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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Transition.

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Strategy. Digital Health Interventions

Approach. Develop Digital Health Interventions that can help youth prepare for healthcare transition while streamlining communication through EHR.

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Overview. Transition Digital Health Interventions offer a promising strategy for enhancing successful transitions from pediatric to adult healthcare, particularly for adolescents with chronic health conditions. These digital tools, which can include social media-style videos or interactive apps like Sisom and iTransition, are designed to promote autonomy-building, deliver age-appropriate health education, provide medication reminders, organize vital resources, and facilitate communication among youth, caregivers, and healthcare professionals.[1,2,3] They aim to help youth feel less isolated and more prepared, encouraging their participation in care by ensuring their views are heard and considered.[1,2] Successful implementation critically relies on human-centered design methods and iterative feedback from end-users to create accessible, relatable, and engaging content.[1] A key factor for adoption by healthcare teams is integration with Electronic Health Records (EHR), which reduces clinician burden and improves communication, as demonstrated by the CF R.I.S.E. program.[3,4] Prioritizing content that is easy to understand, balancing video length with information conveyance, and active dissemination within clinical settings are also crucial for these interventions.[1] Such interventions should support caregivers rather than replacing their role, adapting to varying levels of patient readiness.[1]

Evidence. Emerging Evidence. Strategies based on emerging evidence show promise but have not undergone extensive testing. While these approaches demonstrate potential, their effectiveness remains unconfirmed. Prioritize rigorous monitoring to ensure they achieve desired outcomes for all MCH populations.

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Health and Health Behaviors/Behavior Change. This strategy improves individuals' physical and mental health and their adoption of healthy behaviors (e.g., healthy eating, physical activity).

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Health Teaching (Education and Promotion) (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-Focused

Examples from the Field. There are currently no ESMs that use this strategy. Search similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort (“What/how much did we do?”)

  • Number of digital health transition tools (apps, websites, videos) developed and deployed for youth with chronic health conditions. (Measures infrastructure development)
  • Number of healthcare organizations or clinics that adopt and integrate transition eHealth/mHealth interventions into their EHR systems. (Assesses system-level implementation)
  • Number of adolescents and caregivers who register for or access digital transition readiness interventions. (Quantifies reach and initial engagement)
  • Number of training sessions conducted for healthcare providers on using digital health transition tools in clinical practice. (Builds workforce capacity)

Quadrant 2:
Measuring Quality of Effort (“How well did we do it?”)

  • Percent of digital transition intervention content that meets accessibility standards and reading level appropriateness for adolescents. (Evaluates quality and usability)
  • Percent of youth and caregivers who report that the digital intervention content is relatable, engaging, and easy to understand. (Assesses user experience)
  • Percent of clinicians who report that EHR integration reduces documentation burden and improves transition care delivery. (Measures clinical workflow integration)
  • Percent of digital intervention modules developed through human-centered design methods with iterative youth and caregiver feedback. (Reflects development quality)

Quadrant 3:
Measuring Quantity of Effect (“Is anyone better off?”)

  • Number of adolescents who complete transition readiness self-assessments through digital platforms, with results shared with care teams. (Creates feedback loops for care planning)
  • Number of youth who demonstrate improved transition knowledge, self-management skills, or medication adherence after using digital interventions. (Shows skill acquisition)
  • Number of automated appointment reminders, medication alerts, or resource notifications sent to youth transitioning to adult care. (Provides ongoing support)
  • Number of secure messages exchanged between youth, caregivers, and providers through digital platforms to facilitate transition communication. (Enhances care coordination)

Quadrant 4:
Measuring Quality of Effect (“How are they better off?”)

  • Percent of youth with chronic conditions who successfully transfer to adult care and attend their first adult appointment after completing a digital transition intervention. (Demonstrates impact on care continuity)
  • Percent of transition-age youth who maintain consistent engagement in adult healthcare 12 months post-transfer after utilizing digital health tools. (Shows sustained outcomes)
  • Percent reduction in emergency department visits or hospitalizations among youth who used digital self-management tools during transition. (Reflects health outcomes)
  • Percent of youth reporting increased confidence, autonomy, and self-efficacy in managing their health conditions after participating in digital interventions. (Measures empowerment outcomes)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

[1] Diaz, K. C., Yau, J., Iverson, E., Cuevas, R., Porter, C., Morales, L., Tut, M., Santiago, A., Ghavami, S., Reich, E., & Sayegh, C. S. (2024). Human-centered design approach to building a transition readiness mHealth intervention for early adolescents. Journal of Pediatric Psychology.
[2] Gilljam, B.-M., Nygren, J. M., Svedberg, P., & Arvidsson, S. (2020). Impact of an Electronic Health Service on Child Participation in Pediatric Oncology Care: Quasiexperimental Study. Journal of Medical Internet Research, 22(7), e17673.
[3] Tanner, A. E., Mertus, S., Sheikh, M., Urquhart, R., Phillips, K., Dowshen, N., Dutta, S., Goldstein, M. H., Lee, S., Knowles, K., Darien, K., Rulison, K. L., Madden, J., & Hussen, S. A. (2024). Transitioning Adolescents to Adult HIV Care in the United States: Implementation Lessons from the iTransition Intervention Pilot Trial. Tropical Medicine and Infectious Disease, 9(12), 297–297.
[4] Enochs, C., Filbrun, A. G., Hjelm, M., Lehrmann, J., Mullen, L., Packard, R., Roach, J., Saulitis, A. K., & Nasr, S. Z. (2024). Improving implementation and team communication by integrating a cystic fibrosis transition readiness (CF R.I.S.E.) program into electronic health records. Pediatric Pulmonology, 60(1).

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.