User engagement with digital health technologies among older adults with cancer: A systematic review and qualitative evidence synthesis

BACKGROUND: Although digital health technologies have the potential to improve health outcomes among older adults with cancer, their application remains limited in part due to low levels of user engagement. Understanding user engagement as an integrative concept that covers both subjective experiences (e.g., attention, interest, affect) and objective behaviors (e.g., amount, frequency, duration, depth of usage) is essential for enhancing engagement and improving its positive impact on health outcomes. OBJECTIVE: This review aimed to systematically synthesize qualitative evidence on the experiences and perspectives of user engagement with digital health technologies among older adults with cancer. METHOD: This study conducted a systematic review of qualitative studies. A comprehensive literature search was conducted in PubMed, Embase, Scopus, CINAHL, AgeLine, Web of Science, PsycINFO, IEEE Xplore, and ACM Digital Library for studies published from January 2011 to April 2025. This review was reported in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two independent reviewers conducted article screening and quality appraisal. The eligible studies were assessed using the Critical Appraisal Skills Programme (CASP) checklist. Qualitative data were analyzed through Thomas and Harden's thematic synthesis approach. RESULTS: Of the 7090 articles screened, a total of 25 studies were included in this qualitative evidence synthesis. Overall, user engagement with digital health technologies emerged as a multifaceted phenomenon encompassing subjective experiences as well as cognitive and behavioral efforts, shaped by personal, contextual, and technological factors. Four themes were synthesized: (1) Recognizing the value of user engagement to promote health outcomes, (2) Emphasizing cognitive and behavioral efforts, (3) Experiencing emotional ambivalence, (4) Interacting with technological features and interface design. CONCLUSION: This review highlights the multifaceted nature of user engagement with digital health technologies and identifies opportunities to enhance meaningful and sustainable engagement among older adults with cancer. Mitigating negative emotional experiences and addressing individual needs are essential for optimizing the design of digital health technologies and interventions in this population. STUDY REGISTRATION: The review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD420250639426).