Current issue
Archive
Manuscripts accepted
About the Journal
Editorial office
Editorial board
Section Editors
Abstracting and indexing
Subscription
Contact
Ethical standards and procedures
Most read articles
Instructions for authors
Article Processing Charge (APC)
Regulations of paying article processing charge (APC)
PUBLIC HEALTH / CLINICAL RESEARCH
Smartphone addiction as a risk factor for medication non-adherence in renal transplant recipients
1
Department of Nephrology, Faculty of Medicine, Gazi University Ankara, Turkey
2
Department of Psychiatry, Faculty of Medicine, Gazi University, Ankara, Turkey
Submission date: 2025-02-01
Final revision date: 2025-08-07
Acceptance date: 2025-08-10
Online publication date: 2025-10-26
Corresponding author
Özant Helvacı
Department of Nephrology Faculty of Medicine Gazi University Ankara, Turkey Phone: +90 312 202 52 29
Department of Nephrology Faculty of Medicine Gazi University Ankara, Turkey Phone: +90 312 202 52 29
KEYWORDS
medication adherencemedication non-adherencerenal transplantationsmartphone addictiontransplant recipientsbehavioral risk factors
TOPICS
ABSTRACT
Introduction:
Medication non-adherence (MNA) is a leading cause of graft loss and mortality in renal transplant recipients. Smartphone addiction (SPA) is associated with cognitive impairment and poor time management, but its relationship with MNA remains unclear. This is the first study to investigate the association between SPA and MNA in renal transplant recipients.
Material and methods:
This cross-sectional study included 140 renal transplant recipients. SPA was assessed using the Smartphone Addiction Scale-Short Version (SAS-SV) and weekly screen time. MNA was measured using the Immunosuppressant Therapy Adherence Scale (ITAS), classifying adherence as perfect (12), acceptable (10–11), or poor (≤ 9). Univariate and multivariate logistic regression were performed to identify predictors of MNA.
Results:
Patients with poor adherence had longer weekly screen time (27 ±10 h) than those with perfect (20 ±10 h) or acceptable adherence (21 ±11 h) (p < 0.001). The poor adherence group had a higher prevalence of SPA (66%) than the perfect (38%) and acceptable adherence groups (36%) (p = 0.020). In univariate analysis, higher SAS-SV scores (p = 0.006) and weekly screen time (p = 0.006) were associated with MNA. In multivariate analysis, only weekly screen time > 22 h remained an independent predictor (OR = 4.106, 95% CI: 1.366–12.336, p = 0.012), while SAS-SV scores lost significance.
Conclusions:
Excessive smartphone use, particularly prolonged screen time, is independently associated with MNA in renal transplant recipients. Integrating screen time tracking into routine transplant care may help identify at-risk patients. Future studies should determine whether reducing screen exposure improves adherence.
Medication non-adherence (MNA) is a leading cause of graft loss and mortality in renal transplant recipients. Smartphone addiction (SPA) is associated with cognitive impairment and poor time management, but its relationship with MNA remains unclear. This is the first study to investigate the association between SPA and MNA in renal transplant recipients.
Material and methods:
This cross-sectional study included 140 renal transplant recipients. SPA was assessed using the Smartphone Addiction Scale-Short Version (SAS-SV) and weekly screen time. MNA was measured using the Immunosuppressant Therapy Adherence Scale (ITAS), classifying adherence as perfect (12), acceptable (10–11), or poor (≤ 9). Univariate and multivariate logistic regression were performed to identify predictors of MNA.
Results:
Patients with poor adherence had longer weekly screen time (27 ±10 h) than those with perfect (20 ±10 h) or acceptable adherence (21 ±11 h) (p < 0.001). The poor adherence group had a higher prevalence of SPA (66%) than the perfect (38%) and acceptable adherence groups (36%) (p = 0.020). In univariate analysis, higher SAS-SV scores (p = 0.006) and weekly screen time (p = 0.006) were associated with MNA. In multivariate analysis, only weekly screen time > 22 h remained an independent predictor (OR = 4.106, 95% CI: 1.366–12.336, p = 0.012), while SAS-SV scores lost significance.
Conclusions:
Excessive smartphone use, particularly prolonged screen time, is independently associated with MNA in renal transplant recipients. Integrating screen time tracking into routine transplant care may help identify at-risk patients. Future studies should determine whether reducing screen exposure improves adherence.
REFERENCES (49)
1.
Tonelli M, Wiebe N, Knoll G, et al. Systematic review: kidney transplantation compared with dialysis in clinically relevant outcomes. Am J Transplant 2011; 11: 2093-109.
2.
Gandolfini I, Palmisano A, Fiaccadori E, Cravedi P, Maggiore U. Detecting, preventing and treating non-adherence to immunosuppression after kidney transplantation. Clin Kidney J 2022; 15: 1253-74.
3.
Denhaerynck K, Burkhalter F, Schafer-Keller P, Steiger J, Bock A, De Geest S. Clinical consequences of non adherence to immunosuppressive medication in kidney transplant patients. Transpl Int 2009; 22: 441-6.
