Digital Tools for a High-Stakes Population: mHealth and Medication Adherence In Adolescent Heart Transplant Recipients

Background and Purpose
Adolescence is a critical period for establishing self-management behaviors, yet medication non-adherence among adolescent heart transplant recipients remains a significant threat to graft survival and long-term outcomes. Immunosuppressive regimens require consistent adherence, and adolescents face unique developmental barriers including forgetfulness, low engagement, and resistance to medical routines. Transplant social workers play a critical role in supporting medication adherence among adolescent patients and their caregivers as part of multidisciplinary transplant teams. Mobile health (mHealth) technologies such as smartphone apps, SMS reminders, and wearable devices offer accessible, youth-centered tools to support adherence, yet no comprehensive review has synthesized research specific to this population. This scoping review examined the existing literature on mHealth interventions targeting medication adherence in adolescent heart transplant recipients, with the aims of identifying intervention types, assessing reported effectiveness, and mapping gaps to guide future research.

Methods
A scoping review was conducted by three authors following the PRISMA-ScR framework. PubMed, PsycINFO, CINAHL, and Cochrane Library were searched using keywords including mHealth, mobile health, medication adherence, heart transplant, and adolescents. Studies were eligible if they focused on mHealth interventions (mobile apps, text messaging, wearable devices, or other digital tools) designed to support or monitor medication adherence in adolescent transplant populations. Data extraction focused on intervention types, study designs, population characteristics, and adherence outcomes.

Results
Eighteen studies met inclusion criteria and were included in the final review. The included studies demonstrated that mHealth technologies hold meaningful promise for improving medication adherence in adolescent heart transplant recipients. Smartphone applications featuring customizable reminders, gamification, educational content, and real-time tracking were most commonly examined and showed potential to actively engage adolescents in self-management. SMS-based interventions provided behavioral prompts that address common barriers such as forgetfulness but offer low engagement. Wearable devices offered real-time physiological monitoring that supported both patient self-awareness and provider oversight. Across studies, adolescents generally responded positively to personalized and interactive digital formats which leverage interpersonal support and engagement offered by mobile apps. However, evidence was predominantly short-term; few studies evaluated long-term sustainability or clinical outcomes such as graft survival, hospitalizations, or quality of life.

Conclusions and Implications
Medication nonadherence in adolescent transplant patients is not a simple memory problem, and mHealth technologies represent a promising, youth-centered strategy for promoting adherence following heart transplant in adolescence. Adherence is driven by motivation, habits, and psychosocial context, which is why most reminder-based interventions fail. Personalized, engaging digital tools align with adolescent developmental needs and may help bridge the gap between patient knowledge and consistent behavior. Effective next-generation interventions should offer real-time engagement, accountability, and interpersonal support, rather than passive monitoring or reminders. For practice, clinicians should consider integrating mHealth tools into post-transplant care protocols as adjuncts to standard education. Healthcare systems should prioritize funding and infrastructure to support digital interventions. Rigorous longitudinal studies with clinical outcome measures should examine long-term efficacy and optimize design. Ensuring that all adolescent transplant recipients regardless of background or resources have access to these tools reflects a commitment to equity and the common good in pediatric health.