Health Medication Adherence and Blood Pressure Control in Renal Transplant Recipients: A Proof-of-Concept Randomized Controlled Trial A randomized trial evaluating an mHealth system to monitor and enhance adherence to pharmacotherapy for alcohol use disorders The feasibility of text reminders to improve medication adherence in adolescents with asthma A counselor in your pocket: feasibility of mobile health tailored messages to support HIV medication adherence Mobile phone intervention for increasing adherence to treatment for type 2 diabetes in an urban area of Bangladesh: protocol for a randomized controlled trial Improving treatment adherence for blood pressure lowering via mobile phone SMS-messages in South Africa: a qualitative evaluation of the SMS-text Adherence SuppoRt (StAR) trial The effect of reminder systems on patients’ adherence to treatment Controller adherence following hospital discharge in high risk children: A pilot randomized trial of text message reminders A mobile health intervention for inner city patients with poorly controlled diabetes: proof-of-concept of the TExT-MED program. Use of health information technology to improve medication adherence. Feasibility and Preliminary Outcomes of a Web and Smartphone–Based Medication Self-Management Platform for Chronically Ill Patients Mobile Phone Short Message Service to Improve Malaria Pharmacoadherence in Zambia. Eliciting accurate reports of adherence in a clinical interview: development of the Medical Adherence Measure. Evaluation of a nurse-led disease management programme for chronic kidney disease: a randomized controlled trial. Strategies to improve adherence with medications in chronic, ‘silent’ diseases representing high cardiovascular risk A randomized controlled multimodal behavioral intervention trial for improving antiepileptic drug adherence
Background Mobile health ( mHealth ) has continuously been used as a method in behavioral research to improve self-management in patients with chronic diseases . However , the evidence of its effectiveness in chronic disease management in the adult population is still lacking . We conducted a systematic review to examine the effectiveness of mHealth interventions on process measures as well as health outcomes in r and omized controlled trials ( RCTs ) to improve chronic disease management . Methods Relevant r and omized controlled studies that were published between January 2005 and March 2016 were search ed in six data bases : PubMed , CINAHL , EMBASE , the Cochrane Library , PsycINFO , and Web of Science . The inclusion criteria were RCTs that conducted an intervention using mobile devices such as smartphones or tablets for adult patients with chronic diseases to examine disease management or health promotion . Results Of the 12 RCTs review ed , 10 of the mHealth interventions demonstrated statistically significant improvement in some health outcomes . The most common features of mHealth systems used in the review ed RCTs were real-time or regular basis symptom assessment s , pre-programed reminders , or feedbacks tailored specifically to the data provided by participants via mHealth devices . Most studies developed their own mHealth systems including mobile apps . Training of mHealth systems was provided to participants in person or through paper-based instructions . None of the studies reported the relationship between health outcomes and patient engagement levels on the mHealth system . Conclusions Findings from mHealth intervention studies for chronic disease management have shown promising aspects , particularly in improving self-management and some health outcomes Background Mobile phone based programs for kidney transplant recipients are promising tools for improving long-term graft outcomes and better managing comorbidities ( eg , hypertension , diabetes ) . These tools provide an easy to use self-management framework allowing optimal medication adherence that is guided by the patients ’ physiological data . This technology is also relatively inexpensive , has an intuitive interface , and provides the capability for real-time personalized feedback to help motivate patient self-efficacy . Automated summary reports of patients ’ adherence and blood pressure can easily be uploaded to providers ’ networks helping reduce clinical inertia by reducing regimen alteration time . Objective The aim of this study was to assess the feasibility , acceptability , and preliminary outcomes of a prototype mobile health ( mHealth ) medication and blood pressure ( BP ) self-management system for kidney transplant patients with uncontrolled hypertension . Methods A smartphone enabled medication adherence and BP self-management system was developed using a patient and provider centered design . The development framework utilized self-determination theory with iterative stages that were guided and refined based on patient/provider feedback . A 3-month proof-of-concept r and omized controlled trial was conducted in 20 hypertensive kidney transplant patients identified as non-adherent to their current medication regimen based on a month long screening using an electronic medication tray . Participants r and omized to the mHealth intervention