Chronic Disease Self-Management Interventions using Digital Health Technologies for Community-Dwelling Older Adults: A Systematic Review

Abstract

Purpose The potential of digital health interventions for chronic disease self-management is well recognized. Multiple systematic reviews were conducted focusing on specific conditions (Hewitt et al., 2020; Shen et al., 2019; Slattery et al., 2019) or technologies (Lee et al., 2018; Stellefson et al., 2013). But when applying digital health intervention in older adults, intervention strategies are important because factors such as cognition, motivation, physical ability, and perception might act as barriers (Wildenbos et al., 2018). To our knowledge, it was hard to find the article systematically reviewing strategies to deliver digital health intervention for older adults’ chronic disease self-management. The purpose of this systematic review was to explore strategies of chronic disease self-management interventions using digital health technologies for community-dwelling older adults. Method A systematic search of PubMed, EMBASE, the Cochrane Controlled Register of Trials (CENTRAL), and CINAHL was conducted for the articles published until January 13, 2022. Articles reporting randomized controlled study of intervention effect and written in English and Korean were included. The quality of the studies was assessed by two reviewers independently using the revised Cochrane Risk of Bias tool (ROB2) (Sterne et al., 2019). Results and Discussion A total of 19 randomized controlled studies (21 articles) were included in the review. Narrative synthesis was performed because of high level of heterogeneity of interventions and outcomes across the studies. Fourteen studies were disease-specific (cardiovascular disease, diabetes, arthritis) and 3 studies were for multimorbidity. Most frequently used device was mobile phone (10 studies, 47.6%). Delivery modes were mostly non-contact and only 2 studies were blending non-contact and face-to-face mode. Duration of intervention ranged from 6 weeks to 18 months and 6-month intervention was most frequent (42.9%). Outcome variables were heterogeneous across the studies including physiological indices, quality of life, various health-related behaviors, healthcare utilization, and mortality. Most frequent outcome variables were physiological indices (42.9%) and quality of life (33.3%), but outcome measures were different across the studies. Considering results from review and high prevalence of multimorbidity among older adults (Ofori-Asenso et al., 2019), more studies to develop and evaluate self-management intervention using mobile phone for this population are needed.