Development of a mobile health application to support the management of pediatric familial Mediterranean fever.

Abstract

Familial Mediterranean Fever (FMF) is highly prevalent in Mediterranean countries and represents a substantial proportion of pediatric rheumatology patients. Colchicine, the mainstay of treatment, requires lifelong daily use, yet long-term adherence remains challenging, leading to recurrent attacks and increased healthcare burden. This study aimed to develop a freely downloadable mobile application to improve medication adherence by providing reminders and enabling direct communication with physicians. The application was designed as a structured medication-timing and monitoring tool, providing time-specific medication reminders, real-time intake confirmation ("taken/missed"), and digital adherence tracking. The user interface was tailored to the needs of patients and parents, considering children's attention span, parental workload, and health literacy. Following pilot testing in seven volunteer patients, the application was refined based on user feedback. Physicians used a web-based panel to register patients, define prescriptions and treatment schedules, and assign calendar-based appointments. Medication adherence was assessed using the MASIF scale, and disease activity was evaluated using the AIDAI score. A total of 93 patients with FMF were included in the study. Before application use, adherence was low, with a median MASIF score of 44 and most patients demonstrating poor adherence. After implementation, MASIF scores significantly improved at 3, 6, and 12 months, with a marked reduction in poorly adherent patients (p < 0.001). AIDAI scores and attack frequency significantly decreased, and no patient had an AIDAI score >9 during follow-up. Agreement between application-measured adherence and MASIF scores was excellent (ICC >0.90). Mobile reminder applications are low-cost, accessible digital health tools with strong potential to enhance medication adherence in FMF patients.