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.