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

This article systematically reviews and meta-analyzes randomized controlled trials (RCTs) to evaluate the effectiveness of nudge-based interventions in improving medication adherence among adults with chronic diseases. Nudge interventions—defined as subtle modifications to the decision-making environment that encourage healthier choices without restricting freedom—include strategies such as reminders, commitment devices, salience, framing effects, small financial incentives, and feedback. The meta-analysis of 19 RCTs (total N = 2,690) found a moderate positive effect of nudge-based interventions on medication adherence (Hedges' g = 0.68), with reminder-based and longer-duration interventions showing greater improvements. However, significant heterogeneity and moderate risk of bias across studies, along with variability in adherence measurement methods and healthcare contexts, limit the certainty of evidence. The findings suggest that nudge-based approaches are promising, cost-effective, and scalable strategies for enhancing medication adherence in chronic disease management, but further well-designed, large-scale studies are needed to optimize their implementation and assess long-term outcomes.