Document Type : Original Article

Authors

1 Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Department of Basic Sciences, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 Student Research Committee, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract

BACKGROUND: Patients with cardiovascular disease need to adhere to their treatment and care recommendations to prevent the progression of their condition and improve their quality of life. In this regard, this study was conducted to develop a mobile application and test its effectiveness in improving medication adherence among persons with cardiac disease.
METHODS: The study was conducted in two stages. The first stage involved the preparation of the “Mobile Application for Persons with Cardiac Disease” using the cascade model. In the second stage, 121 patients who were hospitalized in the cardiac intensive care unit of Ayatollah Taleghani Medical Education Center of Tehran from March to August 2023 were enrolled. The participants were randomly assigned to either the control group (63 people) or the intervention group (58 people). The study collected data using a medication adherence questionnaire on the 7th, 14th, and 21st day after discharge and compared the results with the control group. The data were analyzed using SPSS 20.
RESULTS: The average age of the control group was 56.75 ± 11.38 years, and the average age of the intervention group was 57.03 ± 11.55 years. The comparison of the average medication adherence with independent t-tests showed a significant difference between the intervention and control groups on the 7th, 14th, and 21st day after discharge (P<0.01). The results of the repeated measures test in each group also showed that the difference between the groups increased over time (P<0.001).
CONCLUSION: The results of the study showed that the mobile application is effective in improving medication adherence among heart patients.

