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

Abstract

Digital health interventions (DHIs) are increasingly used in long‑term care (LTC) homes, yet evaluation approaches remain fragmented and rarely tailored to the organizational realities of LTC. This scoping review maps the evaluation frameworks, models, and methods applied to DHIs for older adults in LTC and synthesizes implications for health services delivery, access, and equity. We conducted a scoping review guided by the Joanna Briggs Institute methodology for scoping reviews and reported our findings in accordance with PRISMA-ScR guidelines. A health sciences librarian supported a comprehensive multi‑database search (MEDLINE/Ovid, CINAHL/EBSCO, Embase/Ovid, Scopus), supplemented by backward citation tracking. Two reviewers independently screened records and extracted data using a piloted form. Extracted variables were: study characteristics; LTC context; DHI type; evaluation framework(s); domains assessed; stakeholder engagement; dignity/identity considerations; barriers/enablers; and service delivery outcomes. Forty‑eight studies met inclusion criteria. Fifteen studies explicitly used formal frameworks, most adopted ad-hoc evaluation approaches. Frequently referenced frameworks included Technology Acceptance Model (TAM), RE‑AIM (sometimes with PRISM), NASSS, MAST, and economic evaluation models. Evaluated domains clustered into: clinical effectiveness and safety; usability and acceptance; organizational workflow and readiness; economic/resource implications; and resident‑centred outcomes (including privacy, dignity, and identity). Methodological limitations (small samples, weak designs, limited follow‑up) and incomplete consideration of LTC workflows were common. Stakeholder engagement was inconsistently described and rarely included co‑design. Barriers to adoption of DHIs spanned staff capacity, resident factors (e.g., cognitive/sensory), infrastructure, organizational processes, diagnostic constraints, and financing; enablers to the adoption of DHIs included leadership, training, usability, integration with workflows, and perceived clinical value. Evaluation practices for DHIs in LTC remain heterogeneous and often insufficiently aligned with LTC service delivery. We synthesized a pragmatic set of evaluation domains and propose elevating stakeholder co‑design, integrating organizational and economic assessment, and explicitly addressing dignity/identity and equity. Adapting and combining existing frameworks (e.g., RE‑AIM/PRISM with NASSS and economic components) may better guide implementation and scale‑up of DHIs that improve access and quality of care for older adults in LTC. Not applicable.

The authors' abstract, as published at the source. BMC Health Services Research, 2026 · DOI ↗