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Interactive Two-Way mHealth Interventions for Improving Medication Adherence: An Evaluation Using The Behaviour

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Summary

Two-way mobile health (mHealth) interventions like WelTel improve medication adherence by addressing capability, opportunity, and motivation. This personalized communication approach offers a more effective strategy than one-way messaging for various health conditions.

Keywords:
chronic diseasedisease managementmHealthmedication adherenceprimary health care

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Area of Science:

  • Digital Health
  • Behavioral Science
  • Public Health

Background:

  • Medication adherence is crucial for managing infectious diseases like HIV, with significant individual and public health implications.
  • Mobile health (mHealth) text messaging interventions show promise in improving adherence, especially two-way platforms requiring patient responses.
  • The Behavior Change Wheel (BCW) offers a framework to understand behavior change mechanisms, applicable to evaluating mHealth interventions.

Purpose of the Study:

  • To apply the Behavior Change Wheel (BCW) framework to characterize the mechanisms of action for WelTel, an interactive two-way mHealth platform.
  • To understand how WelTel improves adherence to antiretroviral therapy (ART) by analyzing its components through the BCW model.
  • To address the knowledge gap concerning the specific ways two-way mHealth interventions influence medication adherence.

Main Methods:

  • Systematically applied the Behavior Change Wheel (BCW) to analyze the WelTel intervention.
  • Mapped known antiretroviral therapy (ART) adherence barriers to the Capability Opportunity Motivation-Behavior (COM-B) model for a behavioral diagnosis.
  • Specified WelTel's behavior change techniques (BCTs) and intervention functions, linking them to COM-B influences.

Main Results:

  • WelTel's impact on ART adherence is primarily driven by its personalized communication, utilizing 8 behavior change techniques (BCTs) and 5 intervention functions.
  • The identified intervention functions included environmental restructuring, enablement, education, persuasion, and training.
  • Mechanisms of action potentially address all Capability Opportunity Motivation-Behavior (COM-B) influences: capability, opportunity, and motivation.

Conclusions:

  • Systematic evaluation using the Behavior Change Wheel (BCW) aids in developing more targeted and effective mHealth interventions.
  • Interactive two-way mHealth interventions like WelTel demonstrate greater efficacy than one-way approaches in addressing both intentional and unintentional nonadherence.
  • Applying the BCW framework to diverse mHealth interventions can enhance understanding of their mechanisms and improve medication adherence outcomes across various conditions.