Please use this identifier to cite or link to this item:
Title: A smartphone app to improve medication adherence in patients with type 2 diabetes in Asia : feasibility randomized controlled trial
Authors: Huang, Zhilian
Tan, Eberta
Lum, Elaine
Sloot, Peter
Boehm, Bernhard Otto
Car, Josip
Keywords: Science::Medicine
Issue Date: 2019
Source: Huang, Z., Tan, E., Lum, E., Sloot, P., Boehm, B. O., & Car, J. (2019). A smartphone app to improve medication adherence in patients with type 2 diabetes in Asia : feasibility randomized controlled trial. JMIR mHealth and uHealth, 7(9), e14914-. doi:10.2196/14914
Journal: JMIR mHealth and uHealth
Abstract: Background: The efficacy of smartphone apps for improving medication adherence in type 2 diabetes is not well studied in Asian populations. Objective: This study aimed to determine the feasibility, acceptability, and clinical outcomes of using a smartphone app to improve medication adherence in a multiethnic Asian population with type 2 diabetes. Methods: We block randomized 51 nonadherent and digitally literate patients with type 2 diabetes between the ages of 21 and 75 years into two treatment arms (control: usual care; intervention: usual care+Medisafe app) and followed them up for 12 weeks. Recruitment occurred at a public tertiary diabetes specialist outpatient center in Singapore. The intervention group received email reminders to complete online surveys monthly, while the control group only received an email reminder(s) at the end of the study. Barriers to medication adherence and self-appraisal of diabetes were assessed using the Adherence Starts with Knowledge-12 (ASK-12) and Appraisal of Diabetes Scale (ADS) questionnaires at baseline and poststudy in both groups. Perception toward medication adherence and app usage, attitude, and satisfaction were assessed in the intervention group during and after the follow-up period. Sociodemographic data were collected at baseline. Clinical data (ie, hemoglobin A1c, body mass index, low-density lipoprotein, high-density lipoprotein, and total cholesterol levels) were extracted from patients’ electronic medical records. Results: A total of 51 (intervention group: 25 [49%]; control group: 26 [51%]) participants were randomized, of which 41 (intervention group: 22 [88.0%]; control group: 19 [73.1%]) completed the poststudy survey. The baseline-adjusted poststudy ASK-12 score was significantly lower in the intervention group than in the control group (mean difference: 4.7, P=.01). No changes were observed in the clinical outcomes. The average 12-week medication adherence rate of participants tracked by the app was between 38.3% and 100% in the intervention group. The majority (>80%) of the participants agreed that the app was easy to use and made them more adherent to their medication. Conclusions: Our feasibility study showed that among medication-nonadherent patients with type 2 diabetes, a smartphone app intervention was acceptable, improved awareness of medication adherence, and reduced self-reported barriers to medication adherence, but did not improve clinical outcomes in a developed Asian setting.
ISSN: 2291-5222
DOI: 10.2196/14914
Rights: © 2019 Zhilian Huang, Eberta Tan, Elaine Lum, Peter Sloot, Bernhard Otto Boehm, Josip Car. Originally published in JMIR Mhealth and Uhealth ( This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mhealth and uhealth, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.
Fulltext Permission: open
Fulltext Availability: With Fulltext
Appears in Collections:LKCMedicine Journal Articles

Citations 20

Updated on Mar 10, 2021

Citations 20

Updated on Mar 8, 2021

Page view(s)

Updated on May 15, 2021


Updated on May 15, 2021

Google ScholarTM




Items in DR-NTU are protected by copyright, with all rights reserved, unless otherwise indicated.