{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T19:08:02Z","timestamp":1782846482960,"version":"3.54.5"},"reference-count":63,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Internet Res"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Family members of intensive care units (ICUs) often experience psychological difficulties like anxiety and depression, which affect family functioning and their ability to support patient recovery. Digital health interventions (DHIs) offer accessible and timely support; yet, evidence regarding their effectiveness for ICU families demonstrates inconsistent.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This systematic review and meta-analysis aimed to explore the impact of DHIs on psychological outcomes, quality of life (QoL), and quality of communication (QOC) among ICU family members.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 9 databases (CNKI [China Knowledge Resource Integrated Database], Wanfang, VIP [Weipu Database], SinoMed, Cochrane Library, PubMed, Embase, CINAHL, and Web of Science) were searched for randomized controlled trials (RCTs) published up to October 11, 2025. Eligible studies evaluated DHIs targeting adult ICU patients\u2019 family members and reported psychological outcomes, QoL, or QOC; interventions used solely for monitoring or tracking were excluded. Furthermore, 2 reviewers independently screened studies, extracted data, and assessed the risk of bias using the Cochrane Risk of Bias Tool. Random-effects meta-analyses were performed using the Hartung-Knapp-Sidik-Jonkman method. Prediction intervals (PIs) were calculated to reflect between-study heterogeneity. Subgroup analyses were performed by patients\u2019 primary diagnosis, relationship with patients, and type of digital health technology. Evidence quality was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In total, 17\u00a0RCTs involving 1864 participants were included. Interrater agreement was high across study selection and assessment processes (\u03ba=0.55-1.00). Most studies were judged to have some concerns about the risk of bias. Meta-analyses showed no statistically significant pooled effects of DHIs on anxiety (standardized mean difference [SMD] \u20130.34, 95% CI \u20130.68 to 0.00; 95% PI \u20131.46 to 0.79; P=.05), depression (SMD \u20130.26, 95% CI\u00a0\u20130.52 to 0.01; 95% PI \u20131.11 to 0.60; P=.06),\u00a0posttraumatic stress disorder (SMD \u20130.21, 95% CI \u20130.49 to 0.06; 95% PI \u20131.03 to 0.60; P=.11), QoL (SMD 0.09, 95% CI \u20130.10 to 0.28; 95% PI \u20130.41 to 0.60; P=.36), or QOC (SMD 0.14, 95% CI \u20130.03 to 0.31; 95% PI \u20130.26 to 0.55; P=.10). Wide PIs indicated substantial variability in intervention effects across settings. The certainty of evidence ranged from very low to moderate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This review emphasizes significant uncertainty in estimated effects and provides the first thorough synthesis of RCT evidence on DHIs for ICU family members. The inherently high heterogeneity and low certainty of the underlying evidence limit the conclusions of this review, despite its methodological rigor and use of PIs. Compared with previous reviews, this review concentrates on the ICU family members and includes more recent research. Future studies should focus on high-risk subgroups, use mixed methods designs, and develop theory-informed, personalized, and interactive DHIs. DHIs may enable proactive, customized communication techniques for families of ICU patients, even when there are few formal clinical recommendations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>PROSPERO CRD420251044704; https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420251044704<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/83294","type":"journal-article","created":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T21:15:08Z","timestamp":1772054108000},"page":"e83294","source":"Crossref","is-referenced-by-count":1,"title":["The Effects of Digital Health Interventions for Family Members in Intensive Care Units: Systematic Review and Meta-Analysis of Randomized Controlled Trials"],"prefix":"10.2196","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-5277-1047","authenticated-orcid":false,"given":"Chuchu","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8407-3765","authenticated-orcid":false,"given":"Weijing","family":"Sui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3357-165X","authenticated-orcid":false,"given":"Weilin","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9392-3011","authenticated-orcid":false,"given":"Yibing","family":"Shen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2593-3228","authenticated-orcid":false,"given":"Zhenzhen","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6939-0969","authenticated-orcid":false,"given":"Ran","family":"Yan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8918-9622","authenticated-orcid":false,"given":"Jia","family":"Yi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6143-0296","authenticated-orcid":false,"given":"Jiayu","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4358-6298","authenticated-orcid":false,"given":"Chaoyi","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1171-4351","authenticated-orcid":false,"given":"Yiyu","family":"Zhuang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0570-3864","authenticated-orcid":false,"given":"Xiaoyan","family":"Gong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,2,25]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000006770"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000006549"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1002\/ams2.939"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2022.104391"},{"issue":"7","key":"ref5","first-page":"1071","volume":"40","author":"Lin, Z","year":"2025","journal-title":"Chin