Co-designing a mobile application to increase medication adherence for people living with atrial fibrillation

Oral anticoagulation reduces stroke risk in atrial fibrillation, yet up to 30% of patients do not take their anticoagulation as prescribed. Mobile health applications incorporating behaviour change techniques may improve adherence. This study aimed to co-design a mobile health application to increase adherence to oral anticoagulation for atrial fibrillation.

The Person-Based Approach informed by Leventhal's Common Sense Self-Regulatory Model was used to involve participants with atrial fibrilation as co-designers of a medication adherence mHealth app. Participants recruited via British Heart Foundation existing contacts and social media advertising attended three workshops: (i) a patient storytelling session, (ii) an interactive review of existing atrial fibrillation mobile health applications, and (iii) pilot testing of the co-designed application. Data were collected using flipchart, Post-it notes, and researcher field notes, with emphasis placed on direct quotations and storytelling. Eleven participants (7 males, aged 35-80 years) took part; and six were diagnosed with atrial fibrillation within the last 5 years with daily medication counts from 0 to 12. Eight (72%) participants were taking oral anticoagulants, and only two people used smartphones to manage their own health. The newly developed mobile application, My AF Nurse, featured a talking avatar and behaviour change techniques including a medication tracker, information about AF, advice on when and where to seek help, and a quiz to test knowledge.

The co-design approach to app design empowered AF patients, by incorporating their experiences and preferences. This fostered ownership over self-care and produced a tool grounded in users' real-world needs.