Key Elements and Theoretical Foundations for the Design and Delivery of Text Messages to Boost Medication Adherence in Patients With Diabetes, Hypertension, and Hyperlipidemia: Scoping Review

Background: Medication nonadherence in cardiometabolic syndrome negatively impacts patients’ quality of life, health care systems, and economic stability. Despite extensive research, no universally recognized strategy has been established to improve adherence. SMS text messaging has emerged as a widely accessible and cost-effective intervention, particularly when the intervention is structured using behavioral theories. Objective: This study aimed to review existing literature and identify key factors in the design of SMS text messaging interventions for improving medication adherence among patients with diabetes, hypertension, or hyperlipidemia. Methods: We conducted a scoping review following the SPIDER (sample, phenomenon of interest, design, evaluation, research type) framework and guided by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. Relevant literature on SMS text messaging interventions was searched in the PubMed and Scopus databases from inception to October 2024. The search terms included “diabetes,” “hypertension,” “hyperlipidemia,” “message,” “text,” “text message,” “app,” “application,” “digital,” “device,” “mobile,” “medical adherence,” and “medication adherence,” combined using logical operators “OR” and “AND.” Full-text articles were analyzed for study design, author, country, year of publication, disease focus, behavioral theory, and the constructs or domains of text messages. Results: A total of 52 studies investigating SMS text messaging interventions to enhance medication adherence were identified. The targeted conditions included diabetes (26/52, 50%), hypertension (16/52, 31%), and various other chronic diseases (10/52, 19%). More than half of the studies (33/52, 64%) incorporated behavioral theories or techniques in their intervention design, using 19 distinct behavioral models. The most frequently used frameworks were the behavior change technique taxonomy (16/52, 31%) and the capability, opportunity, motivation, and behavior model (6/52, 12%). In addition, 33 (64%) studies implemented tailored messaging strategies, with the most common approach being content customization based on individual patient information (21/52, 40%), followed by personalized timing and frequency of messages (14/52, 27%), to enhance interventions’ adaptability and relevance to users’ needs. Conclusions: This review highlights critical factors influencing the design of SMS text messaging interventions for medication adherence in the management of diabetes, hypertension, and hyperlipidemia. The findings underscore the importance of integrating behavioral theories and tailoring strategies to optimize patient engagement and intervention effectiveness. Further research is needed to evaluate the impact of different tailoring approaches and translate these insights into practical interventions.