The presence of accountability in digital interventions targeting non-adherence: A review

Abstract

Objectives: Provider-centered accountability, defined as the anticipation of a social interaction between a patient and their provider, increases patients' adherence to prescribed treatment. Digital adherence interventions based on accountability may be especially effective at promoting adherence. The current study aimed to assess whether publications on digital adherence interventions discuss accountability, include intervention components related to accountability, and measure feelings of patient accountability as an outcome.

Methods: PubMed was queried between January 2010 and March 2021 to identify randomized controlled trials incorporating digital adherence interventions. Full-text articles were assessed for participant demographics, interventions utilized, outcomes, and intervention effectiveness.

Results: A total of 131 publications met inclusion criteria. Only four publications discussed accountability as a potential factor influencing patient adherence. Although 11% of publications included an intervention with direct accountability, only one did so by design. None of the included studies assessed feelings of accountability as an outcome.

Conclusions: While provider-centered accountability has the potential to boost the efficacy of digital adherence interventions, accountability is rarely incorporated in studies of such interventions.

Practice implications: Additional investigation into the influence of accountability on adherence interventions will allow for the development of these interventions as effective tools applicable to the full range of patients.

Keywords: Accountability; Adherence; Behavior; Digital interventions; MHealth.