Abstract

Introduction
It is estimated that 30% - 50% of patients do not take medicines as prescribed. Medication taking can be described as a behaviour, at which behaviour change techniques (BCTs) could be applied. Text messages have been highlighted as a potential tool to support medicines adherence and could incorporate BCTs to support this. A face-to-face component may also be required alongside digital communication to address wider barriers to medicines taking. This support has been previously been delivered by community pharmacists in services such as medicines use reviews. It is important that stakeholders and intended recipients of new interventions are involved in any design process.

Objectives
To co-design a personalised two-way automated text messaging intervention combined with a community pharmacy consultation to support medication adherence.

Methods
A human centred design (HCD) approach was used[1]. Six prototypes were developed based on a systematic review. Three of these were presented to patients, including a personalisation questionnaire, patient information leaflet and video of an introduction to the intervention in a community pharmacy. A further two prototypes were presented to professionals including two diagrammatic representations, one of how the questionnaire would personalise the text message intervention and a second which suggested how the intervention could be integrated into existing care pathways. Both groups were also shown a video of a consultation incorporating the intervention with a community pharmacist. Nominal group technique was used as a framework to gather feedback for the co-design process. This used focus groups with patients and professionals to generate statements about the prototypes; items that participants liked and items that they felt needed to be changed. These were summarized and formulated into a ranking questionnaire which was then sent out to all participants either on paper or online.

Results
Nine patients and 21 healthcare professionals (pharmacists, nurses, general practitioners) were included in the co-design process across five focus groups. 17 participants also took part in the ranking exercise. The design concept was positively received by all participants. A summary of the highest ranked statements can be found in Table 1.There was agreement that a pharmacy setting and a review by a pharmacist was desirable by both patients and professionals. Changes suggested by patients also included ensuring that recipients understood that communication was automated during the consultation. Professionals additionally liked the range BCTs included in the intervention, especially the support for habit formation. However, they felt uncomfortable with the use of more negatively framed BCTs and wanted more support included for patients to use home monitoring equipment. Changes highlighted as part of the co-design process have now been incorporated into a final design which is undergoing ‘live’ prototyping as part of the next cycle of the HCD process.

Conclusions
HCD methods were effective for supporting a co-design process to assess initial acceptability of a new behavioural intervention to support medicines adherence. Other researchers may also find HCD methods helpful as for co-production of interventions with patients and professionals. The intervention ultimately will also require testing for effectiveness using a clinical trial design.

References
[1] IDEO. the Field Guide To Human-Centered Design. 2014. doi:10.1007/s13398-014-0173-7.2.