4.
TRabulus S. Old but still a significant problem: medication nonadherence in transplant recipients. Turk J Nephrol 2023; 32: 255-9.
5.
Morrissey PE, Flynn ML, Lin S. Medication noncompliance and its implications in transplant recipients. Drugs 2007; 67: 1463-81.
6.
Li J, Yang H. Unveiling the grip of mobile phone addiction: an in-depth review. Front Psychiatry 2024; 15: 1429941.
7.
Al-Hadidi F, Bsisu I, AlRyalat SA, et al. Association between mobile phone use and neck pain in university students: a cross-sectional study using numeric rating scale for evaluation of neck pain. PLoS One 2019; 14: e0217231.
8.
Demir YP, Sumer MM. Effects of smartphone overuse on headache, sleep and quality of life in migraine patients. Neurosciences 2019; 24: 115-21.
9.
Wacks Y, Weinstein AM. Excessive smartphone use is associated with health problems in adolescents and young adults. Front Psychiatry 2021; 12: 669042.
10.
Alhassan AA, Alqadhib EM, Taha NW, Alahmari RA, Salam M, Almutairi AF. The relationship between addiction to smartphone usage and depression among adults: a cross sectional study. BMC Psychiatry 2018; 18: 148.
11.
Ratan ZA, Parrish AM, Zaman SB, Alotaibi MS, Hosseinzadeh H. Smartphone addiction and associated health outcomes in adult populations: a systematic review. Int J Environ Res Public Health 2021; 18: 12257.
12.
Choksi ST. A study to find out the correlation of mobile phone addiction with anxiety, depression, stress and sleep quality in the college students of Surat City. Int J Curr Res Rev 2021; 13: 137-42.
13.
Hartch CE, Dietrich MS, Lancaster BJ, Stolldorf DP, Mulvaney SA. Effects of a medication adherence app among medically underserved adults with chronic illness: a randomized controlled trial. J Behav Med 2024; 47: 389-404.
14.
Kwon M, Kim DJ, Cho H, Yang S. The smartphone addiction scale: development and validation of a short version for adolescents. PLoS One 2013; 8: e83558.
15.
Demirci K, Orhan H, Demirdas A, Akpinar A, Sert H. Validity and reliability of the Turkish version of the smartphone addiction scale in a younger population. Klinik Psikofarmakoloji Bülteni-Bulletin of Clin Psychopharm 2016; 24: 226-34.
16.
Chisholm MA, Lance CE, Williamson GM, Mulloy LL. Development and validation of the immunosuppressant therapy adherence instrument (ITAS). Patient Educ Couns 2005; 59: 13-20.
17.
Madran BKÖ, Spivey CA, Chisholm-Burns MA. Immunosuppressant therapy adherence scale for transplant recipients: the study of validity and reliability. Turkiye Klinikleri J Nurs Sci 2016; 8: 325-34.
18.
Weng FL, Chandwani S, Kurtyka KM, Zacker C, Chisholm-Burns MA, Demissie K. Prevalence and correlates of medication non-adherence among kidney transplant recipients more than 6 months post-transplant: a cross-sectional study. BMC Nephrol 2013; 14: 261.
19.
Shemesh E, Shneider BL, Mazariegos GV. Weekend versus weekday adherence: do we, or do we not, thank God it’s Friday? Am J Transplant 2020; 20: 7-9.
20.
Promraj R, Dumronggittigule W, Sirivatanauksorn Y, et al. Immunosuppressive medication adherence in liver transplant recipients. Transplant Proc 2016; 48: 1198-201.
21.
Regier DA, Kuhl EA, Kupfer DJ. The DSM-5: classification and criteria changes. World Psychiatry 2013, 12: 92-8.
22.
Yu S, Sussman S. Does Smartphone addiction fall on a continuum of addictive behaviors? Int J Environ Res Public Health 2020; 17: 422.
23.
Anderl C, Hofer MK, Chen FS. Directly-measured smartphone screen time predicts well-being and feelings of social connectedness. J Soc Personal Relat 2023; 41: 1073-90.
24.
Alageel AA, Alyahya RA, Y AB, et al. Smartphone addiction and associated factors among postgraduate students in an Arabic sample: a cross-sectional study. BMC Psychiatry 2021; 21: 302.
25.
Vlaminck H, Maes B, Evers G, et al. Prospective study on late consequences of subclinical non-compliance with immunosuppressive therapy in renal transplant patients. Am J Transplant 2004; 4: 1509-13.
26.
Killian MO, Little CW, Mayewski SE. Changes in medication adherence across the posttransplant period in pediatric organ transplant recipients. Clin Transplant 2024; 38: e15442.
27.
Tatoğlu NKÖ, Öğce F. Factors affecting adherence of recipients to immunosuppressive therapy after liver and kidney transplantation. J Educ Res Nurs 2023; 20: 20-7.
28.
