Co-creating logic models of the context-mechanism-outcome configurations for a digital intervention to support medication adherence. (Preprint)

Saha, Srinjaya and Latham, Yvonne and Holland, Carol (2026) Co-creating logic models of the context-mechanism-outcome configurations for a digital intervention to support medication adherence. (Preprint). Other. JMIR Preprints.

Abstract

Background: Co-creating logic models or graphical representations of how interventions are expected to work with various stakeholders can help in understanding potential obstacles and contextual factors related to the implementation of the interventions. Using the realist approach to develop logic models of the contexts, mechanisms and outcomes can help in understanding which intervention components work for whom and under what circumstances. Objective: Therefore, a realist review method was chosen to create programme theories and logic models of a digital intervention that aimed to improve the medication adherence of hospital discharge patients and domiciliary care recipients in the United Kingdom. Methods: Two rounds of workshops were conducted to co-create logic models consisting of programme theories of how the digital medication adherence support device may work. Each workshop round recruited 12 participants, with three workshops in each round. Participants were regional Integrated Care board (ICB) employees involved in implementation of the device, care organisation managers, the device providers, ICB pharmacists, care recipients and informal (family) carers. Consistent with realist methodology, context-mechanism-outcome configurations were identified to analyse the data and presented as logic model visual representations. Results: Analysis resulted in 46 context-mechanism-outcome configurations in 6 different programme theory areas namely “solving medication related barriers”, “care-recipient and patient related factors affecting implementation and use of the device”, “health condition related factors affecting use of the device”, “healthcare related factors affecting implementation of the device”, “technology related factors affecting use of the device” and “social, economic and policy factors affecting implementation of the device”. The programme theories provided recommendations for tailoring intervention delivery for different contexts such as for individuals living with informal carers or alone. Various economic and policy-related barriers to effective implementation were identified, for example, lack of incentives for domiciliary care providers to refer care recipients to use the device. Conclusions: Findings provide recommendations for intervention developers to effectively tailor digital medication adherence implementation for different contexts and populations. Some of the findings are applicable to other digital health and care device implementations. Future studies should co-produce effective implementation strategies of such interventions in the context of adult domiciliary care with care providers and local authorities who commission care services. Policy changes to make the provision of digital medication adherence interventions mandatory for care recipients requiring medication adherence support should be considered.