had the reminder functions of their electronic medication tray enabled and received a bluetooth capable BP monitor and a smartphone that received and transmitted encrypted physiological data and delivered reminders to measure BP using text messaging . Controls received st and ard of care and their adherence continued to be monitored with the medication tray reminders turned off . Providers received weekly summary reports of patient medication adherence and BP readings . Results Participation and retention rates were 41/55 ( 75 % ) and 31/34 ( 91 % ) , respectively . The prototype system appears to be safe , highly acceptable , and useful to patients and providers . Compared to the st and ard care control group ( SC ) , the mHealth intervention group exhibited significant improvements in medication adherence and significant reductions in clinic-measured systolic blood pressures across the monthly evaluations . Physicians made more anti-hypertensive medication adjustments in the mHealth group versus the st and ard care group ( 7 adjustments in 5 patients versus 3 adjustments in 3 patients ) during the 3-month trial based on the information provided in the weekly reports . Conclusions These data support the acceptability and feasibility of the prototype mHealth system . Further trials with larger sample sizes and additional biomarkers ( eg , whole blood medication levels ) are needed to examine efficacy and effectiveness of the system for improving medication adherence and blood pressure control  after kidney transplantation over longer time periods . Trial Registration Clinical trials.gov NCT01859273 ; http:// clinical trials.gov/ct2/show/NCT01859273 ( Archived by WebCite at http://www.webcitation.org/6IqfCa3A3 ) Background Nonadherence to prescribed medication regimens is a substantial barrier to the pharmacological management of alcohol use disorders . The availability of low-cost , sustainable interventions that maximize medication adherence would likely lead to improved treatment outcomes . Mobile health ( mHealth ) technologies are increasingly being adopted as a method of delivering behavioral health interventions and represent a promising tool for adherence interventions . We are evaluating a cell-phone – based intervention called AGATE that seeks to enhance adherence with regular text-messaging . Methods / Design A r and omized controlled effectiveness trial in the context of an eight-week open label naltrexone efficacy trial delivered in a naturalistic clinical setting . Treatment-seeking heavy drinkers ( N = 105 ) are currently being recruited and r and omly assigned to the AGATE intervention or a control condition .  Daily measures of alcohol use and medication side effects are being recorded via cell phone in both conditions . Additionally , participants r and omized to the AGATE condition receive medication reminders via SMS text message according to a schedule that adjusts according to their level of adherence . Discussion Results from this trial will provide initial information about the feasibility and efficacy of mHealth interventions for improving adherence to alcohol pharmacotherapies . Trial Registration NCT01349985 OBJECTIVE Personal health applications have the potential to help patients with chronic disease by improving medication adherence , self-efficacy , and quality of life . The goal of this study was to assess the impact of MyMediHealth ( MMH ) - a website and a short messaging service (SMS)-based reminder system - on medication adherence and perceived self-efficacy in adolescents with asthma . METHODS We conducted a block-r and omized controlled study in academic pediatric outpatient setting s. There were 98 adolescents enrolled . Subjects who were r and omized to use MMH  were asked to create a medication schedule and receive SMS reminders at design ated medication administration times for 3 weeks . Control subjects received action lists as a part of their usual care . Primary outcome measures included  MMH usage patterns and self-reports of system usability , medication adherence , asthma control , self-efficacy , and quality of life . RESULTS Eighty-nine subjects completed the study , of whom 46 were r and omized to the intervention arm . Compared to controls , we found improvements in self-reported medication adherence ( P = .011 ) , quality of life ( P = .037 ) , and self-efficacy ( P = .016 ) . Subjects reported high satisfaction with MMH ; however , the level of system usage varied widely , with lower use among African American patients . CONCLUSIONS MMH was associated with improved medication adherence , perceived quality of life , and self-efficacy . Trial Registration This project was registered under http:// clinical trials.gov/ identifier NCT01730235 Purpose Medication adherence is a major challenge in HIV treatment . New mobile technologies such as smartphones facilitate the delivery of brief tailored messages to promote adherence . However , the best approach for tailoring messages is unknown . Persons living with HIV ( PLWH ) might be more receptive to some messages than others based on their current psychological state . Methods We recruited 37 PLWH from a parent study of motivational states and