Effectiveness of digital health education interventions for chronic disease self-management in community-dwelling older adults: an umbrella review and evidence classification
- 1Department of Nursing, Faculty of Health Sciences, Acibadem Mehmet Ali Aydinlar University, Istanbul, Türkiye
Abstract
Background: Digital health education interventions are widely promoted to support chronic disease self-management. However, existing umbrella reviews pool evidence across all ages and have not assessed community-dwelling older adults, who face barriers to digital access. This umbrella review aimed to determine whether current evidence supports the effectiveness of digital health education interventions for chronic disease self-management in community-dwelling adults aged 60 years or older.
Methods: We conducted an umbrella review of systematic reviews evaluating digital health education interventions for chronic disease self-management in community-dwelling adults aged 60 years or older. Six databases were searched for systematic reviews published between 2015 and 2026. Meta-analytic outcomes were re-estimated using random-effects models, evidence was graded according to the Ioannidis criteria, methodological quality was assessed with AMSTAR 2, and primary-study overlap was quantified using the corrected covered area (CCA).
Results: Of the 1,272 records identified, 11 met the eligibility criteria, and 10 contributed 44 meta-analytic outcomes derived from 199 primary randomized controlled trials (RCTs) across five chronic disease clusters. The evidence base showed minimal overlap among primary studies (overall CCA was 0.76%). None of the outcomes met the criteria for convincing (Class I), highly suggestive (Class II), or suggestive (Class III) evidence. Fifteen outcomes (34.1%) were classified as weak (Class IV), whereas 29 (65.9%) were non-significant. According to AMSTAR 2, only three of the 10 systematic reviews were rated as high confidence, whereas two were rated as low and five as critically low confidence; the 95% prediction interval crossed the null for all 44 outcomes.
Conclusion: When the evidence is limited to community-dwelling older adults, no digital health education intervention for chronic disease self-management is supported by high-credibility evidence at the umbrella review level. This finding most likely reflects the immaturity of the current evidence base—characterized by a limited number of trials, short follow-up periods, and substantial heterogeneity—rather than a lack of intervention effectiveness. Well-powered RCTs with longer follow-up and higher-quality systematic reviews specifically focused on older adults are needed to strengthen the evidence base.
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BibTeX
@article{sezer2026effectiveness,
title = {{Effectiveness of digital health education interventions for chronic disease self-management in community-dwelling older adults: an umbrella review and evidence classification}},
author = {Esra Sezer and Gözde Gür},
journal = {Frontiers in Public Health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1948010},
url = {https://doi.org/10.3389/fpubh.2026.1948010},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Effectiveness of digital health education interventions for chronic disease self-management in community-dwelling older adults: an umbrella review and evidence classification
AU - Esra Sezer
AU - Gözde Gür
PY - 2026
DA - 2026/10/12
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1948010
UR - https://doi.org/10.3389/fpubh.2026.1948010
AB - Background: Digital health education interventions are widely promoted to support chronic disease self-management. However, existing umbrella reviews pool evidence across all ages and have not assessed community-dwelling older adults, who face barriers to digital access. This umbrella review aimed to determine whether current evidence supports the effectiveness of digital health education interventions for chronic disease self-management in community-dwelling adults aged 60 years or older. Methods: We conducted an umbrella review of systematic reviews evaluating digital health education interventions for chronic disease self-management in community-dwelling adults aged 60 years or older. Six databases were searched for systematic reviews published between 2015 and 2026. Meta-analytic outcomes were re-estimated using random-effects models, evidence was graded according to the Ioannidis criteria, methodological quality was assessed with AMSTAR 2, and primary-study overlap was quantified using the corrected covered area (CCA). Results: Of the 1,272 records identified, 11 met the eligibility criteria, and 10 contributed 44 meta-analytic outcomes derived from 199 primary randomized controlled trials (RCTs) across five chronic disease clusters. The evidence base showed minimal overlap among primary studies (overall CCA was 0.76%). None of the outcomes met the criteria for convincing (Class I), highly suggestive (Class II), or suggestive (Class III) evidence. Fifteen outcomes (34.1%) were classified as weak (Class IV), whereas 29 (65.9%) were non-significant. According to AMSTAR 2, only three of the 10 systematic reviews were rated as high confidence, whereas two were rated as low and five as critically low confidence; the 95% prediction interval crossed the null for all 44 outcomes. Conclusion: When the evidence is limited to community-dwelling older adults, no digital health education intervention for chronic disease self-management is supported by high-credibility evidence at the umbrella review level. This finding most likely reflects the immaturity of the current evidence base—characterized by a limited number of trials, short follow-up periods, and substantial heterogeneity—rather than a lack of intervention effectiveness. Well-powered RCTs with longer follow-up and higher-quality systematic reviews specifically focused on older adults are needed to strengthen the evidence base.
SN - 2296-2565
ER -