Digital Health Communication Strategies for Supporting Healthy Lifestyles in Adults with Noncommunicable Diseases and Limited Health Literacy: A Scoping Review
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Abstract
Background: Digital health technologies are pivotal in delivering the WHO-recommended healthy lifestyle messages to reduce premature mortality associated with noncommunicable diseases (NCDs). However, evidence on effective strategies to promote healthy lifestyle behaviours among patients with limited health literacy remains insufficient. This review explores current digital health communication strategies that support healthy lifestyles in adults with NCDs and low health literacy.
Methods: A scoping review was conducted using Arksey and O'Malley's framework, focusing on adults with NCDs and limited health literacy, digital health communication strategies, and healthy lifestyle behaviours. Searches were performed across 14 electronic databases and bibliographies of relevant studies from Jan 2012 to Nov 2022. Only primary studies published in English were included. Findings were reported following the PRISMA Extension for Scoping Reviews guidelines.
Results: Overall, 12 studies involving 15,175 participants, predominantly from high-income countries, met the inclusion criteria. Five digital health communication strategies were identified: telecommunication-based coaching, mobile applications, text messaging programs, eHealth and web-based tools, and bundled or multimodal interventions. These strategies demonstrated positive impacts on supporting healthy lifestyle behaviours.
Conclusion: This review highlights the potential of diverse digital health communication strategies to enhance healthy lifestyle behaviours in adults with NCDs and limited health literacy. Tailoring these strategies to individual preferences is critical for optimizing outcomes. Further research is required to validate these findings, particularly in low- and middle-income countries.
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17. Dwinger S, Rezvani F, Kriston L, et al (2020). Effects of telephone-based health coaching on patient-reported outcomes and health behaviours change: A randomised controlled trial. PLoS One, 15(9): e0236861.
18. Marklund S, Tistad M, Lundell S, Östrand L, et al (2021). Experiences and Factors Affecting Usage of an eHealth Tool for Self-Management Among People With Chronic Obstructive Pulmonary Disease: Qualitative Study. J Med Internet Res, 23(4): e25672.
19. Nanyonga RC, Spies L A, Nakaggwa F (2022). The effectiveness of nurse‐led group interventions on hypertension lifestyle management: A mixed method study. J Nurs Scholarsh, 54(3):286-295.
20. Nelson LA, Spieker A, Greevy R, et al (2020). User Engagement Among Diverse Adults in a 12-Month Text Message-Delivered Diabetes Support Intervention: Results from a Randomized Controlled Trial. JMIR MHealth UHealth, 8(7): e17534.
21. Oh YS, Choi EY, Kim YS (2018). Predictors of Smartphone Uses for Health Information Seeking in the Korean Elderly. Soc Work Public Health, 33(1): 43-54.
22. Redfern J, Coorey G, Mulley J, et al (2020). A digital health intervention for cardiovascular disease management in primary care (CONNECT) randomised controlled trial. NPJ Digit Med, 3: 117.
23. Whittemore R, Vilar-Compte M, Cerda S, et al (2020). ¡Sí, Oo Puedo Vivir Sano con Diabetes! A self-management randomised controlled pilot trial for low-income adults with type 2 diabetes in Mexico City. Curr Dev Nutr, 4(5): nzaa074.
24. Ernsting C, Dombrowski SU, Oedekoven M, et al (2017). Using Smartphones and Health Apps to Change and Manage Health Behaviours: A Population-Based Survey. J Med Internet Res, 19(4): e101.
25. Tiede M, Dwinger S, Herbarth L, Härter M, et al (2017). Long-term effectiveness of telephone-based health coaching for heart failure patients: A post-only randomised controlled trial. J Telemed Telecare, 23(8): 716-724.
26. Blackford K, Jancey J, Lee AH, et al (2016). Effects of a home-based intervention on diet and physical activity behaviours for rural adults with or at risk of metabolic syndrome: a randomised controlled trial. Int J Behav Nutr Phys Act, 13: 13.
27. Wu VX, Dong Y, Tan PC, Gan P, et al (2022). Development of a Community-Based e-Health Program for Older Adults With Chronic Diseases: Pilot Pre-Post Study. JMIR Aging, 5(1): e33118.
