A study on the elements that affect digital technology acceptance in enhancing medication therapy adherence among patients with type 2 diabetes mellitus

Abstract

Despite various interventions, medication adherence among type 2 diabetes mellitus (T2DM) patients remains suboptimal, leading to poor glycaemic control, complications, and higher healthcare expenditure. Although digital apps demonstrated possibilities in improving adherence, the adoption rates are low, and the determinants influencing adoption remain unclear. Therefore, this study aimed to assess the acceptability of digital apps for enhancing medication adherence among Malaysian T2DM patients through four projects. Project 1, a systematic review and meta-analysis, evaluated the effects of mobile apps on adherence and glycaemic outcomes. Project 2, a qualitative phenomenological study, explored T2DM patients' perspectives on adopting mobile apps for medication adherence. Project 3, a quantitative cross-sectional survey, examined factors influencing readiness, acceptance, and barriers to app adoption. Project 4, a grounded theory study, explored strategies to enhance app adoption for T2DM medication adherence and self-management. The findings demonstrated that mobile apps improved medication adherence and glycaemic outcomes, reducing glycated haemoglobin (HbA1c MD -0.36%) and fasting plasma glucose (FPG MD - 16.75mg/dL). An extended Technology Readiness and Acceptance Model (TRAM) was proposed. Four readiness themes were identified: optimism as empowerment, embracing innovativeness, discomfort from unfamiliarity, and data insecurity. For acceptance, three perceived usefulness themes (medication, patient, and healthcare professional elements) and three perceived ease of use themes (patient, app, and family elements) emerged. 76% of participants were unready to use medication apps. 72% found them not useful and 74% perceived them as difficult to use. Hence, 75% were unwilling to use them. Only readiness (β = 0.467, p < 0.001) and perceived usefulness (β = 0.547, p < 0.001) significantly influenced adoption intentions. Readiness factors encompassed anticipated convenience (β = 0.492, p < 0.001), perceived benefits (β = 0.254, p = 0.022), openness to new technologies (β = 0.145, p < 0.001), and digital literacy (β = 0.109, p = 0.001). Meanwhile, perceived usefulness factors included age (β = -0.206, p < 0.001), healthcare professionals’ influence (β = 0.313, p < 0.001), and engagement (β = 0.308, p < 0.001). Furthermore, a multidimensional model for enhancing app adoption was developed, comprising technological, economic, social, behavioural, and environmental strategies. Overall, this study highlighted the prominent factors influencing app adoption for medication adherence, offering actionable strategies to improve app uptake. Future studies should focus on the practical implementation of digital interventions in real-world settings to achieve transformative impacts.