PICOT Question: Is the use of SMS reminders and notifications more effective than standard therapy in reducing the occurrence of medication non-adherence among patients with schizophrenia?

Similarities and Differences of the Reviewed Studies

This section compares the studies based on five key areas: participants and target population, study designs, study variables, research methods, and study findings.

Study Participants and Target Population

The reviewed studies differed in their target populations and study sites. One of the studies (Xu et al., 2019) was conducted on patients with schizophrenia while two (Chiaranai et al., 2023; Belete et al., 2023) focused on patients with type II diabetes mellitus. Two other studies targeted patients with coronary heart disease (Zhao et al., 2019; Park et al., 2020), while one study investigated individuals on antiretroviral therapy (Sherman et al., 2018). The study setting also differed across all six studies. Xu et al. (2019) was based in nine villages in Wuhan, China, while Zhao et al. (2019) was a systematic review and meta-analysis synthesizing data from trials carried out in five countries, including two developing countries. Belete et al. (2023) brought together data from trials carried out in eight countries, including South Africa, Egypt, France, Indonesia, USA, Japan, India, and the Netherlands. One of the studies was based in Thailand, while the other two were based in California and Florida in the US.

Study Design and Data Collection Methods

Two of the studies (Sherman et al., 2018; Park et al, 2020) were qualitative inquiries, while four were quantitative studies. Both qualitative studies made use of primary data, with one using focus group discussions and the other using face-to-face structured interviews to collect data. Two of the quantitative studies (Chiaranai et al., 2023; Xu et al., 2019) were randomized controlled trials with a case-control approach, while two (Zhao et el., 2019; Belete et al., 2023) were systematic reviews and meta analyses of randomized controlled trials. The two randomized controlled trials used primary methods of data collection, including administration of adherence surveys and observation techniques to gather research data.

Study Variables and their Measurement

The primary similarity is that all six studies had medication adherence as the outcome variable and text message reminders/standard care as the independent variable. However, differences lie in the way the studies measure medication adherence. Further, some of the studies have multiple outcome variables. Two of the quantitative studies investigated the impact of text message reminders /alerts on medication adherence and patients clinical outcomes (Zhao et al., 2019; Xu et al., 2019), while one (Chiaranai et al., 2023) investigated the effect of texts on medication adherence and quality of life. Only one study investigated the effect of text message reminders solely on medication adherence among study participants (Belete et al., 2023). The qualitative studies both sought to understand participants experiences and attitudes on the use of text message reminders as a strategy for improving medication adherence.

There were significant differences in the way medication adherence was measured across the quantitative studies. Xu et al. (2019) measured medication adherence among schizophrenic patients using both observation (unannounced pill counts to compare pill numbers to refill records) and adherence rating scales, specifically the Drug...

…message reminders are likely to change adherence behavior if patients are allowed to exercise control over the timing and frequency of such messages. Failure to adapt the texts to meet patients needs may lead to agitation, reducing their effectiveness. It is also prudent that text messages are structured in a manner that protects patients confidentiality. For instance, reminder texts should do not reveal the patients illness, to safeguard them in case third parties read the text (Sherman et al., 2018).

For patients with schizophrenia and other mental illnesses, studies have shown that family support has a significant influence on adherence (Rindayati et al, 2021). Thus, text messaging interventions could be combined with family-based interventions to be more effective for these populations. For instance, text message reminders could be sent out to both patients and their caregivers rather than to patients alone to effectively improve adherence. At the same time, text messages could be combined with regular educational interventions targeting caregivers to ensure they understand the importance of adhering to antipsychotic medication (Rindayati et al., 2021).

Answer to the PICOT Question

The reviewed studies found that text message reminders had a significant positive effect on medication adherence among different patient populations, including patients with schizophrenia. Thus, this text concludes that the use of SMS reminders and notifications is more effective than standard therapy in reducing the occurrence of medication non-adherence among patients with schizophrenia. Further research may be necessary to assess the effect of such reminders on schizophrenic patients clinical outcomes, as well as the effects of timing and frequency of reminder messages…