Habit Strength, Medication Adherence, and Habit-Based Mobile Health Interventions Across Chronic Medical Conditions: Systematic Review

Abstract

Background Unintentional medication nonadherence is common and has been associated with poor health outcomes and increased health care costs. Earlier research demonstrated a relationship between habit strength and medication adherence. Previous research also examined a habit’s direct effect on adherence and how habit interacts with more conscious factors to influence or overrule them. However, the relationship between habit and adherence and the role of habit-based mobile health (mHealth) interventions remain unclear. Objective This review aimed to systematically evaluate the most recent evidence for habit strength, medication adherence, and habit-based mHealth interventions across chronic medical conditions. Methods A keyword search with combinations of the terms habit, habit strength, habit index, medication adherence, and medication compliance was conducted on the PubMed database. After duplicates were removed, two authors conducted independent abstract and full-text screening. The guidelines for the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were followed when reporting evidence across the included and reviewed studies. Results Of the 687 records examined, 11 met the predefined inclusion criteria and were finalized for data extraction, grading, and synthesis. Most included studies (6/11, 55%) were cross-sectional and used a theoretical model (8/11, 73%). The majority of studies measured habit strength using the self-report habit index and self-report behavioral automaticity index (9/11, 82%). Habit strength was positively correlated with medication adherence in most studies (10/11, 91%). Habit mediated the effects of self-efficacy on medication adherence (1/11, 9%), and social norms moderated the effects of habit strength on medication adherence (1/11, 9%). Habit strength also moderated the effects of poor mental health symptoms and medication adherence (1/11, 9%). None of the included studies reported on using or proposing a habit-based mHealth behavioral intervention to promote medication adherence. Conclusions Habit strength was strongly correlated with medication adherence, and stronger habit was associated with higher medication adherence rates, regardless of the theoretical model and/or guiding framework. Habit-based interventions should be used to increase medication adherence, and these interventions could leverage widely available mobile technology tools such as mobile apps or text messaging, and existing routines.

Mobile Apps for Dental Caries Prevention: Systematic Search and Quality Evaluation

“…Growing mobile phone ownership globally and integration with the internet [ 11 , 12 ] have prompted the development of and research into mobile health (mHealth) interventions to address a broad range of behavior change practices for chronic disease management. These mHealth tools seek to modify a range of broad and specific behavioral factors related to diet [ 13 ], exercise [ 14 ], and medication adherence [ 15 , 16 ] to manage a range of chronic conditions, including diabetes [ 17 , 18 ], obesity [ 19 , 20 ], and cardiovascular diseases [ 15 ]. A variety of mHealth interventions have shown promising results in a variety of populations across the lifespan [ 21 , 22 ] and have particularly provided equitable support to remote, regional, and underserved populations [ 23 - 27 ].…”

Daily text message assessments of 6‐mercaptopurine adherence and its proximal contexts in adolescents and young adults with leukemia: A pilot study

“…As described in the Adherence Standard, 6 assessing adherence more regularly may ultimately serve an important interventional role, potentially by way of providing a reminder, increasing accountability and self‐monitoring skills, and promoting healthy habits. Notably, habit strength is positively correlated with medication adherence—if daily adherence surveys promote more automatic behavior, there may be less chance for an AYA to forget to take their medication over time 43 . While medication reminders are prone to habituation, 44–46 providing a two‐way reminder (ie, asking whether or not the patient took the dose) may be more engaging.…”

“…Notably, habit strength is positively correlated with medication adherence-if daily adherence surveys promote more automatic behavior, there may be less chance for an AYA to forget to take their medication over time 43. While medication reminders are prone to habituation,[44][45][46] providing a two-way reminder (ie, asking whether or not the patient took the dose) may be more engaging.…”

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“…Various factors govern drug adherence, including delivery of health care services, economic situation, and cultural factors of patients [28]. Behavioral factors like forgetfulness, inappropriate time management, lack of awareness of disease, and fear of drugs pose additional barriers to drug adherence [29][30][31]. It has been observed that parents of patients with SCD with mild symptoms are less willing to accept the risk associated with taking hydroxyurea, particularly with regard to the long-term side effects, which include birth defects and cancer [29].…”