title: Introducing the Adherence Strategy Engineering Framework (ASEF). Support for developing technology-based self-care solutions.
abstract: BACKGROUND
  Patients performing self-care in the unsupervised setting do not always adhere to the instructions they were initially provided with. As a consequence, a patient's ability to successfully comply with the treatment plan cannot be verified by the treating healthcare professional, possibly resulting in reduced data quality and suboptimal treatment.
  
  
  OBJECTIVE
  The aim of this paper is to introduce the Adherence Strategy Engineering Framework (ASEF) as a method for developing novel technology-based adherence strategies to assess and improve patient adherence levels in the unsupervised setting.
  
  
  METHODS
  Key concepts related to self-care and adherence were defined, discussed, and implemented as part of the ASEF framework. ASEF was applied to seven self-care case studies, and the perceived usefulness and feasibility of ASEF was evaluated in a questionnaire study by the case study participants. Finally, we reviewed the individual case studies usage of ASEF.
  
  
  RESULTS
  A range of central self-care concepts were defined and the ASEF methodological framework was introduced. ASEF was successfully used in seven case studies with a total of 25 participants. Of these, 16 provided answers in the questionnaire study reporting ASEF as useful and feasible. Case study reviews illustrated the potential of using context-aware technologies to support self-care in the unsupervised setting as well as ASEF's ability to support this.
  
  
  CONCLUSIONS
  Challenges associated with moving healthcare to the unsupervised setting can be overcome by applying novel context-aware technology using the ASEF method. This could lead to better treatment outcomes and reduce healthcare expenditures.
authors.affiliation: Department of Engineering, Aarhus University, Finlandsgade 2, 8200 Aarhus N, Denmark. sw@iha.dk
authors.forename: S
authors.initials: S
authors.lastname: Wagner
authors.forename: T S
authors.initials: TS
authors.lastname: Toftegaard
authors.forename: O W
authors.initials: OW
authors.lastname: Bertelsen
mesh_terms: D003718:Denmark; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008962:Models, Theoretical; D036301:Qualitative Research; D012648:Self Care; D011795:Surveys and Questionnaires; D017216:Telemedicine