Current Implementation of Digital Health in Chronic Disease Management: Scoping Review.

BACKGROUND

Approximately 1 in 3 adults live with multiple chronic diseases. Digital health is being harnessed to improve continuity of care and management of chronic diseases. However, meaningful uptake of digital health for chronic disease management remains low. It is unclear how these innovations have been implemented and evaluated.

OBJECTIVE

This scoping review aims to identify how digital health innovations for chronic disease management have been implemented and evaluated: what implementation frameworks, methods, and strategies were used; how successful these strategies were; key barriers and enablers to implementation; and lessons learned and recommendations shared by study authors.

METHODS

We used the Joanna Briggs Institute methodology for scoping reviews. Five databases were searched for studies published between January 2015 and March 2023: PubMed, Scopus, CINAHL, PsycINFO, and IEEE Xplore. We included primary studies of any study design with any type of digital health innovations for chronic diseases that benefit patients, caregivers, or health care professionals. We extracted study characteristics; type of digital health innovation; implementation frameworks, strategies, and outcome measures used; barriers and enablers to implementation; lessons learned; and recommendations reported by study authors. We used established taxonomies to synthesize extracted data. Extracted barriers and enablers were grouped into categories for reporting. Descriptive statistics were used to consolidate extracted data.

RESULTS

A total of 252 studies were included, comprising mainly mobile health (107/252, 42.5%), eHealth (61/252, 24.2%), and telehealth (97/252, 38.5%), with some studies involving more than 1 innovation. Only 23 studies (23/252, 9.1%) reported using an implementation science theory, model, or framework; the most common were implementation theories, classic theories, and determinant frameworks, with 7 studies each. Of 252 studies, 144 (57.1%) used 2 to 5 implementation strategies. Frequently used strategies were "obtain and use patient or consumer feedback" (196/252, 77.8%); "audit and provide feedback" (106/252, 42.1%); and piloting before implementation or "stage implementation scale-up" (85/252, 33.7%). Commonly measured implementation outcomes were acceptability, feasibility, and adoption of the digital innovation. Of 252 studies, 247 studies (98%) did not measure service outcomes, while patient health outcomes were measured in 89 studies (35.3%). The main method used to assess outcomes was surveys (173/252, 68.7%), followed by interviews (95/252, 37.7%). Key barriers impacting implementation were data privacy concerns and patient preference for in-person consultations. Key enablers were training for health care workers and personalization of digital health features to patient needs.

CONCLUSIONS

This review generated a summary of how digital health in chronic disease management is currently implemented and evaluated and serves as a useful resource for clinicians, researchers, health system managers, and policy makers planning real-world implementation. Future studies should investigate whether using implementation science frameworks, including how well they are used, would yield better outcomes compared to not using them.