Does mHealth increase adherence to medication? Results of a systematic review

Summary Aims Adherence to medication is a major problem that affects 50–60% of chronically ill patients. As mobile phone use spreads rapidly, a new model of remote health delivery via mobile phone – mHealth – is increasingly used. The objective of this study is to provide a comprehensive overview of how mHealth can be used to improve adherence to medication. Methods A systematic literature review was conducted using four databases (CINAHL, PubMed, Scopus and PsycARTICLES). Eligible articles available on March 2014 had to be written in English or Spanish and have a comparative design. Articles were reviewed by two authors independently. A Cochrane Collaboration tool was used to assess the studies based on their internal validity. Results Of the 1504 articles found, 20 fulfilled the inclusion criteria [13 randomised clinical trials (RCT), one quasi‐RCT, one non‐randomised parallel group study and five studies with a pre‐post design]. Nearly all the trials were conducted in high‐income countries (80.0%). Articles were categorised depending on the target population into three different groups: (i) HIV‐infected patients, n = 5; (ii) patients with other chronic diseases (asthma, coronary heart disease, diabetes mellitus, hypertension, infectious diseases, transplant recipients and psoriasis), n = 11; and (iii) healthy individuals, n = 4. Adherence improved in four of the studies on HIV‐infected patients, in eight of the studies on patients with other chronic diseases, and in 1 study performed in healthy individuals. All studies reported sending SMS as medication reminders, healthy lifestyle reminders, or both. Only one trial (HIV‐infected patients) had a low risk of bias. Conclusions Our results showed mixed evidence regarding the benefits of interventions because of the variety of the study designs and the results found. Nevertheless, the interventions do seem to have been beneficial, as 65% of the studies had positive outcomes. Therefore, more high‐quality studies should be conducted.