Digital technologies to improve adherence: Limitations and opportunities
Rob Horne
Centre for Behavioural Medicine, UCL School of Pharmacy, University College London
Summary
The proliferation of smart digital technologies has the potential to improve adherence and reduce the global burden of respiratory disease. Traditionally, such technologies have been used to address practical barriers to adherence, making treatment engagement as easy as possible. Although helpful, this has a limited effect (the so-called ‘app trap’) because much of non-adherence is intentional: the patient is able to adhere but does not want to. For adherence support to be most effective, it should address barriers to both motivation (I don’t want to) and ability (I can’t) to adhere. In this talk, we will apply evidence from behavioural science to show how people make decisions about treatment. The Perceptions and Practicalities ApproachTM (PAPA), a framework endorsed by NICE, is a way to understand the psychology of adherence. To improve adherence, interventions need to address perceptual barriers (e.g., patient beliefs, preferences and emotions) influencing motivation and practical barriers (e.g., capacity and resources) influencing ability to adhere to treatment. This presentation will show how PAPATM-based digital and non-digital interventions have significantly increased patient beliefs about the need for their medicine, reduced patient concerns about taking their medicine and increased medication adherence. We will also apply the 3C’s of intervention design: Content, Channel and Context. Digital technologies offer an important Channel for the delivery of adherence support, but we need to couple technological expertise with behavioural science to optimise content (what apps say and do) and Context (the environment in which they are delivered).