The attitudes of pharmacists, students and the general public on mHealth applications for medication adherence
Background: During recent years mobile technology has developed tremendously and has infiltrated the healthcare field. Mobile healthcare (mHealth) applications, or apps, may be used to support patient adherence to medication thus promoting optimal treatment outcomes and reducing medication wastage.
Objective: This study shall consider the opinions of United Kingdom (UK) based pharmacists, pharmacy undergraduates and members of the general public towards the use of mHealth apps to promote adherence to prescribed medication regimens.
Methods: On Liverpool John Moores University (LJMU) ethical approval, the 25 item questionnaire was distributed to UK registered pharmacists within inner city Liverpool and Manchester (n=500), pharmacy undergraduates studying at LJMU (n=420) and members of the general public within Liverpool City Centre (n=400). The questions were formatted as multiple choice, Likert scales or the open answer type. The data were analysed using simple frequencies, cross tabulations and non-parametric techniques in the SPSS v22 program.
Results: The number of completed questionnaires from the pharmacist, student and general public cohorts were 245, 333 and 400; respectively. The data indicated that the general public rely heavily upon daily routine to take medication as prescribed (54.1%) with mHealth app use being extremely low (1.5%); a similar trend was noted for the pharmacist / student cohorts. The age of the individual is an important consideration, with the younger generation likely to engage with mHealth apps and the older generation less so. Here, education and training are important. Pharmacists (82.3%) would be happy to deliver training packages to the public who would in turn happily receive such training (84%). Key barriers precluding mHealth app use include data reliability, security and technical difficulties.
Conclusion: Adherence apps hold great promise to support the patient and their healthcare needs. In order to increase acceptance and uptake simple, user-friendly designs must be considered and constructed. In addition, such technology requires effective promotion and end user training in order to reach its full potential. Furthermore, the regulation of mobile adherence apps will be essential in order to overcome underlying patient concerns.
2. Marcano Belisario JS, Huckvale K, Greenfield G, Car J, Gunn LH. Smartphone and tablet self-management apps for asthma. Cochrane Database Syst Rev. 2013;11:CD010013. doi: 10.1002/14651858.CD010013.pub2
3. Davies MJ, Collings M, Fletcher W, Mujtaba H.Pharmacy Apps: a new frontier on the digital landscape? Pharm Pract (Granada). 2014;12(3):453.
4. Cho J, Park D, Lee HE. Cognitive factors of using health apps: systematic analysis of relationships among health consciousness, health information orientation, eHealth literacy, and health app use efficacy. J Med Internet Res. 2014;16(5):e125. doi: 10.2196/jmir.3283
5. Börve A, Holst A, Gente-Lidholm A, Molina-Martinez R, Paoli J.Use of the mobile phone multimedia messaging service for teledermatology. J Telemed Telecare. 2012;18(5):292-296. doi: 10.1258/jtt.2012.120206
6. Apple. Available from: https://itunes.apple.com/gb/app/Dario (accessed 12th November 2014).
7. MyMeds. Available from: http://about.my-meds.com (accessed 12th November 2014).
8. Dayer L, Heldenbrand S, Anderson P, Gubbins PO, Martin BC. Smartphone medication adherence apps: Potential benefits to patients and providers. J Am Pharm Assoc (2003). 2013;53(2):172-181. doi: 10.1331/JAPhA.2013.12202
9. Thomas D. Medication adherence and associated barriers in hypertension management in India. CVD Prevent Contr. 2011;6(1):9-13.
10. Adherence, World Health Organisation 2014 Available: http://www.who.int/chp/knowledge/publications/adherence_Section1.pdf (accessed 10th November 2014).
11. Kim, H.S. Using mobile phones in healthcare management for the elderly. Maturitas. 2014; 1(1): 1-8.
12. National Institute for Health and Care Excellence. London: NICE public health guidance 76. Medicines adherence: Involving patients in decisions about prescribed medicines and supporting adherence. January 2009. Available from: www.nice.org.uk/guidance/cg76 (accessed 15th November 2014).
