Work

Enhancing Medication Adherence in Adolescent and Young Adult (AYA) Hematopoietic Stem Cell Transplant (HCT) Patients and Their Caregivers through Mobile Health (mHealth) Solutions

Year: 2025

Type: article

Abstract: Background Medication adherence (MA) in AYAs is critical to the effectiveness of allogeneic HCT . Barriers to MA include side effects , forgetfulness, disrupted routines, and the AYAs’ desire for autonomy. Medication management among AYAs often involves a caregiver who provides essential reminders and support, which can strain the AYA-caregiver relationship, adding complexity to adherence. Just-In-Time Adaptive Interventions (JITAIs) offer promising solutions by delivering timely, personalized support. Integrating Artificial Intelligence (AI)-based algorithms, such as Reinforcement Learning (RL), into JITAIs can further tailor real-time support. However, these tools have yet to be fully utilized to benefit AYA-caregiver dyads in enhancing both MA and fostering positive relationships. Objective To explore current adherence strategies, identify opportunities to strengthen the AYA-caregiver relationship, and assess attitudes towards technological interventions, with the aim of developing an app that gamifies MA through RL algorithms. The goal is to promote stronger AYA-caregiver collaboration as a pathway to improving MA. Methods Participants were recruited from inpatient and outpatient HCT and hematology/oncology units, involving 16 AYAs and 14 caregivers. Through qualitative interviews and focus groups, participants discussed current MA practices, relationship-building, and technology use in medication management. Using the think-aloud method, participants provided feedback on mHealth app mock-ups. Data were audio-recorded, transcribed, and thematically analyzed. Results Three key themes emerged from this formative work: 1) Existing MA Strategies: Although AYAs and caregivers use established reminder strategies, like alarms and pill boxes, adherence remains suboptimal. 2) AYA-Specific Challenges: MA adds stress and tension to AYA-caregiver relationships, complicated by AYAs’ busy schedules and desire for autonomy. (3) Positive Attitudes Towards Technology: Participants found the mHealth app mock-ups user-friendly and expressed interest in tools that facilitate relationship-building to improve MA. Conclusion Based on these findings, two intervention components were developed, targeting relationship-building. The first involved sending messages twice daily to AYAs and once daily to caregivers, focusing on well-being and positive relationships rather than MA. The second was a collaborative phrase-guessing game implicitly linked to MA, designed to enhance the quality of the AYA-caregiver relationship by shifting the app's focus to a shared activity. After developing a high-fidelity app prototype, we plan to assess the feasibility and acceptability of a dyadic intervention in a pilot study involving 25 AYA-caregiver HCT dyads.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.jtct.2025.01.835