Effective Interventions and Patient Perceptions on the Management of Medication Adherence: a focus on mHealth

University of Technology Sydney. Graduate School of Health. ; 𝗕𝗮𝗰𝗸𝗴𝗿𝗼𝘂𝗻𝗱 Medication non-adherence is highly prevalent globally with an estimated half of all patient’s non-adherent to their medications. Interventions to improve adherence have been widely evaluated, including variations in component composition, seeing modest improvements. A lack of understanding surrounding the effectiveness of individual components within interventions is implicated. Additionally, the Digital Age is the use of mobile phones to assist in management of health, yet evidence is lacking on their effectiveness and acceptability. This thesis aimed to explore and estimate the effect of component composition within medication adherence interventions as well as analyse a multicomponent mHealth intervention’s impact on adherence and acceptability. 𝗠𝗲𝘁𝗵𝗼𝗱𝗼𝗹𝗼𝗴𝘆 A series of discrete studies were undertaken: (1) a network meta-analysis of studies assessing the effectiveness of interventions and their components aimed at improving medication adherence; (2) evaluation of an innovative mHealth intervention utilising multiple components on sustaining optimal adherence; and (3) analysis of users’ acceptability of the mHealth app. 𝗥𝗲𝘀𝘂𝗹𝘁𝘀 The network meta-analysis identified 249 studies evaluating interventions to improve adherence over multiple periods of time. Multicomponent interventions were found to the be the most effective interventions at improving adherence over 10 months, with education in combination with technical and attitudinal components (OR 0.49, 95% CrI 0.27-0.88) and rewards in combination with technical interventions having the most effective odds ratio (OR 0.03, 95% CrI 0.01-0.13) against standard of care. The Perx mHealth app utilising rewards, technical components, education and attitudinal components revealed high rates of adherence, average at 87.6% (SD 16.9%), above an optimal adherence threshold standard of 80%, over 6 months. An analysis of 6,296 user reviews of the mHealth app discovered a highly accepted and appreciated ...