Effectiveness of health education in improving treatment adherence among patients with chronic communicable diseases: A systematic review and meta-analysis

Introduction: Chronic communicable diseases, such as tuberculosis, HIV, hepatitis B, and hepatitis C, remain major global health challenges. Effective treatment adherence is crucial for improving patient outcomes and health education plays a key role in enhancing adherence. However, evidence for the most effective educational interventions remains limited. Objective: This study aimed to evaluate the effectiveness of health education interventions in improving treatment adherence among patients with chronic communicable diseases. Methods: A systematic review and meta-analysis were conducted following the preferred item for systematic review and meta-analysis (PRISMA) guidelines. Comprehensive searches were performed in PubMed, CINAHL, Scopus, and the Web of Science for studies published between 2015 and 2024. Eligible studies included randomised controlled trials. Quality assessment was conducted using the Joanna Briggs Institute critical appraisal tools. Statistical analysis was performed using the Mantel-Haenszel method to estimate odds ratios (OR) and standardised mean differences (SMD) with 95 confidence intervals (CI) using a random effects model. Meta-regression was conducted to explore potential sources of heterogeneity. Results: Seventeen studies involving 4,157 participants were included. Health education interventions significantly improved treatment adherence compared to usual care (OR 2.42; 95 CI: 1.58-3.72; p <0.0001). Subgroup analyses showed the highest effectiveness in remote-based interventions (OR 5.65; 95 CI: 2.37-13.47), among patients with tuberculosis (OR 6.52; 95 CI: 3.59-11.84), and in upper-middle-income countries (OR 4.54; 95 CI: 1.54-13.39). Meta-regression indicated that younger participant age and intervention type were significant moderators, with media-based and remote-based showing greater effectiveness. Conclusion: Health education interventions significantly improve treatment adherence among patients with chronic communicable diseases, particularly those with tuberculosis and hepatitis C. Remote-based models, such as mHealth platforms and digital reminders, demonstrate the highest effectiveness, especially in low- and middle-income countries where stigma and limited healthcare access remain key barriers. © 2025 The Author(s) Tropical Medicine & International Health published by John Wiley & Sons Ltd.