Digital health tools may modestly boost patient engagement, umbrella review finds

Digital health interventions — from smartphone apps to telehealth platforms — are increasingly integrated into chronic disease care, but the evidence on their effect on patient engagement has remained fragmented across populations, modalities and outcome definitions. A new umbrella review, published in PLOS Digital Health, systematically examines whether these tools actually improve engagement and related health outcomes.

The analysis, led by Usman Iqbal and colleagues, searched six databases for studies published from inception to June 2025, focusing on systematic reviews with meta-analyses of digital health interventions targeting engagement outcomes such as self-management, medication adherence and patient activation. Forty-two reviews met the inclusion criteria, encompassing 853 primary studies and roughly 574,676 participants across diverse populations and conditions.

Quality proved a major caveat. Most of the included reviews were rated low-quality using the AMSTAR-2 assessment tool. This matters because low-quality reviews can overstate or distort effects, and the authors note that fragmented findings have hampered the field.

Despite these limitations, the meta-meta-analyses suggested digital health interventions could improve medication adherence, with a standardised mean difference of 0.65 (95% CI: 0.22 to 1.08). Adherence — the degree to which patients take medications as prescribed — is a frequent target of digital reminder and monitoring tools.

Secondary outcomes also showed promise. Pooled estimates suggested the interventions may improve quality of life (SMD = 0.26) and reduce HbA1c, a marker of long-term blood sugar control in diabetes, by 0.45 percentage points. Subgroup analyses indicated variation in effects across age groups and conditions for both medication adherence and quality of life, suggesting a one-size-fits-all digital approach is unlikely to work.

The authors are explicit about how the findings should be read. Because low-quality reviews dominate the evidence base, they characterise the pooled estimates as exploratory evidence of effectiveness rather than definitive proof, even where results are statistically significant. The review also flags gaps in evidence on patient activation and patient satisfaction, engagement dimensions that remain under-measured.

Looking forward, the team argues that future implementation should be guided by higher-quality systematic reviews, longer-term primary studies, and additional research into the neglected engagement dimensions. Overall, the review concludes that digital health interventions may provide scalable, though moderate, improvements in patient engagement behaviours and selected clinical outcomes across diverse populations and conditions — findings that warrant confirmation through more rigorous evaluation.

Subject of Research: Effectiveness of digital health interventions for patient engagement in chronic disease management

Article Title: Digital health interventions for patient engagement: A systematic umbrella review

Article References: Iqbal, U., Nkhoma, D. E., Manga, Y. B., Tanweer, A., Bokhari, S. M. H., Wibowo, M. F., Ningrum, D. N. A., Rahmanti, A. R., Huang, C.-W., Yang, H.-C., Atique, S., Moldovan, M., Humayun, A., Lazuardi, L., Rajaguru, G., Mickan, S., Celi, L. A., Li, Y.-C. J., & Redfern, J. (2026). Digital health interventions for patient engagement: A systematic umbrella review. PLOS Digital Health, 5(10), e0001785. https://doi.org/10.1371/journal.pdig.0001785

Image Credits: AI Generated

DOI: 10.1371/journal.pdig.0001785

Keywords: digital health, patient engagement, umbrella review, medication adherence, systematic review, chronic disease, quality of life, HbA1c, telehealth, self-management, AMSTAR-2, evidence quality