Implications for Training on Smartphone Medication Reminder App Use by Adults With Chronic Conditions: Pilot Study Applying the Technology Acceptance Model.

BACKGROUND: The majority of middle-aged to older patients with chronic conditions report forgetting to take medications as prescribed. The promotion of patients' smartphone medication reminder app (SMRA) use shows promise as a feasible and cost-effective way to support their medication adherence. Providing training on SMRA use, guided by the technology acceptance model (TAM), could be a promising intervention to promote patients' app use. OBJECTIVE: The aim of this pilot study was to (1) assess the feasibility of an SMRA training session designed to increase patients' intention to use the app through targeting perceived usefulness of app, perceived ease of app use, and positive subjective norm regarding app use and (2) understand the ways to improve the design and implementation of the training session in a hospital setting. METHODS: A two-group design was employed. A total of 11 patients older than 40 years (median=58, SD=9.55) and taking 3 or more prescribed medications took part in the study on one of two different dates as participants in either the training group (n=5) or nontraining group (n=6). The training group received an approximately 2-hour intervention training session designed to target TAM variables regarding one popular SMRA, the Medisafe app. The nontraining group received an approximately 2-hour control training session where the participants individually explored Medisafe app features. Each training session was concluded with a one-time survey and a one-time focus group. RESULTS: Mann-Whitney U tests revealed that the level of perceived ease of use (P=.13) and the level of intention to use an SMRA (P=.33) were higher in the training group (median=7.00, median=6.67, respectively) than in the nontraining group (median=6.25, median=5.83). However, the level of perceived usefulness (U=4.50, Z=-1.99, P=.05) and the level of positive subjective norm (P=.25) were lower in the training group (median=6.50, median=4.29) than in the nontraining group (median=6.92, median=4.50). Focus groups revealed the following participants' perceptions of SMRA use in the real-world setting that the intervention training session would need to emphasize in targeting perceived usefulness and positive subjective norm: (1) the participants would find an SMRA to be useful if they thought the app could help address specific struggles in medication adherence in their lives and (2) the participants think that their family members (or health care providers) might view positively the participants' SMRA use in primary care settings (or during routine medical checkups). CONCLUSIONS: Intervention training session, guided by TAM, appeared feasible in targeting patients' perceived ease of use and, thereby, increasing intention to use an SMRA. Emphasizing the real-world utility of SMRA, the training session could better target patients' perceived usefulness and positive subjective norm that are also important in increasing their intention to use the app.

Listening to patients' voices: linguistic indicators related to diabetes self-management.

A great deal of research in health care has examined a wide range of variables to better understand the degree to which patients follow the advice of medical professionals in managing their health, known as adherence. This paper explains the development of the linguistic systems to describe and evaluate two psychosocial constructs (i.e. control orientation and agency) that have been found to be related to adherence in previous research for subjects with diabetes (Trento et al. 2007; Wangberg 2007; O'Hea et al. 2009). The present data came from 43 semi-structured in-depth interviews of subjects with Type 2 diabetes. One-on-one interviews with open-ended questions elicited subjects' 'stories' about living with diabetes, and the transcribed interviews were analyzed to develop the linguistic systems of control orientation and agency. The resultant systems were applied to the 43 interviews by raters with high inter-rater reliability. The results showed demarcations of clearly identified codings of patient types. The paper presents the linguistic coding systems developed in the study, the results of their application to the patient interview data, and recommendations for improved communication with patients.

Coping with chronic illness: information use and treatment adherence among people with diabetes.

This study's goal is to understand the complex relationship among information usage, medication adherence, and disease management in people with diabetes. Toward this end, we conducted 21 in-depth interviews with Type 2 diabetics. We queried patients on the sources and adequacy of information that they received about their disease, as well as on how closely they adhered to their prescribed medication regimen. Interviewees identified 12 sources of information that they used to varying degrees in managing their diabetes. Of these sources, patients relied most heavily on their doctors, particularly upon initial diagnosis, in spite of delivering mixed assessments of the adequacy of their physicians'provision of information. Other sources patients most frequently discussed included diabetes education programs, friends/family, the internet, the information leaflet that accompanies prescriptions and written information. Further, those who reported high adherence to their treatment regimen tended to rely on different sources than those who reported low adherence. Findings are interpreted within the framework of the Health Belief Model, and implications for designing effective interventions are discussed.

The relationship among performance of instrumental activities of daily living, self-report of quality of life, and self-awareness of functional status in individuals with multiple sclerosis.

