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It is estimated that 20% to 50% of patients do not take their medication correctly, and this leads to increased morbidity and inefficacy of therapeutic approaches. Fostering treatment adherence is a priority objective for all health systems. The growth of mobile apps to facilitate therapeutic adherence has significantly increased in recent years. However, the effectiveness of the apps for this purpose has not been evaluated.
This study aimed to analyze whether mobile apps are perceived as useful for managing medication at home and if they actually contribute to increasing treatment adherence in patients.
We carried out a systematic review of research published using Scopus, Cochrane Library, ProQuest, and MEDLINE databases and analyzed the information about their contribution to increasing therapeutic adherence and the perceived usefulness of mobile apps. This review examined studies published between 2000 and 2017.
Overall, 11 studies fulfilled the inclusion criteria. The sample sizes of these studies varied between 16 and 99 participants. In addition, 7 studies confirmed that the mobile app increased treatment adherence. In 5 of them, the before and after adherence measures suggested significant statistical improvements, when comparing self-reported adherence and missed dose with a percentage increase ranging between 7% and 40%. The users found mobile apps easy to use and useful for managing their medication. The patients were mostly satisfied with their use, with an average score of 8.1 out of 10.
The use of mobile apps helps increase treatment adherence, and they are an appropriate method for managing medication at home.
The World Health Organization has classified the lack of treatment adherence as a major global problem [
It is estimated that 20% to 50% of patients do not take their medication correctly [
The most commonly used device to promote medication adherence is the pillbox. People can independently manage their medications, check whether they have taken them or not, avoid the risk of taking them twice or not taking them at all, and reduce the rate of medication errors. Previous studies found that people who used a pillbox had better treatment adherence [
All the research indicates that new information technologies have been rapidly accepted by the entire population [
This boom in mobile phones has resulted in these devices being used to devise new procedures to promote therapeutic adherence. At first, short message service (SMS) text messages were sent and telephone calls were made to remind users of the need to take medication. These kinds of reminders have been very effective methods and are well accepted by patients [
Then, with the advent of smartphones came mobile apps that have also afforded new opportunities for carrying out actions that simplify daily tasks, among them caring for health [
However, very little research has been undertaken to evaluate the effectiveness of these apps for the purposes for which they were intended or the level of acceptance among users [
This study aimed to analyze whether mobile apps that help people manage their medication in the home contribute to increasing patient adherence and are considered useful by the users.
A systematic review study that applied the recommendations in the Preferred Reporting Items for Systematic reviews and Meta-Analysis declaration for these types of studies was carried out [
A small container that pills are carried in. A pillbox can make the medication task easier because it helps people to manage their daily medication. This device is associated with improvements in medication adherence and, subsequently, with better health [
The MEMS is a pill organizer that has the additional feature of reminding you to take your drugs with visual and audio alerts. This MEMS provides information about treatment adherence. Therefore, it is the gold standard for this purpose [
Mobile apps are computer programs or software installed on mobile electronic devices that supports a wide range of functions and uses, including television, telephone, video, music, word processing, and internet services [
In this study, we considered the kind of mobile apps that help people to manage their medication. These mobile apps, compared with pillboxes or electronic pillboxes, have the main advantage of being a system that is incorporated into our smartphones [
The inclusion criteria for this review included research published in either English or Spanish that provided results about the effectiveness or treatment adherence in using mobile apps in the management of medication in the home, with any age group as the study population and regardless of the pathology and prescribed medication. Both quantitative and qualitative research were included, as well as research with descriptive and experimental approaches. The studies included in this review included presentations of results about the effectiveness in fostering adherence to treatment, safe medication use, viability, acceptance, satisfaction, and usefulness of these mobile apps. We excluded studies that were merely descriptive about the design of the mobile apps without presenting the results of use experience. We also excluded studies in which the interventions to remind patients to take their medication were delivered via SMS text messaging, phone calls, or electronic pillboxes.
