Smartphone addiction as a new behavioral risk factor for medication non-adherence in renal transplantation

Background and Aims Medication non-adherence (MNA) is a significant contributor to graft rejection, impaired graft function, and mortality in renal transplant recipients. Despite well-documented risk factors such as younger age, depression, and complex regimens, the role of smartphone addiction (SPA) in MNA remains unexplored. SPA, linked to cognitive impairments like poor time management and forgetfulness, may negatively impact adherence to immunosuppressive therapy. This study investigates SPA as a potential behavioral risk factor for MNA in renal transplant recipients. Method This cross-sectional study included 140 renal transplant recipients followed at the Gazi University Transplant Outpatient Unit. Smartphone addiction (SPA) was assessed using the Smartphone Addiction Scale-Short Version (SAS-SV) and weekly screen time data objectively recorded from participant devices. Medication non-adherence (MNA) was evaluated with the Immunosuppressant Therapy Adherence Scale (ITAS). ITAS scores were categorized as perfect adherence (12), acceptable adherence (10–11), and non-adherence (0–9). Statistical analyses were conducted to identify associations between SPA, screen time, and adherence levels. Results Patients with poor adherence (ITAS 0–9) reported significantly higher weekly screen times (27 ± 10 hours) compared to those with perfect (20 ± 10 hours) and acceptable adherence (21 ± 11 hours) (P < 0.001). Additionally, 66% of the poor adherence group scored above the SAS-SV threshold (median score: 23) versus 38% and 36% in the perfect and acceptable adherence groups, respectively (P = 0.020). Younger age was significantly associated with poor adherence (P = 0.031). No significant differences were found for gender, transplant duration, donor type, or rejection history across adherence groups. Conclusion SPA may represent a novel behavioral risk factor for MNA in renal transplant recipients, with weekly screen time serving as an objective and practical marker for identifying at-risk patients. Screening for SPA and incorporating behavioral interventions to manage excessive smartphone use may improve adherence and transplant outcomes. Longitudinal studies are required to establish causality and evaluate the effectiveness of targeted interventions