Keywords

  1. 1Hassan AFJ. Assessment of Nurses Knowledge about Patient Safety after Cardiac Catheterization for Adult Patients in Ibn Al-Biter Specialist Center Cardiac Surgery. Int J Sci Res. 2017;6(5):2763-66.
  2. Lin CY, Ganji M, Griffiths MD, Bravell ME, Broström A, Pakpour AH. Mediated effects of insomnia, psychological distress and medication adherence in the association of eHealth literacy and cardiac events among Iranian older patients with heart failure: a longitudinal study. Eur J Cardiovasc Nurs. 2020 Feb;19(2):155-64. https://doi.org/10.1177/1474515119873648
  3. Thabet OF, Al-Maqtari RA, Al-Sanabani RM, Al-Khawlani NM. Assessment of Nurse’s knowledge and practice for patients undergoing Cardiac Catheterization. Int J Sci Res. 2019;7(17):95-101.
  4. Cequier Á, Bueno H, Moreno R, Fernández-Ortiz A, Alonso JJ, Heras M, et al. Requirements and sustainability of primary PCI programs in Spain for the management of patients with STEMI. SEC, AEEC, and SEMES consensus document. Rev Esp Cardiol. 2019;1:108-19. https://doi.org/10.24875/RECICE.M19000042
  5. Riegel B, Moser DK, Buck HG, Dickson VV, Dunbar SB, Lee CS, et al. Self‐care for the prevention and management of cardiovascular disease and stroke: A scientific statement for healthcare professionals from the American Heart Association. J Am Heart Assoc. 2017;6(9):e006997. https://doi.org/10.1161/jaha.117.006997
  6. Gandhi S, Chen S, Hong L, Sun K, Gong E, Li C, et al. Effect of mobile health interventions on the secondary prevention of cardiovascular disease: systematic review and meta-analysis. Can J Cardiol. 2017;33(2):219-31. https://doi.org/10.1016/j.cjca.2016.08.017
  7. Kanyongo W, Ezugwu AE. Feature selection and importance of predictors of non-communicable diseases medication adherence from machine learning research perspectives. Inform Med Unlocked. 2023;38:101232. https://doi.org/10.1016/j.imu.2023.101232
  8. Kvarnström K, Westerholm A, Airaksinen M, Liira H. Factors contributing to medication adherence in patients with a chronic condition: a scoping review of qualitative research. Pharmaceutics. 2021;13(7):1100. https://doi.org/10.3390/pharmaceutics13071100
  9. Sadeghi A, Masjedi Arani A, Karami Khaman H, Qadimi A, Ghafouri R. Patient safety improvement in the gastroenterology department: An action research. PLoS One. 2023;18(8):e0289511. https://doi.org/10.1371/journal.pone.0289511
  10. Wilder ME, Zheng Z, Zeger SL, Elmi A, Katz RJ, Li Y, et al. Relationship Between Social Determinants of Health and Antihypertensive Medication Adherence in a Medicaid Cohort. Circ Cardiovasc Qual Outcomes. 2022 Feb;15(2):e008150. https://doi.org/10.1161/circoutcomes.121.008150
  11. Wan J, Wu Y, Ma Y, Tao X, Wang A. Predictors of poor medication adherence of older people with hypertension. Nurs Open. 2022 Mar;9(2):1370-78. https://doi.org/10.1002%2Fnop2.1183
  12. Alegria M, Atkins M, Farmer E, Slaton E, Stelk W. One size does not fit all: taking diversity, culture and context seriously. Adm Policy Ment Health. 2010 Mar;37(1-2):48-60. https://doi.org/10.1007%2Fs10488-010-0283-2
  13. Dineen-Griffin S, Garcia-Cardenas V, Williams K, Benrimoj SI. Helping patients help themselves: A systematic review of self-management support strategies in primary health care practice. PLoS One. 2019 Aug 1;14(8):e0220116. https://doi.org/10.1371/journal.pone.0220116
  14. Unverzagt, S., et al., Unverzagt S, Meyer G, Mittmann S, Samos FA, Unverzagt M, Prondzinsky R. Improving Treatment Adherence in Heart Failure. Dtsch Arztebl Int. 2016 Jun 24;113(25):423-30. https://doi.org/10.3238%2Farztebl.2016.0423
  15. Forsetlund L, O’Brien MA, Forsén L, Reinar LM, Okwen MP, Horsley T, et al. Continuing education meetings and workshops: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2021 Sep 15;9(9):CD003030. https://doi.org/10.1002/14651858.cd003030.pub3
  16. Cheng C, Donovan G, Al-Jawad N, Jalal Z. The use of technology to improve medication adherence in heart failure patients: a systematic review of randomised controlled trials. J Pharm Policy Pract. 2023 Jun 29;16(1):81. https://doi.org/10.1186/s40545-023-00582-9
  17. Choudhry NK, Kronish IM, Vongpatanasin W, Ferdinand KC, Pavlik VN, Egan BM, et al., Medication Adherence and Blood Pressure Control: A Scientific Statement From the American Heart Association. Hypertension. 2022 Jan;79(1):e1-e14. https://doi.org/10.1161/hyp.0000000000000203
  18. Palathingal JT, Tom R, Babu VN, Chacko SE, Kumar AS, Saravanan M, et al. Assessment of medication adherence in rural population with type 2 diabetes: study in a tertiary care hospital in south India. Int J Biomed Sci. 2020;16(2):21-9. http://dx.doi.org/10.59566/IJBS.2020.16021
  19. Nili M, Epstein AJ, Nunag D, Olson A, Borah B. Using group based trajectory modeling for assessing medication adherence to nintedanib among idiopathic pulmonary fibrosis patients. BMC Pulm Med. 2023 Jun 27;23(1):230. https://doi.org/10.1186%2Fs12890-023-02496-3
  20. Cannon C. Telehealth, Mobile Applications, and Wearable Devices are Expanding Cancer Care Beyond Walls. Semin Oncol Nurs. 2018 May;34(2):118-25. https://doi.org/10.1016/j.soncn.2018.03.002
  21. Alatawi Y, Hansen RA, Chou C, Qian J, Suppiramaniam V, Cao G. The impact of cognitive impairment on survival and medication adherence among older women with breast cancer. Breast Cancer. 2021 Mar;28(2):277-88. https://doi.org/10.1007/s12282-020-01155-3
