Using Mobile Apps May Be Feasible for Promoting Drug Adherence in ALL

Study results from the Journal of Medical Internet Research indicated that medication adherence by way of reminders on mobile devices for patients with acute lymphoblastic leukemia and their caregivers may have validity.

A study published in the Journal of Medical Internet Research showed that the use of mobile health (mHealth) had a positive effect on the regularity of systemic therapy intake in children, adolescent, and young adult patients with acute lymphoblastic leukemia (ALL), representing a potential method for promoting patient adherence.

Historically, patients being treated with oral 6-mercaptopurine (6-MP) have poor drug adherence, which may lead to an increased risk of disease relapse, representing an unmet clinical need.

“Our study contributes to the existing literature on medication adherence in pediatric ALL by reporting on the potential role of mHealth interventions to optimize adherence behavior in this population,” the study investigators, who were led by Mallorie B. Heneghan, MD, MSc, wrote in the paper. “Using a cross-sectional survey design, parents and patients with ALL self-reported on their access to technology as well as preferences for mHealth intervention features.”

In order to combat these effects, investigators on the trial sought to diminish poor therapy adherence in this set with the use of mobile technology by way of mHealth, which utilizes a combination of mobile and wireless applications for the delivery of health-related services. The platform is intended to implement behavior change techniques through its accessibility on mobile devices.

Both patients and caregivers were assessed for use of mHealth and surveyed about its use. Of the 57 families who consented to participate, both parents (n = 49) and patients (n = 15) owned and electric tablet (84% and 67%, respectively), a smartphone (96% and 100%), or both. In addition, most parents and patients had unlimited text messaging (98% and 93%, respectively) and access to high-speed internet at home (92% and 93%).

All 8 proposed features of mHealth were endorsed by more than half of those surveyed, and the median number of features endorsed was 7 (interquartile range, 6-8). For most parents (98%), the most favored quality was the ability to view lab results, followed by information about ALL medication (96%) and information about ALL (92%). For patients, the most favored attributes were daily medication reminders (93%), medication tracking (93%), and education about ALL (93%).

When the data were specifically related to medication adherence aspects of mHealth, parents and patients supported a median of 13 and 11 features, respectively. Both groups favored adherence-promoting app features. Parents indicated liking information provided about what 6-MP does (71%), reminders to refill 6-MP (71%), reminders to take 6-MP (71%), and a list of medications (71%). Patients conveyed positive feedback about reminders to refill 6-MP (73%), reminders to take 6-MP (73%), and a way to track 6-MP (73%).

“Our study adds to existing literature by demonstrating ubiquitous technology access and interest in mHealth among both parents of children with leukemia and AYAs with leukemia,” the investigators wrote. “Our findings suggest previously reported low rates of mHealth use by adolescents and parents of children with cancer are not due to a lack of interest in mHealth and represents the first step in user-centered design.”

Strengths of the study include the high enrollment and completion rates in a patient sample that both racially/ethnically diverse. However, the investigators did acknowledge that there is limited generalizability of the data given the relatively small sample size and its origin from a single center.

The investigators concluded by saying the results support further development of user-centered mHealth intervention, by way of mobile apps, to promote medication adherence in this patient population with ALL. They indicated that 2 versions of the app, one each for patients and parents, may be necessary to meet the needs of each group.


Heneghan MB, Hussain T, Barrera L, et al. Access to technology and preferences for an mHealth intervention to promote medication adherence in pediatric acute lymphoblastic leukemia: approach leveraging behavior change techniques. J Med Internet Res. 2021;23(2):e24893. doi: 10.2196/24893