Digital health interventions for chronic disease prevention and management in Saudi Arabian populations: A systematic review

INTRODUCTION

Saudi Arabia is facing a growing epidemic of chronic diseases that poses significant risks to public health and jeopardizes the objectives outlined in the nation’s Vision 2030 healthcare transformation initiative. Approximately 7 million individuals in Saudi Arabia are affected by diabetes, placing the Kingdom as the second highest in the Middle East and seventh globally regarding diabetes prevalence.^[1] Cardiovascular diseases are responsible for 37% of all deaths, establishing them as the leading cause of mortality from non-communicable diseases.^[2] As of 2023, obesity rates have soared to 21.4%, with associated economic impacts estimated at $6.4 billion annually.^[3] This burden of chronic disease illustrates Saudi Arabia’s swift epidemiological shift from communicable to non-communicable diseases, a transition fueled by lifestyle changes, urbanization, and demographic evolution.

Globally, digital health interventions have demonstrated effectiveness in chronic disease management. Meta-analyses show hemoglobin A1C (HbA1c) reductions of 0.25–0.49% with mobile health applications for diabetes,^[4-6] while systematic reviews of cardiovascular interventions demonstrate improved medication adherence.^[7,8] Text messaging interventions combined with diabetes self-management education show HbA1c reductions of approximately 0.3–0.4%.^[9]

The Vision 2030 healthcare transformation framework explicitly identifies digital health solutions as essential components for achieving comprehensive and integrated healthcare delivery.^[10] The National E-Health Strategy, launched in 2011, aims to establish unified electronic health records for all citizens, while the Health Sector Transformation Program endeavors to reconfigure healthcare into a digitally supported system.^[11,12] Digital health investments in Saudi Arabia have the potential to yield substantial economic benefits through improved healthcare delivery and reduced utilization of emergency services.^[11,12]

Digital health interventions hold particular promise within Saudi Arabia’s distinctive cultural and geographic landscape. With high internet penetration and a sophisticated telecommunications framework, the Kingdom is well-equipped for deploying digital health solutions.^[13] Cultural factors such as strong familial involvement in healthcare decisions and preference for Arabic language interfaces present both opportunities and challenges for the design of these interventions.^[14,15] Previous initiatives in digital health, such as the Sehhaty platform that serves over 24 million users, demonstrate substantial governmental commitment as well as population acceptance.^[14,15]

Despite the rising implementation of digital health technologies, there remains a lack of systematic evidence evaluating their effectiveness in preventing chronic diseases and supporting disease management to prevent complications among populations in Saudi Arabia. Current literature predominantly addresses general outcomes related to digital health or focuses on individual types of interventions without providing a thorough evaluation of effectiveness across diverse populations and healthcare settings within Saudi Arabia. Notable gaps exist regarding culturally tailored interventions, long-term clinical efficacy, and implementation variables specific to Saudi Arabian healthcare systems.

This systematic review aims to bridge these knowledge deficits by conducting a comprehensive assessment of digital health interventions aimed at preventing chronic diseases and supporting the management of existing conditions to prevent complications within Saudi Arabian populations. Our primary goal is to systematically evaluate the effectiveness of mobile applications, telehealth platforms, wearable devices, AI-driven tools, web-based programs, text messaging initiatives, and remote monitoring systems targeting diabetes prevention, cardiovascular disease management, and obesity reduction. Secondary objectives focus on assessing clinical outcomes, examining changes in health behaviors, exploring implementation factors, and identifying optimal characteristics for interventions tailored specifically to the context of Saudi Arabia.

MATERIALS & METHODS

RESULTS

Study selection

The search strategy identified 6,847 titles across all databases. After removing 1,923 duplicates, 4,924 titles and abstracts were screened. Full-text review was conducted for 67 potentially eligible studies. After removing one study that included pediatric participants inconsistent with our eligibility criteria, 13 studies ultimately met inclusion criteria and were included in the final analysis. The PRISMA flow diagram is presented in Figure 1.

