RESUMO
Interventions to improve medication adherence have had limited success and can require significant human resources to implement. Research focused on improving medication adherence has undergone a paradigm shift, of late, with a shift towards developing personalized, theory-driven interventions. The current research integrates foundational and translational science to implement a mechanisms-focused, context-aware approach. Increasing adoption of mobile and wearable sensing systems presents new opportunities for understanding how medication-taking behaviors unfold in natural settings, especially in populations who have difficulty adhering to medications. When combined with survey and ecological momentary assessment data, these mobile and wearable sensing systems can directly capture the context of medication adherence in situ, including personal, behavioral, and environmental factors. The purpose of this paper is to present a new transdisciplinary research framework in medication adherence, highlight critical advances in this rapidly-evolving research field, and outline potential future directions for both research and clinical applications.
RESUMO
BACKGROUND: Health interventions delivered via smart devices are increasingly being used to address mental health challenges associated with cancer treatment. Engagement with mobile interventions has been associated with treatment success; however, the relationship between mood and engagement among patients with cancer remains poorly understood. A reason for this is the lack of a data-driven process for analyzing mood and app engagement data for patients with cancer. OBJECTIVE: This study aimed to provide a step-by-step process for using app engagement metrics to predict continuously assessed mood outcomes in patients with breast cancer. METHODS: We described the steps involved in data preprocessing, feature extraction, and data modeling and prediction. We applied this process as a case study to data collected from patients with breast cancer who engaged with a mobile mental health app intervention (IntelliCare) over 7 weeks. We compared engagement patterns over time (eg, frequency and days of use) between participants with high and low anxiety and between participants with high and low depression. We then used a linear mixed model to identify significant effects and evaluate the performance of the random forest and XGBoost classifiers in predicting weekly mood from baseline affect and engagement features. RESULTS: We observed differences in engagement patterns between the participants with high and low levels of anxiety and depression. The linear mixed model results varied by the feature set; these results revealed weak effects for several features of engagement, including duration-based metrics and frequency. The accuracy of predicting depressed mood varied according to the feature set and classifier. The feature set containing survey features and overall app engagement features achieved the best performance (accuracy: 84.6%; precision: 82.5%; recall: 64.4%; F1 score: 67.8%) when used with a random forest classifier. CONCLUSIONS: The results from the case study support the feasibility and potential of our analytic process for understanding the relationship between app engagement and mood outcomes in patients with breast cancer. The ability to leverage both self-report and engagement features to analyze and predict mood during an intervention could be used to enhance decision-making for researchers and clinicians and assist in developing more personalized interventions for patients with breast cancer.