Technological Strategies to Address Psychiatric Nonadherence

  • Sourav SenguptaEmail author
  • Michael Adragna


This chapter reviews technological approaches to psychiatric nonadherence. Broadly, clinicians have long been engaged in technological approaches to improve patients’ adherence to optimal treatment plans. Nonadherence can be related to the complexity of our health systems and associated difficulties with appropriately accessing or utilizing care. Technologies that have found ways to better connect patients to their clinicians have had the most success. Patients are generally more adherent when they better understand their condition, and accessible psychoeducation materials and platforms that extend patients’ learning process beyond the clinical appointment can be valuable. Similarly, mobile health applications that extend psychoeducation provide medication reminders, and even prompt specific therapeutic interventions can improve adherence. Innovations in the physical processes in which patients receive and take their medication, utilizing devices like medication adherence monitoring systems, can increase the likelihood that patients actually take the medication they need to take. Ultimately, strategies that combine these approaches into multimodal systems in which patients are engaged and understand their mental health conditions, are supported to take full advantage of the treatment available to them, and bridge the divide between the private challenges of mental health treatment and the clinical partnership between patient and provider have the best chance of being successful.


Technology Technological Digital Mobile Treatment adherence Nonadherence 


  1. 1.
    Sabate E. Adherence to long-term therapies: evidence for action [Internet]. World Health Organization; 2003 [cited 2018 Jul 4]. Available from:
  2. 2.
    Morris R. The history of pill boxes [Internet]. The Hunt Magazine. 2017 [cited 2018 Dec 4]. Available from:
  3. 3.
    Costa E, Giardini A, Savin M, Menditto E, Lehane E, Laosa O, et al. Interventional tools to improve medication adherence: review of literature. Patient Prefer Adherence. 2015;9:1303–14.CrossRefGoogle Scholar
  4. 4.
    Lefforge NL, Donohue B, Strada MJ. Improving session attendance in mental health and substance abuse settings: a review of controlled studies. Behav Ther. 2007;38(1):1–22.CrossRefGoogle Scholar
  5. 5.
    Reda S, Makhoul S. Prompts to encourage appointment attendance for people with serious mental illness. Cochrane Database Syst Rev. 2001;(2):CD002085.Google Scholar
  6. 6.
    Kunigiri G, Gajebasia N, Sallah D. Improving attendance in psychiatric outpatient clinics by using reminders. J Telemed Telecare. 2014;20(8):464–7.CrossRefGoogle Scholar
  7. 7.
    Guy R, Hocking J, Wand H, Stott S, Ali H, Kaldor J. How effective are short message service reminders at increasing clinic attendance? A meta-analysis and systematic review. Health Serv Res. 2012;47(2):614–32.CrossRefGoogle Scholar
  8. 8.
    Vernig PM, Repique RJR. Short message service can be a promising tool for psychiatric patients and clinicians. J Am Psychiatr Nurses Assoc. 2015;21(1):31–3.CrossRefGoogle Scholar
  9. 9.
    Chen Z, Fang L, Chen L, Dai H. Comparison of an SMS text messaging and phone reminder to improve attendance at a health promotion center: a randomized controlled trial. J Zhejiang Univ Sci B. 2008;9(1):34–8.CrossRefGoogle Scholar
  10. 10.
    Hubley S, Lynch SB, Schneck C, Thomas M, Shore J. Review of key telepsychiatry outcomes. World J Psychiatry. 2016;6(2):269–82.CrossRefGoogle Scholar