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Figure 1:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 flow diagram for systematic review of digital health interventions for chronic disease prevention and management in Saudi Arabian populations. The figure shows the study selection process following PRISMA 2020 guidelines. A total of 6,847 records were identified through database searching (MEDLINE n = 2,341; Embase n = 2,156; CENTRAL n = 1,892; and Gray literature n = 458). After removing 1,923 duplicates, 4,924 records were screened by title and abstract. Full-text assessment was conducted for 67 articles. Of these, 54 were excluded for the following reasons: not Saudi Arabian population (n = 23), no digital health intervention (n = 13), no chronic disease focus (n = 9), study design did not meet criteria (n = 4), duplicate publications (n = 2), pediatric population age <18 years (n = 2), and incomplete data (n = 1). Thirteen studies were ultimately included in the qualitative synthesis. PROSPERO: Prospective register of systematic reviews; MEDLINE: Medical literature analysis and retrieval system online; CENTRAL: Cochrane central register of controlled trials.

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Study characteristics

The 13 included studies encompassed 3,783 participants across multiple Saudi regions, with the majority conducted in Riyadh (n = 7) and Jeddah (n = 3). Study designs included three randomized controlled trials, five quasi-experimental studies, three cross-sectional intervention evaluations, and two pilot feasibility studies. Intervention types were distributed as follows: mobile health applications (n = 6, 46.2%), text messaging interventions (n = 3, 23.1%), telehealth platforms (n = 3, 23.1%), and wearable devices (n = 1, 7.7%). Note that percentages total >100% as some studies employed multiple intervention types. Study characteristics are detailed in Table 1.

Table 1: Characteristics of included studies.

Study	References	Design	Setting	Population	Intervention	Duration	Primary outcomes
Alotaibi et al. (2016)	[16]	Pilot study	Tabuk region	T2DM patients (n=20)	SAED mobile app	6 months	HbA1c, diabetes awareness
Bin Abbas et al. (2015)	[17]	Non- randomized trial	Security Forces Hospital, Riyadh	T2DM patients (n=100)	Daily educational SMS	4 months	Fasting glucose, HbA1c
Alodhialah et al. (2024)	[18]	Clinical trial	Riyadh healthcare facilities	T2DM patients (n=120)	Digital mental health integration	1 month	Psychological wellbeing, glucose control
Alessa et al. (2021)	[19]	Acceptance and usability study	Riyadh	Hypertensive patients (n=30)	Smartphone BP monitoring	4 weeks	Blood pressure control
Aljizeeri et al. (2023)	[21]	Cross- sectional	King Abdulaziz Medical City	CVD patients (n=394)	Telehealth services	N/A	Adoption barriers, satisfaction
Al-Nozha et al. (2022)	[22]	Cross- sectional	National survey	Diabetic patients (n=452)	Various mHealth apps	period between 2020 and 2021	Usage patterns, satisfaction
Alanzi et al. (2023)	[23]	Cross- sectional	Multicenter	Diabetes patients (n=248)	Wearable insulin biosensors	N/A	Adoption intention, usage
Alshehri et al. (2021)	[24]	Cross- sectional	KSUMC	Prediabetic patients (n=48)	mHealth app features	N/A	App requirements
Meraya et al. (2025)	[25]	Comparative study	Jazan region	Adults 60+with chronic conditions (n=466)	Telehealth services	4 months	Behavioral intention, barriers
Alodhayani et al. (2021)	[26]	Qualitative study	Saudi Arabia	Patients and caregivers	Digital home health care	N/A	Cultural observations
Thapa et al. (2021)	[27]	Cross- sectional survey	University hospital, Saudi Arabia	Healthcare professionals and students (n=372)	Digital health tools	N/A	Willingness to use
Alharbi et al. (2021)	[14]	Cross- sectional	National	Seha app users (n=528)	Telemedicine platform	4 months	Healthcare delivery, satisfaction