28. Malale K, Fu J, Nelson W, Gemuhay HM, Gan X, Mei Z (2020). Potential Benefits of Multimedia-Based Home Catheter Management Education in Patients With Peripherally Inserted Central Catheters: Systematic Review. J Med Internet Res, 22(12): e17899.
29. Minutolo A, Damiano E, De Pietro G, et al (2022). A conversational agent for querying Italian Patient Information Leaflets and improving health literacy. Comput Biol Med, 141:105004.
30. Geboers B, Reijneveld SA, Jansen CJM, et al (2016). Health Literacy Is Associated With Health Behaviourss and Social Factors Among Older Adults: Results from the LifeLines Cohort Study. J Health Commun, 21(sup2): 45-53.
31. Schoenberger YM, Phillips J, Mohiuddin MO, et al (2013). Acceptability of Delivering and Accessing Health Information Through Text Messaging Among Community Health Advisors. JMIR Mhealth Uhealth, 1(2): e22.
32. Senbekov M, Saliev T, Bukeyeva Z, et al (2020). The Recent Progress and Applications of Digital Technologies in Healthcare: A Review. Int J Telemed Appl, 2020: 8830200.
33. Kim SJ, Marsch LA, Brunette MF et al (2017). Harnessing Facebook for Smoking Reduction and Cessation Interventions: Facebook User Engagement and Social Support Predict Smoking Reduction. J Med Internet Res, 19(5): e168.
34. Madrigal L, Escoffery C (2019). Electronic Health Behaviourss Among US Adults With Chronic Disease: Cross-Sectional Survey. J Med Internet Res, 21(3): e11240.
35. Samal L, Fu HN, Camara DS, et al (2021). Health information technology to improve care for people with multiple chronic conditions. Health Serv Res, 56 Suppl 1(Suppl 1):1006-1036.
36. Allman-Farinelli M, Chen J (2017). mHealth technologies in the management of obesity: a narrative review. Smart Homecare Technology and TeleHealth, 2017: 53-59.
37. Strickland JR, Smock N, Casey C, et al (2015). Development of targeted messages to promote smoking cessation among construction trade workers. Health Educ Res, 30(1): 107-120.
38. Ye R, Wu Y, Sun C, et al (2022). Health Communication Patterns and Adherence to a Micronutrient Home Fortification Program in Rural China. J Nutr Educ Behav, 54(1): 36-45.
39. Bhuyan SS, Lu N, Chandak A, et al (2016). Use of Mobile Health Applications for Health-Seeking Behaviours Among US Adults. J Med Syst, 40(6): 153.
40. Stephens J, Allen J (2013). Mobile phone interventions to increase physical activity and reduce weight: a systematic review. J Cardiovasc Nurs, 28(4): 320-329.
41. Jin Q, Boyce TW, Kang H, et al (2021). Acceptability of Phone Calls and Texts to Promote Healthy Behaviourss Among Spanish-Speaking Hispanics. Hispanic Journal of Behavioursal Sciences, 43(3): 073998632110349.
42. Stefanicka-Wojtas, D., & Kurpas, D. (2022). eHealth and mHealth in Chronic Diseases-Identification of Barriers, Existing Solutions, and Promoters Based on a Survey of EU Stakeholders Involved in Regions4PerMed (H2020). J Pers Med, 12(3):467.
2. Haileamlak A (2019). Physical Inactivity: The Major Risk Factor for Noncommunicable Diseases. Ethiop J Health Sci, 29(1):810.
3. Phillips EM, Frates EP, Park DJ (2020). Lifestyle Medicine. Phys Med Rehabil Clin N Am, 31(4): 515-526.
4. World Health Organisation (2019). Global Action Plan for Healthy Lives and Wellbeing for All (SDG3 GAP). Available: https://www.who.int/initiatives/sdg3-global-action-plan Accessed: 15/01/2023.
