SMS vs. Apps: Part 2 What the Evidence Supports

Part 2 calibrates against the trial record: what holds, what doesn’t, and where the channel choice lands per task.

• Introduction and TOC

• Part 1: The System

• Part 2: What Does the Evidence Support?

  • 2.1 Five clinical truths

  • 2.2 Where Apps vs. SMS win

  • 2.3 LLMs in the stack.

• Part 3: The Operating System

• Appendix: 75+ RCTs by specialty and the 4 SMS regulations

2.1 Five clinical truths that persist in the research literature
2.2 Where Apps vs. SMS wins
2.3 LLMs in the care delivery stack

2.1. Five Clinical Truths

Five claims hold across the strongest studies. Most operator decisions follow from them; trial detail lives in the appendix.

First: SMS improves medication adherence at chronic-disease scale.

Thakkar 2016 [16] pooled 16 RCTs (n=2,742) across five chronic conditions: SMS roughly doubled adherence odds (OR 2.11, 95% CI 1.52-2.93). The effect generalizes; design choices (personalization, frequency, bidirectionality, content) didn’t separate in subgroup analysis. Configuration is the operator’s call.

Second: program adherence predicts outcomes; app engagement does not; small SMS-driven adherence gains in short trials do not predict endpoint changes.