Text-based messaging interventions for improving medication adherence among community-dwelling adults with Hypertension: A systematic review and meta-analysis

Abstract

Background: As a leading cause of morbidity and mortality, Hypertension is a pressing global concern. Adherence to antihypertensives is a cornerstone of effective antihypertensive therapy. However, suboptimal medication adherence is widespread. Mobile health technology i.e. text messaging is a promising tool that can promote medication adherence with a wide-reaching effect on population health. Aims: To critically assess the effectiveness of text-based messaging interventions for improving medication adherence among community-dwelling adults with Hypertension. Methods: Studies were identified through a detailed search of six databases by two independent reviewers: PubMed, Embase, Cochrane, PsycINFO, CINAHL and Scopus. Studies included were: (1) published in English, since 2000; (2) randomised controlled trials; (3) done on community-dwelling adults diagnosed with Primary/ Essential Hypertension; (4) utilised 1 or 2-way text messaging, tailored text messaging, interactive voice response and text-based mobile applications; and (5) with medication adherence-related outcomes. Data extraction was conducted based on the Cochrane Handbook for Systematic Reviews of Intervention, and relevant studies underwent a study appraisal using the Cochrane Risk of Bias Tool. Results: Twelve studies were included in the final review. Text-based messaging interventions exhibited a small statistically significant effect on medication adherence scores and systolic blood pressure reduction while the effect on controlled blood pressure and adherence remains uncertain. Subgroup analyses revealed having a multifaceted content on Hypertension management may be more effective than solely medication adherence content and or reminders. Significance of the study: There is limited evidence that text messaging-based interventions resulted in improved medication adherence and blood pressure control as a result of adherence. With the rise of mobile health, future studies exploring the cost effectiveness and feasibility of tailored and interactive text messaging interventions are warranted to influence the use of public health resources into the development of communication tools as a public health strategy for promoting medication adherence.