OBJECTIVE: To investigate the relationship between self-awareness of functional status and performance of Instrumental Activities of Daily Living (IADL), and self-reports of quality of life (QOL) in persons with multiple sclerosis (MS). DESIGN: A between-groups design, using a correlational approach to examine the relationship between self-awareness of functional status, IADL and QOL. PARTICIPANTS: We studied 47 individuals with clinically definite MS and 26 healthy controls (HCs). MEASURES: The Functional Behavior Profile was completed by both participants and their informants. Participants' scores were subtracted from those of their informants', and the absolute value was used as the self-awareness/concordance score. The Executive Function Performance Test measured IADL performance; QOL was measured with the Functional Assessment of Multiple Sclerosis. RESULTS: MS participants showed lower levels of self-awareness relative to HCs. Significant correlations were observed between performance of IADL, reports of QOL and self-awareness levels of functional status. However, reports of QOL were not significantly correlated with performance of IADL. CONCLUSIONS: The positive association between self-awareness of functional status with IADL performance and QOL reports provides support for the role of awareness in rehabilitation.

Patient-directed medicine labeling: text differences between the United States and Spain.

As part of a larger project to examine the complexities of patient adherence to medical directions, the current study compares written information given with prescribed medicines to patients in the United States (US) and Spain suffering from two chronic diseases. First, the legal context of the voluntary nature of the provision of such information in the US, and the mandatory nature of provision in Spain, was explored. Then, 30 drugs in common use in both countries, 19 for cardiovascular disease and 11 for endocrine disorders, were identified and the texts of the corresponding patient-directed written information were included in an electronic corpus and analysed. Ten rhetorical features common to both the US and Spanish texts were identified. Differences were found in the placement of two of the features in relation to the complete text: information on 'side effects' and concerning 'the need to seek medical advice' appeared more frequently throughout the US texts than in the Spanish texts. Detailed lexical analysis showed more technical vocabulary in use in the Spanish texts.

Relationship of the Multiple Sclerosis Neuropsychological Questionnaire (MSNQ) to functional, emotional, and neuropsychological outcomes.

OBJECTIVE: To explore the relationship of the Multiple Sclerosis Neuropsychology Questionnaire (MSNQ; [Benedict, R. H. B., Cox, D., Thompson, L. L., Foley, F., Weinstock-Guttman, B., & Munschauer, F. (2004). Reliable screening for neuropsychological impairment in multiple sclerosis. Multiple Sclerosis, 10, 675-678; Benedict, R. H. B., Munschauer, F., Linn, R., Miller, C., Murphy, E., Foley, F., et al. (2003). Screening for multiple sclerosis cognitive impairment using a self-administered 15-item questionnaire. Multiple Sclerosis, 9, 95-101]), a self-report screening measure of neuropsychological functioning in multiple sclerosis (MS), with everyday life functioning, neuropsychological functioning, and mood in MS. Additionally, to investigate the validity, sensitivity, and specificity of the MSNQ to predict cognitive impairment in persons with MS. STUDY DESIGN: Cross-sectional, correlational analyses; analyses of sensitivity and specificity. SETTING: Neuropsychology lab-based study with adults from the community including persons with MS (n=48) and healthy adults (n=40). MAIN OUTCOME MEASURES: Subjective and objective measures of everyday life functioning, neuropsychological functioning, and mood; ROC curve of MSNQ-Self report and MSNQ-Informant report, sensitivity and specificity of MSNQ-S and MSNQ-I. RESULTS: Correlational analyses indicate the MSNQ-S is significantly correlated with mood and self-reports of functioning, but not with objectively measures daily functioning and to only few neuropsychological tests. The MSNQ-I was not significantly correlated to mood, self-report of daily functioning or objectively measured daily functioning, but was significantly correlated with several measures of neuropsychological functioning. CONCLUSION: The MSNQ-S was not supported as a sensitive screen for neuropsychological impairment in MS. However, the MSNQ-I was supported as a valid and sensitive screen of cognitive impairment in persons with MS, although further research is needed to determine an optimal cutoff score for this measure.

The relation between subjective and objective measures of everyday life activities in persons with multiple sclerosis.

OBJECTIVES: To investigate the relation between subjective and objective performance-based measures of functional status in persons with multiple sclerosis (MS), and to compare their performance with healthy controls. DESIGN: A between-groups design, using a correlational approach to examine the relation between objective and subjective measures of functional capacity. SETTING: Outpatient rehabilitation research institution. PARTICIPANTS: Seventy-four subjects with clinically definite MS and 35 healthy controls. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Executive Function Performance Test (EFPT), Functional Assessment of Multiple Sclerosis (FAMS), and Functional Behavior Profile (FBP). RESULTS: MS participants reported more difficulties performing functional tasks than did the healthy controls. MS participants also performed significantly worse on the EFPT than healthy controls. However, all correlations between subjective and objective functional measures were nonsignificant. After controlling for depressive symptomatology, EFPT performance was significantly associated with FBP scores, but not FAMS scores. CONCLUSIONS: The lack of association between objective performance-based measures and subjective self-report measures of functional activities is a challenge to outcomes measurement and has implications for assessment of functional performance. Results are discussed in terms of the different dimensions that these tools are measuring and their respective strengths and limitations.