13. Ahmed R, Aslani P.What is patient adherence? A terminology overview. Int J Clin Pharm. 2014;36(1):4-7. doi: 10.1007/s11096-013-9856-y
14. Department of Health. Making best use of medicines: Report of a Department of Health roundtable event hosted by The King’s Fund.London: DH; 2011.
15. Kuntz JL, Safford MM, Singh JA, Phansalkar S, Slight SP, Her QL, Lapointe NA, Mathews R, O'Brien E, Brinkman WB, Hommel K, Farmer KC, Klinger E, Maniam N4, Sobko HJ, Bailey SC, Cho I, Rumptz MH, Vandermeer ML, Hornbrook MC. Patient-centered interventions to improve medication management and adherence: a qualitative review of research findings. Patient Educ Couns. 2014;97(3):310-326. doi: 10.1016/j.pec.2014.08.021
16. Hanghøj S, Boisen KA. Self-reported barriers to medication adherence among chronically ill adolescents: a systematic review. J Adolesc Health. 2014;54(2):121-138. doi: 10.1016/j.jadohealth.2013.08.009
17. Khan MU, Shah S, Hameed T. Barriers to and determinants of medication adherence among hypertensive patients attended National Health Service Hospital, Sunderland. J Pharm Bioallied Sci. 2014;6(2):104-108. doi: 10.4103/0975-7406.129175
18. MacDonell K, Naar-King S, Huszti H, Belzer M. Barriers to medication adherence in behaviorally and perinatally infected youth living with HIV. AIDS Behav. 2013;17(1):86-93. doi: 10.1007/s10461-012-0364-1
19. Patel S, Jacobus-Kantor L, Marshall L, Ritchie C, Kaplinski M, Khurana PS, Katz RJ. Mobilizing your medications: an automated medication reminder application for mobile phones and hypertension medication adherence in a high-risk urban population. J Diabetes Sci Technol. 2013;7(3):630-639.
20. Vervloet M, Linn AJ, van Weert JC, de Bakker DH, Bouvy ML, van Dijk L. The effectiveness of interventions using electronic reminders to improve adherence to chronic medication: a systematic review of the literature. J Am Med Inform Assoc. 2012;19(5):696-704. doi: 10.1136/amiajnl-2011-000748
21. https://itunes.apple.com/gb/app/rxmindme-prescription-medicine (accessed 12th November 2014).
22. Foster JM, Usherwood T, Smith L, Sawyer SM, Xuan W, Rand CS, Reddel HK. Inhaler reminders improve adherence with controller treatment in primary care patients with asthma. J Allergy Clin Immunol. 2014;134(6):1260-1268.e3. doi: 10.1016/j.jaci.2014.05.041
23. Propeller Health. The impact of asthma and COPD.http://propellerhealth.com/solutions/ (accessed 22nd October 2015).
24. Dolan B. Lloyds Pharmacies to sell Proteus smart pills, sensors. Available: http://mobihealthnews.com/15820/lloyds-pharmacies-to-sell-proteus-smart-pills-sensors/ (accessed 10th March 2015).
25. Helius for Patients & Families. Available from: http://www.proteus.com/todays-products/for-patients/ (accessed 20th November 2014).
26. Sahoor PK. Efficient security mechanisms for mHealth applications using wireless body sensor networks. Sensors (Basel). 2012;12(9):12606-12633. doi: 10.3390/s120912606
27. Belknap R, Weis S, Brookens A, Au-Yeung KY, Moon G, DiCarlo L, Reves R. Feasibility of an ingestible sensor-based system for monitoring adherence to tuberculosis therapy. PLoS One. 2013;8(1):e53373. doi: 10.1371/journal.pone.0053373
28. Lewis TL, Wyatt JC. mHealth and Mobile Medical Apps: A Framework to Assess Risk and Promote Safer Use. J Med Internet Res. 2014;16(9):e210. doi: 10.2196/jmir.3133
29. Lee JA, Nguyen AL, Berg J, Amin A, Bachman M, Guo Y, Evangelista L. Attitudes and preferences on the use of mobile health technology and health games for self-management: interviews with older adults on anticoagulation therapy. JMIR Mhealth Uhealth. 2014;2(3):e32. doi: 10.2196/mhealth.3196
30. Parker SJ, Jessel S, Richardson JE, Reid MC. Older adults are mobile too!Identifying the barriers and facilitators to older adults' use of mHealth for pain management. BMC Geriatr. 2013;13:43. doi: 10.1186/1471-2318-13-43
31. Boulos MN, Brewer AC, Karimkhani C, Buller DB, Dellavalle RP. Mobile medical and health apps: state of the art, concerns, regulatory control and certification. Online J Public Health Inform. 2014;5(3):229. doi: 10.5210/ojphi.v5i3.4814
