Health Behaviour and Interventions Research, Faculty of Health and Life Sciences, Coventry University, Coventry, United Kingdom.
Public Health Warwickshire, Warwickshire County Council, Warwick, United Kingdom.
JMIR Mhealth Uhealth. 2019 Jun 18;7(6):e8130. doi: 10.2196/mhealth.8130.
Young people with sickle cell disease (SCD) often demonstrate low medication adherence and low motivation for effectively self-managing their condition. The growing sophistication of mobile phones and their popularity among young people render them a promising platform for increasing medication adherence. However, so far, few apps targeting SCD have been developed from research with the target population and underpinned with theory and evidence.
The aim of this study was to develop a theory-and-evidence-based medication adherence app to support children and adolescents with SCD.
The Behavior Change Wheel (BCW), a theoretically based intervention development framework, along with a review of the literature, 10 interviews with children and adolescents with SCD aged between 12 and 18 years, and consultation with experts informed app development. Thematic analysis of interviews provided relevant theoretical and evidence-based components to underpin the design and development of the app.
Findings suggested that some patients had lapses in memory for taking their medication (capability); variation in beliefs toward the effectiveness of medication and confidence in self-managing their condition (motivation); a limited time to take medication; and barriers and enablers within the changing context of social support during the transition into adulthood (opportunity). Steps were taken to select the appropriate behavioral change components (involving behavior change techniques [BCTs] such as information on antecedents, prompts/cues; self-monitoring of the behavior; and social support) and translate them into app features designed to overcome these barriers to medication adherence.
Patients with SCD have complex barriers to medication adherence necessitating the need for comprehensive models of behavior change to analyze the problem. Children and adolescents require an app that goes beyond simple medication reminders and takes into account the patient's beliefs, emotions, and environmental barriers to medication adherence.
患有镰状细胞病（SCD）的年轻人经常表现出较低的药物依从性，并且缺乏有效自我管理病情的动力。随着手机的日益普及和功能日益复杂，手机成为提高药物依从性的有前途的平台。然而，迄今为止，针对 SCD 的应用程序很少是根据目标人群的研究开发的，并且缺乏理论和证据的支持。
本研究旨在开发一种基于理论和证据的药物依从性应用程序，以支持患有 SCD 的儿童和青少年。
行为改变车轮（BCW）是一种基于理论的干预开发框架，结合文献综述、对 10 名 12 至 18 岁 SCD 儿童和青少年的访谈以及与专家的咨询，为应用程序的开发提供了信息。对访谈的主题分析提供了相关的理论和循证组成部分，为应用程序的设计和开发提供了依据。
研究结果表明，一些患者在服用药物的记忆方面存在疏忽（能力）；对药物有效性和自我管理病情的信心存在差异（动机）；用于服药的时间有限；以及在向成年期过渡期间社会支持不断变化的背景下存在障碍和促进因素（机会）。采取了措施来选择适当的行为改变组成部分（涉及行为改变技术[BCT]，例如关于前因、提示/线索的信息；对行为的自我监测；以及社会支持），并将其转化为旨在克服这些药物依从性障碍的应用程序功能。
SCD 患者的药物依从性存在复杂的障碍，需要全面的行为改变模型来分析问题。儿童和青少年需要一个不仅仅是简单药物提醒的应用程序，并且要考虑到患者的信念、情绪和药物依从性的环境障碍。
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