Effectiveness of Strategies to Enhance Patients’ Compliance with Clinical Appointments: A Systematic Review

International audience Missed clinical appointments remain an important barrier to continuity of care, timely clinical review, and efficient use of health service resources. This systematic review examined strategies used to improve patients’ compliance with scheduled clinical appointments across global, African, and Nigerian healthcare settings. The review was guided by the PICO framework and included studies published in English between 2010 and 2026. Searches were conducted in PubMed/MEDLINE, Scopus, Web of Science, CINAHL, Google Scholar, African Journals Online, and relevant reference lists. Eligible studies included systematic reviews, randomised controlled trials, quasi-experimental studies, observational studies, and implementation studies that assessed interventions or determinants related to appointment attendance. Twenty-two studies were included in the qualitative synthesis. The evidence most consistently supported appointment reminder systems, particularly SMS/text reminders, telephone reminders, combined reminders, and reminder-plus interventions. SMS reminders were generally effective compared with no reminders and were often less costly than telephone calls. Evidence from Nigeria also showed benefit from SMS reminders in mental health follow-up, while local studies identified forgetfulness, transport cost, distance, financial constraints, and conflicting commitments as common reasons for missed appointments. Other useful strategies included patient navigation, case management, open-access scheduling, reduced appointment lead time, behavioural message framing, patient education, defaulter tracing, and transport-sensitive support. The review indicates that appointment compliance is best improved through proactive, patient-centred systems rather than passive appointment booking. In Nigeria and similar low-resource settings, low-cost reminders should be combined with updated appointment registers, targeted phone follow-up, flexible scheduling, patient education, and barrier assessment.