  22. Dabaghian FH, Rassouli M, Sadighi J, Ghods R. Adherence to prescribed medications of Iranian traditional medicine in a group of patients with chronic disease. J Res Pharm Pract. 2016 Jan-Mar;5(1):52-7. https://doi.org/10.4103/2279-042x.176563
  23. Pietrzykowski Ł, Michalski P, Kosobucka A, Kasprzak M, Fabiszak T, Stolarek W, et al. Medication adherence and its determinants in patients after myocardial infarction. Sci Rep. 2020 Jul 21;10(1):12028. https://doi.org/10.1038%2Fs41598-020-68915-1
  24. Santo K, Singleton A, Chow CK, Redfern J. Evaluating Reach, Acceptability, Utility, and Engagement with An App-Based Intervention to Improve Medication Adherence in Patients with Coronary Heart Disease in the MedApp-CHD Study: A Mixed-Methods Evaluation. Med Sci (Basel). 2019 Jun 4;7(6):68. https://doi.org/10.3390/medsci7060068
  25. Hunt KL. Utilizing Interactive Digital Media to Impact Patient Knowledge and Medication Adherence in Cardiovascular Disease Patients: A Quality Improvement Project. Georgetown University; 2023.
  26. Athilingam P, Osorio RE, Kaplan H, Oliver D, O’neachtain T, Rogal PJ. Embedding Patient Education in Mobile Platform for Patients With Heart Failure: Theory-Based Development and Beta Testing. Comput Inform Nurs. 2016 Feb;34(2):92-8. https://doi.org/10.1097/cin.0000000000000216
  27. Kripalani S, Risser J, Gatti ME, Jacobson TA. Development and evaluation of the Adherence to Refills and Medications Scale (ARMS) among low-literacy patients with chronic disease. Value Health. 2009 Jan-Feb;12(1):118-23. https://doi.org/10.1111/j.1524-4733.2008.00400.x
  28. Li Y, Gong Y, Zheng B, Fan F, Yi T, Zheng Y, et al. Effects on Adherence to a Mobile App-Based Self-management Digital Therapeutics Among Patients With Coronary Heart Disease: Pilot Randomized Controlled Trial. JMIR Mhealth Uhealth. 2022 Feb 15;10(2):e32251.
  29. Mohapatra DP, Mohapatra MM, Chittoria RK, Friji MT, Kumar SD. The scope of mobile devices in health care and medical education. Int J Adv Med Health Res. 2015;2(1):3-8. https://doi.org/10.4103/2349-4220.159113
  30. Schooley B, Horan TA, Lee PW, West PA. Impacts of mobile tablet computing on provider productivity, communications, and the process of care. Int J Med Inform. 2016;88:62-70. https://doi.org/10.1016/j.ijmedinf.2016.01.010
  31. Arshed M, Mahmud AB, Minhat HS, Ying LP, Umer MF. Effectiveness of mHealth Interventions in Medication Adherence among Patients with Cardiovascular Diseases: A Systematic Review. Diseases. 2023 Mar 1;11(1):41. https://doi.org/10.3390%2Fdiseases11010041
  32. Kulbayeva S, Tazhibayeva K, Seiduanova L, Smagulova I, Mussina A, Tanabayeva S, et al. The Recent Advances of Mobile Healthcare in Cardiology Practice. Acta Inform Med. 2022 Sep;30(3):236-50. https://doi.org/10.5455/aim.2022.30.236-250
  33. Schorr EN, Gepner AD, Dolansky MA, Forman DE, Park LG, Petersen KS, et al., Harnessing Mobile Health Technology for Secondary Cardiovascular Disease Prevention in Older Adults: A Scientific Statement From the American Heart Association. Circ Cardiovasc Qual Outcomes. 2021 May;14(5):e000103. https://doi.org/10.1161/hcq.0000000000000103
  34. Quazi S, Malik JA. A Systematic Review of Personalized Health Applications through Human-Computer Interactions (HCI) on Cardiovascular Health Optimization. J Cardiovasc Dev Dis. 2022 Aug 16;9(8):273. https://doi.org/10.3390/jcdd9080273
  35. Sharma A, Mentz RJ, Granger BB, Heitner JF, Cooper LB, Banerjee D, et al., Utilizing mobile technologies to improve physical activity and medication adherence in patients with heart failure and diabetes mellitus: Rationale and design of the TARGET-HF-DM Trial. Am Heart J. 2019 May;211:22-33. https://doi.org/10.1016/j.ahj.2019.01.007
  36. Dwivedi YK, Hughes DL, Kar AK, Baabdullah AM, Grover P, Abbas R, et al. “So what if ChatGPT wrote it?” Multidisciplinary perspectives on opportunities, challenges and implications of generative conversational AI for research, practice and policy. Int J Inf Manage. 2023;71:102642. https://doi.org/10.1016/j.ijinfomgt.2023.102642
  37. Kuh GD, Kinzie J, Buckley JA, Bridges BK, Hayek JC. What matters to student success: A review of the literature. Washington, DC: National Postsecondary Education Cooperative; 2006. Vol. 8.
  38. Mulford B. School leaders: Challenging roles and impact on teacher and school effectiveness. Paris: OECD; 2003. Available at: www.oecd.org/edu/schoolleadership
  39. Park JYE, Li J, Howren A, Tsao NW, De Vera M. Mobile Phone Apps Targeting Medication Adherence: Quality Assessment and Content Analysis of User Reviews. JMIR Mhealth Uhealth. 2019 Jan 31;7(1):e11919. https://doi.org/10.2196/11919
  40. Bostrom J, Sweeney G, Whiteson J, Dodson JA. Mobile health and cardiac rehabilitation in older adults. Clin Cardiol. 2020 Feb;43(2):118-126. https://doi.org/10.1002/clc.23306
  41. Armitage LC, Kassavou A, Sutton S. Do mobile device apps designed to support medication adherence demonstrate efficacy? A systematic review of randomised controlled trials, with meta-analysis. BMJ Open. 2020 Jan 30;10(1):e032045. https://doi.org/10.1136/bmjopen-2019-032045
  42. Akinosun AS, Polson R, Diaz-Skeete Y, De Kock JH, Carragher L, Leslie S, et al. Digital Technology Interventions for Risk Factor Modification in Patients With Cardiovascular Disease: Systematic Review and Meta-analysis. JMIR Mhealth Uhealth. 2021 Mar 3;9(3):e21061. https://doi.org/10.2196/21061