Actual use, intention to use, and user attitudes toward mobile health applications for coronary heart disease self-management: a systematic review and meta-analysis

BACKGROUND: Mobile Health applications (mHealth) have become a promising approach to support self-management of coronary heart disease (CHD). No previous studies have examined user acceptance constructs, and the results remain inconsistent. The aim of this study is to synthesize and quantify the pooled prevalence of current use, intention to use, perceived usefulness, and positive user attitudes toward mHealth apps among patients with coronary heart disease. METHODS: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD420251018916). Five electronic databases (PubMed, Web of Science, Cochrane Library, CINAHL, and SCOPUS) were searched for studies published in English between January 2015 and April 2025. Primary studies reporting at least one acceptance-related construct: actual use, intention to use, perceived usefulness, and positive user attitude among patients with CHD or cardiac events were included. Random-effects models (metaprop, REML) were used to estimate pooled prevalence. Heterogeneity, sensitivity test, subgroup analysis, and publication bias assessments were performed. RESULTS: A total of 6113 participants in 17 studies. The pooled prevalence of actual use was [39% (95% CI: 24%-54%)], intention to use was [61% (95% CI: 53%-69%)], perceived usefulness was [69% (95% CI: 49%-88%)], and positive user attitude was [80% (95% CI: 69%-91%)]. Substantial heterogeneity was observed across studies. Sensitivity analysis indicated no influential outliers. The funnel plot and Egger's test indicate no statistically significant publication bias. However, the findings should be interpreted with caution due to substantial heterogeneity and a small number of studies. CONCLUSION: According to our findings, despite strong behavioural intention, high perceived usefulness, and positive user attitudes, actual usage remains relatively low, highlighting a gap between acceptance and implementation. The findings provide a potential quantitative basis for guiding the design and development of mHealth applications and for emphasizing user-centered interfaces to translate acceptance into sustained engagement in CHD self-management. These findings reveal significant untapped potential for mHealth-supported CHD self-care and the closely related cardiovascular population with similar self-management needs.