BackgroundThe use of eHealth has increased tremendously in recent years. eHealth is generally considered to have a positive effect on health care quality and to be a promising alternative to face-to-face health care contacts. Surprisingly little is known about possible adverse effects of eHealth apps.ObjectiveWe conducted a scoping review on empirical research into adverse effects of eHealth apps that aim to deliver health care at a distance. We investigated whether adverse effects were reported and the nature and quality of research into these possible adverse effects.MethodsFor this scoping review, we followed the five steps of Arksey and O’Malley’s scoping review methodology. We searched specifically for studies into eHealth apps that replaced or complemented the face-to-face contact between a health professional and a patient in the context of treatment, health monitoring, or supporting self-management. Studies were included when eHealth and adverse effects were mentioned in the title or abstract and when empirical data on adverse effects were provided. All health conditions, with the exception of mental health conditions, all ages, and all sample sizes were included. We examined the literature published between December 2012 and August 2017 in the following databases: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and the Cochrane Library. The methodological quality of the studies was assessed using the Critical Appraisal Skills Programme (CASP) checklists.ResultsOur search identified 79 papers that were potentially relevant; 11 studies met our inclusion criteria after screening. These studies differed in many ways and the majority were characterized by small research populations and low study quality. Adverse effects are rarely subject to systematic scientific research. So far, information on real adverse effects is mainly limited to incidental reporting or as a bycatch from qualitative pilot studies. Despite the shortage of solid research, we found some indications of possible negative impact on patient-centeredness and efficiency, such as less transparency in the relationship between health professionals and patients and time-consuming work routines.ConclusionsThere is a lack of high-quality empirical research on adverse effects of eHealth apps that replace or complement face-to-face care. While the development of eHealth apps is ongoing, the knowledge with regard to possible adverse effects is limited. The available research often focuses on efficacy, added value, implementation issues, use, and satisfaction, whereas adverse effects are underexplored. A better understanding of possible adverse effects could be a starting point in improving the positive impact of eHealth-based health care delivery.

Background:The use of eHealth has increased tremendously in recent years. eHealth is generally considered to have a positive effect on healthcare quality and to be a promising alternative for face-to-face healthcare contacts. Surprisingly little is known about possible adverse effects of eHealth applications. Objective:We conducted a scoping review on empirical research into adverse effects of eHealth applications that aim to deliver healthcare on a distance. We investigated if adverse effects were reported and the nature and quality of research into these possible adverse effects. Methods:For this scoping review, we followed the five steps of Arksey and O'Malley's scoping review methodology. We examined the literature between December 2012 and August 2017 in the following databases: PubMed, CINAHL, Web of Science and the Cochrane Library. Each paper was independently screened by at least two authors; differences were resolved through consensus development. Study characteristics were extracted. The methodological quality of the studies was assessed using the Critical Appraisal Skills Programme (CASP) lists. Results related to the research question were described and categorized. Results:Our search identified 79 papers that were potentially relevant; 11 studies met our inclusion criteria after screening. These studies differed in many ways and the majority was characterized by small research populations and low study quality. Despite the shortage of solid research, we found some indications of possible adverse effects Conclusions:There is a lack of high-quality empirical research on adverse effects of eHealth applications replacing or complementing face-to-face care. While the development of eHealth applications is ongoing, the knowledge with regard to possible adverse effects is limited. The available research focuses often on efficacy, added value, implementation issues, use and satisfaction, whereas adverse effects are underexposed. A better understanding of possible adverse effects might be a starting point to improve the positive impact of eHealth-based health care delivery.