A Pharmaco-cybernetics Approach to Designing an Oncology Drug Interaction Database for Clinical Practice

This chapter describes how OncoRx-MI, a pharmaco-informatics platform for detecting chemotherapy interactions, was designed through a pharmaco-cybernetics approach targeting the 5 activities of the digital health innovation process. This is the first database of its kind that is able to provide interaction information for anticancer drugs and chemotherapy regimen cocktails. In order to identify the gap and determine the usefulness of this database in clinical oncology practice, the quality of online anticancer drug interactions was assessed, and the perceptions of oncology practitioners were sought. The results showed that the accuracy of drug interaction content and the clinical usefulness of the database was highly regarded by these practitioners. In addition, evidence of its relevance and credibility was demonstrated through user feedback on the database.

The Need for Quality Assessment of mHealth Interventions

With growing numbers of mHealth interventions, there is a need to evaluate the quality of existing apps based on quality assessment criteria that are grounded in published literature and health behavior research. These criteria can help identify the quality of mHealth apps from the perspectives of reliability, feature usefulness and feature convenience. This chapter will discuss the various quality criteria that are relevant for mHealth apps that target drug-related problems, as well as for medication management, through the development of two quality assessment tools. In addition to reliability, usability and privacy criteria, other feature criteria related to tele-monitoring, interaction checkers, dose calculators, medication information provision, medication records, as well as tele-support, tele-collaboration and personalization/contextualization, will be discussed. This chapter aims to provide guidance to mobile app developers, clinicians and patients on the types of quality parameters to consider in apps that are designed for pharmaceutical care and medication management.

Acceptability and Adoption of mHealth Interventions for Medication Adherence

The success of medication adherence apps depends on user acceptance and usage of the apps in their daily lives. It is essential for app developers to gain an in-depth understanding of the factors that can influence the acceptance of mHealth apps for adherence. It has been suggested that end users' acceptance of a technology-based health intervention can be studied through evaluation of their behavioral intention to use the intervention. Hence, it is important to continuously engage the target audience (e.g. clinicians, patients, caregivers) for their perceptions, experiences and feedback about the technological intervention, in this case, medication adherence apps. Factors such as socio-demographics and prior use of mobile technologies can influence user acceptance and adoption of mHealth apps. This chapter introduces the evolution of the Technology Acceptance Model (TAM) and the Unified Theory of Acceptance and Use of Technology (UTAUT). In addition, the application of the UTAUT2 model is described through a case study in Singapore that determined the factors which influenced the acceptability of mHealth-based adherence interventions among healthcare institutions in Singapore.

Introduction to Pharmaceutical Care and Medication Adherence

Pharmaceutical care is a concept that involves identifying, solving and preventing drug-related problems, such as drug interactions, with regards to a patient's drug therapy. Cancer patients are at high risk of drug interactions due to the complex pharmacological profiles and narrow therapeutic indices of anticancer drugs. Furthermore, these patients tend to consume complementary and alternative medicines, thus predisposing them to a risk of herb-drug interactions. This can impact their adherence to anticancer therapies. Various factors are involved in medication non-adherence, such as the cost of medications and patients' beliefs about the value of their treatments. There is a need to understand the impact of non-adherence and optimize intervention strategies from a macro-, meso-, and micro-level. Chapter 1 introduces the concept of pharmaceutical care and the impact of oncology drug interactions and medication non-adherence in patients with cancer. The chapter will also provide an insight to the factors influencing medication adherence and the intervention strategies that have targeted non-adherence.

Application of Health Behavior Frameworks in the Design of an Oral Anticancer Medication Adherence App

This chapter describes the application of the Intervention Mapping (IM) framework through a case study of the development of an in-house medication adherence mHealth app for oral anticancer medications (called MedFC). Using the behavioral intervention frameworks described previously, this chapter discusses how patients' medication adherence needs, mobile app usage, perceptions and experiences with the prototype helped inform the development of MedFC. Through iterative evaluations, this chapter will illustrate how a mHealth intervention can be developed in a holistic manner, involving its target audience in the design process.

Design Principles in the Development of Digital Health Applications

The roles of patients and healthcare professionals have evolved with the digital age. The convergence of digital technologies with health and healthcare services has led to the birth of disciplines such as digital health and pharmaco-cybernetics. Development of digital health innovations and mHealth applications need to be useful and user-friendly. For example, ease-of-use associated with mobile app interfaces can be more important to patients than the number and type of functionalities. Therefore, the application of health behavior theories and patient-centered approaches is needed to develop clinically relevant digital health systems and mHealth apps. This chapter introduces the pharmaco-cybernetic frameworks that are relevant for designing digital health innovations and an Intervention Mapping (IM) framework that can help inform behavioral change techniques. Concepts such as the Pharmaco-cybernetic Maxims, user-centered (UCD), experience-centered (ECD) and activity-centered designs (ACD), and the Ecological Systems Theory applied to technological and mHealth systems will be described. In addition, the consideration factors for technological product design based on UCD, ECD and ACD, as well as for iOS and Android platforms will be discussed.

The Role of mHealth in Improving Health and Medication Management

Mobile health (mHealth) involves the application of mobile devices and their related technologies in the provision of healthcare. In recent years, mHealth has become one of the most promising fields in improving healthcare quality and outcomes. There were over 325,000 mHealth apps in 2017, and this number is expected to grow tremendously due to continued investments in health apps. With advancements in mobile technologies and connectivity, mobile app developers now have the flexibility to develop and implement various mHealth-based interventions for medication management. Through improved functionalities and integration with electronic medical records, mHealth can potentially enable the provision of macro-, meso-, micro- and patient-level interventions in a more efficient manner. Chapter 2 provides an overview of the various mHealth interventions that have targeted medication management and medication non-adherence throughout the years, such as short-messaging services (SMSes) and smartphone apps. The functionalities that are useful in mHealth apps will also be discussed.