Development and Evaluation of a Mobile-Based Medication Adherence Monitoring System with Early-Risk Detection and SMS- Based Intervention for Chronic Disease Management in Uganda

Medication adherence is one of the central challenges in the management of patients with chronic diseases. Patients fail to adhere for many reasons, including forgetting to take their medicines, the burden of complex regimens, the cost of treatment, limited understanding of their condition, and the absence of timely support between clinic visits. Poor adherence undermines treatment, worsens clinical outcomes, and increases the cost borne by patients and by the health system. In low-resource settings such as Uganda, where many patients own only basic mobile telephones and face barriers of distance, literacy and connectivity, there is a particular need for simple, affordable and context-sensitive tools to support adherence. This study describes the design and evaluation of a mobile-based tool to monitor medication adherence among patients with chronic diseases in Uganda. The tool is intended to help patients take their medicines as prescribed, to detect early signs that adherence is deteriorating, and to respond with targeted short message service (SMS) interventions matched to the level of risk. It combines four capabilities: medication scheduling, the monitoring of adherence events, an interpretable early-risk detection mechanism, and a risk-driven SMS intervention, together with a feedback loop that updates a patient's risk category as their behaviour changes over time. The Design Science Research Methodology (DSRM) was adopted, because the principal contribution of the study is the development and evaluation of an information-technology artefact rather than the testing of a clinical hypothesis (Hevner et al., 2004; Peffers et al., 2007). The article sets out the problem and the research gap, the conceptual framework and system model, the methodology, the system requirements, the proposed architecture, the early-risk detection mechanism, the SMS-based intervention strategy, the development and demonstration of the artefact, and a prototype-level evaluation framework. Because the study involves no simulated or real clinical experiment, the evaluation distinguishes carefully between prototype-based technical evaluation, which the study can perform, and clinicaleffectiveness claims, which it cannot make. The article argues that a reminder alone is insufficient: a patient who misses occasional doses is in a different position from one whose adherence is steadily collapsing, and an effective system must recognise that difference and respond proportionately.