Technical and Behavioral Interventions for Medication Adherence through Mobile Health

In this research, we present a novel intervention, Carrot and Stick, to improve the outcome of one of the self-management tasks, medication adherence (MA), among patients with chronic disease(s). Our design incorporates the growing importance of mobile health (m-health) in Health Information Technology (HIT) with the users’ dependency on mobile phones to facilitate valuable behavioral changes. Drawing on Social Cognitive Theory, Social Exchange Theory, Goal-setting Theory, and people’s dependence on smartphones, we develop the functionalities in our intervention, including positive and negative reinforcement, goal-setting, and social connections. The iterative process of our development follows the Design Science Approach. In the evaluation and validation of our intervention, we not only examine the intervention’s impacts on patients through analytical models and simulation but also demonstrate the possible active support of the intervention from healthcare providers based on the current pay-for-performance (P4P) scheme. Our results suggest that (1) with the help of electronic medication container, appropriate reminder design can reduce the patients’ chances of forgetting doses, overdosing, and intaking doses at the wrong time, (2) positive reinforcement can help increase the probability of the patient achieving expected MA, while negative reinforcement has a further impact that is added to the increment, (3) our intervention can assist the patient in saving more than $600 per year, and (4) under the current P4P scheme, physicians with the exceptional performance or with bad performance are likely to invest in the intervention to change their patients’ behaviors, while physicians with good performance are less likely to participate. Our research is the first to utilize negative reinforcement in intervention design to enhance MA; it is also the first to provide corresponding interventional solutions that are customized according to elements derived from theories. Besides, the focus and understanding of healthcare providers’ involvement in the incentive program can facilitate the adoption, prescription, and implementation of the proposed intervention