We carried out a search for scientific documentation in the Scopus, Cochrane Library, ProQuest, and MEDLINE databases using keywords associated with pillbox and mobile apps and using the Boolean indicators OR and AND (
The initial search identified 212 papers, of which 32 were eliminated because of being duplicates. Similarly, we found an additional 8 studies within either the bibliographies of the articles selected or through a Google search. We analyzed the titles and abstracts and eliminated 188 papers because they did not fulfill the inclusion criteria. We then fully read the 23 remaining papers and discarded 10 of them because they did not evaluate the effectiveness of the mobile app. Ultimately, 11 papers fulfilled the inclusion criteria (
Flow diagram of the study inclusion and exclusion process.
The data extracted for each study included its country, objective, participants, chronic condition, design, and duration. Moreover, we recorded the functions of each mobile app, names of its designer(s), measures for evaluating adherence, measures for evaluating the mobile app, and outcomes of its evaluation.
In addition, to evaluate the quality of the reviewed publications, we first analyzed the level and degree of evidence following the classification proposed by the Scottish Intercollegiate Guidelines Network [
We classified the levels of evidence as follows: 1++ (meta-analyses, systematic reviews of clinical trials, or high-quality clinical trials with very little risk of bias), 1+ (meta-analyses, systematic reviews of clinical trials, or well-conducted clinical trials with little risk of bias), 1− (meta-analyses, systematic reviews of clinical trials, or clinical trials with high risk of bias), 2++ (systematic reviews of cohort or case-control studies or studies of high-quality diagnostic tests and cohort or case-control studies of high-quality diagnostic tests with very little risk of bias and a high probability of establishing a causal relationship), 2+ (cohort or case-control studies or studies of well-conducted diagnostic tests with a low risk of bias and a moderate probability of establishing a causal relationship), 2− (cohort or case-control studies with a high risk of bias), 3 (nonanalytical studies, such as case reports and case series), and 4 (expert opinions) [
We classified the strengths of the recommendations as (A) at least 1 meta-analysis or systematic review of a controlled and randomized trial (CRT) or a level 1++ CRT, directly applicable to the target population or sufficient evidence extrapolated from 1+ level studies, directly applicable to the target population and whose results demonstrate overall consistency; (B) sufficient evidence deriving from level 2++ studies, directly applicable to the target population and whose results demonstrate overall consistency, with evidence extrapolated from either 1++ or 1+ level studies; (C) sufficient evidence deriving from level 2+ studies, directly applicable to the target population and whose results demonstrate overall consistency, with evidence extrapolated from level 2++ studies; and (D) evidence from either level 3 or 4 studies, with evidence extrapolated from level 2+ studies [
The evaluation and classification of the studies found during the search strategy were completed independently by 2 investigators (MS and VPJ). Discordant elements were discussed by both investigators until an agreement was reached.
The initial search identified 212 papers. Ultimately, 11 papers fulfilled the inclusion criteria (
In 7 of the 11 studies [
Moreover, 1 study [
The sample sizes varied between 16 and 99 participants [
The investigators recruited the samples at hospitals [
The apps used in this study included different conditions, such as asthma [
To compare results, 4 studies carried out randomized controlled trials [
Furthermore, 2 studies compared 2 independent samples. One of these compared the responses of persons older and younger than 55 years as its objective was to verify the differences between the effectiveness and ease of use of the app between these 2 groups [
The remaining 5 studies [
The time that the participants used the mobile apps varied between 2 hours and 6 months, depending upon the study [
A description of these issues is in
Details of the included studies.
