Human-Centered Design of a Personalized Digital Health Intervention to Improve Oral Chemotherapy Adherence in Adolescents and Young Adults With Hematologic Cancers

Acute lymphoblastic leukemia/lymphoma therapy includes a maintenance phase involving daily administration of an oral chemotherapy called 6-mercaptopurine (6-MP). Adolescents and young adults (AYAs) exhibit lower 6-MP adherence than younger patients, which increases their relapse risk. However, effective oral chemotherapy adherence interventions for this AYA population are lacking.

This study describes the human-centered design process of co-creating ADAPTS, an app-based just-in-time adaptive intervention for 6-MP adherence in AYAs.

Across three design waves with input from AYAs (n = 19) and their caregivers (n = 14), we conducted interviews to co-develop and refine ADAPTS. Qualitative data were coded using conventional content analysis to identify themes that informed app design.

Four design priorities for an oral chemotherapy adherence digital intervention were identified: (i) personalize messages to the contextual factors that fluctuate and impact adherence, such as symptoms and mood; (ii) enhance the persuasiveness of adherence messages by framing them positively (e.g., a focus on maintaining remission rather than preventing a relapse), and including the perspectives of peers in popular social media formats; (iii) include customizable app features and the ability to track personal adherence progress; and (iv) facilitate dyadic adherence communication between AYAs and their caregivers, who are often involved.

By developing ADAPTS with AYAs and their caregivers, this digital health intervention offers a novel and patient-centric approach to enhancing adherence. The resulting design priorities and human-centered design methods employed have generalizable potential for addressing other AYA cancer health behaviors.