Nudge-based interventions to improve medication adherence in adults with chronic diseases: systematic review and meta-analysis of randomized controlled trials

Abstract Background Medication adherence is crucial for managing chronic conditions, yet medication adherence rates are often suboptimal. Nudge-based interventions have shown promise in other health behaviors, but their effectiveness in improving medication adherence remains unclear. Purpose To evaluate the effectiveness of nudge-based interventions in improving medication adherence among adults with chronic diseases. Method We searched 6 electronic databases (PubMed, Embase, Web of Science, PsycINFO, Scopus, and Cochrane) for studies (January 1, 2014, to November 23, 2024). Included studies were randomized controlled trials (RCTs), involving adults (≥18 years) with chronic diseases that compared nudge-based interventions to improve medication adherence with usual care. Two reviewers independently extracted data and assessed the risk of bias. Key study characteristics were summarized. Random-effects meta-analyses were conducted to calculate standardized mean differences (Hedges’ g) and 95% CIs. Heterogeneity was assessed using the Cochrane Q test and I2, and sensitivity analyses were performed to evaluate the robustness of the findings. Results A total of 36 studies were included, with 19 RCTs providing data for meta-analysis (total N = 2690). Nearly half were rated as low risk of bias. The pooled effect size was Hedges’ g = 0.68 (95% CI, 0.16-1.20, P < .01). Significant heterogeneity was observed (I2 = 96.3%, P < .01), subgroup analyses were conducted to identify significant sources of this heterogeneity. No publication bias was detected (Egger’s test, P = .447). Conclusion Overall, nudge-based interventions have the potential to improve medication adherence among adults with chronic disease. There is a need for further well-designed studies to enhance the strength of the evidence.