Effect of SMS Reminders on Medication Adherence in Schizophrenia: A Quasi-Experimental Study in Nigeria

Niger Med J. 2026 Mar 2;67(2):626-632. eCollection 2026 Mar-Apr.

ABSTRACT

BACKGROUND: Medication non-adherence remains a major obstacle in schizophrenia management. In resource-limited settings such as Nigeria, mobile health strategies like short message service (SMS) reminders present a practical and low-cost intervention to improve adherence. This study aimed to evaluate the effect of SMS reminders on medication adherence among patients with schizophrenia at a tertiary hospital in Nigeria.

METHODOLOGY: A 24-week quasi-experimental study was conducted among 300 outpatients, randomly assigned using computer-generated random numbers to an intervention group (n=150) that received daily SMS reminders and biweekly motivational messages, or a control group (n=150) that received usual care. Adherence was measured using the Morisky Medication Adherence Scale (MMAS-8) at baseline, 12 weeks, and 24 weeks. Statistical analyses included descriptive and inferential methods.

RESULTS: All 300 participants completed the study (0% attrition). Mean adherence scores in the intervention group increased significantly from 4.6 (±1.3) to 7.1 (±0.9) (p < 0.001), while the control group showed negligible improvement (4.7 ±1.2 to 5.0 ±1.2; p = 0.59). High adherence was attained by 74.7% (n = 112) of the intervention group compared to 32.7% (n = 49) of controls (p < 0.001). A significant group × time interaction effect was found (F = 122.7, p < 0.001). Logistic regression identified SMS intervention as a strong independent predictor of high adherence (AOR = 5.82; 95% CI: 3.45-9.81).

CONCLUSION: SMS reminders significantly enhanced medication adherence among schizophrenia patients in a low-resource setting. Incorporating such digital tools into standard care may greatly improve treatment outcomes.

PMID:42553841 | PMC:PMC13436984