Towards the Design of Sensing-Based Medication Adherence Aids That Support Individualized Activities of Daily Living: Qualitative Study (Preprint)

BACKGROUND Nearly half of Americans taking prescription medications do not take them properly. The resulting implications have broad impact. Non-adhering patients develop worsened medical conditions, increase comorbidity of disease, or die. OBJECTIVE Clinical studies have shown the most effective strategies for addressing adherence are those that are individualized to the context that each patient and situation require. Yet, existing aids for adherence are relatively ridged and poorly support adaptation to individual behaviors and lifestyles. The aim of this work is to better understand this design tension. METHODS A series of three qualitative studies were conducted. Study 1: 200 hypertensive Americans participated in a 52-question online survey. Questions focused on existing adherence strategies and behaviors, and perception of how hypothetical in-home tracking technologies would assist adherence. Study 2: 20 hypertensives from the Pittsburgh region participated in a comprehensive semi-structured interview on personal adherence behaviors. Sessions included demonstration of medication locations and routines, as well as an assessment of hypothetical technologies. Study 3: 6 pharmacists and 3 family doctors participated in semi-structured interviews to gain provider perspective on patient adherence strategies. Feedback on hypothetical technologies in the context of their patient populations was collected. Inductive thematic coding of all interview data was performed. Studies were conducted consecutively, with results informing subsequent studies. RESULTS Four themes were identified across the studies: 1) routines were heavily influenced and adapted by and through the physical location and placement of medication relative to activities of daily living, 2) routines are chosen to be inconspicuous to maintain privacy, 3) the value of provider-involved routines is motivated by a desire to build trust in shared decision making, and 4) introduction of new technologies can create further burden on patients and providers. CONCLUSIONS Technology interventions can aid in adherence, but success will be dependent on the technology’s ability to learn from individual behaviors, needs, and routines and tailor interventions accordingly. Successful interventions must support patient routines that allow for detection and adherence aids that can adjust to variations in patient location, schedule, independence, and habituation.