title: Why do Patients Forget to Take Immunosuppression Medications and Miss Appointments: Can a Mobile Phone App Help?
abstract: BACKGROUND
  Kidney transplant recipients must adhere to their immunosuppressive medication regimen. However, non-adherence remains a major problem.
  
  
  OBJECTIVE
  The aim of this paper is to determine how kidney transplant recipients remember to take their medications, and assess their perception and beliefs about adherence to immunosuppressive medications and barriers to medication adherence. In addition, we aim to assess perception and beliefs about willingness to use a hypothetical, mobile phone app to improve adherence.
  
  
  METHODS
  We conducted a qualitative study that included an average of three home or workplace visits of kidney transplant recipients (N=16) from a single urban transplant center.
  
  
  RESULTS
  The qualitative study revealed that transplant recipients understood the importance of taking their immunosuppressive medications and this motivated them to take their medications. The visits showed that most participants have incorporated medication use into their daily lives and that any minor deviation from daily routines could result in non-adherence. Participants also reported other barriers to adherence. All participants were interested in using an app to remind them to take their medication; however, they reported potential barriers to using the app.
  
  
  CONCLUSIONS
  Although kidney transplant recipients understood the importance of medication adherence, there were significant barriers to maintaining adherence. Participants also reported interest in using a mobile phone app.
authors.affiliation: Hennepin County Medical CenterDepartment of MedicineMinneapolis, MNUnited States.|University of MinnesotaDepartment of Epidemiology and community HealthMinneapolis, MNUnited States.|Minneapolis Medical Research FoundationMinneapolis, MNUnited States.
authors.forename: Ajay
authors.identifier: 0000-0002-7607-0430
authors.initials: A
authors.lastname: Israni
authors.affiliation: University of MinnesotaDepartment of Renal Diseases and HypertensionMinneapolis, MNUnited States.
authors.forename: Carl
authors.identifier: 0000-0002-2266-951X
authors.initials: C
authors.lastname: Dean
authors.affiliation: Minneapolis Medical Research FoundationMinneapolis, MNUnited States.
authors.forename: Brian
authors.identifier: 0000-0003-4678-1124
authors.initials: B
authors.lastname: Kasel
authors.affiliation: Minneapolis Medical Research FoundationMinneapolis, MNUnited States.
authors.forename: Lisa
authors.identifier: 0000-0001-9720-5456
authors.initials: L
authors.lastname: Berndt
authors.affiliation: Minneapolis Medical Research FoundationMinneapolis, MNUnited States.
authors.forename: Winston
authors.identifier: 0000-0002-6164-9562
authors.initials: W
authors.lastname: Wildebush
authors.affiliation: Center for Policy, Outcomes and Prevention and Division of General PediatricsStanford University School of MedicinePalo Alto, CAUnited States.
authors.forename: C Jason
authors.identifier: 0000-0002-6278-4889
authors.initials: CJ
authors.lastname: Wang
keywords: adherence; appointments; immunosuppressive medications; mobile phone