title: mHealth intervention to improve medication management in chronically ill patients: analysis of the recruitment process.
abstract: OBJECTIVE
  Mobile phones have been rapidly adopted by the general population and are now a promising technology with considerable potential in health care. However, refusal rates of 24%-75% have been reported in telemedicine studies. We aimed to report the challenges faced when recruiting patients to use Android and iOS smartphone applications aimed at improving medication management and communication between patients and healthcare professionals.
  
  
  METHODS
  The patients invited to participate had heart failure and/or hypertension and/or dyslipidemia. After reaching the number of participants required for inclusion, the recruitment process was analyzed, and the study team determined the reasons for refusal.
  
  
  RESULTS
  Of the 448 potential participants who were invited to participate, 210 responded. Of these, 37.1% did not use a smartphone, 2.9% owned a mobile phone that was neither iOS nor Android, and 28.6% were smartphone users who refused to participate. In this case, the most common motive was that patients considered their routine healthcare sufficient and had no trouble remembering to take their medicines (81.7%). The final study sample comprised 48 patients. The mean age of the patients enrolled was significantly lower than that of participants who were not included (59.9 ± 10.6 vs. 66.8 ± 11.4 years, respectively; p=0.00).
  
  
  CONCLUSIONS
  We found age to be an important barrier to smartphone use in healthcare. Among smartphone users, good adherence and sufficient routine healthcare were the most common reasons for refusal to participate. Thus, this type of intervention could enhance participation for poor adherers or caregivers. Implementing educational initiatives could play a key role in improving patient perceptions of technology.
authors.affiliation: a Pharmacy Service , Hospital Clínic , Barcelona , Spain.
authors.forename: Helena
authors.initials: H
authors.lastname: Anglada-Martínez
authors.affiliation: a Pharmacy Service , Hospital Clínic , Barcelona , Spain.
authors.forename: Marina
authors.initials: M
authors.lastname: Rovira-Illamola
authors.affiliation: a Pharmacy Service , Hospital Clínic , Barcelona , Spain.
authors.forename: Maite
authors.initials: M
authors.lastname: Martin-Conde
authors.affiliation: a Pharmacy Service , Hospital Clínic , Barcelona , Spain.
authors.forename: Jose Miguel
authors.initials: JM
authors.lastname: Sotoca-Momblona
authors.affiliation: a Pharmacy Service , Hospital Clínic , Barcelona , Spain.
authors.forename: Carles
authors.initials: C
authors.lastname: Codina-Jané
mesh_terms: D000367:Age Factors; D000368:Aged; D002908:Chronic Disease; D050171:Dyslipidemias / Q000188:drug therapy; D005260:Female; D006184:Habits; D006333:Heart Failure / Q000188:drug therapy; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D063731:Mobile Applications; D010342:Patient Acceptance of Health Care / Q000523:psychology; D018579:Patient Selection; D012648:Self Care / Q000295:instrumentation / Q000379:methods*; D000068997:Smartphone
keywords: Medication adherence; chronic patients; mHealth; mobile application; mobile phone; recruitment process