Effectiveness of M-Health Interventions to Improve Medication Adherence in People with Schizophrenia Spectrum Disorder: A Systematic Review

Abstract

Background: Mobile health interventions offer a potential solution to adherence challenges, yet evidence regarding their collective efficacy in schizophrenia spectrum disorders has not been formally synthesized. This systematic review evaluates the impact of mobile health (mHealth) interventions on medication adherence as a primary outcome and on daily functioning and psychotic symptoms as secondary outcomes in individuals with schizophrenia spectrum disorders. Methods: Using the Population, Intervention, Comparison, Outcome (PICO) framework, a systematic search was conducted across multiple databases to identify relevant randomized controlled trials (RCTs) evaluating mHealth strategies for medication adherence in adults with schizophrenia spectrum disorders. The PubMed, CINAHL, PsycINFO, EMBASE, and JBI databases were searched from inception until 24 February 2026, using combinations of search terms such as “Schizo” OR “Psychos” AND “mHealth” OR “Digital Health” AND “Medication Adherence”. Data extraction was conducted using a standardized data extraction table and narratively synthesized. This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, ensuring structured and comprehensive reporting of the findings. Results: Fourteen randomized controlled trials (RCTs) with 1717 participants were included in this review. Four studies evaluated text messaging interventions, four employed phone call interventions, three used electronic medication monitoring systems, and three used mobile applications. Nine of the fourteen studies reported statistically significant improvements in medication adherence. For secondary outcomes, the results were highly inconsistent: only three studies demonstrated significant reductions in psychotic symptoms, and none showed benefits for daily functioning. While various theoretical frameworks, such as the Health Belief Model and Cognitive Behavioral Therapy and intervention modalities, were utilized, the overall evidence was limited by high clinical heterogeneity and a lack of robust long-term data. Conclusions: mHealth interventions, particularly text messaging and mobile applications, demonstrate clear potential to improve medication adherence in individuals with schizophrenia spectrum disorders. Given the high heterogeneity and lack of long-term evidence, future research should prioritize standardized outcome measurements, rigorous designs, and extended follow-up periods to confirm clinical utility.