Feasibility of Mobile Health Application to Enhance Medication Adherence for Older Adults with Type 2 Diabetes Mellitus

Purpose: The purpose of this dissertation was to contribute to the existing body of knowledge to better understand medication adherence mobile application use in older adults with type 2 diabetes mellitus. First, two integrative reviews were conducted to identify and evaluate digital medication adherence technologies and instruments most appropriate to measure medication adherence. Next, a stakeholder engagement case study was completed, which demonstrated that older adults and health care professionals preferred the Medisafe® when compared to the OnTimeRx® mobile health (mHealth) application for medication reminders. Finally, a multiple methods feasibility study examined the use the Medisafe® application to measure the outcomes of adherence, guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework with a convenience sample of 15 community dwelling older adults. The specific aims for the dissertation were as follows: • Aim 1: Evaluate mobile applications used for medication adherence in adults with type 2 diabetes mellitus. • Aim 2: Conduct an integrative review of instruments designed to measure medication adherence. • Aim 3: Examine the feasibility of using a mobile health application for medication adherence with respect to participant recruitment, participant retention, adoption procedures, and fidelity. Design: A multiple method feasibility study guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework guided the collection of quantitative and qualitative data. Findings: In the feasibility study, Medisafe®, a mHealth medication adherence application was evaluated to assess adoption and medication adherence. All participants completed the six-week intervention and the semi-structured interview. Participants reported a mean app adherence rate of 92.9%. Participants mentioned during the interviews that they appreciated the mobile application features such as “easy to use”, “constant reminder”, and “safeguard”. Post-intervention, the ARMS-D score decreased by 1.4, indicating slight improvement in adherence and less barriers to adherence. All 15 enrolled participants completed the qualitative arm of the study and the post-intervention semi-structured interview. Participants self-reported high rates of adherence with an average rate of adherence of 92.9%. Conclusion: In our target population of community-dwelling adults with self-reported T2DM, mHealth application use for medication adherence was accepted by all participants and showed potential to improve medication adherence. Future larger studies and RCT are needed to assess effectiveness of mHealth applications such as Medisafe® for medication adherence in older adult populations with T2DM