Authors and country | Objective | Participants | Chronic condition | Design (Duration) |
Anglada-Martínez et al, Spain [ |
Evaluate 1 Web and smartphone-based medication self-management platform, named MedPlan. | N=42; average age: 56 years | Hypertension “and” or “or” dyslipidemia and HIV | Transversal (6 months) |
Burbank et al, United States [ |
Examine the viability of a mobile application for adolescents with asthma. | N=20; adolescents; average age: 13.5 years | Asthma | Transversal (8 weeks) |
Fallah and Yasini, France [ |
Design and evaluate a mobile medication reminder app. | N=60; <55 years: N=30; and >55 years: N=30 | —a | Transversal (—) |
Goldstein et al, United States [ |
Compare the adherence of 2 interventions, electronic pillbox and mobile apps, under experimental conditions with and without medication reminders, in addition to evaluating the viability and effectiveness of each. | N=58; elderly adults; average age: 69 years | Heart failure | Randomized controlled (28 days) |
Grindrod et al, Canada [ |
Explore the ease of use and usefulness of existing mobile apps for handing medication in elderly adults. | N=35; >50 years; average age: 67 years | — | Transversal (2 hours) |
Kang and Park, South Korea [ |
Develop a mobile application for managing hypertension and evaluate its usefulness, user satisfaction and adherence to medication. | N=38; average age: 56 years | Hypertension | Transversal (4 weeks) |
Mertens et al, Germany [ |
Analyze if mobile application to support the therapy management will be accepted by elderly patients with chronic conditions and would improve their therapy adherence. | N=24; average age: 73.8 years | Coronary heart disease or myocardial infarction | Randomized controlled (84 days) |
Mira et al, Spain [ |
Design, develop, and evaluate a mobile app that enables safer use of medication in elderly patients who take multiple medications. | N=61; elderly adults; average age: 68.8 years | Pluripathology | Transversal (—) |
Mira et al, Spain [ |
Design, implement and evaluate a mobile app for self-management of medication in elderly patients who take multiple medications. | N=99; >65 years; experimental group: N=51; and control group: N=48 | Pluripathology | Randomized controlled (3 months) |
Perera et al, New Zealand [ |
Examine the effectiveness of a mobile application for facilitating treatment adherence to combined antiretroviral therapy. | N=28; average age: 46; experimental group: N=17; and control group: N=11 | HIV | Randomized controlled (3 months) |
Shellmer et al, United States [ |
Design a mobile application for improving treatment adherence in adolescent recipients of solid organ transplants and evaluate its acceptance, ease of use and satisfaction. | N=7; adolescents; + 9 caregivers | Recipients of solid organ transplants | Transversal (6 weeks) |
aMissing data.
The contents of the mobile apps included reminders for taking medication; some of these studies did so with alarms (visual and audio) that the patients had previously recorded [
Some more specific functions of each app included reminders with alarms for doctors’ appointments [
In 6 of the studies, the design of the app was made from patient data compiled with qualitative techniques, such as in nominal groups [
In 5 of the 11 studies, the mobile apps were available in both Android and iOS versions [
The questionnaires administered for evaluating treatment adherence were the Modified Morisky Scale [
The questions used for evaluating the mobile apps included the Post Study System Usability Questionnaire [
Overall, 7 studies compiled patient data using qualitative techniques wherein questions were asked about the satisfaction, usefulness, ease of use, acceptance and the contents of the apps [
Furthermore, 7 studies confirmed that the mobile app increased treatment adherence [
The participants declared that that they were satisfied with the app in all 7 of the studies that included this measure [
Ease of use was estimated in 6 studies [
In 5 studies, the participants stated that these mobile apps were useful [
Finally, 1 study [
A description of these issues is in
Details of the apps used in the included studies.
