mHealth for chronic disease management: effects on adherence in Ghanaian patients with diabetes and hypertension

Clinical Snapshot

Key Findings

• P Value: Not explicitly reported but CI excludes null

• Effect Size: Adjusted beta coefficient 0.062 (95% CI: 0.010-0.123) for overall population

• Primary Outcome: Medication adherence improvement over 6 months

• Nnt Or Sensitivity: Small effect size suggests modest clinical benefit requiring large numbers to treat

• Confidence Interval: 95% CI: 0.010-0.123

Clinical Application

Requires smartphone ownership, digital literacy, and reliable internet connectivity which may limit implementation Limited applicability due to different healthcare infrastructure, universal healthcare access through Medicare, and established chronic disease management programs. May inform digital health initiatives in remote/Indigenous communities Adults with type 2 diabetes or hypertension in resource-limited settings with smartphone access

Abstract

BACKGROUND: Medication non-adherence remains a major barrier to effective chronic disease management, particularly in low- and middle-income countries. In Ghana, limited access to continuous care and patient engagement tools contributes to poor adherence among individuals living with type 2 diabetes and hypertension. Mobile health interventions, including smartphone applications, may offer scalable solutions to support long-term medication use and self-management. Here, we assess the effect of a smartphone-based intervention on medication adherence among adults with these conditions. METHODS: We conducted a quasi-experimental study among 874 adults with type 2 diabetes or hypertension in Ghana. Participants were assigned to either a smartphone-based intervention, which included medication reminders, educational content, and self-monitoring tools, or standard care involving routine outpatient management and follow-up without access to the smartphone-based intervention. We measured medication adherence at baseline and six months using the Medication Adherence Rating Scale and assessed it through generalised estimating equations and difference-in-differences analyses, adjusting for baseline adherence, age, sex, and treatment setting. RESULTS: Use of the smartphone application was associated with a greater improvement in medication adherence over six months in the overall study population (adjusted beta coefficient (aβ) = 0.062; 95% confidence interval (CI) = 0.010-0.123). Similar improvements were observed among participants with type 2 diabetes (aβ = 0.067; 95% CI = 0.012-0.135) and hypertension (aβ = 0.068; 95% CI = 0.005-0.134). However, there was no statistically significant difference in adherence between the intervention and control groups at six months. CONCLUSIONS: Smartphone-based interventions were associated with modest improvements in medication adherence over time, although between-group differences at follow-up were not statistically significant. As access to mobile technology expands across Africa, such interventions may provide scalable strategies to support chronic disease management.

References

1. 1.Aovare, P., Chilunga, F. P., Laar, A., Moens, N., Moll van Charante, E. P., & Agyemang, C. (2026). mHealth for chronic disease management: effects on adherence in Ghanaian patients with diabetes and hypertension. Journal of Global Health. https://doi.org/10.1186/1475-9276-12-85