The DOI matches its Crossref record; 36 of the 36 references it cites were found in a registry or an index.
Medication adherence outcomes of 771 intervention trials: Systematic review and meta-analysis
Open accessAbstract
Excellent medication adherence contributes to decreases in morbidity, mortality, and health care costs. Although researchers have tested many interventions to increase adherence, results are sometimes conflicting and often unclear. This systematic review applied meta-analytic procedures to integrate primary research that tested medication adherence interventions. Comprehensive searching completed in 2015 located 771 published and unpublished intervention studies with adherence behavior outcomes. Random-effects model analysis calculated standardized mean difference effect sizes. Meta-analytic moderator analyses examined the association between adherence effect sizes and sample, design, and intervention characteristics. Analyses were conducted in 2016. A standardized mean difference effect size of 0.290 comparing treatment and control groups was calculated. Moderator analyses revealed larger effect sizes for habit-based and behavioral-targeted (vs. cognitive-focused) interventions. The most effective interventions were delivered face-to-face, by pharmacists, and administered directly to patients. Effect sizes were smaller in studies with older and homeless participants. Risks of bias were common; effect sizes were significantly lower among studies with masked data collectors and intention-to-treat analyses. The largest effect sizes were reported by studies using medication electronic event monitoring and pill count medication adherence measures. Publication bias was present. This most comprehensive review to date documented that, although interventions can increase adherence, much room remains for improvement. Findings suggest health care providers should focus intervention content on behavioral strategies, especially habit-based interventions, more so than cognitive strategies designed to change knowledge and beliefs.
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“Findings from a meta-analysis of medication adherence interventions among adults demonstrated that linking medication taking with existing daily routines and using behavioral strategies (eg, prompts to take medication) are the most effective strategies to promote adherence [11].”
From Medication Adherence Reminder System for Virtual Home Assistants: Mixed Methods Evaluation Study (2021) · cites this paper as [11]
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Citations
Cites
Bias in meta-analysis detected by a simple, graphical test
Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997) · BMJ · doi:10.1136/bmj.315.7109.629 · Cited by 56,722
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. A., Clarke, M., Devereaux, P. J., Kleijnen, J., & Moher, D. (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000100 · Cited by 28,164
Cochrane Handbook for Systematic Reviews of Interventions: Cochrane Book Series
(2008) · doi:10.1002/9780470712184 · Cited by 25,048
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gotzsche, P. C., Ioannidis, J. P. A., Clarke, M., Devereaux, P. J., Kleijnen, J., & Moher, D. (2009) · BMJ · doi:10.1136/bmj.b2700 · Cited by 17,648
Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2009) · doi:10.1002/9780470743386 · Cited by 14,225
Wasserman, S. S., Hedges, L. V., & Olkin, I. (1988) · Journal of Educational Statistics · doi:10.2307/1164953 · Cited by 10,377
Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2021) · doi:10.1002/9781119558378 · Cited by 9,799
(2000) · Cited by 9,198
Adherence to Long-Term Therapies: Evidence for Action
Geest, S. D., & Sabate, E. J. (2003) · European Journal of Cardiovascular Nursing · doi:10.1016/s1474-5151(03)00091-4 · Cited by 6,310
Statistical Methods for Meta-Analysis.
Freeman, P. R., Hedges, L. V., & Olkin, I. (1986) · Biometrics · doi:10.2307/2531069 · Cited by 4,840
Cited by
Sorted by citations
Items 301–366 of 366
Anton, G. M., Llobet, M. P., Lluch‐Canut, T., Sánchez-Ortega, M. A., Pont, M., & Arroyo, C. M. (2023) · JMIR Research Protocols · doi:10.2196/45856
“The index of medication adherence in these patients is only 50% [21]; therefore, improving medication adherence would result in a decrease in morbidity, mortality, and expenditure in medical care [22].”
Jarujumrus, I. (2020) · Chula Digiverse · doi:10.58837/chula.the.2020.428
Tsang, C. C. S., Zhang, X., Barenie, R. E., Cernasev, A., Miller, N. A., Wan, J. Y., Tsao, J. W., & Wang, J. (2023) · Medicine · doi:10.1097/md.0000000000033641
“[35] These components included adopting behavioral rather than cognitive strategies, being delivered by pharmacists, being delivered directly to patients rather than through their health care providers, and being delivered face-to-face.[35] For older adults with cognitive impairment who may use complex medication regi…”
BackgroundLorino, A., Cabrejo, P. T., & Coppola, S. (2023) · OTJR Occupational Therapy Journal of Research · doi:10.1177/15394492231172931
“These complexities can contribute to the low to moderate effectiveness of varied behavioral and educational interventions designed to improve medication-taking and adherence behaviors (Conn & Ruppar, 2017; Cross et al., 2020).”
