Stawarz, KM; (2017) Towards better medication adherence apps: Preventing forgetfulness by facilitating the formation of routine-based remembering strategies. Doctoral thesis , UCL (University College London).

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Abstract

Forgetfulness is one of the main causes of unintentional non-adherence. While different types of adherence technologies exist that aim to address this issue, people still forget to take their medications. This thesis shows that adherence apps could effectively support long-term regimens by facilitating the formation of medication routines based on multiple contextual cues. The first part of the thesis explores common remembering strategies and examines existing smartphone apps. It shows that people who are successful in remembering their medications tend to rely on daily routines and other contextual cues to help them remember. However, currently available medication reminder apps do not support people in adopting these strategies. Similarly, apps intended for supporting habit formation—that could help people to stay adherent to long-term regimens—ignore the importance of contextual cues, even though their presence is essential in order to develop a habit. Starting a new regimen relies on prospective remembering, while ongoing adherence depends on the presence of habitual behaviour—both of which can be supported by contextual cues. Therefore, to extract requirements for adherence apps grounded in users’ everyday behaviour, the second part of the thesis investigates the important characteristics of successful contextual cues. The findings show that not all cues that facilitate habit formation can also support prospective memory. As a result, to help develop medication habits, remembering strategies should be made of multiple interconnected cues, with a daily routine event as the main component. Through a series of empirical studies, this thesis shows that the selection of the right cue is key in ensuring long-term adherence, and highlights the need to account for prospective remembering in future habit formation theories. It ends with a set of design requirements, illustrated with examples, for apps that facilitate the formation of routine-based strategies that support the development of medication habits.

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