JMIR Publications

ABSTRACT

Background Chronic diseases account for most global morbidity and mortality, increasing the need for effective long-term self-care support. Digital health interventions, such as mobile apps, telemonitoring, and connected devices, are increasingly used to promote self-management, yet their overall effectiveness across chronic conditions remains unclear. This systematic review and meta-analysis evaluated whether digital health interventions improve self-care, including medication adherence, in adults with chronic diseases. Methods We searched PubMed, CINAHL, Scopus, and PsycINFO for randomized controlled trials (2013–2025) that assessed digital health interventions targeting self-care outcomes, as measured with validated instruments. Forty-seven RCTs met eligibility criteria. Standardized mean differences were pooled using random-effects models. Certainty of evidence was assessed using GRADE. Results Digital interventions showed variable effectiveness across conditions and outcomes. For diabetes, pooled results suggested small, mostly non-significant improvements in diet, foot care, and physical activity, while glucose monitoring showed a significant but highly heterogeneous effect (SMD 0.76; very low certainty). For heart failure, moderate improvements were observed in self-care maintenance (SMD 0.52; low certainty) and monitoring (SMD 0.50; moderate certainty), particularly in recent app-based studies. Across 14 RCTs, medication adherence showed little to no improvement (SMD 0.06; very low certainty). Narrative evidence indicated benefits in several individual trials, particularly where interventions included interactive features, continuous monitoring, or clinician feedback. Overall heterogeneity was substantial, and certainty was generally low to very low. Conclusion Digital self-management interventions demonstrate promising yet inconsistent effects on self-care and medication adherence across various chronic diseases. Evidence is limited by methodological heterogeneity, small sample sizes, short follow-up periods, and varied outcome measures. Larger, rigorously designed trials using standardized self-care metrics and equity-focused approaches are needed to clarify effectiveness and guide implementation.