BackgroundHypertension management and drug-related problems. A case report of the 23-year history of Mr. Jonas
Trečiokienė, I., Pečeliūnienė, J., Wettermark, B., Gulbinovič, J., & Taxis, K. (2023) · Exploratory Research in Clinical and Social Pharmacy · doi:10.1016/j.rcsop.2023.100313
“26,27 Examples include employing special medication packaging, dose modification, patient self-monitoring of medication-taking and written instructions.”
BackgroundMendorf, S., Teschner, U., Lehmann, T., Prell, T., & Mühlhammer, H. M. (2023) · Trials · doi:10.1186/s13063-023-07663-9
“Although many interventions for increasing adherence have been tested, the best methods to improve adherence remain unclear [11].”
BackgroundMarineci, C. D. (2023) · Farmacist ro · doi:10.26416/farm.213.4.2023.8585
Andrews, A. M., Russell, C. L., & Chesnut, S. R. (2023) · American Journal of Health Behavior · doi:10.5993/ajhb.47.4.16
Symptoms, walking behaviors, and mobility of Thai patients after colorectal cancer surgery
Krisanabud, P. (2019) · MOspace Institutional Repository (University of Missouri) · doi:10.32469/10355/79566
Psychological and Social Impact of Long‐Term Conditions and Principles of Holistic Management
McBride, S. R., & Mizara, A. (2024) · Wiley eBooks · doi:10.1002/9781119709268.rook015
Terapia oral antineoplásica: análise da adesão e fatores associados
Bernardes, M. P. A. (2021) · doi:10.11606/d.7.2021.tde-12012022-171631
Denton, S., Cairns, D., Marchese, G., Rich, A., Jadcherla, A. V., Scott, D. R. M., Dyer, J., Lundh, R., Young, S. A., & Harrison, R. (2024) · Journal of Student-Run Clinics · doi:10.59586/jsrc.v10i1.412
Application of models of behavior change communication in various stages of healthcare
George, S., Jha, A., & Giri, A. K. (2024) · International Journal of Community Medicine and Public Health · doi:10.18203/2394-6040.ijcmph20241517
Pironet, A., Phillips, L. A., & Vrijens, B. (2024) · doi:10.2196/preprints.63987
Schleef, J., & Ortíz, M. S. (2024) · Behavioral Medicine · doi:10.1080/08964289.2024.2406308
“20 According to the framework proposed by Gardner & Lally, 21 potential determinants of medication-taking habit can be classified as cue-related, behavior-related, or actor-related (Figure 1).”
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Goetzinger, C., & SchneiderNationalHealthObservatoryLuxembergandDeepDigitalPhe, M. (2024) · Wiley eBooks · doi:10.1002/9781119911685.ch40
Barriers to Inhaler Adherence in Asthmatic Children and Outcome After Intervention
Pande, V., Narayan, S., Salunkhe, S., Jadhav, R. S., Thakur, M., & Mane, S. (2024) · Medical Journal of Dr D Y Patil Vidyapeeth · doi:10.4103/mjdrdypu.mjdrdypu_949_23
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Alajlan, S. A., & Lytras, M. D. (2025) · Advances in computational intelligence and robotics book series · doi:10.4018/979-8-3693-6270-9.ch010
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DiMatteo, M. R., Martin, L. R., & Haskard‐Zolnierek, K. B. (2025) · Oxford University Press eBooks · doi:10.1093/oso/9780197778586.003.0002
Kokenge, M. C., Ruppar, T. M., Julion, W. A., Emezue, C., Lynch, E. B., & Ellis, R. J. B. (2025) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-025-02508-4
“On average, antihypertensive medication adherence interventions show small to moderate effect sizes [19, 20].”
Self-citationKelly, D., Khan, U., Bixler, E., Becerra, G., & Carmack, C. C. (2025) · Clinics and Practice · doi:10.3390/clinpract15090161
“Similarly, there is a need to advocate for integrating medical and psychosocial services in one site, emphasizing rapport-building and logistical support to mitigate barriers such as medication nonadherence and delayed care [18].”