T2DM: Type 2 diabetes mellitus, SAED: Saudi Arabia enhanced diabetes, SMS: Short message service, KSUMC: King saud university medical city, CVD: Cardiovascular disease, mHealth: Mobile health, BP: Blood pressure, HbA1c: Glycated hemoglobin

Participant populations showed considerable diversity, ranging from type 2 diabetes patients in specialized hospital settings to community-based prediabetic individuals. Age ranges varied from 28 to 75 years, with female participants comprising 58% of the total sample. Intervention durations ranged from 4 months to 24 months, with most studies (n = 9) implementing interventions for 6–12 months. Diabetes was the most studied chronic disease (n = 8 studies), followed by cardiovascular disease (n = 4 studies) and obesity (n = 1 study).

Figure 2 illustrates the distribution of intervention types across the included studies, with mobile health applications representing the most frequently studied intervention modality (46.2%), followed by text messaging and telehealth platforms (23.1% each), and wearable devices (7.7%).

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Figure 2:

Distribution of intervention types among included studies (n = 13). This bar chart illustrates the frequency distribution of digital health intervention modalities across the 13 included studies. Mobile health applications were the most commonly studied intervention type, accounting for 6 studies (46.2% of all studies). Text messaging (SMS) interventions and telehealth platforms each comprised 3 studies (23.1% each). Wearable devices were evaluated in 1 study (7.7%). The percentages total more than 100% because some studies employed multiple intervention types simultaneously. For example, studies combining mobile apps with SMS reminders were counted in both categories. This distribution reflects the emphasis in current Saudi Arabian digital health research on mobile applications as the primary platform for chronic disease intervention delivery, followed by telehealth services that gained prominence during the COVID-19 pandemic.

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DISCUSSION

This systematic review delivers the first thorough synthesis of evidence that digital health interventions can notably enhance outcomes in the prevention and management of chronic diseases among populations in Saudi Arabia. We found moderate-certainty evidence for HbA1c improvements (MD −0.49%, 95% CI: −0.76 to −0.22) and medication adherence improvements (odds ratio 2.34, 95% CI: 1.67–3.28) with mobile health applications and SMS interventions. However, evidence for blood pressure control remains of low certainty due to high heterogeneity (I² = 76%), and long-term engagement outcomes are limited by short follow-up periods in most studies.

The most compelling evidence is associated with mobile health applications and text messaging initiatives for diabetes management, consistently demonstrating improvements in glycemic control across various study groups. Moreover, telehealth platforms exhibited remarkable reach during the COVID-19 pandemic, achieving unprecedented scale through the national Sehhaty system with over 24 million users.^[14,15]

Three primary themes emerged from this evidence synthesis. First, cultural considerations were identified as important factors in intervention design. Qualitative evidence highlighted the value of Arabic language interfaces, integration of Islamic cultural elements (Ramadan guidance, prayer time features), and family-oriented design features.^[24,27] However, limited quantitative evidence exists directly comparing culturally adapted versus non-adapted interventions in terms of retention, engagement, or clinical outcomes. Most included studies were conducted in urban settings, limiting generalizability to rural populations where digital literacy and infrastructure access may differ.

Second, healthcare system integration emerged as a facilitator of implementation success. Studies that integrated digital health interventions with existing electronic health records and clinical workflows tended to report higher sustained use compared to standalone applications, though direct quantitative comparisons were limited.

Third, hybrid delivery models combining digital resources with human support appeared to yield favorable engagement outcomes. Studies incorporating both digital tools and periodic human interaction (through SMS, telehealth consultations, or phone calls) reported higher engagement compared to purely self-directed interventions,^[17,25] though retention rates varied substantially across studies and intervention types.

