Effectiveness of mHealth Interventions for improving eHealth Literacy among Patients with Chronic Diseases: A Meta-analysis and Systematic Review (Preprint)

BACKGROUND With widespread use of the Internet and mobile devices, ehealth literacy promotion is critical for chronic disease management. However, the effectiveness of mhealth interventions on eHealth literacy among patients with chronic diseases are still inconclusive. OBJECTIVE This study seeks to to assess the effectiveness of mhealth interventions on eHealth literacy for chronic diseases patients. METHODS A comprehensive search strategy was developed, and eight electronic databases—PubMed, Web of Science, Embase, Cochrane Library, WanFang Database, China National Knowledge Infrastructure (CNKI), CQVIP, and Chinese Biomedical Literature (CBM)—were systematically searched for studies published up to October 31, 2024. Patients with chronic diseases were included based on predefined inclusion criteria. The Cochrane Effective Practice and Organisation of Care (EPOC) group methods for nonrandomized controlled trials and the Cochrane Collaboration Tool for randomized controlled trials were used to assess the risk of bias. All statistical analyses were performed using Review Manager (version 5.4; Cochrane Informatics & Technology Services) software. Random effects model was applied to evaluate the homogeneity between studies. The outcome was eHealth literacy score. A narrative and quantitative synthesis of the findings was provided where appropriate. RESULTS Among 1665 eHealth literacy–related papers, 10 studies (6 randomized controlled trials and 4 quasi-experimental studies) involving 2272 participants were included in this study. The overall findings demonstrated that eHealth literacy interventions significantly improved eHealth literacy efficacy (standardized mean difference=1.00, 95% CI −0.40 to 1.60; P=0.001), with substantial heterogeneity observed (I²=93%, P<0.001). Subgroup analyses revealed that interventions delivered via online applets were significantly more effective than face-to-face teaching (standardized mean difference=0.50, 95% CI −0.11 to 0.88; P<0.001), and interventions grounded in theoretical frameworks were significantly more effective than those without theoretical guidance (standardized mean difference= 1.14, 95% CI −0.03 to 2.25; P=0.05). Shorter intervention durations (<3months) showed more consistent improvements (standardized mean difference=0.70, 95% CI −0.07 to 1.32; P=0.03) compared to longer durations interventions. Hospital-based interventions showed greater efficacy (standardized mean difference= 1.67, 95% CI −0.08 to 3.26; P=0.04) compared to community-based approaches. CONCLUSIONS This meta-analysis demonstrates that mHealth interventions significantly improve eHealth literacy among patients with chronic diseases. The most effective approaches are delivered via online applets, grounded in theoretical frameworks, and implemented within hospital settings over shorter durations (<3 months). These findings highlight the potential of targeted mHealth strategies to enhance patients' ability to access, understand, and utilize digital health information, thereby supporting chronic disease self-management. CLINICALTRIAL PROSPERO International Prospective Register of Systematic ReviewsCRD42024622807; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024622807