  11. 11.
    Chaiyachati KH, Hubbard RA, Yeager A, Mugo B, Lopez S, Asch E, et al. Association of rideshare-based transportation services and missed primary care appointments: a clinical trial. JAMA Intern Med. 2018;178(3):383–9.CrossRefGoogle Scholar
  12. 12.
    Tierney WM, Harris LE, Gaskins DL, Zhou XH, Eckert GJ, Bates AS, et al. Restricting medicaid payments for transportation: effects on inner-city patients’ health care. Am J Med Sci. 2000;319(5):326–33.PubMedGoogle Scholar
  13. 13.
    Whetten R, Whetten K, Pence BW, Reif S, Conover C, Bouis S. Does distance affect utilization of substance abuse and mental health services in the presence of transportation services? AIDS Care. 2006;18(Suppl 1):S27–34.CrossRefGoogle Scholar
  14. 14.
    Friedmann PD, D’Aunno TA, Jin L, Alexander JA. Medical and psychosocial services in drug abuse treatment: do stronger linkages promote client utilization? Health Serv Res. 2000;35(2):443–65.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Wallace R, Hughes-Cromwick P, Mull H. Cost-effectiveness of access to nonemergency medical transportation: comparison of transportation and health care costs and benefits. J Transp Res Board. 2006;1956:86–93.CrossRefGoogle Scholar
  16. 16.
    Buechel EC, Berger J. Microblogging and the value of undirected communication. J Consum Psychol. 2018;28(1):40–55.CrossRefGoogle Scholar
  17. 17.
    Lin L y, Sidani JE, Shensa A, Radovic A, Miller E, Colditz JB, et al. Association between social media use and depression among U.S. young adults. Depress Anxiety. 2016;33(4):323–31.CrossRefGoogle Scholar
  18. 18.
    O’Keeffe GS, Clarke-Pearson K, Media C on C and. The impact of social media on children, adolescents, and families. Pediatrics. 2011;127(4):800–4.CrossRefGoogle Scholar
  19. 19.
    Chandrashekar P. Do mental health mobile apps work: evidence and recommendations for designing high-efficacy mental health mobile apps. mHealth. 2018;4:6.CrossRefGoogle Scholar
  20. 20.
    Owen JE, Jaworski BK, Kuhn E, Makin-Byrd KN, Ramsey KM, Hoffman JE. mHealth in the wild: using novel data to examine the reach, use, and impact of PTSD coach. JMIR Ment Health. 2015;2(1):e7.CrossRefGoogle Scholar
  21. 21.
    Firth J, Torous J, Nicholas J, Carney R, Pratap A, Rosenbaum S, et al. The efficacy of smartphone-based mental health interventions for depressive symptoms: a meta-analysis of randomized controlled trials. World Psychiatry Off J World Psychiatr Assoc WPA. 2017;16(3):287–98.Google Scholar
  22. 22.
    Ly KH, Topooco N, Cederlund H, Wallin A, Bergström J, Molander O, et al. Smartphone-supported versus full behavioural activation for depression: a randomised controlled trial. PLoS One. 2015;10(5):e0126559.CrossRefGoogle Scholar
  23. 23.
    Firth J, Torous J. Smartphone apps for schizophrenia: a systematic review. JMIR MHealth UHealth. 2015;3(4):e102.CrossRefGoogle Scholar
  24. 24.
    Ahmed I, Ahmad NS, Ali S, Ali S, George A, Danish HS, et al. Medication adherence apps: review and content analysis. JMIR MHealth UHealth. 2018;6(3):e62.CrossRefGoogle Scholar
  25. 25.
    Montes JM, Medina E, Gomez-Beneyto M, Maurino J. A short message service (SMS)-based strategy for enhancing adherence to antipsychotic medication in schizophrenia. Psychiatry Res. 2012;200(2–3):89–95.CrossRefGoogle Scholar
  26. 26.
    Välimäki M, Kannisto KA, Vahlberg T, Hätönen H, Adams CE. Short text messages to encourage adherence to medication and follow-up for people with psychosis (Mobile.Net): randomized controlled trial in Finland. J Med Internet Res. 2017;19(7):e245.CrossRefGoogle Scholar
