A conceptual model for developing digital health interventions to improve medication adherence in culturally and linguistically diverse communities

Introduction: Medication adherence (MA) is critical but challenging in growing CALD communities. Digital health interventions offer potential solutions but face barriers like the digital divide and cultural appropriateness. Effective and tailored medication adherence enhancing interventions (MAEIs) require co-design with stakeholders to ensure cultural sensitivity and sustainability. We aim to formalise a conceptual model for digital health intervention development to improve medication adherence in CALD communities. For this we aim to systematically identify and appraise the theories, strategies, and implementation considerations on MAEIs.

Methods: A rapid scoping review was conducted using pre-defined search terms from the databases including PubMed, Scopus and Web of Science, following PRISMA-ScR guidelines. All articles were screened for relevance, with 21 included.

Results: Predominant technology are SMS/text messaging and smartphone applications. Co-design method emerged as a critical and varied aspect. Available frameworks, including the WHO framework of medication adherence, COM-B model, and CSDH framework, were identified. Medication adherence was influenced by supporting factors and contextual considerations, as well as barriers, namely cultural/societal-related, medication-related, psychological-related, and healthcare system-related factors. Supporting MAEIs involved improved self-management capabilities, use of language familiar to patients, social support, patient education and empowerment. By systematically examining how framework was applied and how interventions were delivered differently across vulnerable populations, we propose a conceptual model that can be adapted to summarize common factors contributing to medication adherence in CALD groups.

Conclusions: Our conceptual models can be utilised as a guide for co-designing digital health interventions for medication adherence in CALD groups.