Understanding Adolescent and Young Adult 6-Mercaptopurine Adherence and mHealth Engagement during Cancer Treatment: Protocol for Ecological Momentary Assessment

Alexandra M. Psihogios*, Mashfiqui Rabbi, Annisa Ahmed, Elise R. McKelvey, Yimei Li, Jean Philippe Laurenceau, Stephen P. Hunger, Linda Fleisher, Ahna L.H. Pai, Lisa A. Schwartz, Susan A. Murphy, Lamia P. Barakat

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Background: Adolescents and young adults (AYAs) with cancer demonstrate suboptimal oral chemotherapy adherence, increasing their risk of cancer relapse. It is unclear how everyday time-varying contextual factors (eg, mood) affect their adherence, stalling the development of personalized mobile health (mHealth) interventions. Poor engagement is also a challenge across mHealth trials; an effective adherence intervention must be engaging to promote uptake. Objective: This protocol aims to determine the temporal associations between daily contextual factors and 6-mercaptopurine (6-MP) adherence and explore the proximal impact of various engagement strategies on ecological momentary assessment survey completion. Methods: At the Children s Hospital of Philadelphia, AYAs with acute lymphoblastic leukemia or lymphoma who are prescribed prolonged maintenance chemotherapy that includes daily oral 6-MP are eligible, along with their matched caregivers. Participants will use an ecological momentary assessment app called ADAPTS (Adherence Assessments and Personalized Timely Support) a version of an open-source app that was modified for AYAs with cancer through a user-centered process and complete surveys in bursts over 6 months. Theory-informed engagement strategies will be microrandomized to estimate the causal effects on proximal survey completion. Results: With funding from the National Cancer Institute and institutional review board approval, of the proposed 30 AYA-caregiver dyads, 60% (18/30) have been enrolled; of the 18 enrolled, 15 (83%) have completed the study so far. Conclusions: This protocol represents an important first step toward prescreening tailoring variables and engagement components for a just-in-Time adaptive intervention designed to promote both 6-MP adherence and mHealth engagement.

Original languageEnglish (US)
Article numberA18
JournalJMIR Research Protocols
Issue number10
StatePublished - Oct 2021


  • adolescents
  • cancer
  • ecological momentary assessment
  • mHealth
  • mobile phone
  • oncology
  • self-management
  • young adults

ASJC Scopus subject areas

  • General Medicine


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