400.7 U-REAACT: Using mobile health to promote medication adherence in youth with kidney transplants
Tuesday May 07, 2019 from 08:00 to 09:30
Bayshore D

Sandra Amaral, United States

Medical Director, Kidney Transplant Program

Pediatric Nephrology

The Children's Hospital of Philadelphia


U-REAACT: Using mobile health to promote medication adherence in youth with kidney transplants

Sandra Amaral1, Lisa Schwartz1, Nataliya Zelikovsky5, Alexandra Psihogios1, Nancy Rodig2, Janaiya Reason1, Roshan George4, Brad Warady3.

1Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States; 2Pediatrics, Boston Children's, Boston, MA, United States; 3Pediatrics, Children's Mercy- Kansas City, Kansas City, MO, United States; 4Pediatrics, Chlidren's Healthcare of Atlanta-Emory Univ, Atlanta, GA, United States; 5Psychology, La Salle Univ, Philadelphia, PA, United States

Introduction: Nonadherence is associated with reduced quality of life and increased comorbidities and cost in young adults with kidney transplants. Adherence interventions are often clinic-based and not designed to intervene real-time when youth face difficulties. Mobile health (m-health) tools have shown promise to enhance healthcare self-management in youth with chronic conditions, but studies in youth with transplants are limited.

Methods: To test the effectiveness of m-health based interventions to improve medication adherence in youth with kidney transplants, we have designed U-REAACT, a multi-center randomized clinical trial that compares two 6-month m-health interventions to promote immunosuppressant adherence among youth with kidney transplants. Arm 1 receives text reminders and a nominal weekly payment for participation. Arm 2 receives text-based individualized feedback with financial incentives for meeting adherence goals. Both groups have access to educational materials. The infrastructure for the m-health component is built on the Way to Health platform, a web-based portal that has shown efficacy in supporting behavioral health interventions in adults. The primary outcome is change in adherence over time. Data are collected real-time when subjects take pictures of their medicines in hand.

Before implementation, a bank of text messages were constructed by study team members, including psychologists, to ensure fidelity to theoretically-informed mechanisms of health behavior change (i.e. social cognitive theory, such as promoting self-efficacy in the setting of financial incentives). The messages provide positive feedback on adherence behavior over each week. Before starting recruitment, we conducted interviews and a one-week pilot with 4 youth with liver transplants (who were ineligible for study but experiencing same adherence demands) to provide feedback on message tone, content and system usability.

Results: In pilot testing, subjects rated customized text-messages favorably and found the portal “simple and easy to use.” Minor content and programming changes were applied to reduce text messaging frequency/burden. Recruitment began in July 2017 and 69 kidney transplant recipients have enrolled. Target enrollment is 200 kidney transplant recipients. Initial recruitment barriers include that patients “already have a good system in place”, do not have enough time, and are “already managing too many things”. For those enrolled, it has been difficult to sustain their engagement with the portal. In addition, initial start-up revealed technical glitches.

Conclusions: Although m-health interventions show promise for youth, U-REAACT implementation has revealed some feasibility and acceptability challenges. Our study will provide new insights regarding the role of m-health interventions in real world settings to promote treatment adherence in youth with kidney transplants.

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