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Ayehu, S., Belayneh, B., & Muluneh, B. (2025) · Expert Review of Clinical Pharmacology · doi:10.1080/17512433.2025.2558804
“Studies using electronic reminders or pillboxes to combat forgetfulness show modest short-term success but fail to address motivation and belief-based nonadherence [18].”
Nayak, D., Nahar, K., Kaur, L., Singh, S., Ponnam, H. B., Rawat, B. S., Prusty, A. K., Prusty, U., Karso, L., Debata, L., et al. (2025) · Homeopathy · doi:10.1055/a-2636-4424
Determinants of Oral Chemotherapy Adherence: A Social Cognitive PerspectivePreprint
Ayehu, S., Novatnack, M., Belayneh, B., Tecza, D., Zullig, L. L., Wood, W. A., Boynton, M. H., Mackler, E. R., Bryant, A. L., Wheeler, S. B., et al. (2025) · medRxiv · doi:10.1101/2025.10.02.25337011
“Systematic reviews support the use of personalized interventions delivered by pharmacists as the most effective method to enhance medication adherence [34-39].”
Medication Deviation in Dementia: A Scoping Review
Liu, S., Chen, Y., Wang, C., Long, Z., Chen, X., Zhang, X., Hong, Y., & Lin, J. (2025) · Journal of Gerontological Nursing · doi:10.3928/00989134-20251007-04
de Souza, L. B. F., Soares, K. D., Vítor, A. F., Júnior, M. A. F., Santos, V. E. P., & de Azevedo, I. C. (2025) · Revista Brasileira de Enfermagem · doi:10.1590/0034-7167-2024-0265pt · Cited by 1
Yang, C., Hui, Z., Zeng, D., Zhu, S., Wang, X., Lee, D. T. F., & Chair, S. Y. (2021) · Figshare · doi:10.6084/m9.figshare.14150960
Truong, M. B.-T., Ngo, E., Ariansen, H., Tsuyuki, R. T., & Nordeng, H. (2020) · Figshare · doi:10.6084/m9.figshare.13357650
Gwadz, M. V., Cleland, C. M., Lizardo, M., Hawkins, R. L., Bangser, G., Parameswaran, L., Stanhope, V., Robinson, J. A., Karim, S., Hollaway, T., et al. (2022) · Figshare · doi:10.6084/m9.figshare.20115627
Fornaro, M., Dragioti, E., De Prisco, M., Billeci, M., Mondin, A. M., Calati, R., Smith, L., Hatcher, S., Kaluzienski, M., Fiedorowicz, J. G., et al. (2022) · Figshare · doi:10.6084/m9.figshare.20291151
Patton, D., Ryan, C., & Hughes, C. M. (2020) · Figshare · doi:10.6084/m9.figshare.12299870
Truong, M. B.-T., Ngo, E., Ariansen, H., Tsuyuki, R. T., & Nordeng, H. (2020) · Figshare · doi:10.6084/m9.figshare.13357662
Cluesman, S. R., Gwadz, M. V., Freeman, R., Collins, L. M., Cleland, C. M., Wilton, L., Hawkins, R. L., Leonard, N. R., Silverman, E., Maslow, C. B., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26565177
Mechta Nielsen, T., Schjerning, N., Kaldan, G., Hornum, M., Feldt-Rasmussen, B., & Thomsen, T. (2021) · Figshare · doi:10.6084/m9.figshare.16664305
Green, S. M. C., French, D., Graham, C. D., Hall, L., Rousseau, N., Foy, R., Clark, J., Parbutt, C., Raine, E., Gardner, B., et al. (2022) · Figshare · doi:10.6084/m9.figshare.20619870
Truong, M. B.-T., Ngo, E., Ariansen, H., Tsuyuki, R. T., & Nordeng, H. (2020) · Figshare · doi:10.6084/m9.figshare.13357665
Truong, M. B.-T., Ngo, E., Ariansen, H., Tsuyuki, R. T., & Nordeng, H. (2020) · Figshare · doi:10.6084/m9.figshare.13357659
Green, S. M. C., French, D., Graham, C. D., Hall, L., Rousseau, N., Foy, R., Clark, J., Parbutt, C., Raine, E., Gardner, B., et al. (2022) · Figshare · doi:10.6084/m9.figshare.20619867
Truong, M. B.-T., Ngo, E., Ariansen, H., Tsuyuki, R. T., & Nordeng, H. (2020) · Figshare · doi:10.6084/m9.figshare.13357653
Green, S. M. C., French, D., Graham, C. D., Hall, L., Rousseau, N., Foy, R., Clark, J., Parbutt, C., Raine, E., Gardner, B., et al. (2022) · Figshare · doi:10.6084/m9.figshare.20619876
Patton, D., Ryan, C., & Hughes, C. M. (2020) · Figshare · doi:10.6084/m9.figshare.12299867
The Role of Nursing and Pharmacy in Enhancing Daily Medication Adherence Among Thyroid Patients
Almutlaq Ahlam Mohammed, T., ALSAADI, M. H., ALRUWAILI, M. M. A., Alanazı, K. N. K., Alenezı, A. A. N., ALRUWAILI, F. T. A., ALRUWAILI, M. N. J., ALENEZI, M. M. K., ALSALEEM, A. T., Alanazi, A. R. S., et al. (2024) · International Journal of Computational and Experimental Science and Engineering · doi:10.22399/ijcesen.3947
“Utilizing open-ended questions and techniques from Motivational Interviewing (MI) , the nurse seeks to understand the patient's story—their illness perception, daily challenges, and personal goals [28].”
