April 4-6, 2024 • Hyatt Regency • Lexington, KY
Innovations in Health Communication
Innovations in Health Communication
Abstract: Improving Medication Adherence Among Adolescent Heart Transplant Patients Using an mHealth Video Direct Observation Intervention
Adherence to immunosuppressive therapy (IT) is vital for improving post-transplant outcomes and reducing risk for late acute organ rejection among pediatric organ transplant patients (1). Adolescent organ transplant patients are twice as likely than children to be non-adherent, with non-adherence rates as high as 40-60% (2, 3). Factors like difficulties in assuming responsibility for self-monitoring as they transition into early adulthood, low self-efficacy, and peer and familial influences (4, 5) explain low medication adherence in adolescents. Masuda et al. (6) found that adherence rates decreased from 68% to 32% after transitioning to young adulthood. This variability in adherence over time emphasizes the need to monitor adolescent transplant patients closely to ensure medication compliance and identify those at high risk before harm occurs(2, 7, 8).
It is critically important to develop interventions that will encourage adolescents to play a more active role in monitoring their adherence to IT. Interventions that target multiple risk factors and that provide immediate and meaningful feedback on patients’ adherence success, enhance parental involvement and social support, and mitigate the multiple factors that increase risk for nonadherence (9) can improve adherence to IT (10, 11). Additionally, real-time monitoring of medication-taking behavior (i.e., Direct Observation Therapy) has been shown to improve patients’ organizational skills, planning, and conscientiousness around medication taking (11).
There is increasing interest in using mHealth approaches to improve medication adherence among organ transplant patients (12, 13). However, studies show that most mHealth interventions address only one risk factor for nonadherence (i.e., forgetfulness) through SMS reminders or notifications (9, 14). mHealth apps that facilitate two-way communication can improve patients’ reflective motivation and self-efficacy and are more likely to improve medication compliance (15).
We conducted a pilot study to test the efficacy of a 12-week mobile video directly observed therapy (MVDOT) intervention with 10 heart transplant recipients (aged 11-21 years) who were at least 6 months post-transplant and had low medication adherence. Through the app, patients can record videos of themselves taking their medications, track their progress over time, report symptoms of illness or medication side effects, and communicate with their transplant team. Transplant nurses can then review the videos and escalate potential concerns to the transplant care provider.
Of the 8 participants who completed the 12-week intervention, MLVI (medication level variability Index) values decreased from 6 months prior (2.86 +/- 1.83) to 6th month follow-up period (2.08 +/- 0.87) representing a 21.7% decrease in non-adherence. Patients and nurses exchanged a total of 894 in-app messages during the intervention, demonstrating high engagement. Escalations (n=39) raised based on videos submitted were associated with the total number of messages exchanged (ρ = 0.444, p = .270) and the number of those uniquely sent by the patient (ρ = −0.194, p = .645). A content analysis of the in-app messages demonstrated the degree to which interpersonal engagement occurred during the intervention, the nature of these exchanges, and their effects on medication adherence. The study demonstrates the acceptability and benefits of in-app messaging in promoting engagement and improving medication adherence (16).
It is critically important to develop interventions that will encourage adolescents to play a more active role in monitoring their adherence to IT. Interventions that target multiple risk factors and that provide immediate and meaningful feedback on patients’ adherence success, enhance parental involvement and social support, and mitigate the multiple factors that increase risk for nonadherence (9) can improve adherence to IT (10, 11). Additionally, real-time monitoring of medication-taking behavior (i.e., Direct Observation Therapy) has been shown to improve patients’ organizational skills, planning, and conscientiousness around medication taking (11).
There is increasing interest in using mHealth approaches to improve medication adherence among organ transplant patients (12, 13). However, studies show that most mHealth interventions address only one risk factor for nonadherence (i.e., forgetfulness) through SMS reminders or notifications (9, 14). mHealth apps that facilitate two-way communication can improve patients’ reflective motivation and self-efficacy and are more likely to improve medication compliance (15).
We conducted a pilot study to test the efficacy of a 12-week mobile video directly observed therapy (MVDOT) intervention with 10 heart transplant recipients (aged 11-21 years) who were at least 6 months post-transplant and had low medication adherence. Through the app, patients can record videos of themselves taking their medications, track their progress over time, report symptoms of illness or medication side effects, and communicate with their transplant team. Transplant nurses can then review the videos and escalate potential concerns to the transplant care provider.
Of the 8 participants who completed the 12-week intervention, MLVI (medication level variability Index) values decreased from 6 months prior (2.86 +/- 1.83) to 6th month follow-up period (2.08 +/- 0.87) representing a 21.7% decrease in non-adherence. Patients and nurses exchanged a total of 894 in-app messages during the intervention, demonstrating high engagement. Escalations (n=39) raised based on videos submitted were associated with the total number of messages exchanged (ρ = 0.444, p = .270) and the number of those uniquely sent by the patient (ρ = −0.194, p = .645). A content analysis of the in-app messages demonstrated the degree to which interpersonal engagement occurred during the intervention, the nature of these exchanges, and their effects on medication adherence. The study demonstrates the acceptability and benefits of in-app messaging in promoting engagement and improving medication adherence (16).