Effectiveness of Digital Health Interventions to Improve Self-Care in Patients With Chronic Diseases: Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND: Chronic diseases account for most global morbidity and mortality, increasing the need for effective long-term self-care support. Digital health interventions, such as mobile apps, telemonitoring, and connected devices, are increasingly used to promote self-care; yet, their overall effectiveness across chronic conditions remains unclear. OBJECTIVE: This systematic review and meta-analysis evaluated whether digital health interventions improve self-care in adults with chronic diseases. METHODS: We searched PubMed, CINAHL, Scopus, and PsycINFO for randomized controlled trials (RCTs; January 1, 2013, to December 31, 2025) that assessed digital health interventions targeting self-care outcomes, as measured with validated instruments, in patients with chronic conditions. Standardized mean differences (SMDs) were pooled using random-effects models, while results not suitable for meta-analysis were synthesized narratively. Risk of bias was assessed with the Cochrane Risk of Bias 2.0 tool for RCTs and certainty of evidence with Grading of Recommendations Assessment, Development and Evaluation. RESULTS: A total of 55 RCTs involving 5889 participants were included. Most interventions were multicomponent and mainly based on mobile or web-based applications, telemonitoring, connected devices, and text-messaging support. In diabetes, pooled analyses showed little to no clear improvement across self-care domains measured with the Summary of Diabetes Self-Care Activities, including general diet (3 studies), specific diet (3 studies), exercise (5 studies), foot care (5 studies), and glucose monitoring (4 studies), with low to very low certainty of evidence. In heart failure, digital interventions probably improved self-care monitoring measured with the Self-Care of Heart Failure Index (5 studies, 364 participants; SMD=0.49, 95% CI 0.13-0.85; low certainty), whereas effects on self-care maintenance (5 studies) and on self-care measured with the European Heart Failure Self-Care Behaviour Scale (3 studies) were not clearly demonstrated. In other chronic conditions, narrative synthesis suggested possible benefits in some cardiovascular conditions, chronic hepatitis B, epilepsy, and hypertension, while no significant effects were found in chronic obstructive pulmonary disease and multimorbidity, and mixed findings emerged in Parkinson disease. Across 17 studies, medication adherence showed little to no overall improvement (SMD=0.06, 95% CI -0.31 to 0.42, 95% prediction interval -0.98 to 1.09; very low certainty), indicating that future studies could plausibly show either benefit or no effect. Overall, heterogeneity was substantial, and most evidence was of low or very low certainty. CONCLUSIONS: This review is innovative in providing an up-to-date, cross-condition synthesis focused specifically on self-care as a multidimensional outcome, rather than on clinical end points alone or single diseases. The findings suggest that digital health interventions may be more effective for supporting self-care monitoring than for promoting broader behavioral maintenance or medication adherence. Evidence is limited by methodological heterogeneity, small sample sizes, short follow-up periods, and varied outcome measures. Larger designed trials using standardized self-care metrics and equity-focused approaches are needed to clarify effectiveness and guide implementation.