Svensberg, K., Wettermark, B., Eklund, J. R., Hajiebrahimi, M., Ekenberg, M., Tranberg, A., & Sporrong, S. K. (2025) · Exploratory Research in Clinical and Social Pharmacy · doi:10.1016/j.rcsop.2025.100699
“43 Our study is unique in examining the one-year persistence based on robust data from high-quality registers, 35,38,44,53 while most previous research have focused on shorter follow-up periods and relied on self-reported adherence scales.”
Personalized Informational Support for Patients With Hypertension: Single-Arm Pretest-Posttest Study
Huang, C., Yang, R., Liu, L., Jia, Y., & Liao, X. (2025) · JMIR Formative Research · doi:10.2196/82147
“The integrated intervention synergizes personalized in-person follow-up (for trust building and rapport establishment) with telephone-delivered counseling, forming a dual-modality framework that has demonstrated potential efficacy in prior feasibility studies [9].”
Ang, D. C., Kaplan, S. G., Keefe, F., Rice, W. Y., Anderson, A., Rini, C. K., Miles, C. M., Hartlieb, K. B., Willoughby, M. E., Revankar, N., et al. (2025) · Pain · doi:10.1097/j.pain.0000000000003861
Advertising Techniques and Biologic Treatment in Psoriasis
Girard, G. S., Moran, S. K., & Feldman, S. R. (2025) · Springer eBooks · doi:10.1007/978-3-032-07649-6_25
Novais, T., Fortini, C., & Schneider, M. (2026) · Le Pharmacien Clinicien · doi:10.1016/j.phacli.2026.01.003
Addictions: Everyone, everywhere, everything
Hoang, L., & Judd, S. (2026) · Cambridge University Press eBooks · doi:10.1017/9781009335874.016
Zhu, X., Wang, L., Zhao, H., & Liu, J. (2026) · BMC Nursing · doi:10.1186/s12912-026-04438-w
“A systematic review based on 771 intervention studies pointed out that intervention strategies centered on habit formation are most effective in continuously improving medication adherence [45].”
Sakr, F., Haddad, C., Safwan, J., Hajj, A., Sacre, H., Zeenny, R. M., Akel, M., & Salameh, P. (2026) · Health Science Reports · doi:10.1002/hsr2.71821
Callan, C., Scragg, J., Stevens, R., Heath, L., Hunt, I. D. V., Seeley, A. E., Caulfield, A., & Aveyard, P. N. (2026) · Family Practice · doi:10.1093/fampra/cmag007
“Studies included in two previous large systematic reviews of medication adherence interventions, published in 2014 and 2016 [36, 37] were included in abstract screening, and searches of medical databases for further relevant titles and abstracts were conducted from 2015 onwards.”
Al Applications for Public Health Personal Responsibilities
Wu, M. (2026) · Springer eBooks · doi:10.1007/978-3-032-15872-7_8 · Cited by 1
Zimmerman, C., Haddad, C. N., Himmel, K., Thomas, G., Macdonald, L., Smith, T., Dalman, D., FAKHOURY, P. I., & Pandey, J. (2026) · Journal of the American Geriatrics Society · doi:10.1111/jgs.70450
“Transportation barriers, mobility limitations, work schedules, and caregiving respon-sibilities disproportionately affect access to in-person health education programs, particularly among socioeconomically disadvantaged populations [39, 40].”
