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Currently submitted to: JMIR mHealth and uHealth

Date Submitted: Sep 27, 2019
Open Peer Review Period: Sep 27, 2019 - Nov 22, 2019
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A pantheoretical framework to optimize adherence to healthy lifestyle behaviors and medication adherence: The use of personalized approaches to overcome barriers and optimize facilitators to achieve adherence

  • Azizi Seixas; 
  • Colleen Conners; 
  • Alicia Chung; 
  • Tiffany Donley; 
  • Girardin Jean-Louis; 



Poor adherence to primary prevention and management of chronic health conditions (such as lifestyle health behaviors and medications) has significant economic and health consequences, resulting in greater healthcare expenditures, multiple morbidities, and deaths. The burgeoning use of mobile technology to deliver health, lifestyle and wellness interventions has shown initial signs of improving adherence to primary prevention and management of chronic health conditions. However, the full potential of achieving optimized levels of adherence are thwarted by a wide range of sociodemographic, psychosocial, behavioral, and system-level barriers and the lack of a personalized medicine and a precision population health approach—approaches that understands disease and health and provides just-in-time, adaptive, and just-enough interventions based on biological/individual (e.g. genes, biomarkers, circadian profile), lifestyle/behavioral (diet, physical activity, sleep and stress management), and environmental/contextual (household, neighborhood, and cultural) factors.


The purpose of this paper is to explore: 1) modifiable and non-modifiable barriers and facilitators of adherence to primary prevention and management of chronic health conditions, especially in mHealth solutions; 2) a personalized medicine and precision population health framework that overcomes barriers and accentuates facilitations to adherence in primary prevention and management solutions of chronic health conditions; and 3) how to implement a personalized medicine and precision population health approach in mHealth/digital health solutions.


Through a careful review of the literature via several public databases such as PubMed and Google Scholar (years 2017-2019), we identified and describe key barriers and facilitators to adherence to primary prevention and management strategies in chronic health conditions. To overcome these challenges, we provide a novel mHealth solution steeped in precision and personalized population health and pantheoretical approach that increase the likelihood of adherence. We describe the stages of a pantheoretical approach focuses on tailoring, clustering/profiling, personalizing and optimizing interventions/strategies to obtain adherence and highlight minimal engineering needed to build such a solution.


Addressing modifiable determinants such as social support, health literacy, user motivation, emotional status, cognition (memory and information processing), and healthcare systems may provide better opportunities to effect behavior change and long-term adherence to health behaviors. We further argue that a mobile health solution may be a viable approach to address modifiable barriers and optimize adherence, while taking into consideration non-modifiable factors, which serve to tailor, cluster/profile, personalize and optimize interventions/strategies to obtain adherence, the pantheoretical approach.


Although mHealth solutions can be ideal for successful achievement and maintenance of adherence behaviors, they can also exacerbate barriers and thus compromise adherence.


Please cite as:

Seixas A, Conners C, Chung A, Donley T, Jean-Louis G

A pantheoretical framework to optimize adherence to healthy lifestyle behaviors and medication adherence: The use of personalized approaches to overcome barriers and optimize facilitators to achieve adherence

JMIR Preprints. 27/09/2019:16429

DOI: 10.2196/preprints.16429


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