Evidence-based mHealth Adherence-related Interventions Adherence is Transdisciplinary, Perhaps Even its Own ‘Discipline’ The issue of patient adherence is complex and involves interacting dimensions of patient-related factors, social/ economic factors, condition-related factors, therapyrelated factors, and health system/healthcare team factors 1 . In other words, the nature of the adherence beast is multi-faceted and inherently interdisciplinary. Expert advice informing best practices to improve patient adherence is needed from healthcare-related clinicians (doctors, nurses, pharmacists), mental health experts (psychologists, psychiatrists), sociologists, social workers, epidemiologists, health-related researchers, and policy-makers (among others). A more appropriate term for how adherence should be properly viewed then may be transdiciplinary. That is, adherence requires a holistic approach, one that seeks to integrate knowledge from all related disciplines into a coherent whole.
Perhaps this points to the need for a shift in perspective. Specifically, a shift from a solutions-oriented approach to an understanding and acceptance of adherence as its own discipline. Adherence is not a science; it is not an art. It is an alchemy of disciplines including medical science, behavioural science, communications, demographics, psychographics, organisational management, systemsoriented thinking, and economics. One argument for considering adherence as a discipline is that it would be subject to the same methodological rigour as other disciplines, including the establishment of an evidence base and organised, systematic dissemination of knowledge that incorporates structured training. These processes are clearly in motion with the publication of adherence-specific journals such as this one, and adherence-related toolkits from reputable sources that are aimed at clinicians (e.g., the one published recently by the American College of Preventive Medicine titled ‘Medication Adherence – Improving Health Outcomes’, available at: http://www.acpm.org/?MedAdherTT_ ClinRef). Of note, these efforts move the field closer to top-quality practices by addressing the key features of evidence-based practice, namely finding, applying, and appraising the evidence (see Figure 1).
Like Adherence, mHealth is Interdisciplinary and in Need of an Evidence Base Similar arguments can be (and have been) made for the field of mHealth, defined as “the delivery of healthcare services via mobile communication devices” 2 . Like adherence, mHealth is by its very nature an interdisciplinary field comprised of elements of both science and art. Again, it requires a team of experts from various fields such as information technology, healthcare, sales and marketing, business management, business development, etc... As in adherence, an evidence base within the field of mHealth is sorely needed, as noted in a recent World Health Organization document summarising global mHealth initiatives 3 : 18 Journal For Patient Compliance Strategies to enhance Adherence and Health Outcomes
Volume 3 - Issue 1
Journal for Patient Compliance - Strategies to enhance Health Outcomes