Text Messaging and Mobile Phone Apps as Interventions to Improve Adherence in Adolescents With Chronic Health Conditions: A Systematic Review
Open accessAbstract
BACKGROUND: The number of adolescents with chronic health conditions (CHCs) continues to increase. Medication nonadherence is a global challenge among adolescents across chronic conditions and is associated with poor health outcomes. While there has been growing interest in the use of mHealth technology to improve medication adherence among adolescents with CHCs, particularly text messaging and mobile phone apps, there has been no prior systematic review of their efficacy. OBJECTIVE: The purpose of this review was to systematically evaluate the most recent evidence for the efficacy of text messaging and mobile phone apps as interventions to promote medication adherence among adolescents with CHCs. METHODS: PubMed, Embase, CENTRAL, PsycINFO, Web of Science, Google Scholar, and additional databases were searched from 1995 until November 2015. An additional hand search of related themes in the Journal of Medical Internet Research was also conducted. The Preferred Reporting Results of Systematic Reviews and Meta-Analyses guidelines were followed. Two reviewers independently screened titles/abstracts, assessed full-text articles, extracted data from included articles, and assessed their quality using Grades of Recommendation, Assessment, Development, and Evaluation criteria. Included studies were described in original research articles that targeted adherence in adolescents with CHCs (12-24 years-old). RESULTS: Of the 1423 records examined, 15 met predefined criteria: text messaging (n=12) and mobile phone apps (n=3). Most studies were performed in the United States (11/15, 73%), were randomized-controlled trials (8/15, 53%), had a sample size <50 (11/15, 73%), and included adherence self-report and/or biomarkers (9/15, 60%). Only four studies were designed based on a theoretical framework. Approaches for text messaging and mobile phone app interventions varied across studies. Seven articles (7/15, 47%) reported significant improvement in adherence with moderate to large standardized mean differences. Most of the included studies were of low or moderate quality. Studies varied in sample size, methods of adherence assessment, and definition of adherence, which prohibited performing a meta-analysis. CONCLUSIONS: The use of text messaging and mobile phone app interventions to improve medication adherence among adolescents with CHCs has shown promising feasibility and acceptability, and there is modest evidence to support the efficacy of these interventions. Further evaluation of short- and long-term efficacy and cost-effectiveness of these interventions is warranted given the early and evolving state of the science.
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Evidence for utilizing internet- and mobile-based interventions in adolescents and young adults with chronic conditions points to their feasibility and effectiveness.
“The evidence for utilizing IMI on AYA with chronic conditions points to their feasibility and effectiveness [20].”
From Feasibility and potential efficacy of a guided internet- and mobile-based CBT for adolescents and young adults with chronic medical conditions and comorbid depression or anxiety symptoms (youthCOACHCD): a randomized controlled pilot trial (2022) · cites this paper as [20]
The Discussion’s Conclusions report promising feasibility for text-messaging and mobile-app interventions in adolescents with chronic health conditions, but only modest evidence of efficacy for improving medication adherence. The Methods’ Study Selection section includes ages 12–24 but explicitly excludes Web- or Internet-based interventions, so the claim is broader than the review’s evidence. (LLM, conf=0.90)
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- Authors
- Badawy, S. M., Barrera, L., Sinno, M. G., Kaviany, S., O’Dwyer, L. C., & Kuhns, L. M.
- Affiliations
- Northwestern University (US)
- Lurie Children's Hospital (US)
- University of Kansas (US)
- Advocate Children's Hospital (US)
- Corresponding author
- Badawy, Sherif M
- Venue
- JMIR mHealth and uHealth
- Publisher
- JMIR Publications Inc.
- Published
- 2017-05-15
- Volume
- 5
- Issue
- 5
- Pages
- e66
- ISSN
- 2291-5222 (ISSN-L)
- PMC
- PMC5447825
- OpenAlex
- W2616486323
- Cited by
- 207
- References
- 51
- Citations by year
- 2026: 8 · 2025: 10 · 2024: 18 · 2023: 17 · 2022: 31 · 2021: 34 · 2020: 40 · 2019: 22 · 2018: 21 · 2017: 6
- FWCI
- 4.29
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR mhealth and uhealth (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Institutes of Health (UL1TR001422)
- Agency for Healthcare Research and Quality (K12HS023011)
- National Center for Advancing Translational Sciences
- 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 › Speech and Hearing › Adolescent and Pediatric Healthcare
- Keywords
- medication adherence, adolescents, chronic disease, text messaging, mobile phone app, mobile health intervention, adherence interventions, intervention efficacy, feasibility and acceptability, adherence measurement, theoretical framework, cost-effectiveness, health equity, health literacy
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