Systematic review| Volume 13, ISSUE 8, P1084-1091, November 2022

Barriers and enablers of uptake and adherence to digital health interventions in older patients with cancer: A systematic review



      Digital health interventions (DHIs) provide patients with remote access to healthcare information and services through devices and online portals. Older patients (≥65 years old) with cancer may face difficulties using DHIs due to higher physical and psychological burden, but little is known about their pattern of use. The aim of this systematic review was to synthesise current findings related to user's perception of barriers and enablers to uptake and adherence of DHIs in this population.

      Materials and Methods

      A search for English-language primary qualitative and mixed methods studies on uptake and adherence of DHIs among older patients with cancer was conducted on seven databases (CINAHL, Cochrane, Emcare, JBI, MEDLINE, Proquest, and SCOPUS), since inception until September 2021. Relevant data was extracted, appraised using the MMAT tool, and synthesised based on common themes.


      Five studies met the eligibility criteria. All five studies examined barriers and enablers to uptake of DHIs but only two studies examined barriers and enablers to adherence to these interventions. Two themes – usability and perceived usefulness – emerged from all analyses. Usability was measured using system usability scale, ease of use survey, and observation or participant feedback. High usability to uptake was facilitated by minimalist and age-appropriate design. High usability to adherence was facilitated by customisability of DHIs and availability to provide feedback on DHI design. High perceived usefulness to uptake was facilitated by DHIs' ability to provide health information and to connect the patient to their healthcare team. High perceived usefulness to adherence was facilitated by DHIs ability to provide, reminders and contingency plans, reinforce long-term treatment plans, and keep healthcare teams updated on patients' progress. The review was limited by a small number of primary studies and longitudinal studies.


      The enablers and barriers to uptake and adherence of DHIs among older patients with cancer followed the same themes (usability and perceived usefulness) found in other populations. The components of usability and perceived usefulness were similar to other populations, rendering the need for more studies to identify factors unique to this population.