adherence . Participants completed smartphone-based surveys at a r and om time every day for 2 weeks , then immediately received intervention or control tailored messages , depending on r and om assignment . After 2 weeks in the initial condition , participants received the other condition in a crossover design . Intervention messages were tailored to match PLWH ’s current psychological state based on five variables – control beliefs , mood , stress , coping , and social support . Control messages were tailored to create a mismatch between message framing and participants ’ current psychological state . We evaluated intervention feasibility based on acceptance , ease of use , and usefulness measures . We also used pilot r and omized controlled trial methods to test the intervention ’s effect on adherence , which was measured using electronic caps that recorded pill-bottle openings . Results Acceptance was high based on 76 % enrollment and 85 % satisfaction . Participants found the hardware and software easy to use . However , attrition was high at 59 % , and usefulness ratings were slightly lower . The most common complaint was boredom . Unexpectedly , there was no difference between mismatched and matched messages ’ effects , but each group showed a 10%–15 % improvement in adherence after crossing to the opposite study condition . Conclusion Although smartphone-based tailored messaging was feasible and participants had clinical ly meaningful improvements in adherence , the mechanisms of change require further study . Possible explanations might include novelty effects , increased receptiveness to new information after habituation , or pseudotailoring , three ways in which attentional processes can affect behavior Background Mobile phone technologies including SMS ( short message service ) have been used to improve the delivery of health services in many countries . However , data on the effects of mobile health technology on patient outcomes in re source -limited setting s are limited . The aim of this study therefore is to measure the impact of a mobile phone SMS service  on treatment success of newly diagnosed type 2 diabetes in an urban area of Bangladesh . Methods / design This is a single-centred r and omized controlled intervention trial ( prospect i ve ) comparing st and ard-of-care with st and ard-of-care plus a mobile phone-based SMS intervention for 6 months . A total of 216 participants with newly diagnosed type 2 diabetes will be recruited . Data will be collected at the outpatient department of Bangladesh Institute of Health Science ( BIHS ) hospital at baseline and after 6 months . The primary outcome measure will be change in HbA1c between baseline and 6 months . The secondary outcome measures are self-reported medication adherence , clinic attendance , self-reported adoption of healthy behaviours , diabetes knowledge , quality of life and cost effectiveness of the SMS intervention .  The inclusion criteria will be as follows : diagnosed as patients with type 2 diabetes by the BIHS physician , using oral medication therapy , living in Dhaka city , registered with the BIHS hospital , using a mobile phone , willing to return for follow up after 6 months and providing written informed consent . Participants will be allocated to control and intervention arms after recruitment using a r and omization software . Data will be collected on socio-demographic and economic information , mobile phone use and habits , knowledge of prevention , management and complications of diabetes , self-perceived quality of life assessment , self-reported diseases , medical history , family history of diseases , medication history , medication adherence , health seeking behaviour , tobacco use , physical activity , diet , mental health status , life events and disability , anthropometric measurements of weight , height , blood pressure and blood tests for HbA1c . Discussion Mobile phone SMS services have the potential to communicate with diabetes patients and to build awareness about the disease , improve self-management and avoid complications also in re source -limited setting . If this intervention proves to be efficient and cost-effective in the current trial , large-scale implementation could be undertaken . Trial registration DRKS00005188 Background Effective use of proven treatments for high blood pressure , a preventable health risk , is challenging for many patients . Prompts via mobile phone SMS-text messaging may improve adherence to clinic visits and treatment , though more research is needed on impact and patient perceptions of such support interventions , especially in low-re source setting s. Method An individually-r and omised controlled trial in a primary care clinic in Cape Town ( 2012–14 ) , tested the effect of an adherence support intervention delivered via SMS-texts , on blood pressure control and adherence to medication , for hypertensive patients . ( Trial registration : Clinical Trials.gov NCT02019823 ) . We report on a qualitative evaluation that explored the trial participants ’ experiences and responses to the SMS-text messages , and identified barriers and facilitators to delivering adherence support via patients ’ own mobile