Digital health interventions for patient engagement: A systematic umbrella review

Digital tools are increasingly integrated into patient engagement (PE) in chronic disease management, yet findings remain fragmented across populations, modalities, and outcome definitions. The aim of this umbrella review was to systematically review evidence on the effectiveness of Digital Health Interventions (DHIs) to enhance PE and related health outcomes. Six databases were searched for eligible studies published from inception to June 2025. Systematic reviews with meta-analyses of DHIs targeting engagement outcomes (e.g., self-management, adherence, activation) were included. Forty-two reviews (853 primary studies; ≈ 574,676 participants) met inclusion criteria, with most rated low-quality using AMSTAR-2. Meta-meta-analyses suggested DHIs could improve medication adherence (SMD = 0.65, 95% CI: 0.22, 1.08). Secondary outcomes also demonstrated potential for DHIs to improve quality of life (SMD = 0.26) and HbA1c (MD = −0.45%). Subgroup analyses indicated variation in effects across age groups and conditions for medication adherence and quality of life. Thus, digital health interventions may provide scalable, though moderate, improvements in patient engagement behaviours and selected clinical outcomes across diverse populations and conditions. Despite statistically significant pooled estimates for selected outcomes, due to the predominance of low-quality reviews, findings should be interpreted as exploratory evidence of effectiveness. Future implementation should be informed by higher-quality systematic reviews, longer-term primary studies, and additional evidence on patient activation and satisfaction.Author summary: Digital technologies such as mobile apps, telehealth, text messaging, patient portals, and wearable devices are increasingly used to help people take a more active role in managing long-term health conditions. We brought together evidence from 42 systematic reviews covering 853 primary studies and more than 574,000 participants. Digital interventions showed potential to improve medication adherence and to achieve small improvements in quality of life and blood sugar. However, the evidence is much less certain than these numerical results alone may suggest. Forty of the 42 reviews were rated as low or critically low in terms of methodological rigor, while some pooled results relied on only three reviews and results often differed substantially across studies. We therefore interpret the pooled estimates as signals of potential benefit rather than proof that a particular digital approach will work for every patient or health system. Future studies should use clearer definitions of patient engagement, report outcomes consistently, follow participants for longer, and examine which digital formats work best for different populations. These improvements are needed before strong clinical, or policy recommendations can be made.