Acceptability of Mobile Directly Observed Therapy for Immunosuppression Medication Adherence in Adolescent Heart Transplant Recipients

Purpose Non-adherence with immunosuppressant medications is a significant challenge for pediatric transplant patients and is an important predictor of poor post-transplant outcomes. The risk of non-adherence in adolescents is 40-60% and few interventions are available. Methods Using a mobile video directly observed therapy (mDOT) application by emocha Health Inc. we conducted a 12-week intervention. Inclusion criteria: age 11-21 years, ≥6 months post-transplant, medically stable, and demonstrating low medication adherence [medication level variability index score (MLVI) >2.0 and/or clinical concern of medication non-adherence from transplant team]. A phone interview was performed at 3 weeks to assess patient acceptability of the mDOT application and intervention. The 3-week participant acceptability intervention interview included the Post Study System Usability Questionnaire (PSSUQ) to assess usability of and experience with the mDOT application with responses ranging from “1=strongly agree” to “5=strongly disagree”. Results 14 patients were approached, 4 (28.6%) consented but did not begin the program, and 2 (14.3%) completed 3 weeks before dropping out. Patients who completed the intervention were more likely to be younger, white, and have lower MLVI values 6 months prior to participation. Socio-economic status as measured by insurance type (Medicaid vs. private) was not a predictor of dropout. Overall, the 8 patients completing the 12-week mDOT program ranged from 12-21 years, majority were female (5, 62.5%), had mean MLVI scores of 2.54±0.65. The 3-week feasibility interview demonstrated high overall user satisfaction. Responses on the PSSUQ items yielded consistent responses (Table 1). Conclusion Adolescents and their parents reported positive perceptions of the mDOT application, with high levels of acceptability, and engagement early in the intervention. Further research is required to assess ongoing acceptability and benefit. Non-adherence with immunosuppressant medications is a significant challenge for pediatric transplant patients and is an important predictor of poor post-transplant outcomes. The risk of non-adherence in adolescents is 40-60% and few interventions are available. Using a mobile video directly observed therapy (mDOT) application by emocha Health Inc. we conducted a 12-week intervention. Inclusion criteria: age 11-21 years, ≥6 months post-transplant, medically stable, and demonstrating low medication adherence [medication level variability index score (MLVI) >2.0 and/or clinical concern of medication non-adherence from transplant team]. A phone interview was performed at 3 weeks to assess patient acceptability of the mDOT application and intervention. The 3-week participant acceptability intervention interview included the Post Study System Usability Questionnaire (PSSUQ) to assess usability of and experience with the mDOT application with responses ranging from “1=strongly agree” to “5=strongly disagree”. 14 patients were approached, 4 (28.6%) consented but did not begin the program, and 2 (14.3%) completed 3 weeks before dropping out. Patients who completed the intervention were more likely to be younger, white, and have lower MLVI values 6 months prior to participation. Socio-economic status as measured by insurance type (Medicaid vs. private) was not a predictor of dropout. Overall, the 8 patients completing the 12-week mDOT program ranged from 12-21 years, majority were female (5, 62.5%), had mean MLVI scores of 2.54±0.65. The 3-week feasibility interview demonstrated high overall user satisfaction. Responses on the PSSUQ items yielded consistent responses (Table 1). Adolescents and their parents reported positive perceptions of the mDOT application, with high levels of acceptability, and engagement early in the intervention. Further research is required to assess ongoing acceptability and benefit.