Impact of a Mobile Application-Based Medication Reminder on Treatment Adherence Among Patients With Chronic Diseases and Memory Impairment: A Nursing Leadership Perspective

Improving medication adherence in patients with chronic illnesses and cognitive decline is a key priority in healthcare management and nursing administration. This quasi-experimental study utilizes a pretest-posttest design to examine the effectiveness of a mobile application-based reminder system designed specifically for patients experiencing memory impairment.

Participants will be selected based on specific inclusion criteria, including being diagnosed with a chronic disease and exhibiting mild-to-moderate memory impairment. Baseline assessments (pretest) will be conducted to measure initial medication adherence levels, patient demographics, and health status. Following the baseline phase, the intervention will be introduced, where participants will utilize the mobile application to receive automated medication alerts and reminders over a specified period. Evaluation (posttest) will be performed post-intervention to analyze changes in adherence rates. The findings are expected to provide insights into how nursing leadership can leverage mobile health (mHealth) technology to design supportive care pathways, enhance patient independence, and reduce clinical complications associated with poor treatment adherence.

• Mobile Application-Based Medication Reminder (Device): The intervention consists of a mobile application specifically designed to support medication adherence. It features automated push notifications, customized reminder alerts matching prescribed medication schedules, and tracking logs. Participants will be instructed on how to install, configure, and use the application on their personal smartphones. The system is designed to provide immediate prompts to overcome memory-related adherence barriers.

Primary outcomes

• Medication Adherence (MMAS-8) [Baseline (pre-intervention) and 3 months post-intervention]: Medication adherence will be assessed using the 8-item Morisky Medication Adherence Scale (MMAS-8). This self-reported tool evaluates patients' behaviors regarding taking their prescribed chronic medications. Total scores range from 0 to 8, where a score of 8 indicates high adherence, 6 to <8 indicates medium adherence, and <6 indicates low adherence.

Secondary outcomes

• Objective Medication Adherence: Medication Possession Ratio (MPR) [3 months post-intervention]: Medication Possession Ratio (MPR) will be calculated using pharmacy refill records to determine the proportion of time the patient has access to their prescribed medication during the study period. Total scores will range from 0 to 1 (or 0% to 100%), with higher values indicating better adherence.
• Objective Medication Adherence: Proportion of Days Covered (PDC) [3 months post-intervention]: Proportion of Days Covered (PDC) will be assessed using pharmacy refill records to measure the percentage of days the patient covered their prescribed medication dosage over the study duration. Total scores will range from 0 to 1 (or 0% to 100%), where higher values reflect superior medication adherence.
• Cognitive Function Status (MMSE) [Baseline]: Cognitive impairment levels will be screened using the Mini-Mental State Examination (MMSE) to classify the severity of cognitive/memory impairment among participants.
• Perceived Nursing Care and Leadership Support [3 months post-intervention.]: Evaluated using the Nursing Care and Leadership Support Assessment Tool to measure patient satisfaction and perception of the supportive role played by nursing leadership during the application-based program.

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* Patients diagnosed with one or more chronic diseases requiring regular long-term medication.
* Patients exhibiting mild-to-moderate memory impairment or cognitive decline as screened by the Mini-Mental State Examination (MMSE).
* Patients who personally own and are capable of operating a smartphone or have a primary caregiver willing to manage the mobile application.
* Patients aged 18 years and older.
* Patients who provide voluntary informed consent to participate in the study.

Exclusion Criteria:

* Patients with severe cognitive impairment or advanced dementia who cannot interact with mobile technology even with caregiver assistance.
* Patients with severe acute clinical complications or unstable psychiatric conditions.
* Patients participating in another concurrent clinical trial or study targeting medication adherence