Facilitators and Barriers to Digital Health Technologies for Self-Management in Patients With Chronic Kidney Disease: Systematic Review Based on the Updated CFIR 2.0 Framework.

چکیده اصلی

BACKGROUND: The integration of digital health technology (DHT) into chronic kidney disease (CKD) care holds transformative potential for enhancing patient self-management and slowing disease progression. Despite the growing availability of DHT, there remains limited understanding of the factors that facilitate or hinder their adoption and use among patients with CKD. OBJECTIVE: This study aims to identify the facilitators and barriers to the use of digital health interventions for self-management in patients with CKD, and to provide evidence to inform the development of implementation strategies. METHODS: A systematic search was performed across 11 databases (CNKI, WanFang Data, VIP Database, Chinese Medical Journals Database, PubMed, CINAHL, Embase, Cochrane Library, Scopus, PsycINFO, and Web of Science Core Collection) from database inception to May 12, 2026, with reports restricted to those published in English or Chinese. Eligible studies were required to enroll adult patients with CKD (aged ≥18 years); report facilitators, barriers, or influencing factors related to DHT use for self-management; and use qualitative, quantitative, or mixed methods designs. Nonempirical articles, conference abstracts, and studies without accessible full text were excluded. Two researchers (Feiyue Su and Yao Yao) independently assessed the quality of the included studies using the Mixed Methods Appraisal Tool (MMAT). Extracted data were coded deductively to the Consolidated Framework for Implementation Research 2.0 (CFIR 2.0) constructs using open and axial coding; recurring themes were then synthesized into a narrative summary organized by the 5 CFIR domains. RESULTS: Thirteen studies (8 mixed methods, 3 quantitative, and 2 qualitative) were included, encompassing 3002 patients with CKD across 8 countries. Of these, 9 met all applicable MMAT criteria, while the remaining 4 had methodological limitations. In total, 19 facilitators and 15 barriers were identified and mapped to the 5 CFIR 2.0 domains. The most frequently reported facilitators were a simple and easy-to-use user interface (9 studies, high confidence), care and support from family members and peers (8 studies, high confidence), convenient anytime access to health information, high perceived usefulness, personalized educational content, and continuous content updates (each reported in 5 studies, high confidence). The most frequently reported barriers were low health literacy (6 studies, high confidence), poor economic status of patients (6 studies, moderate confidence), and advanced age (5 studies, high confidence). CONCLUSIONS: The use of digital health interventions for CKD self-management is influenced by multilevel factors. However, the evidence base is limited by the predominance of mixed methods designs, the lack of longitudinal studies, and the concentration of studies in high-income countries, which may limit the generalizability of the findings. Targeted, multilevel strategies that address the identified facilitators and barriers are essential for enhancing effective and equitable implementation.

ترجمه فارسی چکیده

ادغام فناوری‌های سلامت دیجیتال (DHT) در مراقبت از بیماری مزمن کلیه (CKD) پتانسیل تحول‌آفرینی برای بهبود خودمدیریت بیماران و کند کردن پیشرفت بیماری دارد. با وجود افزایش دسترسی به DHT، درک محدودی از عواملی وجود دارد که تسهیل‌کننده یا مانع استفاده از آن‌ها در بیماران CKD هستند. این مطالعه هدف دارد عوامل تسهیل‌کننده و موانع استفاده از مداخلات سلامت دیجیتال را شناسایی کرده و شواهدی برای هدایت توسعه استراتژی‌های اجرایی ارائه دهد. یک جستجوی نظام‌مند در ۱۱ پایگاه داده انجام شد. ۱۳ مطالعه (۸ روش ترکیبی، ۳ کمی و ۲ کیفی) شامل ۳۰۰۲ بیمار در ۸ کشور وارد شد. ۱۹ عامل تسهیل‌کننده و ۱۵ مانع شناسایی شدند. عوامل تسهیل‌کننده شامل رابط کاربری ساده، حمایت خانواده و همسالان، دسترسی آسان به اطلاعات سلامت و محتوای آموزشی شخصی‌سازی‌شده بود. موانع شامل کم‌یابی سواد سلامت، وضعیت اقتصادی پایین و سن بالا بود. شواهد محدودیت‌هایی مانند غلبه طراحی‌های ترکیبی و تمرکز مطالعات در کشورهای درآمد بالا دارد.

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