Study | App functions and design | Medication adherence measure | Measure for evaluating app | App evaluation |
Anglada-Martínez et al [ |
MEDPLAN. Drugs information, medication reminder alarm system, where patients confirm whether they have taken the drug or not. App designed by health professionals. | Simplified Medication Adherence Questionnaire (SMAQ), pharmacy refill method and number of days with missing dose. | Usability and satisfaction assessed through self-reported questionnaires. | When adherence was measured using the SMAQ, treatment adherence improved during the intervention phase (19.4%; |
Burbank et al [ |
Medication reminder, reminder for recording symptoms, feedback on its adherence and education about asthma. The App was designed by patients and health professionals. | Asthma Control Test. Child Asthma Self-Efficacy Questionnaire. | Questions about satisfaction. | In spite of the improvement in the control of asthma before and after the study, there were no significant differences ( |
Fallah and Yasini [ |
Reminders via alarms, instructions and information about medication. The App was designed by patients, health professionals, and technology specialists. | —a | Questionnaire for evaluating the application’s effectiveness and ease of use. The questions for evaluating its ease of use were taken from the System Usability Scale adapted for mobile applications. | No significant differences were found between the effectiveness or ease of use in either age group (greater and younger than 50). Both groups found the app effective and easy to use. |
Goldstein et al [ |
— | Electronic pillbox: opening the pillboxes. Mobile application: electronic self-reports. The number of medications taken was divided by the number of medications prescribed. | Questionnaire for evaluating the acceptance, usefulness, satisfaction, willingness to recommend it and their opinion about the device. | Improves treatment adherence with both interventions (80%). No significant differences were found between the type of device and adherence ( |
Grindrod, Li and Gates [ |
— | — | System Usability Scale. Questions in a group session: ease of use, user experiences, expected adoption, concerns about the potential for data entry errors, perceived quality of the provided information and preferences for the different characteristics. | The Pocket Pharmacist application received an ease of use score that was significantly lower when compared to the remaining applications ( |
Kang and Park [ |
HYPERTENSION MANAGEMENT APP. Reminders with alarms for taking medication and doctor’s appointments, recording blood pressure, recommendations about lifestyle and information on medication. The App was designed by patients and experts. | Modified Morisky Scale. | Questionnaire with a scale from 1 to 5 that evaluated perceived usefulness and satisfaction with each of the application’s contents. | The average scores on adherence increased significantly before and after the study from 4.2 to 5.2 out of a maximum of 6 points ( |
Mertens et al [ |
MEDICATION PLAN. Reminders via alarms, instructions and information about medication. The App was designed by health professionals. | Subjective adherence was determined by the A14-scale. Objective adherence was measured by number of medications each participant had to take each day. | Semistructured interviews. | The mean for subjectively assessed adherence there was a significant increase after the interventional phase from 50 to 54 out of a maximum of 56 points ( |
Mira et al [ |
TUMEDICINA. Scans the bar codes on the medication box to provide information about its therapeutic objective, indications for taking it, interactions with other medications and its date of expiration. This information is stored as audio recordings. The App was designed by patients. | — | Group session and individual questionnaire for evaluating the characteristics and operation of the application. | The characteristics rated highest were the simplicity and clarity of the verbal messages (96.7%), the usefulness of the verbal messages (93.4%) and the clarity of the information provided (95.1%). No significant differences were found in the assessment of the satisfaction between patients with or without experience of using mobile telephones or browsing the Internet ( |
Mira et al [ |
ALICE. Reminders with alarms for taking medication and carrying out healthy habits, images of drugs, instructions on how to take medication, SMS sent to caregivers in cases where the medication is not taken. The App was designed by patients, health professionals, and technology specialists. | Morisky Medication Adherence Scale. Questionnaire for evaluating rates of missed doses and medication errors. | Questions for evaluating the application: satisfaction, ease of use, performance, usefulness, reliability, acceptance, design, simplicity, accessibility, if they would recommend it and if it afforded them independence. | Treatment adherence improved in the experimental group (28%; |
Perera et al [ |
The application used by the control group contained a 24-hour medication watch. For the experimental group, in addition to the watch, it contained personalized messages about the levels of medication and immunoprotection in the patient’s body. | Medication Adherence Report Scale. Pharmacy prescriptions filled. HIV viral load. | Questionnaire for evaluating the satisfaction, perceived usefulness, ease of use, visual appeal, discretion and provision of information. | Greater treatment adherence in the experimental group according to the scores on the Medication Adherence Report Scale (40%; |
Shellmer et al [ |
TEEN POCKET PATH. Reminder of what medication must be taken and in what dose, confirmation that it had been taken, information about the type of transplant received and general information, such as telephone help lines. Caregivers received information as to whether the adolescents had taken their medication. The App was designed by patients and caregivers. | — | Post Study System Usability Questionnaire. Questions during one session: ease of use, viability, satisfaction, usefulness, simplicity of the reminder, warning messages sent to the caregivers and perceptions about long-term use of the application. | Users and caregivers found the application easy to use, effective, useful and they were satisfied with it. The caregivers said that they felt less need to constantly ask the adolescents about whether or not they had taken their medication. |
aMissing data.
