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Effect of Mobile Health Reminders on Medication Adherence among Patients with Hypertension in Nigeria

Abstract

Hypertension is a major public health challenge and an important risk factor for cardiovascular disease, stroke, kidney disease, and premature mortality. Effective management of hypertension requires long-term adherence to prescribed antihypertensive medicines and regular engagement with healthcare services. Medication adherence refers to the extent to which patients take their prescribed medicines according to the recommended dosage, frequency, timing, and duration. Mobile health reminders refer to digital reminder interventions delivered through mobile phones, including short message service (SMS), automated voice messages, mobile applications, interactive messaging platforms, or other mobile-based communication technologies, to remind patients to take prescribed medicines or attend scheduled healthcare appointments. In Nigeria, poor medication adherence among patients with hypertension may be associated with forgetfulness, complex medication schedules, inadequate patient education, limited follow-up, treatment fatigue, socioeconomic challenges, and limited continuity of patient-provider communication. Mobile health reminders may provide a relatively simple and scalable approach for supporting patients with long-term treatment by delivering timely medication prompts and reinforcing adherence to prescribed treatment regimens. Against this background, this study investigates the effect of mobile health reminders on medication adherence among patients with hypertension in Nigeria. The study is anchored on the Health Belief Model, Technology Acceptance Model, and Social Support Theory. The Health Belief Model explains medication-taking behaviour through patients' perceptions of disease severity, susceptibility to complications, benefits of treatment, perceived barriers, and cues to action. The Technology Acceptance Model explains the use of mobile health technologies through perceived usefulness and perceived ease of use. Social Support Theory emphasizes the role of communication, reminders, encouragement, and supportive interactions in promoting positive health behaviours. Collectively, these theoretical perspectives provide a suitable framework for explaining how mobile health reminders may influence medication adherence among patients with hypertension in Nigeria. The study will adopt a quantitative quasi-experimental research design. Patients diagnosed with hypertension will be recruited from selected Nigerian healthcare facilities and assigned to intervention and comparison groups where appropriate. A multistage sampling technique will be employed to select states, healthcare facilities, and eligible participants. Participants in the intervention group will receive structured mobile health reminders at predetermined intervals over the study period. The reminders may include medication-taking prompts, refill reminders, appointment reminders, and brief messages reinforcing adherence to prescribed antihypertensive treatment. Mobile health reminder exposure will be assessed using indicators such as frequency of reminders, duration of exposure, consistency of message delivery, type of reminder, timing of reminders, and participants' receipt of reminder messages. Medication adherence will be assessed using validated adherence measures, medication-taking behaviour, missed-dose frequency, refill records where available, and adherence to prescribed dosage and schedule. Pharmacy refill or prescription records may be reviewed where feasible to complement self-reported adherence and reduce reporting bias. Descriptive statistics will be used to summarize participants' demographic and clinical characteristics, reminder exposure, and medication-adherence patterns. Inferential statistical techniques, including paired-sample tests, chi-square tests, correlation analysis, and regression analysis, will be used to determine the effect of mobile health reminders on medication adherence. Diagnostic tests will also be conducted to assess the reliability of the research instruments, model assumptions, goodness of fit, and robustness of the findings. The study is expected to find that mobile health reminders have a significant positive effect on medication adherence among patients with hypertension in Nigeria. Patients receiving regular mobile reminders are expected to report fewer missed doses and demonstrate greater adherence to prescribed medication schedules than patients who do not receive the intervention. Timely reminders may help patients overcome forgetfulness and treatment-related fatigue while reinforcing the importance of consistent medication use. Refill and appointment reminders may also encourage continuity of treatment and regular interaction with healthcare providers. The intervention is expected to be particularly useful because mobile phones are widely used and can support communication without requiring patients to make frequent additional visits to healthcare facilities. However, mobile reminders alone may not completely determine medication adherence because adherence may also be influenced by medication cost, adverse effects, treatment complexity, availability of medicines, patient understanding, healthcare-provider communication, health literacy, and access to healthcare services. Therefore, mobile reminders should complement, rather than replace, appropriate clinical care, patient counselling, and medication-management support. The study is expected to contribute to the literature on mobile health interventions, medication adherence, hypertension management, digital health, health informatics, pharmacy practice, nursing, chronic disease management, and public health in Nigeria by providing empirical evidence on the effectiveness of mobile-based reminders in supporting long-term antihypertensive treatment. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, hospitals, primary healthcare centres, pharmacists, nurses, physicians, digital health providers, public-health practitioners, development partners, and policymakers regarding the use of mobile technologies in chronic disease management. The study will also provide evidence-based recommendations for integrating SMS and other mobile reminder systems into hypertension-care programmes, developing patient-centred reminder schedules, strengthening digital follow-up systems, improving medication counselling, supporting medicine-refill monitoring, and expanding cost-effective digital health interventions for patients with hypertension across Nigeria.

Keywords: Mobile health reminders, medication adherence, hypertension, Nigeria, digital health, mHealth, SMS reminders, chronic disease management, antihypertensive medication, health informatics, pharmacy practice, public health.