Selecting behaviour change techniques for asthma medication adherence apps::an evidence-based approach for developers

Background: Poor medication adherence is a widespread issue that causes adverse patient outcomes and is expensive to all aspects of the healthcare system. Developing cost-effective and scalable interventions to promote medication adherence is a key goal. Mobile apps hold promise as a mode of delivery for adherence interventions, but app design rarely takes into account the behavioural influences on non-adherence with sufficient rigour. As a result, apps may not realise their full potential at enhancing adherence. Medication non-adherence is common among adults prescribed preventer inhalers for asthma and has a variety of influences, creating a need to identify what components, or behaviour change techniques (BCTs), apps should include to effectively tackle each influence. <br/><br/>Objectives: To identify the most acceptable and practicable BCTs to include in a medication adherence app targeting factors that influence preventer inhaler adherence in adults with asthma<br/><br/>Methods: Key influences on preventer inhaler adherence in adults with asthma were identified based on reviews of peer reviewed and grey literature, and domain expert knowledge. These influences were then mapped to a published set of 26 mechanisms of action of behaviour change interventions. Next, candidate BCTs to change each mechanism of action (MoA) were identified using the Theory &amp; Techniques Tool (TaT Tool), an online resource that reflects almost 100 expert behavioural scientists’ consensus about which BCTs are most likely to change particular MoAs. Finally, candidate BCTs were filtered by considering their potential acceptability and practicability. <br/><br/>Results: 31 influences on preventer inhaler adherence were identified and coded to 15/26 of the influences on behaviour listed by the TaT Tool. The initial mapping of influences on behaviour to candidate BCTs to change those influences identified 41 candidate BCTs. After considering the potential acceptability and practicability of the candidate BCTs, the number of BCTs suggested for inclusion reduced to 24. <br/><br/>Discussion: Using an evidence-based approach, this study identified 24 BCTs that may be particularly useful to include in apps promoting adherence to preventer inhalers in order to target particular influences on adherence. The list can be used by app developers to improve the quality of adherence behaviour change support, which their apps provide, or by healthcare decision-makers to identify which apps contain elements addressing a range of adherence difficulties. <br/>