In the Middle East, particularly Lebanon, the adoption of digital health interventions has been growing. Mobile health (mHealth) platforms, social media campaigns, and telemedicine services are being integrated into healthcare systems. However, while digital marketing for health promotion is gaining traction globally, few studies have specifically examined its impact on medication adherence in Lebanon. The e-MedAL Study aims to fill this gap by evaluating whether tailored digital marketing strategies can foster better adherence among patients with chronic diseases, taking into account the local healthcare infrastructure and cultural context. Lebanon faces unique challenges in managing chronic diseases due to its healthcare system, which is fragmented and highly privatized. The ongoing economic crisis, coupled with the COVID-19 pandemic, has placed additional stress on healthcare delivery, making it difficult for patients to maintain consistent access to medications. Moreover, the high cost of chronic medications, coupled with the population's general reliance on out-of-pocket expenditures, contributes to non-adherence.

Exploring cost-effective and scalable interventions like digital marketing becomes vital in this context. Lebanon has a high internet and mobile phone penetration rate, which presents an opportunity for leveraging digital tools to promote health. By utilizing culturally tailored messaging and communication strategies, the e-MedAL Study has the potential to improve medication adherence rates significantly. This, in turn, would alleviate the burden on healthcare resources, enhance patient outcomes, and reduce the economic impact of poorly managed chronic diseases in the country. Furthermore, the success of this initiative could serve as a model for other countries in the region facing similar healthcare challenges. Lebanon's diverse and tech-savvy population makes it an ideal test case for assessing the role of digital marketing in healthcare, particularly in resource-constrained settings.

The study focuses on the role of digital marketing in improving medication adherence for chronic diseases in Lebanon. Here's a detailed breakdown of the study:

1. Study Overview and Purpose Chronic diseases like diabetes, hypertension, and cardiovascular disorders are growing global health concerns. One of the biggest challenges is ensuring long-term adherence to prescribed treatments, which, if not followed, leads to poor health outcomes and higher healthcare costs .

   The e-MedAL study investigates how digital marketing strategies-such as mobile applications, social media campaigns, and online education-can improve medication adherence among patients in Lebanon . It evaluates the local healthcare infrastructure and cultural factors affecting adherence.

2. State of Digital Marketing in Healthcare Digital marketing has revolutionized how healthcare providers engage with patients. By offering more personalized and interactive communication channels, it provides opportunities to boost medication adherence. Digital tools like reminders, educational campaigns, and behavioral nudges have been shown to improve adherence by as much as 17% across various chronic diseases .

   Lebanon's high internet penetration presents an opportunity to implement these strategies. However, the country also faces unique challenges, such as a fragmented healthcare system, economic difficulties, and a reliance on out-of-pocket payments, making adherence a significant issue .

3. Research Format and Methodology (PECO) Population: Patients residing in Lebanon who have been taking chronic medications for at least six months.

   Exposure: The use of digital marketing strategies to improve medication adherence.

   Comparison: A questionnaire-based assessment to evaluate patients' perceptions and readiness to adopt digital marketing strategies.

   Outcomes: Correlation between the effectiveness of digital strategies and patient adherence, along with demographic characteristics.

4. Questionnaire Sections General Characteristics: Participants provide demographic information such as age, education, smoking habits, and economic status .

   Medical and Medication History: Participants detail their chronic conditions, medication routines, and healthcare provider preferences .

   Adherence Assessment: Using a Likert scale, participants assess how closely they follow their prescribed medication regimen .

   Effectiveness of Digital Marketing: This section assesses how digital reminders, educational content, social media, and telemedicine services influence medication adherence .

   Perceived Barriers: Participants indicate potential challenges in using digital health tools, such as internet access, privacy concerns, and trust in digital channels .

5. Study Timeline and Outcome The study began on July 15th, 2024, and is ongoing (IRB Faculty of Pharmacy, Lebanese University).

The expected outcomes include a thesis, a scientific publication, and possibly a presentation at an international conference .

The study aims to provide insights that could serve as a model for other countries facing similar healthcare challenges, particularly in resource-constrained settings like Lebanon.

Inclusion Criteria:

• Patients taking the same medication for at least six months
• Lebanese patients
• Those who agree to participate in the study

Exclusion Criteria:

• Those with electronic illiteracy
• Those who are not themselves responsible for purchasing the medications

Patients from the general population residing in Lebanon and taking the same medication for at least six consecutive months