Evaluating the role of digital health technologies to support medication adherence in young adults living with asthma
Murphy, Jane
Murphy, Jane
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Identifiers
http://hdl.handle.net/10379/16995
https://doi.org/10.13025/17686
https://doi.org/10.13025/17686
Repository DOI
Publication Date
2021-10-17
Type
Thesis
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Abstract
Background: Asthma represents the most prevalent chronic respiratory condition affecting over 330 million people globally. Inhaled corticosteroids (ICS) can effectively control the condition, increase lung function, and decrease exacerbations and related healthcare use. However, despite their established efficacy adherence to ICS remains low. Adhering to this medication may be especially challenging for young adults as they become responsible for their self-management amidst a dynamic period of psychological development, defined as Emerging Adulthood. Emerging Adulthood occurs from approximately age 18-29 years and typically involves greater autonomy, exploration in life directions and more engagement in health risk behaviours. Simultaneously balancing these developmental demands impacts young adults’ self-management of asthma including adherence to ICS, thus warranting appropriate intervention. However, the extent and predictors of ICS adherence have not been systematically explored and synthesised for this population, which is a critical step to identify appropriate intervention components. Digital health technologies (DHTs) may provide a suitable solution for young adults, that is accessible, cost-effective and scalable with high reach. However, young adult preferences for DHTs to support ICS adherence and whether they consider these technologies usable, acceptable and feasible to support this behaviour remains unknown. These factors are essential to ensure the successful uptake and use of such DHTs. Aim: The aim of this research is to determine the extent and predictors of adherence to ICS in young adults living with asthma and to investigate the potential for DHTs to support ICS adherence behaviour within this population. Method: The studies conducted in this research were based on the development/identification and feasibility stages of the UK Medical Research Council Framework for developing and evaluating complex evaluations. A combination of quantitative and qualitative methods were used. In study 1, a systematic review and meta-analysis was conducted to determine the prevalence of adherence to ICS and to synthesise the predictors of this behaviour in young adults living with asthma. Study 2 involved a qualitative exploration of young adult preferences for ICS adherence supports and DHT features to deliver these supports. These preferences were used to identify the most suitable, freely available DHT for this population, i.e. AsthmaMD app. Finally, a multi-methods feasibility assessment was conducted in study 3 to determine the usability, acceptability and feasibility of using AsthmaMD to support ICS adherence in a population of young adults living with asthma, and the feasibility of recruiting and retaining this population to future AsthmaMD efficacy and effectiveness trials. Findings: The systematic review and meta-analysis estimated that 28% of young adults adhere to their ICS as prescribed. Subgroup analysis by age found that study populations aged over 18 had significantly lower adherence than those aged under 18. Additional sub-group analyses by method of measurement and recruitment demonstrated that studies using self-report produced significantly higher adherence estimates than those using pharmacy refill data, and study populations recruited through secondary care are significantly more adherent than those recruited through non-secondary care, e.g. primary care, educational institutions, population health surveys. Personality, illness perceptions and treatment beliefs were identified as potentially important predictors of ICS adherence behaviour. Study 2 identified three main themes in qualitative interview data regarding young adult preferences for adherence supports: ‘Enabling young adults to find their “own way of knowing”, ‘Support for making a habit of adherence’, and ‘Providing accessible information’ which included the sub-themes: ‘Education on asthma self-management and medication’, ‘Self-monitoring information’ and ‘Personal feedback on outcomes of adherence’. Preferred features to deliver these supports included a medication and prescription refill reminder, adherence charts, symptom and trigger monitoring, goal setting and rewards, visual representations of lungs before and after adherence to ICS and lung function monitoring. Accordingly, the AsthmaMD app was selected as the most suitable, freely available DHT for young adults. Findings from study 3 indicated that AsthmaMD is usable, acceptable and feasible to support adherence to ICS in young adults and that it appears feasible to recruit and retain this cohort in future trials. The findings identified opportunities to optimise the usability of AsthmaMD by providing more accessible information on how to use the app and simplifying the language used. Two main themes were identified in qualitative data: ‘Learning how to use the app to suit the individual’, and ‘Benefits and relevance of using the app’. Conclusion: The findings of this research provide important new insights into ICS adherence among young adults living with asthma and the potential for DHTs to support his behaviour. Moreover, this research has demonstrated the potential for successful use of a freely available DHT which may provide a scalable and accessible solution to support ICS adherence and decrease the substantial impact of uncontrolled asthma at this pivotal and challenging stage of lifespan development.
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NUI Galway