One-way Versus Two-way Text Messaging on Improving Medication Adherence: Meta-analysis of Randomized Trials

Two-way text messaging (reminder plus patient reply) improves medication adherence by 23%, while one-way text messaging (reminder only) has little or no effect.

Abstract
Background
Mobile telephone text messaging is a simple potential solution to the failure to take medications as directed. There is uncertainty over the effectiveness of 1-way text messaging (sending text message reminders only) compared with 2-way text messaging (sending reminders and receiving replies confirming whether medication has been taken) as a means of improving medication adherence.

Methods
A meta-analysis of 8 randomized trials (1994 patients) that tested the effectiveness of text messaging on medication adherence was performed. The trials were divided into 2 groups: trials using 1-way text messaging versus no text messaging and trials using 2-way text messaging versus no text messaging. The summary estimates of the effect of the 2 methods of text messaging (1-way or 2-way) were compared.

Results
The summary relative risk estimate was 1.04 (95% confidence interval, 0.97-1.11) for 1-way text messaging and 1.23 (95% confidence interval, 1.13-1.35) for 2-way text messaging. The difference in effect between the 2 methods was statistically significant (P = .007).

Conclusions
Two-way text messaging is associated with substantially improved medication adherence compared with 1-way text messaging. This has important implications in the provision of mobile-based messaging in the management of patients taking medication for the prevention of chronic disease.

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– David S. Wald, MD, FRCP, Shahena Butt, MSc, Jonathan P. Bestwick, MSc

This article originally appeared in the October 2015 issue of The American Journal of Medicine.