JMIR Publications

ABSTRACT

Background:

Digital medication adherence interventions for individuals diagnosed with chronic conditions have been developed but their long-term efficacy in improving medication adherence has been limited. Exploring mechanisms and contexts related to the outcomes of digital medication adherence interventions is important for these to be effectively tailored for different populations and contexts.

Objective:

To conduct a realist review to help in understanding which intervention components might work for whom and under what circumstances.

Methods:

A realist review of literature published between 2002-2024 was conducted according to RAMESES guidelines (Realist and Meta-narrative Evidence Synthesis: Evolving Standards). Studies reporting digital medication adherence interventions for people diagnosed with chronic diseases and experiencing unintentional medication non-adherence issues were included. The databases MEDLINE, CINAHL, PsycINFO, Web of Science, Scopus, EMBASE and grey literature databases, Overton and Policy commons were searched. Data regarding contexts, mechanisms and outcomes were extracted and synthesised into programme theories. Programme theories from the realist review were triangulated with findings from two rounds of workshops (three workshops in each round), in which context-mechanism-outcome configurations were co-created with various stakeholders of a project aimed at implementing a digital medication adherence intervention to reduce unintentional non-adherence among people with chronic diseases. There were 12 participants in each round.

Results:

The analysis included a review of 83 articles and of outcomes of the co-creation workshops, which led to 35 context-mechanism-outcome (CMOs) theories in seven theory areas which were: 1) Building and maintaining medication intake habits; 2) Solving medication-related barriers to adherence; 3) Enabling collection of prescription medications on time; 4) Supporting people with unpredictable health conditions and sensory or motor impairments; 5) Supporting individuals with high anxiety, low medication self-efficacy and low social support; 6) Supporting individuals who are uncomfortable with technology; 7) Economic, policy and organisational factors affecting implementation of smart medication devices. Fourteen CMOs came from both the literature and workshops, 7 CMOs from the literature alone and 14 CMOs from the workshops alone.

Conclusions:

Analysis of the programme theories suggested a range of intervention components considering various contextual factors that may improve medication adherence of individuals. These were utilised to form recommendations for intervention developers and those implementing them. Further studies are required on policy and economic factors affecting large-scale implementation and scalability of digital medication adherence interventions in different settings. Future interventions should report intervention content and delivery in detail and co-develop effective implementation strategies with professionals who can support the large-scale implementation of the intervention. Clinical Trial: CRD42025641383