5. Jandoo T (2020). WHO guidance for digital health: What it means for researchers. Digital Health, 6:2055207619898984.
6. Madanian S, Nakarada-Kordic I, Reay S, et al (2023). Patients' perspectives on digital health tools. PEC Innov, 2:100171.
7. Smith B, Magnani JW (2019). New technologies, new disparities: The intersection of electronic health and digital health literacy. Int J Cardiol, 292: 280-2.
8. Shuren J, Patel B, Gottlieb S (2018). FDA Regulation of Mobile Medical Apps. JAMA, 320(4): 337-8.
9. van Kessel R, Wong BLH, Clemens T, et al (2022). Digital health literacy as a super determinant of health: More than simply the sum of its parts. Internet Interv, 27: 100500.
10. Arksey H, O'Malley L (2005) Scoping studies: towards a methodological framework. International Journal of Social Research Methodology, 8(1): 19-32.
11. Malale K, Reid M, Moorhead A (2022). Digital health communication strategies to support a healthy lifestyle in adults with chronic diseases who have possible limited health literacy: a scoping review.
12. Tricco AC, Lillie E, Zarin W, et al (2018). PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and explanation. Ann Intern Med, 169(7): 467-73.
13. Ouzzani M, Hammady H, Fedorowicz Z, et al (2016). Rayyan—a web and mobile app for systematic reviews. Syst Rev, 5(1): 210.
14. Creswell JW (2009). Research Design: Qualitative, Quantitative, and Mixed Methods Approaches (3rd ed.). Thousand Oaks, CA: Sage Publications.
15. Tesch R (1990). Qualitative research: Analysis types and software tools. Falmer, New York.
16. Duplaga M (2021). The association between Internet use and health-related outcomes in older adults and the elderly: a cross-sectional study. BMC Med Inform Decis Mak, 21(1): 150.
17. Dwinger S, Rezvani F, Kriston L, et al (2020). Effects of telephone-based health coaching on patient-reported outcomes and health behaviours change: A randomised controlled trial. PLoS One, 15(9): e0236861.
18. Marklund S, Tistad M, Lundell S, Östrand L, et al (2021). Experiences and Factors Affecting Usage of an eHealth Tool for Self-Management Among People With Chronic Obstructive Pulmonary Disease: Qualitative Study. J Med Internet Res, 23(4): e25672.
19. Nanyonga RC, Spies L A, Nakaggwa F (2022). The effectiveness of nurse‐led group interventions on hypertension lifestyle management: A mixed method study. J Nurs Scholarsh, 54(3):286-295.
20. Nelson LA, Spieker A, Greevy R, et al (2020). User Engagement Among Diverse Adults in a 12-Month Text Message-Delivered Diabetes Support Intervention: Results from a Randomized Controlled Trial. JMIR MHealth UHealth, 8(7): e17534.
21. Oh YS, Choi EY, Kim YS (2018). Predictors of Smartphone Uses for Health Information Seeking in the Korean Elderly. Soc Work Public Health, 33(1): 43-54.
22. Redfern J, Coorey G, Mulley J, et al (2020). A digital health intervention for cardiovascular disease management in primary care (CONNECT) randomised controlled trial. NPJ Digit Med, 3: 117.
23. Whittemore R, Vilar-Compte M, Cerda S, et al (2020). ¡Sí, Oo Puedo Vivir Sano con Diabetes! A self-management randomised controlled pilot trial for low-income adults with type 2 diabetes in Mexico City. Curr Dev Nutr, 4(5): nzaa074.
24. Ernsting C, Dombrowski SU, Oedekoven M, et al (2017). Using Smartphones and Health Apps to Change and Manage Health Behaviours: A Population-Based Survey. J Med Internet Res, 19(4): e101.
25. Tiede M, Dwinger S, Herbarth L, Härter M, et al (2017). Long-term effectiveness of telephone-based health coaching for heart failure patients: A post-only randomised controlled trial. J Telemed Telecare, 23(8): 716-724.
26. Blackford K, Jancey J, Lee AH, et al (2016). Effects of a home-based intervention on diet and physical activity behaviours for rural adults with or at risk of metabolic syndrome: a randomised controlled trial. Int J Behav Nutr Phys Act, 13: 13.
