University of Oulu

Paalimäki-Paakki K, Virtanen M, Henner A, Nieminen MT, Kääriäinen M. Effectiveness of Digital Counseling Environments on Anxiety, Depression, and Adherence to Treatment Among Patients Who Are Chronically Ill: Systematic Review, J Med Internet Res 2022;24(1):e30077, doi: 10.2196/30077, PMID: 34989681

Effectiveness of digital counseling environments on anxiety, depression, and adherence to treatment among patients who are chronically ill : systematic review

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Author: Paalimäki-Paakki, Karoliina1,2; Virtanen, Mari3; Henner, Anja2;
Organizations: 1Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland
2Degree Programme of Radiography and Radiation Therapy, Oulu University of Applied Sciences, Oulu, Finland
3School of Rehabilitation and Examination, Helsinki Metropolia University of Applied Sciences, Helsinki, Finland
4Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
5Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
6Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
7Oulu University Hospital, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.6 MB)
Persistent link:
Language: English
Published: JMIR Publications, 2022
Publish Date: 2022-05-17


Background: Patients who are chronically ill need novel patient counseling methods to support their self-care at different stages of the disease. At present, knowledge of how effective digital counseling is at managing patients’ anxiety, depression, and adherence to treatment seems to be fragmented, and the development of digital counseling will require a more comprehensive view of this subset of interventions.

Objective: This study aims to identify and synthesize the best available evidence on the effectiveness of digital counseling environments at improving anxiety, depression, and adherence to treatment among patients who are chronically ill.

Methods: Systematic searches of the EBSCO (CINAHL), PubMed, Scopus, and Web of Science databases were conducted in May 2019 and complemented in October 2020. The review considered studies that included adult patients aged ≥18 years with chronic diseases; interventions evaluating digital (mobile, web-based, and ubiquitous) counseling interventions; and anxiety, depression, and adherence to treatment, including clinical indicators related to adherence to treatment, as outcomes. Methodological quality was assessed using the standardized Joanna Briggs Institute critical appraisal tool for randomized controlled trials or quasi-experimental studies. As a meta-analysis could not be conducted because of considerable heterogeneity in the reported outcomes, narrative synthesis was used to synthesize the results.

Results: Of the 2056 records screened, 20 (0.97%) randomized controlled trials, 4 (0.19%) pilot randomized controlled trials, and 2 (0.09%) quasi-experimental studies were included. Among the 26 included studies, 10 (38%) digital, web-based interventions yielded significantly positive effects on anxiety, depression, adherence to treatment, and the clinical indicators related to adherence to treatment, and another 18 (69%) studies reported positive, albeit statistically nonsignificant, changes among patients who were chronically ill. The results indicate that an effective digital counseling environment comprises high-quality educational materials that are enriched with multimedia elements and activities that engage the participant in self-care. Because of the methodological heterogeneity of the included studies, it is impossible to determine which type of digital intervention is the most effective for managing anxiety, depression, and adherence to treatment.

Conclusions: This study provides compelling evidence that digital, web-based counseling environments for patients who are chronically ill are more effective than, or at least comparable to, standard counseling methods; this suggests that digital environments could complement standard counseling.

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Series: Journal of medical internet research
ISSN: 1439-4456
ISSN-E: 1438-8871
ISSN-L: 1439-4456
Volume: 24
Issue: 1
Article number: e30077
DOI: 10.2196/30077
Type of Publication: A2 Review article in a scientific journal
Field of Science: 113 Computer and information sciences
3141 Health care science
3142 Public health care science, environmental and occupational health
Funding: The authors thank Business Finland (grant 6557/31/2016) and the Scholarship Fund of the University of Oulu (grants 20180022 and 20210019) for financial support during the protocol, data collection, and publication phases. These institutions had no role in the findings or preparation of the manuscript.
Copyright information: ©Karoliina Paalimäki-Paakki, Mari Virtanen, Anja Henner, Miika T Nieminen, Maria Kääriäinen. Originally published in the Journal of Medical Internet Research (, 06.01.2022. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.