Effects of coaching on adherence in remote health monitoring systems: Analysis and prediction of participant adherence

Among all of the major organizations, including the World Health Organization, the Centers for Disease Control and the Pew report the focus on disease prevention is critical. Given the rapid advances in technology it has become clear that there is a critical role for remote health monitoring systems (RHMS) in the prevention of chronic disease. The number of interdisciplinary clinical trials has increased over the past few years. In preventive medicine RHMS are designed to reinforce patient education, monitor and insure participant adherence, and provide a means of communicating information to the clinician. In this paper we examined data collected from a smartphone-based RHMS intervention for young Black women at risk for cardiovascular disease. The goal of the intervention was to improve cardiovascular risk factors through classroom-instituted self-management education on risk factor reduction in an attempt to change behavior over time. To augment the classroom education we created a means of remediation and social support through wireless monitoring and coaching creating a sense of "connectedness". This paper reports the effects of RHMS automated messages, clinician text messages and clinician phone calls in improving adherence to the study protocol. Typically participants with low adherence maintain low adherence, and participants with a high level of adherence maintain a high level of adherence. We examined the effects of messaging on adherence from one week to another and show that prior week adherence is a valuable predictor of the following week's adherence level. Our findings show that RHMS messages are successful in motivating the group of participants that are inconsistently adhering to the study regimen. We also show that it is possible to predict weekly participant adherence with high accuracy.