Improving the quality and reporting of evidence for digital health interventions for maximum population-level impact: a meta-review

Introduction: The rapid development of digital health has resulted in poor reporting and quality of the scientific evidence. Many interventions remain under-evaluated, with a dearth of evidence of their wider, population level impact.
Methods: Between 2001 and 2015, we undertook a meta-review to describe, synthesize and evaluate (i) the effectiveness of digital health interventions for the prevention or control of cardiovascular disease, type 2 diabetes and/or depression; and (ii) their population impact using 8 parameters identified in the CONSORT-eHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile HEalth Applications and onLine TeleHealth) guidelines.
Results: Thirty three systematic reviews were included. Effectiveness data were most consistent for mobile health interventions. With respect to population impact: 3% reported comprehensive data on program development, 27% reported comprehensive data on participant program access, 45% provided a comprehensive description of the program being evaluated (model, theory, content, communications channels, prompts), 30% provided indication of
where supplementary resources, 15% detailed data collection and storage process such as security, 6% provided a detailed flow chart /diagram of usage, dose, engagement, 48% presented comprehensive data on demographics related to digital divide, and 36% reported comprehensive process outcomes.
Conclusions: Digital health interventions reported in reviews seldom considers parameters beyond effectiveness such as cost-effectiveness, feasibility to scale, and sub-population specific delivery. Their population level impact is likely to be of limited translational value in the absence of such data or standardized protocols that enable consolidation of these data.