Abstract:

Background: Many midlife and older adults in the United States have multimorbid chronic conditions (MCC) with complex medication regimens and may face particular challenges to reaching optimal disease self-management, including medication adherence. There is evidence to support the use of mobile technology to teach health-related behavior in persons living with certain conditions, but most studies focus on a single technology (e.g., short message service [SMS] reminders) or a single disease state (e.g., HIV, single chronic condition) for mobile health (mHealth) education applications. There is great potential for mHealth tools to better facilitate adherence to multiple chronic disease management, but a more comprehensive approach inclusive of psychosocial or cultural influences are warranted. We discuss psychological, behavioral, sociocultural and age-related factors associated with learning disease self-management to guide the development of a mHealth teaching application to improve medication adherence, increase health literacy, and enhance quality of life adherence among this group for whom tailored health educations interventions have not yet been developed.

Methods: A mixed methods approach using quantitative and qualitative interviews with 21 persons with MCC aged 51-77 years from diverse cultural backgrounds was employed. The interviews lasted from 60 to 90 minutes. Using the Information-Motivation-Behavior Skills model as a conceptual framework, we employed a triangulation approach to identify major themes within sociocultural contexts relevant to understanding factors related to disease self-management. From the findings we outline integral components for the development of a culturally-tailored mHealth education intervention for midlife and older persons with MCC to be deployed over the Internet using computers or mobile technology (smart phones, tablets).

Results: The chronic conditions most often reported by participants for which medications were prescribed included diabetes, hypertension, heart disease, and hyperlipidemia. Major themes within psychological and sociocultural contexts relevant to understanding how older person with MCC manage their multiple chronic conditions and engage in self-care emerged: anxiety/depression, family and social support, spiritual influences, and doctor-patient relationship. Moreover, participants were receptive to engaging in an interactive, theoretically-based mHealth education intervention delivered using smartphones or tablets to be developed and tested in a future study. These education programs have the potential to engage patients who are less inclined to utilize traditional health services.

Conclusions: Teaching older persons with MCC to address depression and enhance positive coping skills through social support may prove a highly effective approach to improve not only their treatment adherence but their quality of life. For midlife and older persons with MCC, education programs to improve disease self-management and medication adherence will likely be most effective by using a tailored approach by targeting a variety of multi-level influences using technology that is easy and fun to use. Delivering health education interventions using technology-based strategies show promise, but may be more efficacious if the content and components are theoretically grounded, relevant, and applicable to the patient user.

Keywords:

Chronic illness, disease self-management education, health literacy, mobile health, older adults, Information-Motivation-Behavior (IMB) skills.