A narrative review of digital health evaluation frameworks

The rapid expansion of digital health has increased the necessity for standardized methods to assess program success. Nevertheless, current evaluation frameworks vary in terminology, stakeholder perspectives, and measurement methodologies, thereby constraining comparability across different programs.

This narrative review describes and compares major frameworks for evaluating digital health programs and identifies areas of similarity and deficits that could guide the choice of framework and future progress of such health programs.

A narrative review was conducted following a data search from PubMed and OpenEvidence databases. English-language and peer-reviewed publications from 2016 to the present were considered. Frameworks developed by consensus groups, professional organizations, or identified in prior scoping reviews were included. Frameworks were compared by primary focus, stakeholder considerations, core domains, and strengths and limitations.

Seven frameworks were examined: the Quintuple Aim, STEEP, SPROUT Telehealth Evaluation and Measurement (STEM), World Health Organization (WHO) Monitoring and Evaluating (M&E) Guideline, National Quality Forum (NQF), American Medical Association (AMA), and Stakeholder-Driven Muti-Stage Adaptive Real-World Theme-Oriented (SMART). Most include access, cost, experience, outcomes, and equity, but they differ in how these domains are defined and measured. STEM, NQF, AMA, and SMART explicitly incorporate stakeholder perspectives. Equity is addressed to varying degrees. Frameworks also differ in their emphasis on implementation, clinical outcomes, economic evaluation, and program maturity.

Existing frameworks offer complementary approaches to digital health evaluation; however, they lack consistent operational definitions and measurement strategies. Greater standardization of measures, clinical outcomes, stakeholder perspectives, and equity assessments could improve comparability and help sustain digital interventions that provide significant value.