THE ROLE OF CULTURAL AND CREATIVE INDUSTRIES IN IMPROVING ADHERENCE IN DIGITAL HEALTHCARE
DOI:
https://doi.org/10.55877/cc.vol32.555Keywords:
adherence, cultural and creative industries, digital health, engagementAbstract
Cultural and Creative Industries (CCIs) are an important sector in the European Union (EU) economy, recognized for their spill-over effect in promoting innovation and driving growth across various other sectors. This paper examines the impact of CCIs on digital health interventions (DHIs), addressing the critical problem of low therapy adherence. Poor adherence undermines therapy effectiveness, increases healthcare costs, and leads to premature deaths. By focusing on the role of CCIs in increasing user engagement, this study highlights their potential to improve therapy outcomes and thus public health. Through a systematic literature review, five domains were identified where CCIs directly influence DHIs: interaction experience, design, delivery formats, narrative, and gamification. The paper demonstrates how CCIs contribute to creating user-centric, accessible, and engaging DHIs by refining usability and design, tailoring content delivery, and crafting compelling narratives. These elements play a critical role in motivating users and sustaining engagement. Evidence highlights that CCIs hold great potential to influence engagement in digital health tools in both positive and negative directions. The findings underscore that by leveraging CCI expertise, DHIs can be optimized to enhance user experience, mitigate risks of disengagement, and improve therapy outcomes, ultimately contributing to better public health.
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Al-Arkee, S., Mason, J., Lane, D. A., Fabritz, L., et al. (2021). Mobile Apps to Improve Medication Adherence in Cardiovascular Disease: Systematic Review and Meta-analysis. Journal of Medical Internet Research, 23(5), e24190. https://doi.org/10.2196/24190
Amagai, S., Pila, S., Kaat, A. J., Nowinski, C. J., et al. (2022). Challenges in Participant Engagement and Retention Using Mobile Health Apps: Literature Review. Journal of Medical Internet Research, 24(4), e35120. https://doi.org/10.2196/35120
Andrade, E. L., Abroms, L. C., González, A. I., Favetto, C., et al. (2023). Assessing Brigada Digital de Salud Audience Reach and Engagement: A Digital Community Health Worker Model to Address COVID-19 Misinformation in Spanish on Social Media. Vaccines, 11, 1346. https://doi.org/10.3390/vaccines11081346
Baryakova, T. H., Pogostin, B. H., Langer, R., and McHugh, K. J. (2023). Overcoming barriers to patient adherence: the case for developing innovative drug delivery systems. Nature Reviews Drug Discovery, 22(5), 387–409. https://doi.org/10.1038/s41573-023-00670-0
Baryakova, T. H., Pogostin, B. H., Langer, R., McHugh, K. J. et al. (2020). Barriers and Strategies for Improving Medication Adherence Among People Living With COPD: A Systematic Review. Respiratory Care, 65(11), 1738–1750. https://doi.org/10.4187/respcare.07355
Berghs, M., Prick, A. E. J. C., Vissers, C., Van Hooren, S. (2022). Drama Therapy for Children and Adolescents with Psychosocial Problems: A Systemic Review on Effects, Means, Therapeutic Attitude, and Supposed Mechanisms of Change. Children (Basel), 9(9), 1358. https://doi.org/10.3390/children9091358
Bilham, J. (2021). Case Study: How Headspace Designs for Mindfulness. Raw Studio. Available: https://raw.studio/blog/how-headspace-designs-for-mindfulness/
Borghouts, J., Eikey, E., Mark, G., De Leon, C., et al. (2021). Barriers to and Facilitators of User Engagement With Digital Mental Health Interventions: Systematic Review. Journal of Medical Internet Research, 23(3), e24387. https://doi.org/10.2196/24387
Burns, Q., and Voida, S. (2023). Investigating Mobile Mental Health App Designs to Foster Engagement Among Adolescents. In: Tentori, M., Weibel, N. (eds.), Adjunct Proceedings of the 2023 ACM International Joint Conference on Pervasive and Ubiquitous Computing & the 2023 ACM International Symposium on Wearable Computing. New York: Association for Computing Machinery, 118–122. https://doi.org/10.1145/3594739.361070
Chadwick, H., Laverty, L., Finnigan, R., Elias, R., et al. (2024). Engagement With Digital Health Technologies Among Older People Living in Socially Deprived Areas: Qualitative Study of Influencing Factors. JMIR Formative Research, 8, e60483. https://doi.org/10.2196/60483
Chowdhury, R., Khan, H., Heydon, E., Shroufi, A., et al. (2013). Adherence to cardiovascular therapy: A meta-analysis of prevalence and clinical consequences. European Heart Journal, 34(38), 2940–2948. https://doi.org/10.1093/eurheartj/eht295