27. Wu VX, Dong Y, Tan PC, Gan P, et al (2022). Development of a Community-Based e-Health Program for Older Adults With Chronic Diseases: Pilot Pre-Post Study. JMIR Aging, 5(1): e33118.
28. Malale K, Fu J, Nelson W, Gemuhay HM, Gan X, Mei Z (2020). Potential Benefits of Multimedia-Based Home Catheter Management Education in Patients With Peripherally Inserted Central Catheters: Systematic Review. J Med Internet Res, 22(12): e17899.
29. Minutolo A, Damiano E, De Pietro G, et al (2022). A conversational agent for querying Italian Patient Information Leaflets and improving health literacy. Comput Biol Med, 141:105004.
30. Geboers B, Reijneveld SA, Jansen CJM, et al (2016). Health Literacy Is Associated With Health Behaviourss and Social Factors Among Older Adults: Results from the LifeLines Cohort Study. J Health Commun, 21(sup2): 45-53.
31. Schoenberger YM, Phillips J, Mohiuddin MO, et al (2013). Acceptability of Delivering and Accessing Health Information Through Text Messaging Among Community Health Advisors. JMIR Mhealth Uhealth, 1(2): e22.
32. Senbekov M, Saliev T, Bukeyeva Z, et al (2020). The Recent Progress and Applications of Digital Technologies in Healthcare: A Review. Int J Telemed Appl, 2020: 8830200.
33. Kim SJ, Marsch LA, Brunette MF et al (2017). Harnessing Facebook for Smoking Reduction and Cessation Interventions: Facebook User Engagement and Social Support Predict Smoking Reduction. J Med Internet Res, 19(5): e168.
34. Madrigal L, Escoffery C (2019). Electronic Health Behaviourss Among US Adults With Chronic Disease: Cross-Sectional Survey. J Med Internet Res, 21(3): e11240.
35. Samal L, Fu HN, Camara DS, et al (2021). Health information technology to improve care for people with multiple chronic conditions. Health Serv Res, 56 Suppl 1(Suppl 1):1006-1036.
36. Allman-Farinelli M, Chen J (2017). mHealth technologies in the management of obesity: a narrative review. Smart Homecare Technology and TeleHealth, 2017: 53-59.
37. Strickland JR, Smock N, Casey C, et al (2015). Development of targeted messages to promote smoking cessation among construction trade workers. Health Educ Res, 30(1): 107-120.
38. Ye R, Wu Y, Sun C, et al (2022). Health Communication Patterns and Adherence to a Micronutrient Home Fortification Program in Rural China. J Nutr Educ Behav, 54(1): 36-45.
39. Bhuyan SS, Lu N, Chandak A, et al (2016). Use of Mobile Health Applications for Health-Seeking Behaviours Among US Adults. J Med Syst, 40(6): 153.
40. Stephens J, Allen J (2013). Mobile phone interventions to increase physical activity and reduce weight: a systematic review. J Cardiovasc Nurs, 28(4): 320-329.
41. Jin Q, Boyce TW, Kang H, et al (2021). Acceptability of Phone Calls and Texts to Promote Healthy Behaviourss Among Spanish-Speaking Hispanics. Hispanic Journal of Behavioursal Sciences, 43(3): 073998632110349.
42. Stefanicka-Wojtas, D., & Kurpas, D. (2022). eHealth and mHealth in Chronic Diseases-Identification of Barriers, Existing Solutions, and Promoters Based on a Survey of EU Stakeholders Involved in Regions4PerMed (H2020). J Pers Med, 12(3):467.
| Files | ||
| Issue | Vol 54 No 10 (2025) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v54i10.20120 | |
| Keywords | ||
| Digital health Health literacy Healthy lifestyle mHealth Noncommunicable diseases | ||
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How to Cite
1.
Malale K, Reid M, Moorhead A. Digital Health Communication Strategies for Supporting Healthy Lifestyles in Adults with Noncommunicable Diseases and Limited Health Literacy: A Scoping Review. Iran J Public Health. 2025;54(10):2059-2072.
