Motivating and Supporting Medication Adherence Behaviour for Chronic Conditions: Persuasive design of a mHealth app.

Abstract

Arthritis requires long-term treatment and lifestyle management to manage symptoms and prevent disease progression. Medication adherence behaviour is essential for managing arthritis. However, the adherence rates for arthritis patients are often low due to factors like lack of motivation, forgetfulness, and limited knowledge about the condition. Mobile health applications (mHealth apps) emerged as a promising solution to support patient adherence by providing users with personalised, accessible, and interactive features that promoted medication management. Educational features that enable users to access health information can improve user awareness about the condition, reminder features can assist users from forgetting to take medication and motivational features like rewards and social support can be tailored to motivate and engage users. This thesis focuses on the motivational design of mHealth apps to support medication adherence behaviour for chronic arthritis conditions. The thesis addresses the gaps in existing mHealth apps for arthritis and medication adherence, which often fail to involve patients in the design process or address the specific barriers to adherence they encounter. The research question of this study is: What are the key design features of a motivational mobile health app that can promote medication adherence among chronic arthritis patients in Saudi Arabia? The thesis has several objectives to answer this research question, which include exploring the arthritis patients' needs, designing a mHealth app prototype, and evaluating the usability of the mHealth app among Saudi arthritis patients. This research adopts qualitative research methods, starting with a scoping review of medication adherence apps for different chronic health conditions, interviews with health care providers (HCPs), and online focus group discussions with chronic arthritis patients across Saudi Arabia. Interpretivism is used to understand adherence behaviour barriers, facilitators, and user needs and preferences to ensure the user-centric design process. Additionally, the research embraces pragmatism in the design and evaluation process through 3 design cycles that follow the six-design science research methodology (DSRM) steps. The selection of user requirements considers the theoretical framework adopted combining three components of the IMB model: information, motivation, and behavioural skills. Motivation aspects consider the intrinsic motivation that can be satisfied according to Self Determination Theory. The principles of persuasive design are considered to ensure that the app motivates users and supports health behaviour change. The user research, design, and evaluation resulted in an interactive mHealth app prototype tailored to the needs and preferences of Saudi arthritis patients. The evaluation steps in each cycle identified usability problems, and areas for improvements, confirmed user acceptance, and validated the features and content with HCPs. Therefore, user-evaluation in the final cycle showed high user satisfaction among arthritis patients in Saudi Arabia. The research highlights the potential of mHealth apps to engage users and support adherence behaviour by satisfying their needs, simplifying medication management, empowering users to monitor their arthritis, engaging users with the local arthritis community, and enabling users to access credible content and supportive services that aim to support patient adherence. Future work will focus on the app’s development, evaluate the app’s effectiveness, and explore scalability options to make the app accessible to a broader population of Arabic arthritis patients.