De Witte, M. da Silva Pinho, A., Stams, G.J., Moonen, X., et al. (2020). Music therapy for stress reduction: A systematic review and meta-analysis. Health Psychology Review, 16(1), 134–159. https://doi.org/10.1080/17437199.2020.1846580
Elkefi, S., Blecker, S., and Bitan, Y. (2024). Health Information Technology Supporting Adherence Memory Disorder Patients: A Systematic Literature Review. Applied Clinical Informatics, 15(01), 85–100. https://doi.org/10.1055/s-0043-1776792
European Commission (2021). Annual Single Market Report 2021. Available: https://eur-lex.europa.eu/legal-content/en/TXT/?uri=CELEX%3A52021SC0351
Ferreira-Brito, F., Alves, S., Guerreiro, T., Santos, O., at al. (2024). Digital health and patient adherence: A qualitative study in older adults. DIGITAL HEALTH, 10. https://doi.org/10.1177/20552076231223805
Gan, D. Z. Q., McGillivray, L., Larsen, M. E., and Torok, M. (2023). Promoting engagement with self-guided digital therapeutics for mental health: Insights from a cross-sectional survey of end-users. Journal of Clinical Psychology, 79(5), 1386–1397. https://doi.org/10.1002/jclp.23486
Graham, A. K., Kwasny, M. J., Lattie, E. G., Greene, C. J., et al. (2021). Targeting subjective engagement in experimental therapeutics for digital mental health interventions. Internet Interventions, 25, 100403. https://doi.org/10.1016/j.invent.2021.100403
Hasnan, S., Aggarwal, S., Mohammadi, L., and Koczwara, B. (2022). Barriers and enablers of uptake and adherence to digital health interventions in older patients with cancer: A systematic review. Journal of Geriatric Oncology, 13, 1084–1091. https://doi.org/10.1016/j.jgo.2022.06.004
Intawong, K., Puritat, K. (2021). A Framework of Developing Mobile Gamification to Improve User Engagement of Physical Activity: A Case Study of Location-Based Augmented Reality Mobile Game for Promoting Physical Health. International Journal of Online and Biomedical Engineering (iJOE), 17(07), 100–122. https://doi.org/10.3991/ijoe.v17i07.22349
Jakob, R., Narauskas, J., Fleisch, E., König, L. M., et al. (2024). Factors associated with adherence to a public mobile nutritional health intervention: Retrospective cohort study. Computers in Human Behavior Reports, 15, 100445. https://doi.org/10.1016/j.chbr.2024.100445
Kamei, M., Matsumoto, S., and Sakuma, H. (2018). The Effect of a Pseudo Winning or Losing Streak on Mental Attitudes and the Evaluation of Results. Psychological Reports, 121(3), 488–510. https://doi.org/10.1177/0033294117732344
Khan, N., Marvel, F. A., Wang, J., and Martin, S. S. (2017). Digital Health Technologies to Promote Lifestyle Change and Adherence. Current treatment options in cardiovascular medicine, 19(8), 60. https://doi.org/10.1007/s11936-017-0560-4
Khan, R., Socha-Dietrich, K. (2018). Investing in medication adherence improves health outcomes and health system efficiency. Organisation for Economic Co-operation and Development (OECD). https://doi.org/10.1787/8178962c-en
Langdon, K. J., Scherzer, C., Ramsey, S., Carey, K., et al. (2021). Feasibility and acceptability of a digital health intervention to promote engagement in and adherence to medication for opioid use disorder. Journal of Substance Abuse Treatment, 131(14), 108538. https://doi.org/10.1016/j.jsat.2021.108538
Lipschitz, J. M., Pike, C. K., Hogan, T. P., Murphy, S. A., et al. (2023). The Engagement Problem: a Review of Engagement with Digital Mental Health Interventions and Recommendations for a Path Forward. Current Treatment Options in Psychiatry, 10(3), 119–135. https://doi.org/10.1007/s40501-023-00297-3
McBride, C. M., Morrissey, E. C., and Molloy, G. J. (2020). Patients’ Experiences of Using Smartphone Apps to Support Self-Management and Improve Medication Adherence in Hypertension: Qualitative Study. JMIR mHealth and uHealth, 8(10), e17470. https://doi.org/10.2196/17470
Menhart, S., and Cummings, J. J. (2022). The Effects of Voice Qualities in Mindfulness Meditation Apps on Enjoyment, Relaxation State, and Perceived Usefulness. Technology, Mind, and Behavior, 3(4), 494–503. https://doi.org/10.1037/tmb0000089
Miller, A. C., Keenan, J. M., Betjemann, R. S., Willcutt, E. G., et al. (2013). Reading comprehension in children with ADHD: cognitive underpinnings of the centrality deficit. Journal of Abnormal Child Psychology, 41(3), 473–483. https://doi.org/10.1007/ s10802-012-9686-8
Naderi, S. H., Bestwick, J. P., and Wald, D. S. (2012). Adherence to Drugs That Prevent Cardiovascular Disease: Meta-analysis on 376,162 Patients. The American Journal of Medicine, 125(9), 882–887.e1. https://doi.org/10.1016/j.amjmed.2011.12.013
O’Brien, H. L., Chen, A. T., Kaneshiro, J., Zaslavsky, O. (2024). User Engagement in an Online Digital Health Intervention to Promote Problem Solving. Interacting with Computers, 36(5), 355–369. https://doi.org/10.1093/iwc/iwae030
