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Adherence is a critical predictor of post-transplant outcomes, including organ rejection, hospitalization, and mortality. Despite the high risk of non-adherence during adolescence, few existing interventions effectively engage patients in the behavioral change process and facilitate meaningful patient-provider communication. An asynchronous video directly observed therapy (DOT) mHealth application was delivered to a sample of adolescent heart transplant (HT) recipients. This study specifically explored a digital mHealth medication adherence program and each the impact on medication adherence, the nature and degree of in-app communication between patients and transplant healthcare staff, and the consistent timing of medication-taking behavior within a sample of adolescent HT recipients.
Methods:
In this study, ten adolescent HT recipients experiencing significant non-adherence with their immunosuppressant medication participated in a 12-week asynchronous DOT program. Utilizing a mobile app, participants recorded and uploaded videos of themselves taking their medication, which were then reviewed by transplant nurses. The app monitored each patient's medication adherence on a dose-by-dose basis. Videos and in-app messaging allowed transplant team members to directly engage with patients, providing encouragement, promoting adherence, and addressing risk factors associated with poor adherence. The primary outcome measured in this DOT pilot study was the proportion of daily medication doses confirmed by video submissions reviewed by the transplant team. The app logged the time and date of each medication dose, calculating the intervals between doses. For a medication prescribed twice daily, the expected interval was 12 hours, and deviations from these 12-hour intervals were specifically quantified (i.e., deviation from 12-hour intervals).
Results:
Over 12 weeks, the 10 patients submitted 90.1% of possible videos demonstrating taking their medication doses twice daily. Patient and transplant team members exchanged 894 unique in-application text messages including those from transplant care team members encouraging patients, building rapport, and offering patients feedback about their progress. A total of 1342 videos were submitted by patients during the program, and mean dose intervals were calculated. Patients deviated from their 12-hour interval between doses on average by 2.11±7.16 hours (median = 0.38 hours or 22.8 minutes). Older patients and those reporting increased barriers to medication adherence had greater inter-dose deviation. Patients receiving messages containing praise, rapport-building, and medically relevant information were those with more consistent 12-hour dosing intervals.
Conclusion and Implications: Results supported promise of the DOT mobile health app promoting medication adherence among adolescent HT recipients. The interactive features of the mobile app not only facilitated real-time monitoring of medication adherence through direct observation but also enabled interpersonal engagement between patients and transplant teams. Moreover, the app's capability to record and analyze inter-dose timings provided insights into the variability of patients' medication-taking behaviors, allowing healthcare providers to promptly identify and address non-adherence. Future research should continue to explore the long-term outcomes and scalability of DOT interventions to reinforce their integration into pediatric transplant care practices, highlighting the potential for widespread adoption in health social work and pediatric healthcare settings.