Effectiveness and acceptability of asynchronous digital health in asthma care: a mixed-methods systematic review

Background: Asynchronous digital health (e.g., online portal, text, email communication) can overcome practical barriers associated with in-person and remote synchronous (real-time) consultations. However, little is known about the effectiveness and acceptability of asynchronous digital health to support care for individuals with asthma (e.g. asthma reviews).

Objective: We aimed to systematically review the qualitative and quantitative evidence on the role of asynchronous digital health for asthma care.

Methods: Following Cochrane methodology, we searched six databases (January 2001 – July 2022; search update: September 2023) for quantitative/qualitative/mixed-methods studies supporting asthma care using asynchronous digital health. Screening and data extraction were duplicated. We assessed the risk of bias in the clinical outcomes of randomised controlled trials included in the meta-analysis using the revised Cochrane risk of bias tool. For the remaining studies, we evaluated the methodological quality using the Downs and Black checklist, Critical Appraisal Skills Programme, and Mixed Methods Appraisal Tool for quantitative, qualitative, and mixed-methods studies, respectively. We determined the confidence in the evidence using the Grading of Recommendations, Assessment, Development, and Evaluation criteria. We conducted a meta-analysis of trial data and a thematic analysis of qualitative data. PROSPERO registration number: CRD42022344224.

Results: We included 30 studies (20 quantitative, 6 qualitative, and 4 mixed-methods) conducted in nine countries involving individuals with asthma, their caregivers, and healthcare professionals. Asynchronous digital consultations linked with other functionalities, compared to usual care, improved asthma control (SMD 0.32; 95% CI 0.02 to 0.62; P=.04) and reduced hospitalisations (RR 0.36; 95% CI 0.14 to 0.94; P=.04). However, there were no significant differences in quality of life (SMD 0.16; 95% CI -0.12 to 0.43; P=.26). or emergency department visits (RR 0.83; 95% CI 0.33 to 2.09; P=.69). Patients appreciated the convenience of asynchronous digital health, though healthcare professionals expressed concerns. Successful implementation necessitated an organisational approach. Integrative synthesis underscored the ease of asking questions, monitoring logs, and medication reminders as key digital functionalities.

Conclusions: Despite low confidence in evidence, asynchronous consultation supported by digital functionalities is an effective and convenient option for non-emergency asthma care. This type of consultation, well-accepted by individuals with asthma and their caregivers, offers opportunities for those facing challenges with traditional synchronous consultations due to lifestyle or geographic constraints. However, efficient organisational strategies are needed to manage the associated workload.