JMIR Publications

ABSTRACT

Background:

Chronically ill patients need novel patient counseling methods to support their self-care at different stages of the disease. At present, knowledge of how effective digital counseling is at managing patients’ anxiety, depression and adherence to treatment seems to be fragmented, and the development of counseling will require a more comprehensive view of this subset of interventions.

Objective:

This study aimed to identify and synthesize the best available evidence on the effectiveness of digital counseling environments at improving anxiety, depression and adherence to treatment among chronically ill patients.

Methods:

Systematic searches of the Ebsco (CINAHL), Pubmed, Scopus and Web of Science databases were conducted in May 2019 and complemented in October 2020. The review considered studies that included adult patients 18 years or older with chronic diseases, interventions evaluating digital (mobile, web-based, virtual, ubiquitous, online) counseling interventions, and anxiety, depression and/or adherence to treatment, including clinical indicators related to adherence to treatment, as outcomes. Methodological quality was assessed using the standardized JBI critical appraisal tool for randomized controlled trials or quasi-experimental studies. As a meta-analysis could not be conducted due to considerable heterogeneity in the reported outcomes, narrative synthesis was used to synthesize the results.

Results:

Of the 2056 records screened, 20 randomized controlled trials, 4 pilot randomized controlled trials and 2 quasi-experimental studies were included. Ten digital, web-based interventions yielded significantly positive effects on anxiety, depression, adherence to treatment and the clinical indicators related to adherence to treatment. Another eighteen studies reported positive, yet statistically non-significant, changes among chronically ill patients. The results indicate that an effective digital counseling environment comprises high-quality educational materials that are enriched with multimedia elements and activities that engage the participant in self-care. Due to the methodological heterogeneity of the included studies, it is impossible to determine which type of digital intervention is the most effective for managing anxiety, depression, and adherence to treatment.

Conclusions:

This study provides compelling evidence that digital, web-based counseling environments for chronically ill patients are more effective or comparable than standard counseling methods; this suggests that digital environments could complement standard counseling.