Keywords: digital health literacy, primary health care, mental health, afective disorders,

Background:

Depression and anxiety are highly prevalent in primary care and often go underdiagnosed or undertreated. Digital health interventions—including apps, telehealth, and online platforms—offer promising tools to support emotional wellbeing and improve health literacy. However, evidence on their real-world effectiveness in primary care remains limited and heterogeneous.

Research questions:

What is the effectiveness of digital health literacy interventions in reducing symptoms of depression and/or anxiety in adult patients in primary care settings?

Method:

This systematic review and meta-analysis included randomized controlled trials (RCTs) evaluating digital health literacy interventions in adults (≥18 years) within primary care. Digital formats included mobile apps, telemonitoring systems, web-based platforms, and structured phone-based support. Outcomes were changes in validated depression and anxiety scores. A random-effects meta-analysis using standardized mean differences (SMD) with 95% confidence intervals (CI) was conducted. Subgroup analyses examined intervention type and patient characteristics.

Results:

Overall, digital strategies showed a moderate-to-large reduction in affective symptoms (SMD = −1.756; 95% CI: −2.55 to −0.96). Telephone-based interventions had the strongest effect (SMD = −2.226), followed by mobile apps and online platforms. In patients with chronic diseases, digital interventions had a greater impact (SMD = −5.115; 95% CI: −6.95 to −3.28). Studies reporting significant post-intervention health literacy improvement also showed greater symptom reduction (SMD = −2.233; 95% CI: −3.04 to −1.42). However, heterogeneity was high (I² > 98%).

Conclusions:

Digital health literacy interventions appear effective in reducing depression and anxiety symptoms, particularly in chronically ill patients. Despite promising results, heterogeneity and methodological variation limit generalizability. Further standardized trials are needed. These tools may offer accessible, scalable options to enhance mental health care in primary settings.

Points for discussion:

1. How can culturally adapted digital tools be better integrated into routine primary care?

2. What standardized outcomes should be used to assess digital mental health literacy interventions?

3. What are the key drivers behind the high heterogeneity among studies?