Barriers and facilitators to participation in electronic health interventions in older adults with cognitive impairment: an umbrella review.

Background: Research increasingly supports the role of electronic health technology in improving cognitive function. However, individuals with mild cognitive impairment or dementia often show low compliance with electronic health technology. To understand the barriers and facilitators for this group, this study was conducted.

Methods: This study used the Joanna Briggs Institute (JBI) umbrella review method, searching relevant English articles in PubMed, Embase, Cochrane, Scopus, MEDLINE, Web of Science, and CINAHL from inception to May 2023. Two researchers independently selected articles based on predefined criteria, assessed study quality using Meta-QAT and A Measurement Tool to Assess Systematic Reviews (AMSTAR), and determined confidence in the evidence using GRADE-CERQual. The Unified Theory of Acceptance and Use of Technology (UTAUT) model was employed to analyze factors related to electronic health technology, and Behavior Change Techniques (BCTs) were used to develop implementation strategies.

Results: This study included 21 reviews, covering 535 primary studies, identifying 13 factors. The three most impactful factors on engagement were Perceived Behavioral Control, Relative Advantage, and Social Factors. Six implementation strategies were formulated based on BCT: enhancing targeted approaches, adapting to existing contexts, involving care organizations, accommodating family involvement, accessing virtual community resources, and recognizing patient variability.

Conclusions: This umbrella review underscores the need for a multi-level stakeholder approach and a holistic perspective in developing targeted implementation strategies. Using the UTAUT framework, key influential factors have been identified, offering valuable insights for future interventions and enhancing participation in electronic health interventions.

Registration: This study was registered with the PROSPERO (CRD42023429410).