  27. 27.
    Santo K, Singleton A, Rogers K, Thiagalingam A, Chalmers J, Chow CK, et al. Medication reminder applications to improve adherence in coronary heart disease: a randomised clinical trial. Heart Br Card Soc. 2019;105:323–9.Google Scholar
  28. 28.
    Corden ME, Koucky EM, Brenner C, Palac HL, Soren A, Begale M, et al. MedLink: a mobile intervention to improve medication adherence and processes of care for treatment of depression in general medicine. Digit Health. 2016;2:2055207616663069.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Wenze SJ, Armey MF, Miller IW. Feasibility and acceptability of a mobile intervention to improve treatment adherence in bipolar disorder: a pilot study. Behav Modif. 2014;38(4):497–515.CrossRefGoogle Scholar
  30. 30.
    Metcalfe JZ, O’Donnell MR, Bangsberg DR. Moving beyond directly observed therapy for tuberculosis. PLoS Med. 2015;12(9):e1001877.CrossRefGoogle Scholar
  31. 31.
    Farooq S, Nazar Z, Irfan M, Akhter J, Gul E, Irfan U, et al. Schizophrenia medication adherence in a resource-poor setting: randomised controlled trial of supervised treatment in out-patients for schizophrenia (STOPS). Br J Psychiatry J Ment Sci. 2011;199(6):467–72.CrossRefGoogle Scholar
  32. 32.
    Spaniel F, Vohlídka P, Hrdlicka J, Kozený J, Novák T, Motlová L, et al. ITAREPS: information technology aided relapse prevention programme in schizophrenia. Schizophr Res. 2008;98(1–3):312–7.CrossRefGoogle Scholar
  33. 33.
    Brissos S, Veguilla MR, Taylor D, Balanzá-Martinez V. The role of long-acting injectable antipsychotics in schizophrenia: a critical appraisal. Ther Adv Psychopharmacol. 2014;4(5):198–219.CrossRefGoogle Scholar
  34. 34.
    Conn VS, Ruppar TM, Chan KC, Dunbar-Jacob J, Pepper GA, De Geest S. Packaging interventions to increase medication adherence: systematic review and meta-analysis. Curr Med Res Opin. 2015;31(1):145–60.CrossRefGoogle Scholar
  35. 35.
    Gutierrez PM, Wortzel HS, Forster JE, Leitner RA, Hostetter TA, Brenner LA. Blister packaging medication increases treatment adherence in psychiatric patients. J Psychiatr Pract. 2017;23(5):320–7.CrossRefGoogle Scholar
  36. 36.
    Byerly M, Fisher R, Whatley K, Holland R, Varghese F, Carmody T, et al. A comparison of electronic monitoring vs. clinician rating of antipsychotic adherence in outpatients with schizophrenia. Psychiatry Res. 2005;133(2):129–33.CrossRefGoogle Scholar
  37. 37.
    Byerly MJ, Thompson A, Carmody T, Bugno R, Erwin T, Kashner M, et al. Validity of electronically monitored medication adherence and conventional adherence measures in schizophrenia. Psychiatr Serv. 2007;58(6):844–7.CrossRefGoogle Scholar
  38. 38.
    Wahle F, Kowatsch T, Fleisch E, Rufer M, Weidt S. Mobile sensing and support for people with depression: a pilot trial in the wild. JMIR MHealth UHealth. 2016;4(3):e111.CrossRefGoogle Scholar
  39. 39.
    Wang R, Wang W, daSilva A, Huckins JF, Kelley WM, Heatherton TF, et al. Tracking depression dynamics in college students using mobile phone and wearable sensing. Proc ACM Interact Mob Wearable Ubiquit Technol. 2018;2(1):43:1–43:26.Google Scholar
  40. 40.
    Torous J, Nicholas J, Larsen ME, Firth J, Christensen H. Clinical review of user engagement with mental health smartphone apps: evidence, theory and improvements. Evid Based Ment Health. 2018;21(3):116–9.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Jacobs School of Medicine at State University of New York at BuffaloBuffaloUSA

Personalised recommendations