phones . Two focus groups and fifteen individual interviews were conducted . We used comparative and thematic analysis approaches to identify themes and triangulated our analysis amongst three research ers . Results Most participants were comfortable with the technology of using SMS-text messages . Messages were experienced as acceptable , relevant and useful to a broad range of participants . The SMS-content , the respectful tone and the delivery ( timing of reminders and frequency ) and the relational aspect of trial participation ( feeling cared for ) were all highly valued . A subgroup who benefitted the most , were those who had been struggling with adherence due to high levels of personal stress . The intervention appeared to coincide with their readiness for change , and provided practical and emotional support for improving adherence behaviour . Change may have been facilitated through increased acknowledgement of their health status and attitudinal change towards greater self-responsibility . Complex interaction of psycho-social stressors and health service problems were reported as broader challenges to adherence behaviours . Conclusion Adherence support for treatment of raised blood pressure , delivered via SMS-text message on the patient ’s own phone , was found to be acceptable , relevant and helpful , even for those who already had their own reminder systems in place . Our findings begin to identify for whom and what core elements of the SMS-text message intervention appear to work best in a low-re source operational setting , issues that future research should explore in greater depth Background Patient adherence is an important component of the treatment of chronic disease . An underst and ing of patient adherence and its modulating factors is necessary to correctly interpret treatment efficacy and barriers to therapeutic success . Purpose This meta- analysis aims to systematic ally review published r and omized controlled trials of reminder interventions to assist patient adherence to prescribed medications . Methods A Medline search was performed for r and omized controlled trials published between 1968 and June 2011 , which studied the effect of reminder-based interventions on adherence to self-administered daily medications . Results Eleven published r and omized controlled trials were found between 1999 and 2009 which measured adherence to a daily medication  in a group receiving reminder interventions compared to controls receiving no reminders .  Medication adherence was measured as the number of doses taken compared to the number prescribed within a set period of time . Meta- analysis showed a statistically significant increase in adherence in groups receiving a reminder intervention compared to controls ( 66.61 % versus 54.71 % , 95 % CI for mean : 0.8 % to 22.4 % ) . Self-reported and electronically monitored adherence rates did not significantly differ ( 68.04 % versus 63.67 % , P = 1.0 ) . Eight of eleven studies showed a statistically significant increase in adherence for at least one of the reminder group arms compared to the control groups receiving no reminder intervention . Limitations The data are limited by imperfect measures of adherence due to variability in data collection methods . It is also likely that concomitant educational efforts in the study population s , such as instructions regarding proper administration and importance of correct dosing schedules , contributed to improved patient adherence , both in reminder and control arms . The search strategy could have missed relevant studies which were categorized by disease rather than adherence . Conclusions Reminder-based interventions may improve adherence to daily medications . However , the interventions used in these studies , which included reminder phone calls , text messages , pagers , interactive voice response systems , videotelephone calls , and programmed electronic audiovisual reminder devices , are impractical for widespread implementation , and their efficacy may be optimized when combined with alternative adherence-modifying strategies . More practical reminder-based interventions should be assessed to determine their value in improving patient adherence and treatment outcomes ABSTRACT Objective : To assess the feasibility of a mobile health , inhaled corticosteroid ( ICS ) adherence reminder intervention and to characterize adherence trajectories immediately following severe asthma exacerbation in high-risk urban children with persistent asthma . Methods : Children aged 2–13 with persistent asthma were enrolled in this pilot r and omized controlled trial during an asthma emergency department ( ED ) visit or hospitalization . Intervention arm participants received daily text message reminders for 30 days , and both arms received electronic sensors to measure ICS use .  