Jindal RM, Neff RT, Abbott KC, et al. Association between depression and nonadherence in recipients of kidney transplants: analysis of the United States renal data system. Transplant Proc 2009; 41: 3662-6.
29.
Tecen-Yucel K, Bayraktar-Ekincioglu A, Yıldırım T, Demirkan K, Erdem Y. Assessment of adherence to immunosuppressive treatment in kidney transplant patients: a descriptive study. Turk J Nephrol 2023; 32: 241-8.
30.
Sawicka OP, Kocięba-Łaciak AH, Gałuszka D, Ślusarczyk K, Kasperowicz J. Parents’ attitudes towards children’s transplantology. Arch Med Sci 2024; 20: 326-31.
31.
Butler JA, Peveler RC, Roderick P, Smith PW, Horne R, Mason JC. Modifiable risk factors for non-adherence to immunosuppressants in renal transplant recipients: a cross-sectional study. Nephrol Dial Transplant 2004; 19: 3144-9.
32.
Griva K, Davenport A, Harrison M, Newman SP. Non-adherence to immunosuppressive medications in kidney transplantation: intent vs. forgetfulness and clinical markers of medication intake. Ann Behav Med 2012; 44: 85-93.
33.
Hu Y, Long X, Lyu H, Zhou Y, Chen J. Alterations in white matter integrity in young adults with smartphone dependence. Front Hum Neurosci 2017; 11: 532.
34.
Lee D, Namkoong K, Lee J, Lee BO, Jung YC. Lateral orbitofrontal gray matter abnormalities in subjects with problematic smartphone use. J Behav Addict 2019; 8: 404-11.
35.
Horvath J, Mundinger C, Schmitgen MM, et al. Structural and functional correlates of smartphone addiction Addict Behav 2020; 105: 106334.
36.
Hartstein LE, Mathew GM, Reichenberger DA, et al. The impact of screen use on sleep health across the lifespan: a National Sleep Foundation consensus statement. Sleep Health 2024; 10: 373-84.
37.
Burkhalter H, Wirz-Justice A, Cajochen C, et al. Daytime sleepiness in renal transplant recipients is associated with immunosuppressive non-adherence: a cross-sectional, multi-center study. Clin Transplant 2014; 28: 58-66.
38.
Judice PB, Sousa-Sa E, Palmeira AL. Discrepancies between self-reported and objectively measured smartphone screen time: before and during lockdown. J Prev 2023; 44: 291-307.
39.
Sarris J, Thomson R, Hargraves F, et al. Multiple lifestyle factors and depressed mood: a cross-sectional and longitudinal analysis of the UK Biobank (N = 84,860). BMC Med 2020; 18: 354.
40.
Twenge JM, Blake AB, Haidt J, Campbell WK. Commentary: screens, teens, and psychological well-being: evidence from three time-use-diary studies. Front Psychol 2020; 11: 181.
41.
Burén J, Nutley SB, Thorell LB. Screen time and addictive use of gaming and social media in relation to health outcomes. Front Psychol 2023; 14: 1258784.
42.
Peng Y, Wang H, Fang Q, et al. Effectiveness of mobile applications on medication adherence in adults with chronic diseases: a systematic review and meta-analysis. J Manag Care Spec Pharm 2020; 26: 550-61.
43.
Ping Y, Visaria A, Suppiah SD, Tan YW, Malhotra R. Prevalence and correlates of medication reminder app ‘use and use intention’ among older adults. Exp Res Clin Soc Pharm 2022; 6: 100150.
44.
Robbins R, Krebs P, Jagannathan R, Jean-Louis G, Duncan DT. Health App use among US mobile phone users: analysis of trends by chronic disease status. JMIR mHealth uHealth 2017; 5: e197.
45.
Malinauskas R, Malinauskiene V. A meta-analysis of psychological interventions for Internet/smartphone addiction among adolescents. J Behav Addict 2019; 8: 613-24.
46.
Olson JA, Sandra DA, Chmoulevitch D, Raz A, Veissiere SPL. A nudge-based intervention to reduce problematic smartphone use: randomised controlled trial. Int J Ment Health Addict 2022: 1-23. 10.1007/s11469-022-00826-w.
47.
McGillicuddy J, Chandler J, Sox L, et al. “Smartphone Medication Adherence Saves Kidneys” for kidney transplantation recipients: protocol for a randomized controlled trial. JMIR Res Protocols 2019; 8: e13351.
48.
Zhou L, Cheng K, Chen L, Hou X, Wan J. Effectiveness of eHealth for medication adherence in renal transplant recipients: systematic review and meta-analysis. J Med Internet Res 2025; 27: e73520.
49.
Paneerselvam GS, Lua PL, Chooi WH, Rehman IU, Goh KW, Ming LC. Effectiveness of mobile apps in improving medication adherence among chronic kidney disease patients: systematic review. J Med Internet Res 2025; 27: e53144.
| eISSN: | 1896-9151 |
| ISSN: | 1734-1922 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
