JMIR Publications

ABSTRACT

Background:

Low adherence frequently undermines the effectiveness of digital health interventions for adolescents, yet a systematic synthesis of the factors influencing adherence across health domains is lacking.

Objective:

This systematic review identified and analysed factors influencing adherence to digital health interventions targeting key adolescent lifestyle domains: physical activity, dietary habits, obesity management, alcohol consumption, and tobacco use.

Methods:

We systematically searched PubMed, PsycINFO, Embase, and CINAHL in March 2024 for studies of digital interventions targeting adolescents (10–19 years). Studies were included if they reported adherence or engagement outcomes. Data on intervention characteristics, user-related factors, and adherence outcomes were extracted and narratively synthesised.

Results:

Eighty-five studies, comprising 32,397 participants, were included. The average completion rate (binary measure) was 51.85% (SD = 25.33%), while average adherence to individual intervention components was 49.35% (SD = 24.01). Consistently reported facilitators included personalisation, user-friendly design, reminders, goal setting, gamification, and human support. The most common barriers were technical difficulties and poor system usability. Evidence regarding intervention duration and social components showed inconsistent effects.

Conclusions:

Adherence to digital health interventions in adolescents is driven by user-centred design features and robust technical performance, while the impact of social and user-related factors varies considerably. To advance the field, future research should adopt standardised frameworks for reporting and measuring adherence to enable meaningful cross-study comparisons and the development of adaptive engagement strategies.