32. Morris LS, Schulz RM.Patient compliance - an overview. J Clin Pharm Ther. 1992;17(5):283-295.
33. Donovan JL. Patient decision making: the missing ingredient in compliance research. Int J Technol Assess Health Care. 1995;11(3):443-455.
34. Becker S, Brandl C, Meister S, Nagel E, Miron-Shatz T, Mitchell A, Kribben A, Albrecht UV, Mertens A. Demographic and health related data of users of a mobile application to support drug adherence is associated with usage duration and intensity. PLoS One. 2015;10(1):e0116980. doi: 10.1371/journal.pone.0116980
35. Arnhold M, Quade M, Kirch W. Mobile applications for diabetics: a systematic review and expert-based usability evaluation considering the special requirements of diabetes patients age 50 years or older. J Med Internet Res. 2014;16(4):e104. doi: 10.2196/jmir.2968
36. Mira JJ, Navarro I, Botella F, Borrás F, Nuño-Solinís R, Orozco D, Iglesias-Alonso F, Pérez-Pérez P, Lorenzo S, Toro N. A Spanish pillbox app for elderly patients taking multiple medications: randomized controlled trial. J Med Internet Res. 2014;16(4):e99. doi: 10.2196/jmir.3269
37. Pharmaceutical Services Negotiating Committee Available: http://psnc.org.uk/ (accessed 1st October 2015).
38. West JH, Hall PC, Hanson CL, Barnes MD, Giraud-Carrier C, Barrett J. There’s an App for That: Content Analysis of Paid Health and Fitness Apps. J Med Internet Res. 2012;14(3):e72. doi: 10.2196/jmir.1977
39. DiDonato KL, Liu Y, Lindsey CC, Hartwig DM, Stoner SC. Community pharmacy patient perceptions of a pharmacy-initiated mobile technology app to improve adherence. Int J Pharm Pract. 2015;23(5):309-319. doi: 10.1111/ijpp.12168
40. Van Velsen L, Beaujean DJ, van Gemert-Pijnen JE. Why mobile health app overload drives us crazy, and how to restore the sanity. BMC Med Inform Decis Mak. 2013;13:23. doi: 10.1186/1472-6947-13-23
41. NICE apps for smartphones and tablets. National Institute for Heath and Care Excellence. Available: https://www.nice.org.uk/about/what-we-do/nice-apps-for-smartphones-and-tablets (accessed 15th March 2015).
42. Visser BJ, Buijink AW.Need to peer-review medical applications for smart phones. J Telemed Telecare. 2012;18(2):124. doi: 10.1258/jtt.2011.110205
43. Boudreaux ED, Waring ME, Hayes RB, Sadasivam RS, Mullen S, Pagoto S. Evaluating and selecting mobile health apps: strategies for healthcare providers and healthcare organizations. Transl Behav Med. 2014;4(4):363-371. doi: 10.1007/s13142-014-0293-9
44. Inc A. Privacy. Apple. Available from: http://www.apple.com/privacy/ (accessed 12th November 2014).
The authors hereby transfer, assign, or otherwise convey to Pharmacy Practice: (1) the right to grant permission to republish or reprint the stated material, in whole or in part, without a fee; (2) the right to print pr epublish copies for free distribution or sale; and (3) the right to republish the stated material in any format (electronic or printed). In addition, the undersigned affirms that the article described above has not previously been published, in whole or part, is not subject to copyright or other rights except by the author(s), and has not been submitted for publication elsewhere, except as communicated in writing to Pharmacy Practice with this document.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-NC-ND) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.