Using the behaviour change wheel to identify an eHealth intervention to enhance medication adherence in breast cancer survivors

Medication adherence to oral hormonal therapies (OHT) decreases the risk of breast cancer (BC) recurrence by over 30%. Depending on the drug and method of measurement, up to half of BC survivors discontinue their treatment before the recommended five years of treatment. This suboptimal persistence represents a major challenge to patients, healthcare providers and health systems, becoming a major public health priority. Despite the existence of numerous apps claiming to improve medication adherence, they lack successful and sustainable implementation and use.

This paper outlines a theory-driven development of an intervention to enhance medication adherence in BC survivors. The Behaviour Change Wheel (BCW) and the Capability Opportunity Motivation and Behavior (COM-B) model were applied to define the problem in behavioural terms, to identify intervention options and to determine content and implementation options.

Persistent OHT taking and timing, side-effect management, and consistent OHT pharmacy refill were defined as target behaviors. Using the COM-B model we identified the following umbrella components necessary to enhance OHT adherence; Capability (lack of knowledge, side-effects, size and texture of OHT), Opportunity (social support, patient-physician communication) and Motivation (lack of routine, religion and beliefs). The following 6 intervention functions were chosen; education, persuasion, training, environmental restructuring, modeling and enablement. Various implementation options were discussed.

The present work provides insight into a theory-driven analysis, enabling app developers to conceive a successful and sustainable eHealth intervention for BC survivors to enhance OHT adherence.

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