These results indicate that mobile apps help promote treatment adherence [
One thing to keep in mind is that these studies focused exclusively on the lack of adherence caused involuntarily by the patient. They did not control participant variables of the locus control type or confidence or relationship with health professionals. Users of these apps who voluntarily and consciously rule out following the treatment can use these devices to gain greater credibility with their caregivers or health professionals by indicating in the app that their medication has been taken even when this is not the case. This is the same problem with traditional pillboxes and in research on therapeutic adherence [
The gold standard used for determining therapeutic effectives has been based on the use of reports by patients obtained using validated scales and widely used in research on adherence [
The majority of patients stated that the mobile apps they had used were easy to use [
It should be noted that in most of the studies, the mobile apps were designed especially for future users [
The main contents in the apps to foster treatment adherence were reminders with alarms for taking the medication [
Although the level of knowledge about the illnesses or their treatments was not controlled in the studies carried out, one could expect that using these apps contributes to greater knowledge about the disease and the drugs that are taken every day. In some cases, these apps include information about drug storage and about potential (the most frequent) drug interactions with other active ingredients or natural products [
Other app functions to promote adhering to the therapeutic regimen were reminders about leading a healthy lifestyle [
This review shows that mobile apps are effective in promoting treatment adherence and that they contribute to patient safety by avoiding errors in the administration of their treatments. Owing to this, health professionals, such as physicians or pharmacists [
Among the possible limitations of this study, it should be mentioned that despite having carried out the search in the most important databases on medicine, it is probable that other databases were not considered. In addition, although we used a wide range of descriptors to obtain a more precise strategy, there might be a specific keyword from a concrete area that was not controlled.
Furthermore, we did not include articles in languages other than English and Spanish nor did we consider abstracts from conferences.
Another limitation to highlight is the difficulty in compiling the results because of the wide heterogeneity of methodologies and results from the articles that were found.
This study evaluates the effectiveness of mobile apps as a method for overcoming errors by patients in managing medication. However, these mobile apps do not offer alternatives for controlling voluntary nonadherence by patients.
We know that 1 in 5 elderly patients forget to take their medication or make mistakes when doing so [
Most of the studies focused on specific diseases, but all of them had a common approach toward chronic diseases [
The relevance of using smartphones to foster treatment adherence is also because of their acceptance, ease of use, and affordability [
Park et al [
Other studies have evaluated the effectiveness of other technological methods by which treatment adherence can be enhanced, such as telephone calls or SMS [
In addition to mobile apps found for fostering treatment adherence, there are also apps for promoting adherence to other therapeutic regimens, with reminders for leading an appropriate lifestyle, reminders for keeping doctors’ appointments, and monitoring other health information (eg, supplements and manage pets), among others [
From these results, recommendations for the design of future apps can also be deduced when considering the contents valued highest by the patients. Park et al [
The majority studies included in this review evaluated treatment adherence by validated scales such as the Morisky Medication Adherence Scale [
In addition, patient safety should be considered in these mobile apps because these help them to manage their medication and they could make mistakes when taking their drugs [
Finally, the studies with longer use times of the apps are considered necessary to integrate the mobile apps in their daily routine and examine their effectiveness for treatment adherence in the long term [
Mobile apps prevent forgetting about medication and incorrect administration and, thus, contribute to patient safety. In the future, these apps should include personalization of the personal conditions and posology of the medication the patient takes.
Levels of evidence and degrees of recommendation.
Assessment of the internal quality of the design of the studies.
controlled and randomized trial
mobile health
Medication Event Monitoring System
short message service
This study was financed by the Conselleria de Educación, Generalitat Valenciana Excellence Groups Prometeo/2017/173.
None declared.