3, 23 Contextual cues such as preceding actions or surrounding objects also support the process of habit formation, which makes remembering easier in the long-term, as elements of the environment start to drive the behavior and make it automatic. 20, 21 Prospective memory research shows that tasks associated with existing routine events are easier to remember and, 22 by preventing forgetfulness, they can help to maintain higher adherence. taking medications at 9am and event-based tasks, e.g. 20 Based on the type of cue, prospective memory tasks can be divided into time-based tasks, e.g. a set of cognitive processes that regulate the formation, retention, and retrieval of intended actions at a particular point in the future. Remembering to take medications on time is linked with prospective memory, i.e. 19 This is especially relevant for understanding forgetfulness, as remembering relies heavily on contextual cues. When we think about context in terms of technology design, it is more than just a background in which a specific activity takes place: context arises from the activity it is something that people do. While various commercial products exist, from simple smartphone apps to complex medication management systems, and various researchers are working on novel approaches to supporting patients’ memory, 13 – 18 existing adherence technologies seem to neglect people’s actual behavior and the context within which they remember their medications. Moreover, such forgetfulness is still prevalent despite the wide access to technologies designed specifically to avoid this problem. 12 We focus specifically on forgetting to take medications on time, as it can occur even when people have medications with them and remember their regimen. the number of doses, number of pills per dose, taking instructions and drug interactions), forget to take medications on time, forget to pack them when going away or travelling, or forget to order prescription refills. There are several ways in which patients’ memory can fail: they can forget their regimen (e.g. In this paper, we focus on forgetfulness, as it is the main reason for unintentional non-adherence and can affect anyone, 11 including those who are motivated and would like to stay adherent. 9 Patients can be non-adherent intentionally and unintentionally to the same medication regimen at different times, 6 and both types of non-adherence can overlap as, for example, people with lower motivation to take their medications are less likely to put effort into developing a reliable remembering strategy and therefore are more likely to forget. medication unavailable at the local pharmacy), unclear communication with the physician, misunderstanding of the regimen, 3, 8 or deficiencies in their memory or dexterity. 6, 7 They can also become non-adherent because of factors beyond their control (unintentional non-adherence), such as the inability to access the medication (e.g. They may consciously decide to modify or discontinue their treatment (intentional non-adherence) because of side effects, lack of understanding of how the treatment works, their beliefs regarding the necessity of the treatment, and other related concerns. Once patients obtain their medications, they may still fail to adhere to their regimen. 5 However, redeeming the prescription is just the first obstacle. 2 – 4 Non-adherence can start even before the patient visits a pharmacy: primary non-adherence, a situation where a patient fails to redeem their prescription in the first place, affects an estimated 15% of patients. Despite high adherence being crucial to ensure that medications are effective, 1 adherence rates are low.
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