# Influencing Factors of Mobile Health Apps in Kidney Transplant Care: Systematic Review Using the Consolidated Framework for Implementation Research

## TL;DR

This study reviews factors affecting mobile health app use in kidney transplant care to improve patient outcomes and app adoption.

## Contribution

A systematic review of mHealth app influencing factors in kidney transplant care using the Consolidated Framework for Implementation Research.

## Key findings

- 19 studies identified 16 facilitators and 14 barriers across five domains.
- Intervention characteristics were the most prominent influencing domain.
- Outer setting and process domains were relatively underrepresented.

## Abstract

Kidney transplant recipients require lifelong self-management and follow-up care to maintain allograft function. Mobile health (mHealth) effectively improves self-management behaviors and clinical indicators, consequently enhancing nursing care quality. However, these apps commonly face challenges, including low adoption rates and high discontinuation. Although researchers have explored associated facilitators and barriers from various perspectives, a systematic review of these influencing factors is lacking.

The objective of this study was to systematically review the influencing factors of mHealth apps in kidney transplant care and to provide evidence for developing targeted interventions.

The systematic review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, and the protocol was registered in PROSPERO (International Prospective Register of Systematic Reviews, CRD420251091361). PubMed, Web of Science, Embase, MEDLINE, and Chinese databases, including China National Knowledge Infrastructure, Wanfang Data, China Science and Technology Journal Database, and SinoMed, were searched from inception to March 2025. The Mixed Methods Appraisal Tool was used for quality assessment given its suitability for appraising diverse study designs. Influencing factors were identified and coded according to the Consolidated Framework for Implementation Research due to its utility in systematically identifying multilevel implementation factors.

A total of 19 studies (all English-language publications) were included, comprising 9 qualitative studies, 5 mixed methods studies, and 5 quantitative studies, involving 1265 kidney transplant recipients and 34 health care providers. A total of 16 facilitators and 14 barriers were identified and categorized into 5 domains: intervention characteristics, outer setting, inner setting, characteristics of individuals, and process.

The use of mHealth apps in kidney transplant care is influenced by multidimensional factors, with intervention characteristics constituting the most prominent domain, while the outer setting and process domains are relatively underrepresented. Future research should investigate these influencing factors and implement multidimensional strategies to optimize mHealth apps in kidney transplant care.