Thursday, June 26, 2014

A quantitative systematic review of the efficacy of mobile phone interventions to improve medication adherence

Review of Linda Park's research paper of text messages interventions

Main researcher
Linda G. Park, Post-doctoral fellow, Division of Geriatrics, University California, San Francisco, VA Medical Center

Research objective
Evaluate efficacy of mobile phone interventions to improve medication adherence and explore acceptability and satisfaction of patients.

Review of existing studies to date.

Reviewed studies

All reviewed studies used text messaging. Studies that were based on calling patients on their mobile phones were excluded as one of the key features of mHealth is having less 'intrusive' methods.

Chronic diseases treated by the studies: HIV, diabetes, asthma, schizophrenia, hypertension, acne, atopic dermatitis, systematic lupus erythematosus and immunosuppression after pediatric liver transplant.

Positive effects on medication adherence occurred in all 8 studies that applied 'tailored' or 'personalized' messages.

Measures of med adherence include Morisky Medication Adherence Scale (MMAS).

One study did SMS on 5 domains: educational/motivational, med reminders, healthy living challenges, diabetes trivia.

Outcome of trials: High satisfaction in helpfulness of SMS, enjoying SMS, and recommending to others. Bad outcome: 33% people ignoring sms after 2 weeks and 26% found SMS to be 'annoying'.

Social support

Social support, communicating concern and providing assistance.

Young adult population sent interesting and light-hearted messages at random times from a virtual friend named 'Tim'.

'Mambo?' (How are you?) They felt like somebody cared.
Healthcare providers called participants who responded with Shida (I have a problem) and participants reported that they felt that someone cared about them.

Messages that were developed by the participants at the beginning of the study (e.g. 'Superman calling you', 'Take it or die'). A visual analogue scale and a 4-day recall of medication administration showed significant changes.

Motivation messages included religious (Bible) verses to vote. 


It is important to evaluate participant satisfaction.

eMedication Dispenser could be used to send reminders only if dispenser not opened. Discrepancy between self-reported and electronically monitored medication was evident.

Mixed methods with electronic devices, biomarkers, and self-report is important.

88% of patients used other co-interventions such as alternative alarm systems (alarm clock or mobile phone alarms).

A major barrier in using mobile technology may be deterioration of interest.

The total healthcare costs were not analyzed. Consideration of reimbursement models for medication adherence and mHealth interventions is also needed.

Real-time feedback on disease management will be instrumental in designing future interventions.

Theoretical basis are needed. Adherence theories: 

  • Transtheoretical Model
  • Social Cognitive Theory
  • Health Belief Model of Behavior Change
  • Behavioral Learning Theory
  • Theory of Planned Behavior


TextMessaging programs improve medication adherence but their major barrier is deterioration of interest over time.

The next decade will evolve into applying more smartphone apps in place of TM interventions. 58% of Americans own a smartphone in 2014.

Manuel Acevedo’s personal analysis

Text messaging reminders improve adherence because remembering is inhuman. Tech prompts reminders and never forgets.

Customized and tailored messages work better, but the major barrier is still deterioration of interest. Once the patient detects the pattern in the messages, they are not perceived as tailored anymore. 

Mobile apps allow ever-renewed high value tailored images and messages that clearly surpass the computer generated message.

88% of patients used other co-interventions such as alternative alarm systems (alarm clock or mobile phone alarms). In other words, patients prefer a decentralized system they can manage (iPhone app) than a Clinic managed SMS system.

Therefore, I agree with Dr Park when she says “The next decade will evolve into applying more smartphone apps in place of TM interventions”.


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