title: Addressing medication nonadherence by mobile phone: development and delivery of tailored messages.
abstract: BACKGROUND
  Medication nonadherence remains a significant public health problem, and efforts to improve adherence have shown only limited impact. The tailoring of messages has become a popular method of developing communication to influence specific health-related behaviors but the development and impact of tailored text messages on medication use is poorly understood.
  
  
  OBJECTIVE
  The aim of this paper is to describe an approach to developing theory-based tailored messages for delivery via mobile phone to improve medication adherence among patients with diabetes.
  
  
  METHODS
  Kreuter's five-step tailoring process was followed to create tailored messages for mobile phone delivery. Two focus group sessions, using input from 11 people, and expert review of message content were used to adapt the survey instrument on which the messages were tailored and edit the developed messages for the target population.
  
  
  CONCLUSIONS
  Following established tailoring methods a library of 168 theory-driven and 128 medication-specific tailored messages were developed and formatted for automated delivery to mobile phones. Concepts from the Health Belief Model and Self-Determination Theory were used to craft the messages and an algorithm was applied to determine the order and timing of messages with the aim of progressively influencing disease and treatment-related beliefs driving adherence to diabetes medication. The process described may be applied to future investigations aiming to improve medication adherence in patients with diabetes and the effectiveness of the current messages will be tested in a planned analysis.
authors.affiliation: University of Michigan College of Pharmacy, 428 Church St., Ann Arbor, MI 48109, USA. Electronic address: gatwood@umich.edu.
authors.forename: Justin
authors.initials: J
authors.lastname: Gatwood
authors.affiliation: University of Michigan College of Pharmacy, 428 Church St., Ann Arbor, MI 48109, USA.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Balkrishnan
authors.affiliation: University of Michigan College of Pharmacy, 428 Church St., Ann Arbor, MI 48109, USA.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Erickson
authors.affiliation: University of Michigan Medical School, Ann Arbor, MI, USA; University of Michigan Center for Health Communication Research, Ann Arbor, MI, USA.
authors.forename: Lawrence C
authors.initials: LC
authors.lastname: An
authors.affiliation: University of Michigan Medical School, Ann Arbor, MI, USA; Department of Veterans Affairs, Ann Arbor, MI, USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Piette
authors.affiliation: University of Michigan College of Pharmacy, 428 Church St., Ann Arbor, MI 48109, USA.
authors.forename: Karen B
authors.initials: KB
authors.lastname: Farris
mesh_terms: D000368:Aged; D000465:Algorithms; D040421:Cell Phone; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D017010:Reminder Systems; D060145:Text Messaging
keywords: Adherence; Behavioral theory; Mobile health; Tailoring; Text messaging