Development of a nurse-led mHealth intervention framework for patients with chronic diseases: A systematic review and Delphi study

Abstract

Objective: mHealth is increasingly becoming popular and useful for managing chronic diseases. Nurse-led mHealth services offer a patient-centred perspective, but many existing solutions lack a robust empirical foundation. Therefore, this study aimed to address this gap by developing a comprehensive framework to support mHealth implementation through a systematic review and the Delphi method. Specifically, the study sought to create a nurse-led mobile health (mHealth) intervention framework designed for managing patients with chronic diseases. Methods: We conducted a systematic review of PubMed, Web of Science, Cochrane Library, CNKI, and Wanfang databases to identify existing nurse-led mHealth intervention programs. Items from these articles were compiled into an inclusion list, and the Delphi method was applied to rank their priority. The Delphi process involved 13 nursing specialists and was conducted over two rounds using a Likert priority scale (1–5) to establish consensus. Results: Based on the systematic review (included 16 articles for full review) and study group contributions, 36 potential framework items were identified. In the initial round of the Delphi study, specialists rejected 7 of the 36 items and recommended merging 6. In the subsequent round, the specialists recommended removing the self-monitoring diet items. The final items were consolidated into a 22-item nurse-led mHealth intervention framework categorized into three domains: pre-hospital evaluation, in-hospital intervention, and post-hospital continuity. Conclusions: The Delphi-approved items offer a basis for evidence-based nurse-led mHealth intervention frameworks. These findings highlight the need for an intervention framework and its practical integration into the existing mHealth system.