Pérez-Jover, V., Sala-González, M., Guilabert, M., and Mira, J. J. (2019). Mobile Apps for Increasing Treatment Adherence: Systematic Review. Journal of Medical Internet Research, 21(6), e12505. https://doi.org/10.2196/12505
Perski, O., Blandford, A., West, R., and Michie, S. (2017). Conceptualising engagement with digital behaviour change interventions: a systematic review using principles from critical interpretive synthesis. Translational Behavioral Medicine, 7(2), 254–267. https://doi.org/10.1007/s13142-016-0453-1
PRISMA (n.d.). PRISMA Statement. Available: https://www.prisma-statement.org/
Ridho, A., Alfian, S. D., Van Boven, J. F. M., Levita, J., et al. (2022). Digital Health Technologies to Improve Medication Adherence and Treatment Outcomes in Patients With Tuberculosis: Systematic Review of Randomized Controlled Trials. Journal of Medical Internet Research, 24(2), e33062. https://doi.org/10.2196/33062
Saleem, M., Kühne, L., De Santis, K. K., Christianson, L., et al. (2021). Understanding Engagement Strategies in Digital Interventions for Mental Health Promotion: Scoping Review. JMIR Mental Health, 8, e30000. https://doi.org/10.2196/30000
Tran, S., Smith, L., El-Den, S., and Carter, S. (2022). The Use of Gamification and Incentives in Mobile Health Apps to Improve Medication Adherence: Scoping Review. JMIR mHealth and uHealth, 10(2), e30671. https://doi.org/10.2196/30671
Ridho, A., Alfian, S. D., Van Boven, J. F. M., Levita, J., et al. (2023). Design Features Associated With Engagement in Mobile Health Physical Activity Interventions Among Youth: Systematic Review of Qualitative and Quantitative Studies. JMIR mHealth and uHealth, 11, e40898. https://doi.org/10.2196/40898
Sheng, Y., Bond, R., Jaiswal, R., Dinsmore, J., et al. (2024). Augmenting K-Means Clustering With Qualitative Data to Discover the Engagement Patterns of Older Adults With Multimorbidity When Using Digital Health Technologies: Proof-of-Concept Trial. Journal of Medical Internet Research, 26, e46287. https://doi.org/10.2196/46287
Stewart, S.-J. F., Moon, Z., and Horne, R. (2022). Medication nonadherence: health impact, prevalence, correlates and interventions. Psychology & Health, 38(6), 726–765. https://doi.org/10.1080/08870446.2022.2144923
Van Kessel, R., Ranganathan, S., Anderson, M., McMillan, B., et al. (2024). Exploring potential drivers of patient engagement with their health data through digital platforms: A scoping review. International Journal of Medical Informatics, 189, 105513. https://doi.org/10.1016/j.ijmedinf.2024.105513
Vigo Health (n.d). The only clinic stroke patients will ever have to visit. Available: https://vigo.health/usa/
Walsh, C. A., Cahir, C., Tecklenborg, S., Byrne, C., et al. (2019). The association between medication non-adherence and adverse health outcomes in ageing populations: A systematic review and meta-analysis. British Journal of Clinical Pharmacology, 85(11), 2464–2478. https://doi.org/10.1111/bcp.14075
West, R., Michie, S. (2016). A Guide to Development and Evaluation of Digital Behaviour Change Interventions in Healthcare. United Kingdom: Silverback Publishing.
World Health Organization (2019). WHO guideline: recommendations on digital interventions for health system strengthening. Geneva: World Health Organization.
World Wide Web Consortium (n.d.). Web Content Accessibility Guidelines (WCAG) Overview. Available: https://www.w3.org/WAI/standards-guidelines/wcag/
Wu, T., Xiao, X., Yan, S., Fang, Y., et al. (2023). Digital health interventions to improve adherence to oral antipsychotics among patients with schizophrenia: a scoping review. BMJ Open, 13(11), e071984. https://doi.org/10.1136/bmjopen-2023-071984
Xiang, X., Turner, S., Ruiz-Sierra, S., Zheng, C., et al. (2024). Older Adults Experience with a Layperson-Supported Digital Mental Health Intervention for Depression: Qualitative Insights on Engagement. Clinical Gerontologist, 1–12. https://doi.org/10.1080/07317115.2024.2395890
Xu, J., Wang, B., Zhu, W., Ao, H. (2024). Creative art therapy for postpartum depression: A systematic review and meta-analysis. Complementary Therapies in Clinical Practice, 57, 101886. https://doi.org/10.1016/j.ctcp.2024.101886
Yeager, C. M., and Benight, C. C. (2018). If we build it, will they come? Issues of engagement with digital health interventions for trauma recovery. mHealth, 4, 37. https://doi.org/10.21037/mhealth.2018.08.04
Zainal, M., Zainal-Abadin, A. I., and Sulaiman, S. (2024). A study of quality criteria of mobile health application for medication adherence: User viewpoints. Journal of Theoretical and Applied Information Technology, 102(17), 6317–6329.
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