JMIR Publications

ABSTRACT

Background:

Medication non-adherence in chronic diseases negatively impacts patients’ quality of life, healthcare systems, and economic stability. Despite extensive research, no universally recognized strategy has been established to improve adherence. With the rapid advancement of digital health technologies, text messaging has emerged as a widely accessible and cost-effective intervention, particularly when structured using behavioral theories.

Objective:

This study aimed to review existing literature and identify key factors in the design of text message-based interventions for improving medication adherence among patients with chronic diseases.

Methods:

A narrative review was conducted using the SPIDER (sample, phenomenon of interest, design, evaluation, research type) framework. Relevant literature on text messaging interventions was searched in PubMed and Scopus from inception to October 2024. The search terms included “diabetes,” “hypertension,” “hyperlipidemia,” “message,” “text,” “text message,” “app,” “application,” “digital,” “device,” “mobile,” “medical adherence,” and “medication adherence,” combined using logical operators “OR” and “AND.” Full-text articles were analyzed for study design, author, country, year of publication, disease focus, behavioral theory, and the constructs or domains of text messages.

Results:

A total of 52 studies investigating text message-based interventions to enhance medication adherence were identified. The targeted conditions included diabetes (n = 26), hypertension (n = 16), and various other chronic diseases (n = 14). More than half of the studies (n = 33) incorporated behavioral theories or techniques in their intervention design, utilizing 19 distinct behavioral models. The most frequently employed frameworks were the Behavior Change Technique Taxonomy (n = 16) and the COM-B model (n = 6). Additionally, 33 studies implemented tailored messaging strategies, with the most common approach being content customization based on individual patient information (n = 21), followed by personalized timing and frequency of messages (n = 14), to enhance interventions’ adaptability and relevance to users’ needs.

Conclusions:

This review highlights critical factors influencing the design of text message-based interventions for medication adherence in chronic disease management. The findings underscore the importance of integrating behavioral theories and tailoring strategies to optimize patient engagement and intervention effectiveness. Further research is needed to evaluate the impact of different tailoring approaches and translate these insights into practical interventions.