Hualian Pei

Background: The integration of digital health technology (DHT) into chronic kidney disease (CKD) care holds transformative potential for enhancing patient self-management and slowing disease progression. Despite the growing availability of DHT, there remains limited understanding of the factors that facilitate or hinder their adoption and use among patients with CKD. Objective: This study aims to identify the facilitators and barriers to the use of digital health interventions for self-management in patients with CKD, and to provide evidence to inform the development of implementation strategies. Methods: A systematic search was performed across 11 databases (CNKI, WanFang Data, VIP Database, Chinese Medical Journals Database, PubMed, CINAHL, Embase, Cochrane Library, Scopus, PsycINFO, and Web of Science Core Collection) from database inception to May 12, 2026, with reports restricted to those published in English or Chinese. Eligible studies were required to enroll adult patients with CKD (aged ≥18 years); report facilitators, barriers, or influencing factors related to DHT use for self-management; and use qualitative, quantitative, or mixed methods designs. Nonempirical articles, conference abstracts, and studies without accessible full text were excluded. Two researchers (Feiyue Su and Yao Yao) independently assessed the quality of the included studies using the Mixed Methods Appraisal Tool (MMAT). Extracted data were coded deductively to the Consolidated Framework for Implementation Research 2.0 (CFIR 2.0) constructs using open and axial coding; recurring themes were then synthesized into a narrative summary organized by the 5 CFIR domains. Results: Thirteen studies (8 mixed methods, 3 quantitative, and 2 qualitative) were included, encompassing 3002 patients with CKD across 8 countries. Of these, 9 met all applicable MMAT criteria, while the remaining 4 had methodological limitations. In total, 19 facilitators and 15 barriers were identified and mapped to the 5 CFIR 2.0 domains. The most frequently reported facilitators were a simple and easy-to-use user interface (9 studies, high confidence), care and support from family members and peers (8 studies, high confidence), convenient anytime access to health information, high perceived usefulness, personalized educational content, and continuous content updates (each reported in 5 studies, high confidence). The most frequently reported barriers were low health literacy (6 studies, high confidence), poor economic status of patients (6 studies, moderate confidence), and advanced age (5 studies, high confidence). Conclusions: The use of digital health interventions for CKD self-management is influenced by multilevel factors. However, the evidence base is limited by the predominance of mixed methods designs, the lack of longitudinal studies, and the concentration of studies in high-income countries, which may limit the generalizability of the findings. Targeted, multilevel strategies that address the identified facilitators and barriers are essential for enhancing effective and equitable implementation.

Background: Rehabilitation through exercise is the core content of cardiac rehabilitation, which is conducive to promoting myocardial recovery and reducing mortality. However, the overall participation rate in exercise rehabilitation is low. Thus, this study aimed to comprehensively evaluate the barriers and facilitators of exercise rehabilitation for patients with myocardial infarction using the updated Consolidated Framework for Implementation Research (CFIR 2.0). Methods: Systematic research retrieval was reviewed via PubMed, Embase, Web of Science, Cochrane Library, ProQuest, and PsycINFO databases. Based on CFIR 2.0, this study used descriptive analyses to analyze the research results of each included document and identify it as a barrier or facilitator. Results: In total, 5185 studies were obtained from a preliminary search; 11 studies were ultimately included; 5 studies were quantitative. This study summarized 50 influencing factors, including 27 barriers and 23 facilitators. Most factors were related to the individual domain (64%). The remaining factors were related to the inner setting domain (20%), innovation domain (10%), implementation process domain (4%), and outer setting domain (2%). Conclusions: This study integrated the barriers and facilitators of exercise rehabilitation of patients with myocardial infarction. The study emphasizes the importance of considering the individual domain, inner setting domain, innovation domain, implementation process domain, and outer setting domain factors when implementing exercise rehabilitation. This study provides a systematic foundation for optimizing cardiac rehabilitation programs. The PROSPERO Registration: CRD42024521287, https://www.crd.york.ac.uk/PROSPERO/view/CRD42024521287.

Venous thromboembolism (VTE) is an under-appreciated vascular disease that has been a growing global healthcare challenge, with increasing morbidity, mortality, and associated healthcare costs. Few works have been placed on using the technology-based intervention (TBI) approach to assist patients at risk in actively completing exercise therapy for VTE Prophylaxis. We present a wearable virtual rehabilitation system that could trace and evaluate the patient's exercise therapy progress while offering an immersive experience to guide and motivate the patient to complete the training spontaneously through multi-sensory feedback.