Introduction

Non-communicable diseases (NCDs) are usually persistent, which result from a combination of genetic, physiological, environmental and behavioural factors. The main types of NCDs are cardiovascular diseases (such as heart attacks and strokes), cancer, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma) and diabetes.1 NCDs have a long period, complex aetiology, health damage and social severe harm.2 The incidence of NCDs is increasing worldwide, which poses a considerable challenge to the global health system because of the high cost of NCD treatment and the increased economic burden on society and families.3 NCDs cause 410 000 deaths per year, accounting for 74% of all deaths worldwide.4 The global cost of NCDs is estimated to exceed US $30 trillion during 2011–2030 or 48% of the global gross domestic product.5 In addition, NCDs can damage the basic organs of the human body, easily cause disability and affect the ability to work and the quality of life. It accounts for 61.4% of all disability-adjusted life years worldwide.6 In developing countries, the economic level is not high, and the medical resources are limited. Moreover, patients are often unable to receive timely and effective intervention. Consequently, the disease cannot be effectively contained, further exacerbating the increase in mortality and disability.7 In China, the disease burden caused by NCDs accounts for 70% of the total disease burden in China.8 In clinical practice, most patients with NCDs require long-term pharmacological interventions or lifelong management, which encourages patients to start lifestyle change programmes to reduce the adverse effects and burden of NCDs by relying on correct health behaviours.9 In order to effectively address the risk factors for NCDs, comprehensive measures, including improving lifestyle practices, strengthening environmental governance, improving healthcare and strengthening the development and implementation of public health policies, are needed. At the same time, raising public awareness of risk factors for chronic diseases and encouraging a healthy lifestyle is also an important way to prevent chronic diseases.

E-education programme refers to the form of distance education and online learning through computer networks and Internet technology. Patients with NCDs can obtain relevant knowledge about disease prevention and adjuvant treatment through the Internet, which enhances their awareness of personal health management.10 E-educational programmes for older adults are an important social task. With population ageing, health problems among older adults are becoming increasingly prominent, and strengthening e-educational programmes for older adults is urgently necessary.11 At present, with the popularity of Internet smartphones, older adults have changed their learning methods, and they can easily use the Internet to learn health knowledge. The convenience and timeliness of e-educational programmes greatly improve the efficiency of obtaining health information and provide older adults more opportunities to acquire health knowledge. E-educational programmes for older adult patients with NCDs aim to improve the older adults’ awareness of health and enhance their self-management ability. E-educational programmes for older adults are an important measure developed to meet the growing health needs of older adults, which are important for changing unhealthy behaviours.12 By imparting health knowledge and life skills to older adult patients with NCDs, we can help the older adults consciously choose a healthy lifestyle, get rid of bad habits and master correct health behaviours, thereby delaying the progression of the disease and improving the quality of life.13 Learning health knowledge through the Internet has become a new trend for older adults. This way of learning not only provides older adults with more learning opportunities but also enables them to comprehensively understand and manage their own health. In the future, with the progression of science and technology, online health education will become convenient and intelligent, providing more comprehensive and professional health services for older adults.

For NCDs, e-education programmes often include online courses, mobile apps, social media newsletters, online lectures and health counselling. Health education can promote the realisation of a healthy lifestyle such as no smoking, low-salt diet, proper diet, proper physical activity and mental health.14 The intervention can be any form (one or more combinations), and the intervention can be conducted in any setting. Measures to promote interventions include interventions delivered at the individual or group level. Patients can obtain health information by downloading the APP, reading the push information and watching relevant videos. Through e-educational programmes, older adults can obtain novel and more comprehensive health information and scientific research results online, thereby enhancing their self-management ability. This systematic review will summarise and critically evaluate the impact of education programmes on older adults with NCDs and provide guidance for developing interventions for NCD health management programmes to improve patient quality of life and overall health.

Previous studies have investigated the effects of e-educational programmes on patients with NCDs. However, there is no consensus on the content, form, dose and strategy of e-educational programmes. For older adult patients with NCDs, thoroughly examining the intensity and state of e-educational programme interventions is necessary. This evidence will be used to practice and evaluate effective e-educational programmes and guide future design.

Methods

The systematic review protocol was registered and it has been certified. The registration date is 27 October 2023. The access website is https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023455272. The study was conducted in accordance with the meta-analysis’ guidelines for observational epidemiological studies and the preferred reporting programmed for systematic reviews and meta-analyses (PRISMA statement), ensuring strict and transparent methods in the study process.15 The completed PRISMA-P checklist can be found in online supplemental table 1.

