SuMMiT-D - Formative development of a mobile-device based system to support type 2 diabetes medication adherence in primary care: qualitative studies with patients and healthcare staff.
Problem
Type 2 diabetes is a lifelong condition affecting 2.9 million people in the UK. Alongside lifestyle change, medicines are used to lower blood glucose, blood pressure and lipids to prevent long-term complications. However, between a third and half of these medicines are not taken as prescribed and many current interventions for improving medicine use are ineffective. Brief messages delivered via a mobile device could reach a large patient population at low cost, but current interventions using brief messages rarely adequately describe message content, or base messages on explicit behaviour change principles. The multi-site Support through Mobile Messaging and digital health Technology for Diabetes (SuMMiT-D) project is developing and testing a mobile-device based system delivering automated brief messages to offer support for medicine use alongside usual care to people with type 2 diabetes in primary care.
Approach
A bank of brief messages was developed by experts, based on evidence-based Behaviour Change Techniques (BCT) for medication adherence improvement. The delivery system was developed using an iterative approach including stakeholder consultation. This was followed by a six-month pilot study, where patients received up to three automated brief health messages per week and users were asked to react to messages using a limited range of responses. Additionally, we explored patient expectations and experiences of the system during multiple qualitative interviews. Healthcare professionals with a potential role in system implementation participated in focus groups.
Findings
Seven focus groups with 44 healthcare professionals (including GPs, nurses, healthcare assistants, pharmacists and receptionists) were conducted. Twenty-three patients took part in five focus groups and 48 additional patients participated in the pilot study. Primary care staff described adherence as a problem and saw the benefits of a mobile-device based system to support patients. However, practice staff felt a system could only be implemented if the patient sign-up process was simple and the system supported “more than” medication adherence. This was echoed by patient participants, who described a need for messages to support self-management more broadly. Pilot study participants perceived the system as acceptable and indicated a preference for actionable, pragmatic information. Receipt of information served as a useful reminder of the importance of self-management even if individual messages were not perceived as useful. Analysis regarding acceptability of BCTs is ongoing.
Consequences
There is evidence to suggest that medication adherence in the context of type 2 diabetes can be supported through the delivery of brief messages and that this is acceptable to healthcare practitioners and patients. Understanding of the impact of certain BCTs may permit tailoring. In addition, the findings from this study confirm the importance of collecting stakeholder views early in the development process and underline the value of iterative, multidisciplinary team work in the development and evaluation of digital health interventions.