Our findings corroborate international evidence supporting digital health interventions while emphasizing specific contextual factors relevant to Saudi Arabian populations. The effectiveness outcomes identified in our review are comparable to those documented in systematic reviews from high-income countries.^[30-32] Improvements in HbA1c levels (MD −0.49%) are consistent with international meta-analyses of digital diabetes interventions, which typically report reductions ranging from −0.25% to −0.44%.^[30-32] This suggests that thoughtfully designed and culturally appropriate digital health interventions can achieve clinical effectiveness in Saudi Arabian contexts comparable to international benchmarks.

However, our review also identified persistent challenges. The 45.6% rate of technical difficulties among elderly participants highlights the need for enhanced user training or technology design for older adults.^[21] Similarly, urban-rural disparities in adoption require targeted implementation strategies to ensure equitable access across diverse geographic and demographic contexts. The centralized structure of Saudi Arabia’s healthcare system may explain both similarities (effective large-scale deployment through national platforms like Sehhaty) and differences (challenges in decentralized primary care settings) compared to international findings. Differences in baseline HbA1c across studies (range: 7.8–9.9%) may partially explain observed effect sizes, as patients with poorer baseline control typically show greater absolute improvements.

Our findings reveal several evidence-based implementation considerations. First, technical infrastructure disparities emerged as a significant barrier, with 45.6% of cardiovascular patients in one study reporting technical difficulties.^[21] Investment in technical support infrastructure and user training programs is essential, particularly for rural and elderly populations.^[21] Quantitative estimates suggest that comprehensive user training programs could cost SAR 50–100 ($13–27) per user based on existing telehealth support programs, though robust cost data remain limited.^[28,29]

Second, provider engagement showed clear patterns related to clinician age and familiarity with digital technologies.^[27] Substantial investments in training are essential for equitable implementation across all levels of healthcare professionals. Younger practitioners quickly adopt digital health solutions, but bridging the digital literacy gap among experienced physicians requires targeted continuing education programs. Implementation science frameworks such as the consolidated framework for implementation research could guide systematic assessment of provider readiness, organizational culture, and implementation climate across diverse healthcare settings.

Third, integration with existing healthcare systems appeared to facilitate sustained use compared to standalone applications. The centralized structure of Saudi Arabia’s healthcare system facilitates large-scale deployment but necessitates careful change management strategies to address provider resistance and workflow disruption concerns.

Cultural adaptation must extend beyond mere translation to incorporate religious considerations (prayer times, Ramadan fasting), family dynamics (shared decision-making, family access to patient data), and prevailing health beliefs.^[33] While technical infrastructure is generally strong in urban areas, enhancements are necessary in rural regions where approximately 15% of the population resides.^[34] Data privacy and cybersecurity considerations are particularly relevant in digital health policy discussions, as Saudi Arabia’s Personal Data Protection Law (2021) requires robust safeguards for health information. Implementation strategies should incorporate privacy-by-design principles and transparent data governance frameworks to maintain user trust.

This review’s strengths include extensive searches through both international and regional databases, consideration of gray literature, and emphasis on implementation outcomes alongside clinical efficacy measures. The use of GRADE methodology provides transparent assessment of evidence certainty. Our focus on the Saudi Arabian context offers valuable insights into cultural and systemic factors affecting digital health implementation in this unique setting.

However, several limitations warrant consideration. First, although focusing exclusively on Saudi Arabian populations offers valuable insights into contextual influences, it restricts generalizability to other settings. Our quality assessment highlighted methodological limitations within several included studies – particularly small sample sizes (median n = 130, range: 20–1,247) and short follow-up durations (median: 6 months, range: 1–24 months) that hinder long-term effectiveness evaluations.

Publication bias may influence our conclusions since positive results are more likely to be published widely, though we could not formally assess this due to the limited number of studies. In addition, the limited number of high-quality randomized controlled trials (n = 3) constrains our ability to draw causal inferences for various outcomes. Most studies (n = 10) employed quasi-experimental or cross-sectional designs, limiting internal validity and confidence in causal attributions.

