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Mobile technology interventions for improving medication adherence in patients with mental health disorders Open Access


Other title
medication adherence
mobile technology
mental health
text message
Type of item
Degree grantor
University of Alberta
Author or creator
Watson, Tyler L
Supervisor and department
Hughes, Christine (Pharmacy and Pharmaceutical Sciences)
Examining committee member and department
Necyk, Candace (Pharmacy and Pharmaceutical Sciences)
Simpson, Scot (Pharmacy and Pharmaceutical Sciences)
Schindel, Terri (Pharmacy and Pharmaceutical Sciences)
Faculty of Pharmacy and Pharmaceutical Sciences
Pharmacy Practice
Date accepted
Graduation date
2017-11:Fall 2017
Master of Science
Degree level
ABSTRACT Poor medication adherence in the mental health population leads to compromised treatment outcomes and increased health care costs. Traditional interventions for medication adherence, while effective if addressing multiple determinants of medication-taking behavior, are expensive and resource-intense when applied to clinical practice. As a result, novel approaches to medication adherence interventions, such as those supported by mobile technology, must be considered. In the first study of this thesis, a systematic review examined the effect of text message-based interventions on medication adherence in the mental health population. The second study sought to better understand medication-taking behaviors among individuals with mental health disorders to determine how technology-based interventions could improve medication adherence. The systematic review was completed by searching four electronic databases from January 1999 to October 2015. Of the seven studies which met our inclusion criteria, six were randomized controlled trials and one was a prospective pilot study. Three studies evaluated text messaging in patients with diagnosis of schizophrenia or schizoaffective disorder, two studies evaluated text messaging in patients with chronic alcohol dependence, and two studies evaluated text messaging in patients with mood disorders. Five studies examined medication adherence as an outcome, while all seven measured changes in psychiatric or social functioning scores using a variety of validated scales. One study reported significant improvement in medication adherence, while five studies reported significant improvements in the symptom measurement scales used. Overall, text messaging interventions for medication adherence in the mental health population appears promising in improving medication adherence and behavioral symptoms; however, methodological limitations of the included studies minimize our ability to determine the extent of the impact. In our second study, 15 individuals with histories of mental illness and housing instability were interviewed regarding their attitudes toward medications, current medication-taking practices, and perspectives on mobile technology-supported adherence interventions. All patients enrolled in this study were clients of the Pathways to Housing Program - an outreach program providing access to community-based apartments for individuals with history of chronic homelessness and concomitant mental illness. Medication-taking behavior was measured using the Medication Adherence Rating Scale (MARS), with all participants except one scoring in the “good adherence” range (result of 6 or greater on the scale). The mean MARS score was 7.3 out of 10 (SD = 1.5). A number of patient factors such as insight, coping strategies, and attitudes toward medications supported medication-taking in this sample. External factors, such as family support and the therapeutic alliance were also identified as important in enabling medication adherence. Regarding the use of mobile phones to support adherence, some patients were conceptually supportive of the idea; however, none were currently utilizing mobile phones for this purpose. Common barriers to regular mobile phone access included high acquisition and subscription costs, theft, and unfamiliarity with newer device technology.
This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for the purpose of private, scholarly or scientific research. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.
Citation for previous publication
Watson T, Simpson S, Hughes C. Text messaging interventions for individuals with mental health disorders including substance use: A systematic review. Psychiatry Res. 2016;243:255-262.

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