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        • Digital Health and Care Institute
        What is Digital Health?.
        ([Online]. Available:)
        • Ronquillo Y.
        • Meyers A.
        • Korvek S.
        Digital health.
        ([Online]. Available:)
        • Merkel S.
        • Hess M.
        The use of internet-based health and care services by elderly people in Europe and the importance of the country context: multilevel study.
        JMIR Aging. 2020; 3e15491
        • Shi Y.
        • Ma D.
        • Zhang J.
        • Chen B.
        In the digital age: a systematic literature review of the e-health literacy and influencing factors among Chinese older adults.
        J Public Health (Berl.). 2021;
        • Kampmeijer R.
        • Pavlova M.
        • Tambor M.
        • Golinowska S.
        • Groot W.
        The use of e-health and m-health tools in health promotion and primary prevention among older adults: a systematic literature review.
        BMC Health Serv Res. 2016;
        • Kruse C.
        • Mileski M.
        • Moreno J.
        Mobile health solutions for the aging population: a systematic narrative analysis.
        J Telemed Telecare. 2017; 23: 439-451
        • Wildenbos G.
        • Peute L.
        • Jaspers M.
        Aging barriers influencing mobile health usability for older adults: a literature based framework (MOLD-US).
        Int J Med Inform. 2018;
        • Wilson J.
        • Heinsch M.
        • Betts D.
        • Booth D.
        • Kay-Lambkin F.
        Barriers and facilitators to the use of e-health by older adults: a scoping review.
        BMC Public Health. 2021; 21: 1556
        • Mahajan S.
        • Lu Y.
        • Spatz E.
        • Nasir K.
        • Krumholz H.
        Trends and predictors of use of digital health technology in the United States.
        Am J Med. 2021; 134: 129-134
        • Chang S.
        • Goldstein N.
        • Dharmarajan K.
        Managing an older adult with cancer: considerations for radiation oncologists.
        BioMed Res Int. 2017;
        • Burt J.
        • Shipman C.
        • Richardson A.
        • Ream E.
        • Addington-Hall J.
        The experiences of older adults in the community dying from cancer and non-cancer causes: a national survey of bereaved relatives.
        Age Ageing. 2010; 1: 39
        • Deshields T.
        • Penalba V.
        • Liu J.
        • Avery J.
        Comparing the symptom experience of cancer patients and non-cancer patients.
        Support Care Cancer. 2017; 25: 1103-1109
        • McCann L.
        • McMillan K.
        • Pugh G.
        Digital interventions to support adolescents and young adults with cancer: systematic review.
        J Med Internet Res Cancer. 2019; 5e12071
        • Adam R.
        • de Bruin M.
        • Burton C.
        • Bond C.
        • Clausen M.
        • Murchie P.
        What are the current challenges of managing cancer pain and could digital technologies help?.
        BMJ Support Palliat Care. 2018; 8: 204-212
        • Cooley M.
        • Nayak M.
        • Abrahm J.
        • Braun I.
        • Rabin M.
        • Brzozowski J.
        • et al.
        Patient and caregiver perspectives on decision support for symptom and quality of life management during cancer treatment: implications for eHealth.
        Psychooncology. 2017; 26: 1105-1112
        • Badr H.
        • Lipnick D.
        • Diefenbach M.
        • Posner M.
        • Kotz T.
        • Miles B.
        • et al.
        Development and usability testing of a web-based self-management intervention for oral cancer survivors and their family caregivers.
        Eur J Cancer Care (Engl). 2016; 25: 806-821
        • Webb
        The supportive care needs of cancer patients: a systematic review.
        J Cancer Educ. 2021;
        • Cheng L.
        • Liu F.
        • Mao X.
        • Peng W.
        • Wang Y.
        • Huang H.
        • et al.
        The pediatric cancer survivors' user experiences with DIgital Health Interventions.
        Cancer Nursing. 2020;
        • Aapro M.
        • Bossi P.
        • Dasari A.
        • Fallowfield L.
        • Gascon P.
        • Geller M.
        • et al.
        Digital health for optimal supportive care in oncology: benefits, limits, and future perspectives.
        Supportive Care in Cancer. 2020;
        • Ramsey W.
        • Heidelberg R.
        • Gilbert A.
        • Heneghan M.
        • Badawy S.
        • Alberts N.
        eHealth and mHealth interventions in pediatric cancer: a systematic review of interventions across the cancer continuum.
        Psycho-Oncology. 2019;
        • Quan N.
        • Pluye P.
        • Fàbregues S.
        • Bartlett G.
        • Boardman F.
        • Cargo M.
        • et al.
        Improving the content validity of the mixed methods appraisal tool: a modified e-Delphi study.
        J Clin Epidemiol. 2019; 111: 49-59
        • Ryan G.
        • Bernard H.
        Techniques to identify themes.
        Field Methods. 2003; 15: 85-109
        • Aoki N.
        • Ohta S.
        • Yamamoto H.
        • Kikuchi N.
        • D. K
        Triangulation analysis of tele-palliative care implementation in a rural community area in Japan.
        Telemed e-Health. 2006; 12: 655-662
        • Bolle S.
        • Romijn G.
        • Smets E.
        • Loos E.
        • Kunneman M.
        • van Weert J.
        Older cancer patients’ user experiences with web-based health information tools: a think-aloud study.
        J Med Internet Res. 2016; 18e208
        • Binkley J.
        • Mark M.
        • Finley J.
        • Brazelton A.
        • Pink M.
        Meeting the rehabilitation and support needs of patients with breast cancer during COVID-19: opening new frontiers in model of care.
        Rehab Oncol. 2020; 10: 159-168
        • Fromme E.
        • Kenworthy-Heinige T.
        Developing an easy-to-use tablet computer application for assesing patient-reported outcomes in patients with cancer.
        Support Care Cancer. 2011; 19: 815-822
        • Loh K.
        • Ramsdale E.
        • Culakova E.
        • Mendler J.
        • Liesveld J.
        • O’Dwyer K.
        • et al.
        Novel mHealth app to deliver geriatric assessment-driven interventions for older adults with cancer: pilot feasibility and usability study.
        JMIR Cancer. 2018; 4e10296
        • Brooke J.
        SUS: A "quick and dirty" usability scale.
        in: Usability Evaluation in Industry. Taylor & Francis, London1996: 189-194
        • Ruland C.
        • White T.
        • Stevens M.
        • Fanciullo G.
        • Khilani S.
        Effects of a computerised system to support shared decision making in symptom management of cancer patients: preliminary results.
        J Am Med Inform Assoc. 2003;
        • Davis F.
        Perceived usefulness, perceived ease of use, and user acceptance of information.
        MIS Q. 1989; 13: 319-340
        • O’Connor S.
        • Hanlon P.
        • O’Donnell C.
        • Garcia S.
        • Glanville J.
        • Mair F.
        Understanding factors affecting patient and public engagement and recruitment to digital health interventions: a systematic review of qualitative studies.
        BMC Med Inform Decision Making. 2016; 16: 120
        • Cheng L.
        • Liu F.
        • Mao X.
        • Peng W.
        • Wang Y.
        • Huang H.
        • et al.
        The pediatric cancer survivors' user experiences with digital health interventions.
        Cancer Nursing. 2020;
        • Moilanen T.
        • Kangasniemi M.
        • Papinaho O.
        • Mynttinen M.
        • Siipi H.
        • Suominen S.
        • et al.
        Older people’s perceived autonomy in residential care: an integrative review.
        Nurs Ethics. 2020; 28: 414-434
        • Aoun S.
        • Deas K.
        • Skett K.
        Older people living alone at home with terminal cancer.
        Eur J Cancer Care. 2015; 25: 356-364
        • Baldini D.C.
        in: Prolonged Isolocation may be Detrimental for Elderly Cancer Patients during the Pandemic. [Interview]. 2020 (15 May)
        • Verma R.
        • Saldanha C.
        • Ellis U.
        • Sattar S.
        • Haase K.
        eHealth literacy among older adults living with cancer and their caregivers: a scoping review.
        J Geriat Oncol. 2021;
        • Williams G.
        • Pisu M.
        • Rocque G.
        • Williams C.
        • Taylor R.
        • Kvale E.
        • et al.
        Unmet social support needs among older adults with cancer.
        Cancer. 2018; 125: 473-481
        • Moore S.
        • Leung B.
        • Bates A.
        • Ho C.
        Social isolation: impact on treatment and survival in patients with advanced cancer.
        J Clin Oncol. 2018; 36: 156
        • Peikari H.
        • Ramayah T.
        • Shah M.
        • Lo M.
        Patients’ perception of the information security management in health centers: the role of organizational and human factors.
        BMC Med Inform Decision Making. 2018;
        • Mosnaim G.
        • Stempel H.
        • Sickle D.
        • Stempel D.
        The adoption and implementation of digital health care in the post–COVID-19 era.
        J Allergy Clin Immunol In Pract. 2020; 8: 2484-2486