Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Dec 28, 2025
Date Accepted: Jun 12, 2026
Effectiveness and Implementation of Digital Health Interventions on Health Outcomes in Adults With Multimorbidity: A Systematic Review and Meta-analysis of Randomized Controlled Trials
ABSTRACT
Background:
Multimorbidity is increasingly prevalent and challenges traditional disease-specific care models. Digital health interventions may improve care coordination and self-management, but evidence of their effectiveness and implementation remains uncertain.
Objective:
To evaluate the effectiveness and implementation of digital health interventions (DHIs) for adults with multimorbidity.
Methods:
We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) published in English from inception to June 7, 2025, across six databases. Eligible studies enrolled adults (≥18 years) with multimorbidity and compared any DHIs with usual care. Primary outcomes were glycated haemoglobin (HbA1c), systolic blood pressure (SBP), and diastolic blood pressure (DBP), pooled with random-effects models. Evidence certainty was appraised with GRADE, and data on reach, uptake, and feasibility were synthesised narratively. The protocol was registered with PROSPERO (CRD420251067068).
Results:
From 47,243 records, 26 RCTs with 22,124 participants in 20 countries were included. DHIs achieved modest but significant reductions in HbA1c (–0.27% [95% CI –0.49 to –0.05]), SBP (–2.79 mmHg [–5.15 to –0.43]), and DBP (–1.33 mmHg [–2.38 to –0.27]). Certainty was high for DBP and moderate for HbA1c and SBP. No consistent effects were observed for secondary outcomes. Median reach across six trials was 62.7% and uptake across 20 trials was 91.8%. Most interventions were feasible, though web-based cognitive behavioural therapy showed lower engagement.
Conclusions:
DHIs provide modest but meaningful improvements in clinical indicators in multimorbidity, with high reach and uptake. They can complement usual care, but evidence for quality of life and mortality is limited. Heterogeneity and bias call for cautious interpretation. Future trials should extend follow-up, clarify mechanisms, and include low- and middle-income settings to support equitable implementation. Clinical Trial: CRD420251067068
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