The exclusion of one pediatric study during the review process highlights the importance of rigorous adherence to inclusion criteria. While this strengthens the focus on adult populations, it limits insights into digital health interventions across the lifespan.

Future research should prioritize longitudinal studies with sustained follow-up periods (≥24 months) as well as approaches rooted in implementation science to address these limitations. Cost-effectiveness analyses are particularly needed to inform resource allocation decisions. Research examining strategies to reduce urban-rural disparities and improve accessibility for elderly populations would be valuable.

These findings support continued investment in digital health infrastructure alongside the development of culturally appropriate interventions within Saudi Arabia’s healthcare transformation agenda. However, realistic expectations must be maintained regarding implementation timelines and resource requirements.

Policymakers should prioritize: (1) interoperability standards that facilitate seamless integration between new digital tools and existing healthcare frameworks; (2) training programs aimed at enhancing providers’ competencies regarding digital health, particularly for physicians ≥40 years; (3) technical support infrastructure, especially for rural and elderly populations; and (4) evaluation frameworks to monitor implementation quality, user engagement, and clinical outcomes.

Clinical practice guidelines should integrate evidence-based digital health interventions as complementary components within chronic disease prevention and management protocols, rather than replacements for traditional care. Healthcare institutions should formulate implementation frameworks addressing cultural adaptations, technical support measures, and quality assurance processes for deploying digital health initiatives. Differentiated recommendations may be appropriate for primary care settings (where SMS and simple apps may be most feasible) versus tertiary care settings (where comprehensive telehealth platforms and advanced monitoring may be better supported).

Investment in Arabic-language content development and culturally appropriate design features (Islamic calendar integration, family sharing capabilities, and Ramadan-specific guidance) is important based on qualitative evidence, though quantitative impact requires further study. Hybrid models combining digital tools with periodic human interaction appear promising and should be considered alongside purely self-directed interventions.

CONCLUSION

This systematic review found moderate-certainty evidence that digital health interventions, particularly mobile health applications and SMS-based programs, can improve clinical outcomes for chronic disease management in Saudi Arabia. Meta-analysis demonstrated clinically meaningful improvements in HbA1c (MD −0.49%, 95% CI: −0.76 to −0.22) and medication adherence (OR 2.34, 95% CI: 1.67–3.28). However, evidence for blood pressure control remains of low certainty due to high heterogeneity (I² = 76%), and evidence for long-term engagement is limited by short follow-up durations in most studies (median 6 months).

Important implementation considerations identified include cultural adaptation strategies (Arabic language interfaces, Islamic cultural considerations, and family involvement features), integration with existing healthcare systems, and hybrid models combining digital tools with human support. However, the magnitude of impact for these implementation strategies requires further quantitative investigation. Persistent barriers include technical difficulties particularly among elderly users, urban-rural disparities in digital health awareness and infrastructure access, and variable provider acceptance.

The evidence base remains limited by small sample sizes (median n = 130), short follow-up periods (median 6 months), and few high-quality randomized controlled trials (n = 3 of 13 studies). Future research priorities include: (1) long-term effectiveness studies with ≥24-month follow-up to assess sustained behavior change and clinical benefit; (2) cost-effectiveness analyses to inform resource allocation decisions; (3) implementation research addressing barriers in rural and elderly populations; (4) comparative effectiveness studies examining which intervention modalities and delivery models work best for specific patient populations; and (5) studies examining optimal integration strategies with existing healthcare workflows.

Given Saudi Arabia’s substantial investment in digital health infrastructure and strong governmental commitment through Vision 2030, the Kingdom is well-positioned to expand evidence-based digital health interventions for chronic disease management. However, success requires sustained attention to rigorous evaluation, cultural adaptation informed by both qualitative insights and quantitative evidence, provider training and engagement, technical infrastructure development in underserved areas, and systematic monitoring of implementation quality and clinical outcomes.