Effectiveness of digital health interventions in enhancing self-efficacy in adults with type 2 diabetes mellitus: A systematic review and meta-analysis of randomised controlled trials

Background/Aim: Self-efficacy is a key psychosocial determinant influencing individuals' ability to perform effective self-management behaviours in type 2 diabetes mellitus (T2DM). The rapid expansion of digital health interventions has introduced new approaches to support diabetes self-care; however, the magnitude of its impact on self-efficacy has not been clearly established. This systematic review and meta-analysis were conducted to examine the effectiveness of digital health interventions in improving self-efficacy among adults with T2DM. Methods: A systematic search was undertaken across Scopus, PubMed/MEDLINE and EBSCO to identify randomised controlled trials published between 2017 and 2024. Eligible studies included adults with T2DM who received digital health interventions and reported self-efficacy outcomes. Quantitative data were pooled using a random-effects meta-analytic approach, with standardised mean differences (SMDs) and 95 % confidence intervals (CIs) calculated. Methodological quality was assessed using the Cochrane Risk of Bias 2 tool. Results: Eight randomised controlled trials involving 817 participants were included in the meta-analysis. Digital health interventions demonstrated a statistically significant improvement in self-efficacy compared with control conditions (SMD = 1.38; 95 % CI: 0.77-2.00; p < 0.00001). Considerable heterogeneity was observed (I² = 93 %). The high heterogeneity observed may be attributed to variations in intervention design, duration and outcome measurement across studies. Leave-one-out sensitivity analysis confirmed that the pooled effect was robust and not driven by any single study. Conclusion: Digital health interventions were effective in enhancing self-efficacy among adults with T2DM. Despite substantial heterogeneity, these findings support digital strategies as complementary components of diabetes self-management. Further research employing standardised self-efficacy measures and follow-up periods is warranted to strengthen the evidence base.