Selection of Behavior Change Techniques for Asthma Medication Adherence Apps: Evidence-Based Design Study.

Background: Poor medication adherence is a widespread issue that causes adverse patient outcomes and is expensive for all aspects of the health care system. Developing cost-effective and scalable interventions to promote medication adherence is a key goal. Mobile apps hold promise as a mode of delivery for adherence interventions, but app design rarely takes into account the behavioral influences on nonadherence with sufficient rigor. As a result, apps may not realize their full potential in enhancing adherence. Medication nonadherence is common among adults prescribed preventer inhalers for asthma and has a variety of influences, creating a need to identify what components behavior change technique (BCT) apps should include to effectively tackle each influence.

Objective: This study aimed to identify the most acceptable and practicable BCTs to include in a medication adherence app targeting factors that influence preventer inhaler adherence in adults with asthma.

Methods: Key influences on preventer inhaler adherence in adults with asthma were identified based on reviews of peer-reviewed and gray literature and domain expert knowledge. These influences were then mapped to a published set of 26 mechanisms of action (MoAs) of behavior change interventions. Next, candidate BCTs to change each MoA were identified using the Theory and Techniques tool, a web-based resource that reflects almost 100 expert behavioral scientists' consensus about which BCTs are most likely to change particular MoAs. Finally, candidate BCTs were filtered by considering their potential acceptability and practicability.

Results: A total of 31 influences on preventer inhaler adherence were identified and coded to 15/26 of the influences on behavior listed by the Theory and Techniques tool. The initial mapping of influences on behavior to candidate BCTs to change those influences identified 41 candidate BCTs. After considering the potential acceptability and practicability of the candidate BCTs, the number of BCTs suggested for inclusion was reduced to 24.

Conclusions: Using an evidence-based approach, this study identified 24 BCTs that may be particularly useful to include in apps promoting adherence to preventer inhalers in order to target particular influences on adherence. The list can be used by app developers to improve the quality of adherence behavior change support that their apps provide or by health care decision-makers to identify which apps contain elements addressing a range of adherence difficulties.