Adolescence (age 12-18 years) is a life phase where many physical, psychological, and social changes occur. Adolescents take over responsibility for their medication use, but they are not always ready for this task. Consequently, adherence rates drop, potentially resulting in uncontrolled disease. Most adolescents own a smartphone and have a positive attitude towards mobile technology. Mobile health (mHealth) interventions might therefore be useful to increase adolescents’ involvement in disease management and to improve adherence. However, until now, no effective mHealth intervention have been developed specifically for adolescents. In fact, little is known about adolescents’ medication use, as most studies do not distinguish between younger children and adolescents. Therefore, the aim of this thesis was (1) to evaluate adolescents’ perspectives on chronic medication use, and (2) to evaluate the effect of a pharmacy-based mHealth intervention to support adherence and self-management in adolescents with asthma.
1. We focused on the most common chronic conditions among adolescents: asthma, atopic dermatitis, and attention-deficit/hyperactivity disorder (ADHD). Most adolescents reported that their adherence was suboptimal. Many adolescents had an indifferent attitude towards their medication use; they perceived both low necessity and low concerns regarding their medication.
2. We evaluated the ADolescent Adherence Patient Tool (ADAPT) to improve medication adherence of adolescents with asthma. The ADAPT intervention consisted of a smartphone application (app) for patients, which was connected to a desktop management system for pharmacists. The app contained several functionalities and it improved adherence in non-adherent adolescents with asthma. The most frequently used functionalities were the questionnaires to monitor symptoms and adherence. Adolescents that actively engaged in chatting with their pharmacist seemed to benefit most from the intervention. Both pharmacists and patients were positive about the ADAPT intervention. The intervention also promoted contact between pharmacists and adolescents. However getting a new intervention into routine practice (i.e. normalization) is a complex and continuous process. During the study, only a small number of adolescents participated. Large scale implementation would require more time. The absence of appropriate reimbursement will then become a significant barrier. The potential for normalization could be enhanced by the use of product champions and appropriate reimbursement. Support from professional bodies for the use of mHealth would also promote normalization.
We concluded that adolescents with chronic conditions are a unique patient population, who have specific needs and preferences, and are poorly adherent. Adolescents therefore require special attention from healthcare providers. MHealth interventions are interesting for adolescents and should contain multiple functionalities. Suggested key functions to promote self-management are questionnaires to monitor symptoms and an opportunity to chat with healthcare providers. The ADAPT intervention has the potential to become normalized in the community pharmacy, however full normalization would require changes in pharmacy practice and reimbursement models.