As discussed previously, the ‘adherence problem’ is complex and inherently interdisciplinary, that is, it requires experts from many different disciplines to solve it: healthcare-related clinicians (doctors, nurses, pharmacists, psychologists, psychiatrists), social workers, epidemiologists, health-related researchers, and policy makers (among others).  In fact, a more appropriate term for how adherence should be approached is ‘transdiciplinary’.  This term is a better fit because it suggests that adherence requires a holistic approach, one that integrates knowledge from all related disciplines into a coherent whole.

Alternatively, an argument can be made that adherence should be considered its own discipline.  The advantages of this approach are two-fold.  First, adherence would be subject to the same methodological rigour as other disciplines including the establishment of an evidence base.  Secondly it means that adherence would undergo organized, systematic dissemination of knowledge that incorporates structured training.  These processes are already moving forward with publications such as adherence-specific journals and adherence-related toolkits from reputable sources (aimed at clinicians).  Unfortunately, while the evidence base is building, the use of the evidence in adherence-based interventions is still lacking.  As summarized recently in an article on medication adherence and healthcare reform, “there needs to be greater use of proven screening and assessment tools to identify and target the patients who are at the greatest risk for nonadherence”1.  In other words the field of adherence also requires that this evidence be put into practice.

Similar arguments can (and have) been made for the field of mHealth – namely that mHealth is by its very nature an interdisciplinary field and that establishment of an evidence base within the field of mHealth is sorely needed.  In fact a recent World Health Organization document summarizing global mHealth initiatives2 stated: “In order to be considered among other priorities, mHealth programmes require evaluation. This is the foundation from which mHealth (and eHealth) can be measured: solid evidence on which policy-makers, administrators, and other actors can base their decisions” (page 10).

The strengths of the MEMOTEXT platform are that we contribute to the evidence base for adherence and mHealth because we design our intervention programs around the importance of measuring outcomes and we place a heavy emphasis on communicating these results.  We also use the evidence base that has already been established to inform the design and implementation of our interventions.  In a future blog we will explain a bit more about what constitutes an evidence base and, more specifically, what we consider good and/or appropriate evidence.

References:

  1. Cutler DM and Everett W. 2010. Thinking Outside the Pillbox — Medication Adherence as a Priority for Health Care Reform. N Engl J Med 362:1553-1555.
  2. World Health Organization. mHealth: New horizons for health through mobile technologies (2nd Global Survey on eHealth). 2011. Geneva, Switzerland: World Health Organization. http://www.who.int/goe/publications/goe_mhealth_web.pdf. Accessed February 6, 2013.