Designing for adherence

Creating effective digital tools through understanding patient needs and psychology

The latest systematic reviews analysing the efficacy of digital interventions supporting adherence often come to an anticlimactic conclusion. Sure, some solutions have a positive impact, but others still don’t show significant progress. Even so, there is a critical lesson here: outcomes can be improved only by digital tools that address real patient pain-points and integrate seamlessly into users’ lives.

Purely technological solutions aren’t sufficient by themselves for guiding patients through successful behaviour change. We need effective tools and strategies to comprehend patient behaviour and assist them in taking the correct actions.

Merely having an app on a patient's smartphone that lists which medications to take each day is not helpful unless the patient regularly uses the app and takes the medication as prescribed. Likewise, owning a device that tracks blood glucose levels is ineffective without the patient using it every day and acting on its recommendations.

Patients need different help in various stages of their journey

Outpatient treatments almost always require active patient involvement for effectiveness. Whether it’s using medical devices, applying ointments, or taking pills, treatments necessitate adapting daily routines and changing habits.

Adherence is a broad concept, but essentially it encompasses all actions a patient must take to ensure the success of their treatment plan. This begins with adopting the solution, i.e., filling a prescription to acquiring a device,  and spans through various stages to establish a long-term routine (persistence phase), which may last for a lifetime in some cases.

Success hinges on the patient’s willingness and ability to tackle challenges in the distinct stages of their journey. Digital solutions need to take these stages into account and customise support to address specific pain points in each stage to ensure a successful patient journey.

Patients go through several distinct stages in the process of adopting new medications, medical devices or health-tech solutions in their daily routines —each having its own challenges to be tackled by these solutions.

To illustrate this, we outline a typical patient journey of adopting and using a medical device, and highlight the behavioural and motivational challenges encountered at each stage.

Combining the power of tech and behavioural science to support the patient journey

To significantly influence patient behaviour, we recommend integrating technology solutions —such as sensory monitoring and AI insights — with behavioral science strategies, including Behavior Change Techniques (BCTs), habit loops, and reward systems.

Behavioural design is a growing field that merges the latest insights and frameworks from behavioural science research with practical product design methodologies. 

It strives to develop tools that empower individuals to change their behaviours to improve their health and tackle the behavioural challenges of their health management journey.

The 3 factors of behaviour change

The Fogg Behavior Model provides a practical framework to look at adherence. According to the model, complex human behaviours, including lifestyle changes, treatment adherence, and medical device use, hinge on three main factors: the ability, the motivation, and the trigger. The relation of these three critical elements influence whether an individual will engage in a specific action, such as using a medical device or adhering to a treatment plan.

The three factors:

• The ability of the person to carry out the behaviour
• The motivation of the person to do it
• Whether there is an adequate trigger that starts the process

The figure illustrates that motivation and ability are inversely related: the easier an action is (the higher the person’s ability), the less motivation is required to engage in the action. The action line marks the motivation and ability combinations that can successfully trigger a behaviour. However, it’s crucial to understand that without the right trigger, no action will take place, even with ample motivation and ability.

3 strategies for behaviour design interventions

Behaviour design interventions start by understanding what prevents patients from taking action: the factors contributing to non-adherence. 

Building on the insights of the Fogg Behavior Model, we have identified three key strategies to facilitate behaviour change and combat non-adherence. 

We design specific solutions along these strategies detailed below to remove the obstacles and establish a system that maximises the likelihood of people consistently performing the desired behaviour.

• Increase ability
• Increase motivation
• Provide triggers

Applying behaviour design to treatment adherence

Let’s use an example to demonstrate how the behavioural design approach can be applied to treatment adherence. We have a patient with hypertension who is required to measure their blood pressure frequently for medication adjustment. Based on the Fogg Behavior Model, we can identify the hindering factors that prevent our patient from

Infusing behavioural science with the right digital toolkit 

Technology creates numerous possibilities for using behavioural science to improve patient adherence and promote healthier behaviours. Below, we outline a few common solutions on how to integrate technology with behavioural design principles.

• Use tech to simplify patient actions: Identify possible mental or physical barriers to adherence, and develop tech solutions that radically simplify patient actions via automation. For example, an app could automatically send a prescription refill request to the doctor when the current supply is nearing depletion, then forward the prescription to the patient’s preferred pharmacy to organise delivery.
  
  
• Offer monitoring & feedback loops: Gather data through an app, integration with wearable sensors or other passive monitoring technology to track health stats and related patient behaviour. Provide feedback on their progress to reinforce positive actions.
  
  
• Utilise AI for personalised insights & recommendations: Leverage AI to analyse data collected through device usage or other monitoring technologies. Turn this data into tailored recommendations that guide patients to take specific steps and adjust their routines for improved adherence. Utilise AI for personalised motivational messaging and timely, context-aware nudges that may prompt the patient.
  
  
•  Build dynamic digital motivator systems: Make use of AI and machine learning to build dynamic motivator systems that adapt to user behaviour (e.g., medication adherence or app engagement). By analysing user data in real time, such a system could provide personalised rewards (e.g., virtual badges, points, or discounts) to encourage consistent positive actions.
  
  
• Deliver adequate triggers with digital tools: Leverage technology to deploy digital triggers that are both timely and pertinent. Use data to ensure that these prompts are delivered at the ideal moment and location, and are tailored to fit the user’s context. If a patient typically takes meds after arriving home in the evening, the system can send reminders precisely when the user is detected to be at home. 

In this series of blog articles, we've laid the groundwork for understanding the pivotal role of behavioral science in boosting patient adherence through digital aids. In this second piece, we delved into the process of creating impactful digital tools. 

In the third article, we are showcasing innovative health-tech solutions that have significantly improved patient engagement and adherence. To jump back to the basics, check out the introductory piece that equips you with essential insights into the factors shaping patient adherence and the effective utilization of supportive digital solutions.