Mobile Telephone Text Messaging for Medication Adherence in Chronic Disease: A Meta-analysis
Open accessAbstract
IMPORTANCE: Adherence to long-term therapies in chronic disease is poor. Traditional interventions to improve adherence are complex and not widely effective. Mobile telephone text messaging may be a scalable means to support medication adherence. OBJECTIVES: To conduct a meta-analysis of randomized clinical trials to assess the effect of mobile telephone text messaging on medication adherence in chronic disease. DATA SOURCES: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, PsycINFO, and CINAHL (from database inception to January 15, 2015), as well as reference lists of the articles identified. The data were analyzed in March 2015. STUDY SELECTION: Randomized clinical trials evaluating a mobile telephone text message intervention to promote medication adherence in adults with chronic disease. DATA EXTRACTION: Two authors independently extracted information on study characteristics, text message characteristics, and outcome measures as per the predefined protocol. MAIN OUTCOMES AND MEASURES: Odds ratios and pooled data were calculated using random-effects models. Risk of bias and study quality were assessed as per Cochrane guidelines. Disagreement was resolved by consensus. RESULTS: Sixteen randomized clinical trials were included, with 5 of 16 using personalization, 8 of 16 using 2-way communication, and 8 of 16 using a daily text message frequency. The median intervention duration was 12 weeks, and self-report was the most commonly used method to assess medication adherence. In the pooled analysis of 2742 patients (median age, 39 years and 50.3% [1380 of 2742] female), text messaging significantly improved medication adherence (odds ratio, 2.11; 95% CI, 1.52-2.93; P < .001). The effect was not sensitive to study characteristics (intervention duration or type of disease) or text message characteristics (personalization, 2-way communication, or daily text message frequency). In a sensitivity analysis, our findings remained robust to change in inclusion criteria based on study quality (odds ratio, 1.67; 95% CI, 1.21-2.29; P = .002). There was moderate heterogeneity (I2 = 62%) across clinical trials. After adjustment for publication bias, the point estimate was reduced but remained positive for an intervention effect (odds ratio, 1.68; 95% CI, 1.18-2.39). CONCLUSIONS AND RELEVANCE: Mobile phone text messaging approximately doubles the odds of medication adherence. This increase translates into adherence rates improving from 50% (assuming this baseline rate in patients with chronic disease) to 67.8%, or an absolute increase of 17.8%. While promising, these results should be interpreted with caution given the short duration of trials and reliance on self-reported medication adherence measures. Future studies need to determine the features of text message interventions that improve success, as well as appropriate patient populations, sustained effects, and influences on clinical outcomes.
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Previous systematic reviews reported that digital health interventions improve medication adherence and other health outcomes.
“The effectiveness of digital health interventions on adherence to medication was reported in previous systematic reviews with an improvement in medication adherence and other health outcomes.59,61,62”
From Effectiveness of digital health interventions on blood pressure control, lifestyle behaviours and adherence to medication in patients with hypertension in low-income and middle-income countries: a systematic review and meta-analysis of randomised controlled trials (2024) · cites this paper as [62]
The Meta-analysis of the Intervention Efficacy section reports that text-message interventions significantly improved medication adherence in patients with chronic disease. The paper evaluates text messaging rather than digital health interventions generally, and the passages do not report improvement in other health outcomes. (LLM, conf=0.88)
Experimental — accuracy not yet measuredMobile phone messaging interventions are a potential cost-effective approach to promote habit formation.
“Mobile phone messaging interventions are a potential cost-effective approach to promote habit formation.43–45”
From Refining and optimising a behavioural intervention to support endocrine therapy adherence (ROSETA) in UK women with breast cancer: Protocol for a pilot fractional factorial trial (2023) · cites this paper as [43]
The Meta-analysis of the Intervention Efficacy section reports that text-message interventions improved medication adherence, and the Discussion describes them as simple and often automated. That supports their potential to encourage repeated medication-taking, but the paper does not establish habit formation or assess cost-effectiveness. (LLM, conf=0.82)
Experimental — accuracy not yet measuredSeveral meta-analyses corroborate the effectiveness of SMS for medication adherence.
“Several meta-analyses corroborate the effectiveness of SMS for medication adherence [18-20].”
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Percentages, sums and reported differences re-computed from the paper’s own numbers.
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- Authors
- Thakkar, J., Kurup, R., Laba, T.-L., Santo, K., Thiagalingam, A., Rodgers, A., Woodward, M., Redfern, J., & Chow, C. K.
- Affiliations
- The University of Sydney (AU)
- Westmead Hospital (AU)
- Corresponding author
- Thakkar, Jay
- ORCID
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2016-03-01
- Volume
- 176
- Issue
- 3
- Pages
- 340
- ISSN
- 2168-6106 (ISSN-L)
- OpenAlex
- W2272515352
- Cited by
- 685
- References
- 46
- Citations by year
- 2026: 41 · 2025: 47 · 2024: 49 · 2023: 69 · 2022: 72 · 2021: 89 · 2020: 88 · 2019: 83 · 2018: 62 · 2017: 55 · 2016: 30
- FWCI
- 14.63
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Health Professions › Health Information Management › Health, Technology, Consumer Behavior
- Keywords
- chronic disease, mobile health intervention, SMS reminders, personalized reminders, two-way communication, publication bias, intervention duration, study quality heterogeneity, chronic disease patients, patient-provider communication
- MeSH terms
- Adult, Chronic Disease, Female, Humans, Male, Middle Aged, Patient Acceptance of Health Care, Odds Ratio, Randomized Controlled Trials as Topic, Databases, Factual, Reminder Systems, Medication Adherence, Text Messaging
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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