Factors Influencing App Use in Elderly Cardiac Patients

Chronic heart disease is highly prevalent among adults over 65; however, the adoption and sustained use of mobile health applications to support self-management is limited. Understanding the multilevel determinants of adoption is essential to informing nursing practice and implementation strategies.

A scoping review was conducted using a diffusion of innovations framework to guide the analysis, to identify and synthesize the principal barriers and facilitators affecting the adoption and use of mobile health applications among adults aged 65 and over with chronic heart disease.

A scoping review was conducted in accordance with the Joanna Briggs Institute methodology, with reporting following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. A 3-stage search of the databases MEDLINE (PubMed), Cumulative Index for Nursing and Allied Health Literature, Scopus, PsycINFO, and the Cochrane Library was conducted to identify studies published between 2015 and 2025. Eligible studies included adults aged 65 years and over who used mHealth applications in a home, community, or outpatient setting and that reported on related barriers, facilitators, or outcomes. Two reviewers independently screened the records and extracted the data. The findings were analyzed thematically and mapped to the 6 domains of Greenhalgh's framework. The Mixed Methods Appraisal Tool was used to assess risk of bias and standardize interpretation.

Twelve studies were included. The apps primarily addressed telemonitoring, telerehabilitation, medication adherence, and education. Barriers included low usability, technological anxiety, cognitive and sensory limitations, social isolation, fragmented organizational support, limited infrastructure, and unclear funding or regulatory frameworks. Facilitators included simple, customizable interfaces; clear, perceived benefits; caregiver and peer support; clinical endorsement; structured training; and institutional integration. The evidence was methodologically heterogeneous, and several nonrandomized studies were more susceptible to bias.

App adoption depends on alignment among design features, older adults' capabilities, social networks, and organizational and policy contexts. Fragmented implementation, heterogeneous outcomes, and short-term projects undermine sustainability and equity. Co-designed, theory-informed interventions, hybrid effectiveness-implementation studies, and policies enhancing accessibility, digital literacy, and integration into geriatric cardiology pathways are warranted.

Nurses play a pivotal role in assessing digital readiness, providing training support, engaging caregivers, and integrating apps into routine cardiovascular care pathways.