Primary outcomes were feasibility of sensor use and text message acceptability . Secondary outcomes included adherence to prescribed ICS regimen and 30-day adherence trajectories . Group-based trajectory modeling was used to examine adherence trajectories . Results : Forty-one participants ( mean age 5.9 ) were r and omized to intervention ( n = 21 ) or control ( n = 20 ) . Overall , 85 % were Black , 88 % had public insurance , and 51 % of the caregivers had a high school education or less . Thirty-two participant families ( 78 % ) transmitted medication adherence data ; of caregivers who completed the acceptability survey , 25 ( 96 % ) chose to receive daily reminders beyond that study interval . Secondary outcome analyses demonstrated similar average daily adherence between groups ( intervention = 36 % ; control = 32 % , P = 0.73 ) . Three adherence trajectories were identified with none ever exceeding 80 % adherence . Conclusions : Within a high-risk pediatric cohort , electronic monitoring of ICS use and adherence reminders delivered via text message were feasible for most participants , but there was no signal of effect . Adherence trajectories following severe exacerbation were suboptimal , demonstrating an important opportunity for asthma care improvement OBJECTIVE Numerous mobile health ( mHealth ) interventions are being developed to aid in management of complex chronic medical conditions . However , the acceptance of mHealth programs by low-income , bilingual population s has not yet been evaluated . The Trial to Examine Text-based mHealth for  Emergency department patients with Diabetes ( TExT-MED ) program is a text message-based mHealth program design ed specifically for re source -poor patients with diabetes . We conducted a prospect i ve proof-of-concept trial to assess satisfaction and preliminary effectiveness of the TExT-MED program . RESEARCH DESIGN AND METHODS A consecutive sample of adult patients in the emergency department with diabetes and a text message-capable mobile phone was enrolled in the TExT-MED program .  Participants received three text messages daily for 3 weeks in English or Spanish in the following domains : educational/motivational , medication reminders , healthy living challenges , diabetes trivia , and links to free diabetes management tools . RESULTS Twenty-three patients with diabetes ( median hemoglobin A1c , 8.9 % ) were enrolled in TExT-MED .  In the week before TExT-MED , 56.5 % of subjects reported eating fruits/vegetables daily versus 83 % after , 43.5 % reported exercising before versus 74 % after , and 74 % reported performing foot checks before versus 85 % after . Self-efficacy , measured by the Diabetes Empowerment Scale-Short Form , improved from 3.9 to 4.2 . Scores on the Morisky Medication Adherence Scale improved more dramatically from 3.5 to 4.75 . Ninety percent of participants indicated they would like to continue the program , and 100 % would recommend the program to family or friends . CONCLUSIONS This pilot trial of the TExT-MED program demonstrated increased healthy behaviors , improved diabetes self-efficacy and medication adherence , and received excellent satisfaction scores in re source -poor , inner city patients with diabetes OBJECTIVES To evaluate the effectiveness of an intervention based on health information technology ( HIT ) that used speech recognition software to promote adherence to inhaled corticosteroids ( ICS ) among individuals with asthma who were members of a large health maintenance organization . STUDY DESIGN Pragmatic r and omized clinical trial . METHODS Adults with asthma enrolled in a large managed care organization ( N = 8517 ) were r and omized to receive either usual care or an interactive voice recognition ( IVR ) intervention design ed to prompt medication refills and improve ICS adherence . The primary outcome was ICS adherence as measured by modified medication possession ratio calculated from the electronic medical record ( EMR ) . Secondary measures included survey- and EMR-based measures of asthma morbidity . RESULTS Our primary analyses found that ICS adherence increased modestly but significantly for participants in the intervention group relative to those in the usual care group ( Δ= 0.02 , 95 % confidence interval 0.01 - 0.03 ) , with a baseline adherence of 0.42 in both groups . No difference was observed in asthma morbidity measures . In post hoc analyses of participants receiving 2 or more direct IVR contacts or detailed messages , the intervention effect was more marked . The overall effect was triple that observed in the primary analyses ( 0.06 vs 0.02 ) , and significant differences were observed between groups in asthma control . CONCLUSIONS An HIT-based adherence intervention shows potential for supporting medication adherence in patients with chronic diseases such as asthma . However , additional research is needed to determine how best to enhance the reach and effectiveness of such interventions Objective The aim of this study was to assess the feasibility and preliminary outcomes of a medication self-management platform for chronically ill patients , Medplan . Methods We performed a 6-month single-arm prospect i ve pre-post intervention study of patients receiving treatment for hypertension and /or dyslipidemia and /or heart failure and /or human immunodeficiency virus infection . During the pre-intervention phase , participants were followed according to their usual care ; during the intervention phase , they used Medplan . We evaluated adherence , health outcomes , healthcare re sources and measured