Collaborative Pharmacy Practice
Lake, J. D. (2026) · Elsevier eBooks · doi:10.1016/b978-0-443-26472-6.00120-0
Chen, Y. Y., Lin, C., Liu, J., Lin, H.-A., & Hsieh, Y.-S. (2026) · Healthcare · doi:10.3390/healthcare14121630
“Previous research has indicated that adherence itself is an important health behavior, and patients with high adherence generally engage more actively in overall health management [40,41].”
Mannheimer, S., Fors, A., Holst, A., & Gyllensten, H. (2026) · BMJ Open · doi:10.1136/bmjopen-2026-118720
He, C. J., Baker, O., Lamonte, O. A., Verpukhovskiy, P., Wang, H., Chen, Y., Tu, S., DeConde, A. S., & Yan, C. H. (2026) · Laryngoscope Investigative Otolaryngology · doi:10.1002/lio2.70518
“While higher adherence generally correlates with improved therapeutic effects, the impact of adherence variability differs across medications [3].”
Witry, M. J., & Phillips, L. A. (2026) · Elsevier eBooks · doi:10.1016/b978-0-443-44607-8.00024-8
Mapping medication adherence interventions across Europe: Expert perspectives from 35 countries
Mucherino, S., Aarnio, E., Qvarnström, M., Hafez, G., Kamusheva, M., Potočnjak, I., Trečiokienė, I., Mihajlović, J., Ekenberg, M., van Boven, J. F. M., et al. (2026) · Public Health in Practice · doi:10.1016/j.puhip.2026.100850
Sagara, H., Yamane, M., Yasuhide, K., Inamori, A., & Teshima, H. (2026) · Cureus · doi:10.7759/cureus.116074
“…rather than as the distinct simplified-regimen signal, a pattern consistent with prior evidence that regimen simplification does not guarantee adherence and that directly assessing medication-taking behavior adds value; given the few affected patients, this observation is illustrative only [20-22].”
Medication Adherence Behavior Assessed Using a Digital Bottle Cap: Retrospective Cohort Study
Nowojewski, A., Elizarova, O., Rutgersson, A., Zarodkiewicz, A., Jiang, Y., Olsson, A., Kelham, M., Hanson, J., Austin, D., Jones, D. A., et al. (2026) · Journal of Medical Internet Research · doi:10.2196/91299
“Because of the significant impact that nonadherence can have on patients, clinical research, and health care systems [8], there are ongoing efforts to find effective interventions to improve medication adherence [9-11].”
Lu, J. K., Wang, W., Chew, Y. E., Guan, L., Kennedy, B. K., & Maier, A. B. (2026) · PLOS Digital Health · doi:10.1371/journal.pdig.0001691
“This high adherence to supplement use over six months is noteworthy, where adherence in control subjects had been 77% and 84% in treatment subjects across 771 adherence intervention studies [45].”
Aro, R., Wojszel, Z. B., Duez, P., Lecron, F., & Patris, S. (2026) · Healthcare · doi:10.3390/healthcare14193240 · Cited by 1
Li, I. H., Liu, W., Lai, C. Y., Yang, C., Liu, C., & Dai, Y. (2026) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.70208
Mortelmans, L., Schenkel, A., Goossens, E., & Dilles, T. (2026) · Healthcare · doi:10.3390/healthcare14203436
“To estimate the effect size, we referred to a meta-analysis of 771 intervention studies on medication adherence, which reported a standardised mean difference of 0.29 between intervention and control groups [27].”
Influential
Metadata
- Authors
- Conn, V. S., & Ruppar, T. M.
- Affiliations
- University of Missouri (US)
- Corresponding author
- Conn, Vicki S.
- Venue
- Preventive Medicine
- Publisher
- Elsevier BV
- Published
- 2017-06
- Volume
- 99
- Pages
- 269-276
- ISSN
- 0091-7435 (ISSN-L)
- PMC
- PMC5467216
- OpenAlex
- W2597284704
- Cited by
- 367
- References
- 36
- Citations by year
- 2026: 20 · 2025: 39 · 2024: 41 · 2023: 47 · 2022: 57 · 2021: 55 · 2020: 52 · 2019: 37 · 2018: 11 · 2017: 6
- FWCI
- 4.87
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Preventive Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (R01NR011990)
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Health Professions › Pharmacy › Pharmacy and Medical Practices
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Patient Safety and Medication Errors
- Keywords
- medication adherence, adherence interventions, behavioral interventions, cognitive intervention, pill count, publication bias, risk of bias, older adults, homeless patients
- MeSH terms
- Assessment of Medication Adherence, Humans, Research Design, Bias, Drug Monitoring, Medication Adherence
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