Human-Centered Design of a Personalized Digital Health Intervention to Improve Oral Chemotherapy Adherence in Adolescents and Young Adults With Hematologic Cancers.
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BACKGROUND: Acute lymphoblastic leukemia/lymphoma therapy includes a maintenance phase involving daily administration of an oral chemotherapy called 6-mercaptopurine (6-MP). Adolescents and young adults (AYAs) exhibit lower 6-MP adherence than younger patients, which increases their relapse risk. However, effective oral chemotherapy adherence interventions for this AYA population are lacking. OBJECTIVE: This study describes the human-centered design process of co-creating ADAPTS, an app-based just-in-time adaptive intervention for 6-MP adherence in AYAs. METHODS: Across three design waves with input from AYAs (n = 19) and their caregivers (n = 14), we conducted interviews to co-develop and refine ADAPTS. Qualitative data were coded using conventional content analysis to identify themes that informed app design. RESULTS: Four design priorities for an oral chemotherapy adherence digital intervention were identified: (i) personalize messages to the contextual factors that fluctuate and impact adherence, such as symptoms and mood; (ii) enhance the persuasiveness of adherence messages by framing them positively (e.g., a focus on maintaining remission rather than preventing a relapse), and including the perspectives of peers in popular social media formats; (iii) include customizable app features and the ability to track personal adherence progress; and (iv) facilitate dyadic adherence communication between AYAs and their caregivers, who are often involved. CONCLUSIONS: By developing ADAPTS with AYAs and their caregivers, this digital health intervention offers a novel and patient-centric approach to enhancing adherence. The resulting design priorities and human-centered design methods employed have generalizable potential for addressing other AYA cancer health behaviors.