Patient Engagement in Mobile Health for Community-Dwelling Older Adults: A Systematic Review

Mobile health (mHealth) is being actively developed for healthcare and can be an effective intervention through active engagement. However, despite the rapidly growing older adult population, mHealth is often designed for younger populations, and there is a need to explore engagement strategies that are appropriate for older adults. Therefore, this systematic review aimed to summarise the evidence for improving older adult engagement in community-based mHealth intervention studies.

Participants were community-dwelling older adults. Interventions included mHealth for self-care, self-management, health promotion or health education with no restriction on type. Eligible studies were randomised controlled trials, excluding those involving hospitalised older adults, focusing solely on treatment compliance or symptom monitoring without reporting mHealth engagement outcomes or published in non-English languages. Searches were conducted in Cochrane CENTRAL, PubMed, EMBASE and CINAHL to identify studies on December 1, 2023 (date of last searched studies). Risk of bias in the included studies was assessed using the RoB 2 tool. The focus was on presenting engagement strategies for community-dwelling older adults in a summary of findings table.

Ten studies with 1293 participants were included. Delivery modes varied, with the most engagement-associated outcome being improved physical functioning. Participant dropout rates ranged from 0% to 28%. While 10 studies employed strategies to encourage ongoing engagement, none included 'engage as early as possible' or 'include a plan for evaluation'.

While mHealth interventions show potential, their engagement strategies remain underdeveloped. Limitations include heterogeneity in study designs and the inability to perform meta-analysis. Future research should incorporate comprehensive engagement plans and evaluation systems to optimise the use of mHealth for community-dwelling older adults.

The findings highlight the need to strengthen nurses' digital health competencies and implement tailored clinical strategies, such as early support and ongoing feedback, to promote sustained engagement and adherence to mHealth among community-dwelling older adults.