the satisfaction of patients and health care professionals . Results The study population comprised 42 patients . No differences were found in adherence to medication measured by proportion of days covered with medication ( PDC ) . However , when adherence was measured using the SMAQ , the percentage of adherent patients improved during the intervention phase ( p < 0.05 ) , and the number of days with missed doses decreased ( p < 0.05 ) . Adherence measured using the Medplan app showed poor concordance with PDC . No differences were found in health outcomes or in the use of health care re sources during the study period . The mean satisfaction score for Medplan was 7.2 ± 2.7 out of 10 among patients and 7.3 ± 1.7 among health care professionals . In fact , 71.4 % of participants said they would recommend the app to a friend , and 88.1 % wanted to continue using it . Conclusion The Medplan platform proved to be feasible and was well accepted by its users . However , its impact on adherence differed depending on the assessment method . The lack of effect on PDC is mainly because patients were already good adherers at baseline . The study enabled us to vali date the platform in real patients using many different mobile devices and to identify potential barriers to scaling up the platform PURPOSE The current malaria treatment in Zambia is more than 97 % effective when the regimen is strictly adhered to . However , the mean adherence rate in sub-Saharan Africa is only 38 % to 48 % . Poor pharmacoadherence remains a significant barrier to malaria control and elimination . The purpose of this study was to determine if adherence rates to a six-dose artemesinin-based combination therapy ( ACT ) treatment differ between patients who received  short message service ( SMS )  reminders and those who did not . This is the first study of its kind using SMS directly to the patient for ACT adherence in sub-Saharan Africa . DESIGN An experimental , r and omized controlled trial was conducted through a sample of 96 adult malaria patients at Fisenge Clinic in Zambia in 2014 . METHODS The intervention group received SMS messages to remind them to take their medication according to the prescribed regimen . An electronic pillbox was used to measure pharmacoadherence for both groups , and patients were classified as probably adherent or probably nonadherent . FINDINGS Data were analyzed using chi-square for association between the SMS intervention and pharmacoadherence , and logistic regression was used for predictors of adherence . No significant association was found between SMS reminders and pharmacoadherence ( χ(2 ) = 0.19 , df = 1 , p = .67 ) . Binary logistic regression indicated that there were no variables associated with adherence ( p > .05 ) . CONCLUSIONS SMS reminder messages did not appear to improve pharmacoadherence in malaria medication . CLINICAL RELEVANCE The study indicates few implication s to nursing practice due to the lack of association between SMS and adherence , but adds to current knowledge Nonadherence is a major public health concern but reliable assessment methods are limited . The Medical Adherence Measure ( MAM ) was design ed as a semi-structured clinical interview to elicit comprehensive and accurate responses from patients regarding adherence during the course of st and ard clinical care . The measure was developed in three phases and administered to 219 pediatric patients ( ages 1.3 - 23 ) and /or their parents to assess the content , clinical utility , and ease of use . The MAM has three general regimen domains ( medication , diet , clinic attendance ) and several treatment specific modules . Items assess knowledge of the prescribed regimen , self-reported adherence , organizational system used to manage the regimen , and perceived barriers to optimal management . The MAM is a screening tool that assists providers in identifying patients at risk for adherence problems , assessing the extent of nonadherence , and targeting specific barriers to care in interventions . The interview emphasizes a supportive patient-provider relationship with the goal of improving patient care BACKGROUND Patients with end stage renal failure require dialysis and strict adherence to treatment plans to sustain life . However , non-adherence is a common and serious problem among patients with chronic kidney disease . There is a scarcity of studies in examining the effects of disease management programmes on patients with chronic kidney disease . OBJECTIVES This paper examines whether the study group receiving the disease management programme  have better improvement than the control group , comparing outcomes at baseline ( O1 ) , at 7 weeks at the completion of the programme ( O2 ) and at 13 weeks ( O3 ) . METHODS This is a r and omized controlled trial . The outcome measures were non-adherence in diet , fluid , dialysis and medication , quality of life , satisfaction , symptom control , complication control and health service utilisation . RESULTS There was no significant difference between the control and study group for the baseline measures , except for sleep . Significant differences ( p<0.05 ) were found between the control and study group at O2 in