title: Targeting Medication Non-Adherence Behavior in Selected Autoimmune Diseases: A Systematic Approach to Digital Health Program Development.
abstract: BACKGROUND
  29 autoimmune diseases, including Rheumatoid Arthritis, gout, Crohn's Disease, and Systematic Lupus Erythematosus affect 7.6-9.4% of the population. While effective therapy is available, many patients do not follow treatment or use medications as directed. Digital health and Web 2.0 interventions have demonstrated much promise in increasing medication and treatment adherence, but to date many Internet tools have proven disappointing. In fact, most digital interventions continue to suffer from high attrition in patient populations, are burdensome for healthcare professionals, and have relatively short life spans.
  
  
  OBJECTIVE
  Digital health tools have traditionally centered on the transformation of existing interventions (such as diaries, trackers, stage-based or cognitive behavioral therapy programs, coupons, or symptom checklists) to electronic format. Advanced digital interventions have also incorporated attributes of Web 2.0 such as social networking, text messaging, and the use of video. Despite these efforts, there has not been little measurable impact in non-adherence for illnesses that require medical interventions, and research must look to other strategies or development methodologies. As a first step in investigating the feasibility of developing such a tool, the objective of the current study is to systematically rate factors of non-adherence that have been reported in past research studies.
  
  
  METHODS
  Grounded Theory, recognized as a rigorous method that facilitates the emergence of new themes through systematic analysis, data collection and coding, was used to analyze quantitative, qualitative and mixed method studies addressing the following autoimmune diseases: Rheumatoid Arthritis, gout, Crohn's Disease, Systematic Lupus Erythematosus, and inflammatory bowel disease. Studies were only included if they contained primary data addressing the relationship with non-adherence.
  
  
  RESULTS
  Out of the 27 studies, four non-modifiable and 11 modifiable risk factors were discovered. Over one third of articles identified the following risk factors as common contributors to medication non-adherence (percent of studies reporting): patients not understanding treatment (44%), side effects (41%), age (37%), dose regimen (33%), and perceived medication ineffectiveness (33%). An unanticipated finding that emerged was the need for risk stratification tools (81%) with patient-centric approaches (67%).
  
  
  CONCLUSIONS
  This study systematically identifies and categorizes medication non-adherence risk factors in select autoimmune diseases. Findings indicate that patients understanding of their disease and the role of medication are paramount. An unexpected finding was that the majority of research articles called for the creation of tailored, patient-centric interventions that dispel personal misconceptions about disease, pharmacotherapy, and how the body responds to treatment. To our knowledge, these interventions do not yet exist in digital format. Rather than adopting a systems level approach, digital health programs should focus on cohorts with heterogeneous needs, and develop tailored interventions based on individual non-adherence patterns.
authors.affiliation: Evolution Health Systems Inc., 1266 Queen Street West, Suite 8, Toronto, Ontario, M6K 1L3, Canada; Research Associate, Henley Business School, University of Reading, Greenlands, Henley-on-Thames, Oxfordshire, RG9 3AU, United Kingdom.
authors.forename: Trevor
authors.initials: T
authors.lastname: van Mierlo
authors.affiliation: Evolution Health Systems Inc., 1266 Queen Street West, Suite 8, Toronto, Ontario, M6K 1L3, Canada; Research Associate, Henley Business School, University of Reading, Greenlands, Henley-on-Thames, Oxfordshire, RG9 3AU, United Kingdom.
authors.forename: Rachel
authors.initials: R
authors.lastname: Fournier
authors.affiliation: Janssen Scientific Affairs LLC, 850 Ridgeview Dr., Horsham, Pennsylvania, 19044, United States of America.
authors.forename: Michael
authors.initials: M
authors.lastname: Ingham
mesh_terms: D001327:Autoimmune Diseases / Q000188:drug therapy* / Q000191:economics / Q000523:psychology*; D005260:Female; D066296:Grounded Theory; D017048:Health Care Costs; D006293:Health Promotion; D006801:Humans; D020407:Internet; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008962:Models, Theoretical; D010353:Patient Education as Topic; D016730:Program Development; D011788:Quality of Life; D017010:Reminder Systems; D012307:Risk Factors; D060145:Text Messaging