A framework for mobile healthcare answers to chronically ill outpatient non-adherence

Abstract

Non-adherence (also known as 'non-compliance') is a major barrier undermining healing efforts within out-of-hospital self-management programmes, resulting in waste of human and social resources. This study suggests a theoretical framework of activities through which mobile patient solutions might address non-adherence determinants in a broader context of clinical interventions. The goal of the paper is to explore a dilemma associated with such interventions: the uncertainty regarding the level of patient involvement and technology support. We follow a critical orientation approach in discussing this multi-faceted conundrum: we summarise the latest vision on adherence factors, we suggest several types of interventions through which mobile healthcare solutions could address them, and we explore in detail the dilemma of patient and technology roles. We conclude that there is no universally optimal solution, and practical conditions depending on patient, disease, treatment and healthcare system are determining factors in prescribing the level of patient involvement and technology support. Our work is intended to stimulate further research into the nature of mobile solutions in health care and, especially, into patient acceptance aspects, in an endeavour to contribute to improving adherence with minimum obtrusiveness. © 2005 PHCSG, British Computer Society.