the outcome measures of diet degree non-adherence , sleep , symptom , staff encouragement , overall health and satisfaction . Sustained effects at O3 were noted in the outcome measures of continuous ambulatory peritoneal dialysis ( CAPD ) non-adherence degree , sleep , symptom , and effect of kidney disease . CONCLUSIONS Many studies exploring chronic disease management have neglected the group with end stage renal failure and this study fills this gap . This study has employed an innovative model of skill mix using specialist and general nurses and demonstrated patient improvement in diet non-adherence , CAPD non-adherence , aspects of quality of life and satisfaction with care . Re design ing chronic disease management programmes helps to optimize the use of different levels of skills and re sources to bring about positive outcomes Given the burden of illness related to diabetes , hypertension and dyslipidemia , it is very important to achieve glycemic control , optimal blood pressure and low-density lipoprotein cholesterol ( LDL-C ) in order to avoid severe long-term complications . Patients ’ adherence with , and persistence to , the treatment regimen is a critical factor in achieving this goal . Medication taking behavior in these chronic , nonsymptomatic ( ‘ silent ’ ) diseases is generally low , although a wide range of results have been reported . The literature has shown that nonadherence to medications is a multidimensional phenomenon ; relating factors can be grouped into the following categories : health system related , social/economic , condition-related , therapy-related and patient-related factors . Although several interventions exist to improve patients ’ medication-taking behavior , none appear to be clearly superior to others . The key steps to improve adherence are to identify individual barriers and to develop patient-specific self-management plans to overcome them ( called ‘ patient-centric ’ approach ) . When developing intervention strategies one should always remember that ‘ one size does not fit all ’ . Well design ed ( but not r and omized ) , observational studies ( for example , patient registries ) may be required with sufficient follow-up periods and multiple adherence measurements in order to advance the field PURPOSE Medication nonadherence is one of the most important reasons for treatment failure in patients with epilepsy . The present study investigated the effectiveness of a multicomponent intervention to improve adherence to antiepileptic drug ( AED ) medication in patients with epilepsy . METHODS In a prospect i ve , r and omized multicenter trial , three sessions of face-to-face motivational interviewing ( MI ) in combination with complementary behavior change techniques were compared with st and ard care . Motivational interviewing prompted change talk and self-motivated statements from the patients , planning their own medication intake regimen and also identifying and overcoming barriers that may prevent adherence . Participants were provided with calendars to self-monitor their medication taking behavior . A family member and the health-care team were invited to attend the last session of MI in order to improve the collaboration and communication between patients , their caregiver or family member , and their health-care provider . At baseline and 6-month follow-up , psychosocial variables and medical adherence were assessed . RESULTS In total , 275 participants were included in the study . Compared with the active control group , patients in the intervention group reported significantly higher medication adherence , as well as stronger intention and perceptions of control for taking medication regularly . The intervention group also reported higher levels of action planning , coping planning , self-monitoring , and lower medication concerns . CONCLUSIONS This study shows that MI can be effective in clinical practice to improve medication adherence in patients with epilepsy . It also provides evidence that combining volitional interventions , including action planning , coping planning , and self-monitoring with motivational interviewing can promote the effectiveness of the medical treatments for epilepsy by improving adherence
There is potential for mHealth tools to better facilitate adherence to chronic disease management , but the evidence supporting its current effectiveness is mixed .
BACKGROUND Adherence to chronic disease management is critical to achieving improved health outcomes , quality of life , and cost-effective health care .
As the burden of chronic diseases continues to grow globally , so does the impact of non-adherence .
Mobile technologies are increasingly being used in health care and public health practice ( mHealth ) for patient communication , monitoring , and education , and to facilitate adherence to chronic diseases management .
OBJECTIVE We conducted a systematic review of the literature to evaluate the effectiveness of mHealth in supporting the adherence of patients to chronic diseases management ( " mAdherence " ) , and the usability , feasibility , and acceptability of mAdherence tools and platforms in chronic disease management among patients and health care providers .