Criteria for consideration of this review

All randomised controlled trials (RCTs) on e-educational programmes for patients with NCDs published in recent 10 years (2013–2023) will be included, without language, region or ethnicity restrictions. This study will collect all available RCTs on e-educational programmes for NCDs in older adults, regardless of blinding, publication status, region and language. The papers written in English or Chinese will be included. Studies, where the source data cannot be obtained, include literature reviews, systematic reviews, non-experimental studies, qualitative studies, editorial reviews, case studies, conference papers and studies where only abstracts are available; studies that do not explicitly mention the e-educational programme methods used will be excluded. Our review is currently in the screening literature section and is expected to review on 30 December 2024.

Types of participants: all patients diagnosed with NCDs and age than or equal to 60 years will be included without restrictions on gender, ethnicity, nationality and medical institution. Moreover, no restriction on disease severity is established.

Types of interventions: the interventions can be any type of e-educational programme and include multiple controlled interventions, including no treatment, placebo, or other interventions.

Types of outcome measures: there are no limitations on assessment methods, and data collection be conducted before the intervention. The primary and secondary outcomes identified by the proposed systematic review in online supplemental table 2.16–23

Information sources and search strategy

We will comprehensively search relevant studies in accordance with the following database indices. During the systematic review, in addition to existing studies, we will also include new studies that meet the abovementioned criteria. The full retrieval strategy for all databases is presented in online supplemental table 3. We will search the following eight databases: PubMed, Cochrane Library, Web of Science, EMBASE, MEDLINE, China Biology Medicine, China National Knowledge Infrastructure and Wan Fang Data.

In ensuring a comprehensive literature collection and further identifying unpublished, published and ongoing studies, the following procedures are performed:

Search grey literature sources, including Grey Literature Report (www.greylit.org) and Open Grey (www.opengrey).

Contact experts and authors of possible ongoing or unpublished studies in the field.

Review the list of references of the included trials identified through the search.

Manually retrieve relevant journals and conference papers.

Contact the authors of relevant studies and ask them to provide additional data pertinent to the review as necessary.

Use the Scopus citation index to track citations for all included studies.

Data collection

We will use the Cochrane Collaboration’s evidence to screen and extract data from the included trials. Two authors will independently filter the studies by title and abstract. Then, two graduate students will independently read the full text of those potentially eligible studies to see if they are eligible for inclusion. In selecting the most suitable included trials to use the proposed criteria, any disagreements between the two researchers in screening will be resolved by discussion and, if necessary, by consultation with a third author. We will collate multiple reports of the same study to avoid duplicate reports. PRISMA flowcharts will document the search, screening and inclusion processes as well as the reasons for exclusion (figure 1).

Two graduate students will independently read the full text of those potentially eligible studies to see if they are eligible for inclusion.

Data extraction and management

The data were extracted from the table, including the title, author, year, diagnosis, sample size, age, method of intervention, educational strategy, duration of the intervention, and outcome.

The results will be initially screened by two authors. The primary screening will be conducted by independently reading the titles and abstracts. The table extracted valid information, including the title, year, author, disease diagnosis, sample size, age, method of intervention, duration of the intervention and outcome indicators. Two authors will read the full text of these potentially eligible studies independently to see if they qualify for inclusion. In addition, we will independently check the full texts of the remaining articles through a standardised data extraction table to determine whether they meet the inclusion criteria. If necessary, we will contact the corresponding author to clarify relevant details. Any disagreements between the two authors in screening will be resolved by discussion and, if necessary, further evaluated by a third author.

Risk assessment of included literature

Two authors independently assessed the risk of bias in the included studies using the Cochrane toolkit in accordance with the quality assessment criteria outlined in the Cochrane Handbook.

Assessment of reporting bias

We will try to prevent bias by applying an integrated search strategy to identify the registration of eligible published studies, grey literature and prospective trials.24 Reporting bias will be assessed as necessary to ensure the accuracy of the study results. The symmetry of the funnel plots will be assessed using Stata V.14.0, if applicable.

Measures of treatment effect

OR, relative risk or risk difference were the main tools used to assess the treatment effect for dichotomous outcomes. The mean difference or standardised mean difference were analysed for continuous results. Outcome data, including dichotomous and continuous data, were expressed as mean±95% CIs.

