Scoping review finds fragmented digital health evaluations in long-term care homes

A scoping review of 48 studies found that evaluations of digital health interventions for older adults in long-term care homes remain fragmented and are often insufficiently aligned with how care is organized and delivered. Only 15 studies explicitly used a formal evaluation framework, while most relied on ad hoc approaches. The review, published in BMC Health Services Research , mapped the frameworks, models, methods and outcome domains applied to digital interventions in this setting; it did not directly test whether a particular tool improved resident outcomes.

The researchers used the Joanna Briggs Institute methodology for scoping reviews and reported their findings in accordance with PRISMA-ScR guidance. A health sciences librarian supported a comprehensive search of MEDLINE through Ovid, CINAHL through EBSCO, Embase through Ovid and Scopus, supplemented by backward citation tracking. Two reviewers independently screened records and extracted data with a piloted form.

Variables included study characteristics, the long-term care context, digital health intervention type, evaluation frameworks, assessed domains, stakeholder engagement, dignity and identity considerations, barriers and enablers, and service-delivery outcomes. This design was intended to describe the breadth and organization of existing evaluation practices rather than produce pooled estimates of effectiveness. Formal frameworks cited across the included studies included the Technology Acceptance Model, RE-AIM, NASSS, MAST and economic evaluation models.

RE-AIM was sometimes used with PRISM. Evaluated domains clustered into five broad groups: clinical effectiveness and safety; usability and acceptance; organizational workflow and readiness; economic and resource implications; and resident-centred outcomes, including privacy, dignity and identity. The review also identified frequent methodological limitations, including small samples, weak study designs and limited follow-up.

Stakeholder engagement was reported inconsistently and rarely involved co-design. Reported barriers to adopting digital health interventions included insufficient staff capacity, residents’ cognitive and sensory factors, infrastructure constraints, organizational processes, diagnostic limitations and financing difficulties. Reported enablers included leadership, training, usability, integration with workflows and perceived clinical value.

The findings indicate that evaluations frequently captured only part of the environment in which these tools were introduced, particularly organizational conditions and resident-centred considerations. On the basis of this synthesis, the authors proposed a pragmatic set of evaluation domains centered on stakeholder co-design, organizational and economic assessment, and explicit consideration of dignity, identity and equity. They also suggested that adapting and combining existing frameworks—for example, RE-AIM or PRISM with NASSS and economic components—could help guide evaluation of implementation and scale-up.

This is an evidence-informed proposal rather than a tested intervention: the scoping review included heterogeneous studies and did not establish that any particular combined framework would improve care, access or quality. Its central finding is that digital health evaluation in long-term care homes needs greater consistency and a closer fit with resident-centred care, staff practices, organizational readiness and resource constraints.

Subject of Research: Evaluation frameworks for digital health interventions in long-term care homes

Article Title: Evaluation frameworks for digital health interventions in long-term care homes: a scoping review

Article References: Todam Nguepnang, N., Scarvelis, L., Patel, O., Havor-Nutogo, W., Spencer, A., Juwle, Z. N., Fatima, F., Mathew, D., Aliyeva, K., Lumb, A., Bonhomme, L., Hasan, A., Qudrat, A., Vaca-Benavides, D., Robertson, J., Sai, V., Chan, A., Hughes, G., Shenkin, S., … Jaiswal, A. (2026). Evaluation frameworks for digital health interventions in long-term care homes: a scoping review. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15429-7

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15429-7

Keywords: digital health, long-term care, care homes, older adults, scoping review, evaluation frameworks, stakeholder engagement, organizational readiness, resident-centred outcomes, health services research, Evaluation, frameworks