Mobile health interventions to improve adherence to oral anticoagulant treatment: A systematic review and critical analysis

Aims
Non-adherence to oral anticoagulants (OACs) is associated with significant morbidity and mortality. Mobile health (mHealth) interventions have been used to improve medication adherence across the three phases of initiation, implementation and persistence. This review investigated the effectiveness of mHealth interventions in improving OAC adherence.

Methods
PubMed, Embase, Cochrane Register and Web of Science were searched from 1/1/2000 to 14/11/2025 using terms identifying mHealth, OACs, medication adherence and randomized controlled trials. Included studies were assessed using the Risk of Bias for Interventional Adherence Studies tool. A narrative synthesis of the findings was undertaken. The study protocol was published in PROSPERO (CRD42022372863).

Results
A total of 2571 studies were screened from which 24 randomized controlled trials met the criteria for inclusion. Adherence was most frequently assessed electronically using smart pill bottles and medication events monitoring systems. Nine of the 13 trials reporting statistically significant improvements in adherence tested smartphone-based apps, telephone calls or text messages to support participants or as medication intake reminders. In terms of methodological quality, studies scored best with respect to randomization and blinding procedures, data analysis and interpretation. Studies scored worst in relation to study design and implementation of procedures and adherence outcome measurement and reporting.

Conclusions
mHealth interventions involving smartphone-based apps or telephone and text messages may be effective in improving adherence to OACs. Future research should focus on optimizing the frequency of delivery, content of calls or messages and automation. Research should prioritize larger, longer-term trials with emphasis placed on trial design, conduct and reporting.