Data analysis

We will include the study sample in randomised or selected units in the evaluation. In this review, we will use individual result analysis for the units of analysis. If only part of the data extraction form is provided in the study report, then we will contact the first author or the corresponding author via email to get the missing data. In the absence of a reply, then only the available data were analysed. Heterogeneity among studies was evaluated by calculating the standard Cochrane Q test and I2 statistic, and all statistical analyses were performed using Rev Man. We will assess the heterogeneity among studies by calculating the forest plot, χ2 test, and I2 statistic at a significance level of p<0.10. If p≥0.10, then no interstudy heterogeneity was found; if p<0.10, then interstudy heterogeneity was observed. A threshold of I2 more significant than 50% indicated statistical heterogeneity.25 If I2 was ≤50%, then heterogeneity was considered to be good, and a fixed-effect model was used; if I2 was >50%, then heterogeneity was considered significant, and the source of heterogeneity was explored through subgroup analysis or sensitivity analysis. Subgroup analyses will be performed for significant heterogeneity during the clinical study. Subgroup analyses will be performed if distinct heterogeneity is observed in the results of data analysis. Such analyses will be conducted in accordance with the education content, form of education, sample size or other factors affecting the results.

If more than two controlled trials are included and if the studies are sufficiently similar, then meta-analysis will be performed. We will perform meta-analysis using the general inverse variance method and the Mantel–Haenszel method combined with continuous and dichotomous data, respectively. When significant heterogeneity exists, a random-effect model will be used for meta-analysis; when the heterogeneity test shows no heterogeneity among the included studies (p>0.10, I2<50%), a joint analysis will be performed using a fixed-effect model. If meta-analysis cannot be performed for all or part of the included studies, then a narrative summary of the characteristics and results of the remaining studies will be performed. One author will enter the data into Review Manager V.5.4, and another author will check the accuracy of the entries. Similar negotiation methods will be used for any inconsistencies or disagreements.

Analyses will be performed to verify the stability of the analyses by comparing the results of meta-analyses that include or exclude questionable studies. These uncertain studies must meet at least one of the following criteria:

Unreported methods of the inadequate quality or unclear methodology (serial generation, assignment hiding or ignoring participants or evaluators).

Suspicious sample size (small sample size trials, eg, fewer than 40 cases per group).26

No reported or inadequate/unclear methods for handling missing data.

Confidence in the accumulated evidence

Evidence quality grading (Grading of Recommendations, Assessments, Developments and Evaluations) will be used to assess the quality of the evidence for the primary results,27 including methodological quality, directivity of the evidence, heterogeneity, accuracy of effect estimates, and risk of publication bias.28

Patient and public involvement

Given that this study would be a review of published data, seeking patients or members of the public is not necessary in the review process. However, information from patients and public stakeholders (caregivers or healthcare providers) may be required during the writing and dissemination of the review.

Discussion

NCDs caused disability, reduced working capacity and quality of life and impaired mental function. Implementing e-educational programmes enables individuals to improve or maintain their physical and mental functioning. Based on a comprehensive assessment of the patient’s condition, we will develop an e-education programme content to guide patients in learning correct health behaviours, thereby enhancing their self-management ability. By improving the individual’s ability to self-manage the disease, the progression of the disease can be effectively controlled, thereby reducing the incidence of rehospitalisation and other relevant indicators.29 As an educational intervention, we must clearly understand the content, form, dose and strategy of e-educational programmes before establishing e-educational programme guidelines for patients with NCDs. Many studies have described interventions for different types of health education programmes, and interventions for e-education may also be included. Using evidence-based medicine is necessary to objectively evaluate the impact of e-educational programmes and intervention models on older adults with NCDs, and health professionals and other relevant beneficiaries may only consider such interventions with sufficient evidence to support them.

This study will systematically review the available evidence for applying e-education programmes to older adults with NCDs. By conducting a transparent and rigorous systematic review, we will obtain the best evidence for applying such programmes to the target population. In addition, the report will elaborate on the included study limitations to guide future work and to make the findings more credible. Through compelling evidence and best practices, awareness can be raised among public healthcare and health professionals, thereby promoting the wide application of e-educational programmes in target populations.

The main potential challenges faced by this review are the large number of articles included, the wide variety of diseases involved and the large number of related methods, which result in the poor classification of articles. If the number of the literature included is too large, then we will develop stricter criteria and exclude a portion of the literature. Second, we plan to establish a clear literature database to classify the literature in accordance with the subject, time, method and other factors to facilitate literature collation and management. Bias and significant heterogeneity may occur during this study, which may affect the reliability of the results. Our review will provide scientific evidence for the e-educational programme efforts of researchers in relevant fields, health managers and relevant populations.