Design-Driven Adherence Canvas

Poor adherence stands as a barrier to success in many health technologies, especially those self-administered by patients. The Adherence Canvas is a tool to guide, measure, and evaluate adherence in health tech solutions during the design process, especially patient self-administering. It uses an Adherence Framework designed to focus on the adherence factors in self-administered health technology.

The Adherence Canvas presents an evidence-based rating system for companies to consider adherence factors during the design of health technological inventions. New companies can use the Canvas as a guide to identify how to consider adherence while developing their products. Experienced companies can use it to evaluate the level of consideration to patient adherence.

The AHSN NENC was a close partner in this PhD research when it started in 2017 at the School of Design, Northumbria University. The network companies were the first step to search for case studies. The team there provided support in both knowledge and networking through the AHSN NENC events in the Northeast. The WearCare II project was another collaboration stage while working with MA Design students to design vital healthcare products. The AHSN NENC contributed to a Delphi study in a panel of 15 organisations and experts in healthcare technology design and psychology. The panel assessed the Adherence Framework and adherence levels used in the Adherence Canvas to improve adherence to self-administered treatment technology. I acknowledge the partnership with AHSN NENC and looking forward to extending this research collaboration to future researchers.
Dr Rafiq Elmansy, lecturer and researcher, Northumbria University
Show/hide all

Low level of treatment adherence is one of the challenges that faces the healthcare system in the UK. An estimated 30%-50% of patients with chronic diseases fail to adhere to prescribed medical intervention (Sabaté, 2003; Barnett, 2014). While medical technology provides an opportunity to overcome existing healthcare system challenges (Mirza et al., 2008; Ganasegeran et al., 2017), poor adherence blurs this opportunity by reducing the intervention’s positive impact. The spread of COVID-19 dramatically increased the healthcare system’s pressure (Willan et al., 2020) and turned a red alert to address the low adherence problem.

Various studies have investigated the underlying factors behind low adherence. However, two main gaps were identified: 1) a lack of adherence frameworks that considered self-administered treatment technology, and 2) a lack of a practical mechanism to help companies consider adherence factors during the design and development of the treatment technology (Bosworth et al., 2005).

The Adherence Canvas is an evidence-based tool to guide, measure, and evaluate adherence in self-administered health technologies. Companies can use Adherence Canvas during the design process to measure the consideration of the adherence factors and their level of importance. It uses an Adherence Framework designed to focus on the adherence factors in self-administered health technology.



The Adherence Canvas (including the Adherence Framework) is based on an evaluation study conducted as part of Rafiq Elmansy’s PhD research at the School of Design, Northumbria University, Newcastle upon Tyne. The PhD researched the Role of Design Thinking in Improving Adherence in Self-Administered Treatment Technology.

  • The Adherence Framework and Adherence Canvas are the results of a PhD study by Rafiq Elmansy at the School of Design, Northumbria University.
  • Five health tech SMEs contributed to identify the adherence factors and explore the design process inside each company.
  • 15 organisations and experts in health tech design and patient psychology contributed to assessing the Adherence Canvas, including AHSN NENC, NHS, Philips Europe and CPI.
  • Now, the Adherence Canvas is available online as a free tool. You can have an online session with the inventor, Rafiq Elmansy, to customise the tool to fit your health tech product and get the best results.

Companies can use the Adherence Canvas to guide them to factors that can drive their patients to adherence to the treatment regime. Also, it can be used to evaluate the consideration of adherence in the health tech. The implementation of the Adherence Canvas has a multi-dimensional impact:

Company – The company will have a realistic image of the intervention usage and the outcome either during product evaluation (i.e. clinical trials or patients advisory groups) or real-life use.

Patients – with additional adherence patients will see the full intended benefit of their medical technology which in turn will assist their healthcare team to advise and prescribe accordingly. This will empower patients to manage their condition as best they can.

Financial/Economic – by operating at full adherence, time can be saved by healthcare professionals which in turn will save the system time and money.

Healthcare system – Improving adherence especially to self-administered technology can reduce hospital admissions, GP appointments and the need of more staff.

  • Provide an evidence-based mechanism to consider adherence factors during the design of the health technology
  • Empower patients through driving successful self-administered health technology
  • Support the efficacy of the outcome of the treatment intervention
  • Reduce the pressure on the healthcare system, including the pressure on the clinicians and nurses
  • Reduce the long waiting lists by involving a positive patient’s role in the healthcare process
  • Reduce the wasted cost of low adherence to medical treatment intervention.

The AHSN NENC was an essential partner in the research since its start in 2017, when the PhD study started. The AHSN helped the researcher find case study companies to evaluate as part of the first stage of the research. Later, the AHSN contributed to the WearCare II project run as part of the study in MA Design at the School of Design, Northumbria University.

During the assessment of the Adherence Framework, the AHSN was part of the Delphi panel, which included 15 members representing the NHS, CPI, Philips Medical, medical psychology academics, and representatives of seven design for medical technology companies.

The next stage of the study is to extend the collaboration with companies and provide support for companies to test the Adherence Canvas in the organizational context and help companies explore how the Canvas can add value to their product. Currently, six companies are ready to start the next stage.



Sabaté, E., & Sabaté, E. (Eds.). (2003). Adherence to long-term therapies: evidence for action. World Health Organization.

Barnett, N. L. (2014). Medication adherence: where are we now? A UK perspective. European Journal of Hospital Pharmacy: Science and Practice21(3), 181-184.

Mirza, F., Norris, T., & Stockdale, R. (2008). Mobile technologies and the holistic management of chronic diseases. Health informatics journal14(4), 309-321.

Ganasegeran, K., Renganathan, P., Rashid, A., & Al-Dubai, S. A. R. (2017). The m-Health revolution: Exploring perceived benefits of WhatsApp use in clinical practice. International journal of medical informatics97, 145-151.

Willan, J., King, A. J., Jeffery, K., & Bienz, N. (2020). Challenges for NHS hospitals during covid-19 epidemic. Chicago

Bosworth, H. B., Weinberger, M., & Oddone, E. Z. (2005). Patient treatment adherence: Concepts, interventions, and measurement. In Patient Treatment Adherence: Concepts, Interventions, and Measurement.