Enhancing Medication Adherence Through Behavioral Nudging: Potentials of a Smartphone App-Based Approach

Poor medication adherence remains a persistent challenge in healthcare, significantly impacting treatment outcomes and healthcare costs. While reminders and education have shown limited success, recent developments in behavioral economics suggest that subtle interventions, known as "nudges", can influence patient behavior more effectively. This paper presents the design, development, and initial evaluation of a smartphone application aimed at improving medication adherence through nudging techniques and interactive features. The app combines behavioral design principles with human-centered development to offer functions such as context-aware reminders, a social avatar interface (Adii), symptom and appointment tracking, and customizable scheduling. Nudging strategies include default settings, motivational prompts, social reinforcement, and salience through feedback mechanisms. The app's structure was co-designed with healthcare stakeholders, informed by literature and market analysis, and implemented using React Native for cross-platform compatibility. A two-phase usability study with 16 participants revealed that default schedules and visual feedback significantly influenced adherence behaviors. Personalized reminders and the avatar enhanced emotional engagement, while onboarding ease and offline support improved user trust. Though still in prototype phase, the app demonstrates promising utility for long-term adherence improvement. Future versions aim to incorporate adaptive nudging based on AI-driven user behavior modeling.