Adaptive Cell Phone Support to Promote Medication Adherence among Adolescents and Young Adults with Chronic Health Conditions - Project Summary/Abstract As more children with chronic health conditions (CHC) survive into adulthood, adolescence has become a vital stage for developing skills such as medication adherence. Unfortunately, adolescent and young adult (AYA) nonadherence rates are commonly >50%, leading to cascading negative outcomes such as poor health, reduced quality of life, and increased mortality risk. Although clinical trials show that mobile health (mHealth) interventions promote adherence among AYA-CHC, implementing these interventions in practice has proven difficult. Two substantial hurdles to scaling up mHealth interventions are creating highly acceptable interventions and securing resources to sustain interventions in healthcare systems. The scientific objective of this proposal is to create, pilot, and plan implementation for a highly scalable mHealth adherence intervention for AYA-CHC, centering the patient experience and minimizing required human resources. As an early stage investigator, I have pilot tested Cell Phone Support (CPS), an intervention entirely delivered by human coaches through phone calls and text messages. In CPS, adherence facilitators reach out to AYA-CHC several times a week to support them in remembering to take their medication, problem-solving to overcome adherence barriers, and accessing community resources. Although we found signals of efficacy that CPS promotes adherence across various CHCs (i.e., human immunodeficiency virus, organ transplant, sickle cell disease, type 2 diabetes), we have identified two major barriers to scalability: 1) CPS only demonstrates moderate acceptability to eligible youth; and 2) human coaches make the intervention relatively costly. We hypothesize that re-designing CPS to include both computer- and human-delivered components that can be offered in an adaptive structure based on individual needs will result in a more tailored and acceptable intervention better suited for widespread implementation. I propose using human-centered design research to co-create Adaptive CPS in partnership with an existing mHealth Research Youth Advisory Board (Aim 1). Adaptive CPS would offer all youth a foundation of computer-delivered adherence coaching, with human coaching provided in response to individually demonstrated needs. Then, we will conduct a pilot sequential multiple assignment randomized trial to evaluate feasibility, usability, acceptability, and preliminary efficacy of Adaptive CPS (Aim 2). Finally, we will engage patients, families, and workforce members in planning for future implementation (Aim 3). While completing the proposed research, I will achieve competencies in human-centered design research, clinical trial methods with an emphasis on optimization designs, and implementation science, which will lay a necessary foundation for a career creating, evaluating, and implementing mHealth self-management interventions with AYA-CHC. This project could produce a scalable, efficacious intervention to prepare AYA- CHC for a healthier transition to adulthood. I will concurrently develop the expertise needed to submit a competitive R01 proposal to conduct a full-scale hybrid effectiveness-implementation trial of Adaptive CPS.
