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Medication nonadherence is common among patients diagnosed with schizophrenia and is associated with poor clinical outcomes. The effectiveness of adherence therapy (AT) in improving adherence remains debated, particularly in community settings. This systematic review evaluated the impact of AT on medication adherence among individuals with schizophrenia. Following PRISMA guidelines, eight databases were searched for randomized controlled trials (RCTs) published in English between 2010 and 2023. Study quality was assessed using CONSORT criteria, and risk of bias was evaluated independently by two reviewers using the Cochrane RoB 2 tool. Ten RCTs met the inclusion criteria. Findings indicate that AT is significantly associated with improved medication adherence and positive patient outcomes. Despite these promising results, further high-quality, double-masked RCTs involving diverse populations across different geographic and ethnic backgrounds are required to strengthen the evidence base and support the generalizability of AT in community-based mental health care settings.Study Registration: PROSPERO Protocol registration ID: CRD420261416466.