J Rehabil Med"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000006793"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1111\/jocn.15962"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-024-07577-3"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e318236ebf9"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2024.08.002"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1111\/nicc.12158"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000003497"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1016\/j.iccn.2021.103156"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-023-07215-4"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.2196\/63743"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1016\/j.iccn.2024.103817"},{"key":"ref17","year":"2021","journal-title":"Global Strategy on Digital Health 2020-2025"},{"issue":"4","key":"ref18","first-page":"37","volume":"17","author":"Zhao, Q","year":"2022","journal-title":"China Digit Med"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1002\/pon.70166"},{"issue":"11","key":"ref20","first-page":"1389","volume":"59","author":"Guo, G","year":"2024","journal-title":"Chin J Nurs"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1016\/S2589-7500(23)00049-3"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.2196\/52609"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.2196\/46116"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1159\/000524780"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.2196\/19468"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrtlng.2024.11.001"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.15199"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"ref29","unstructured":"JulianHJamesTJacquelineCMirandaCTianjingLMatthewPVivianWCochrane Handbook for Systematic Reviews of Interventions (Current Version)20242025-07-27https:\/\/www.cochrane.org\/authors\/handbooks-and-manuals\/handbook\/current"},{"issue":"1","key":"ref30","doi-asserted-by":"crossref","first-page":"159","DOI":"10.2307\/2529310","volume":"33","author":"Landis, JR","year":"1977","journal-title":"Biometrics"},{"key":"ref31","unstructured":"RoB 2: A revised cochrane risk-of-bias tool for randomized trialsCochrane bias20192025-07-27https:\/\/methods.cochrane.org\/bias\/resources\/rob-2-revised-cochrane-risk-bias-tool-randomized-trials"},{"key":"ref32","unstructured":"SterneJACSavoviJPageMJElbersRGRoB 2: A revised tool for assessing risk of bias in randomised trialsBMJ20192025-07-27https:\/\/www.bmj.com\/content\/366\/bmj.l4898.long"},{"key":"ref33","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2010.04.026"},{"key":"ref34","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-14-25"},{"key":"ref35","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2022.104276"},{"key":"ref36","doi-asserted-by":"publisher","DOI":"10.1002\/jrsm.12"},{"key":"ref37","doi-asserted-by":"publisher","DOI":"10.1016\/j.imr.2023.101014"},{"key":"ref38","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.d4002"},{"key":"ref39","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.315.7109.629"},{"key":"ref40","doi-asserted-by":"publisher","DOI":"10.1016\/j.iccn.2017.03.006"},{"key":"ref41","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.49666"},{"key":"ref42","doi-asserted-by":"publisher","DOI":"10.7326\/M18-2335"},{"key":"ref43","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-025-05281-2"},{"key":"ref44","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-050305"},{"key":"ref45","doi-asserted-by":"publisher","DOI":"10.4037\/ajcc2023800"},{"key":"ref46","doi-asserted-by":"publisher","DOI":"10.1177\/10547738211017688"},{"key":"ref47","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.202006-585OC"},{"key":"ref48","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000006546"},{"key":"ref49","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000006429"},{"key":"ref50","doi-asserted-by":"publisher","DOI":"10.1016\/j.iccn.2023.103394"},{"key":"ref51","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2024.12.022"},{"key":"ref52","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2024.6838"},{"key":"ref53","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.20807"},{"issue":"19","key":"ref54","first-page":"41","volume":"45","author":"Wen, J","year":"2024","journal-title":"Med Philos"},{"key":"ref55","doi-asserted-by":"publisher","DOI":"10.1111\/jocn.15766"},{"key":"ref56","doi-asserted-by":"publisher","DOI":"10.4037\/ccn2021322"},{"key":"ref57","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmedinf.2012.04.004"},{"key":"ref58","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejon.2021.101924"},{"key":"ref59","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2025.105096"},{"key":"ref60","doi-asserted-by":"publisher","DOI":"10.1016\/j.iccn.2025.104059"},{"key":"ref61","doi-asserted-by":"publisher","DOI":"10.5114\/ait.2023.130831"},{"key":"ref62","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000006714"},{"key":"ref63","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-019-05306-9"}],"container-title":["Journal of Medical Internet Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.jmir.org\/2026\/1\/e83294","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T18:17:23Z","timestamp":1782843443000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.jmir.org\/2026\/1\/e83294"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,25]]},"references-count":63,"URL":"https:\/\/doi.org\/10.2196\/83294","relation":{"has-preprint":[{"id-type":"doi","id":"10.2196\/preprints.83294","asserted-by":"object"}]},"ISSN":["1438-8871"],"issn-type":[{"value":"1438-8871","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,25]]}}}