Supporting Medication Adherence in Pediatric Hematopoietic Stem Cell Transplant Patients: A Mixed Methods Usability Study of the BMT4me© mHealth App (Preprint)
Authors: Kochashvili Mariam , Guttoo Parishma , Sazgin Emre , Pai Ahna , Bajwa Rajinder , Landier Wendy , Gerhardt Cynthia A , Skeens Micah A 
Published: September 2024

BACKGROUND

In high-risk pediatric hematopoietic stem cell transplant (HCT) populations, caregivers must manage complex treatment regimens at home with limited logistic and social support. These factors increase the risk for medication non-adherence with previously observed rates indicating 52% to 73% of pediatric HCT patients do not take their medications as prescribed during the treatment course. Poor medication adherence places patients at high risk for poor health outcomes, thus, adherence post-HCT remains a critical issue. The development of innovative smartphone solutions, which have proven effective in improving adherence and clinical outcomes in a range of pediatric conditions, have the potential to benefit caregivers, who are managing the medication regimens, of children receiving HCT.

OBJECTIVE

The aim of this study was to assess the usability and feasibility of a mHealth app (BMT4me©) designed to serve as a real-time, personalized intervention for medication management/adherence, symptom tracking, and journal keeping.

METHODS

Following a mixed methods approach, 14 caregivers of children (ages 0-18) in the acute phase (first 100 days) post-HCT were recruited from a Midwestern children’s hospital. Caregivers completed semi-structured interviews, standardized measures of usability, and weekly adherence. Quantitative data were analyzed using descriptive statistics. Thematic analysis was used for qualitative data.

RESULTS

The mean System Usability Scale score was 86.15 (SD=12.81) at enrollment and 73.13 (SD=16.13) at study completion, with most participants reporting the app easy to use and acceptable during both time points. At enrollment, 80% (n=12) of caregivers reported that the app was effective in motivating them to stay on schedule, and 87% (n=13) indicated they would recommend it to others. At study completion, 75% (n=6) of caregivers found the app helpful for tracking their child's medication schedule, and 64% (n=5) would recommend it to others. Caregivers described the app as “accessible,” “useful,” and “valuable.” Qualitative interviews during both time points revealed caregivers’ positive reactions to the app, particularly regarding medication reminders, tracking symptoms, and notes features, while also providing suggestions for improvements, such as integrating the BMT4me© app with electronic medical records, incorporating educational content, adding fields for recording vital signs, and important phone numbers.

CONCLUSIONS

The BMT4me© app demonstrated promising usability as a digital health intervention for managing medication adherence and tracking symptoms among pediatric patients undergoing HCT. Caregivers considered the app user-friendly and valuable, with positive feedback on its features, such as medication reminders and symptom tracking. Despite minor reported issues with app functionality, the overall acceptance of the app suggests its potential to support families in managing complex treatment regimens and to improve adherence outcomes. The findings from this study will inform the feasibility of testing in larger randomized controlled trials.

CLINICALTRIAL

ClinicalTrials.gov NCT04976933; https://clinicaltrials.gov/ct2/show/NCT04976933