Background Digital technology has influenced many aspects of modern living, including health care. In the context of elective surgeries, there is a strong association between preoperative physical and psychological preparedness, and improved postoperative outcomes. Health behavior changes made in the pre- and postoperative periods can be fundamental in determining the outcomes and success of elective surgeries. Understanding the potential unmet needs of patients undergoing elective surgery is central to motivating health behavior change. Integrating digital and mobile health technologies within the elective surgical pathway could be a strategy to remotely deliver this support to patients. Objective This meta-ethnographic systematic review explores digital interventions supporting patients undergoing elective surgery with health behavior changes, specifically physical activity, weight loss, dietary intake, and psychological support. Methods A literature search was conducted in October 2019 across 6 electronic databases (International Prospective Register of Systematic Reviews [PROSPERO]: CRD42020157813). Qualitative studies were included if they evaluated the use of digital technologies supporting behavior change in adult patients undergoing elective surgery during the pre- or postoperative period. Study quality was assessed using the Critical Appraisal Skills Programme tool. A meta-ethnographic approach was used to synthesize existing qualitative data, using the 7 phases of meta-ethnography by Noblit and Hare. Using this approach, along with reciprocal translation, enabled the development of 4 themes from the data. Results A total of 18 studies were included covering bariatric (n=2, 11%), cancer (n=13, 72%), and orthopedic (n=3, 17%) surgeries. The 4 overarching themes appear to be key in understanding and determining the effectiveness of digital and mobile interventions to support surgical patients. To successfully motivate health behavior change, technologies should provide motivation and support, enable patient engagement, facilitate peer networking, and meet individualized patient needs. Self-regulatory features such as goal setting heightened patient motivation. The personalization of difficulty levels in virtual reality–based rehabilitation was positively received. Internet-based cognitive behavioral therapy reduced depression and distress in patients undergoing cancer surgery. Peer networking provided emotional support beyond that of patient-provider relationships, improving quality of life and care satisfaction. Patients expressed the desire for digital interventions to be individually tailored according to their physical and psychological needs, before and after surgery. Conclusions These findings have the potential to influence the future design of patient-centered digital and mobile health technologies and demonstrate a multipurpose role for digital technologies in the elective surgical pathway by motivating health behavior change and offering psychological support. Through the synthesis of patient suggestions, we highlight areas for digital technology optimization and emphasize the importance of content tailored to suit individual patients and surgical procedures. There is a significant rationale for involving patients in the cocreation of digital health technologies to enhance engagement, better support behavior change, and improve surgical outcomes.

BACKGROUND The introduction of digital and mobile technologies has influenced many aspects of modern-day life, including healthcare. In the context of elective surgeries, there is a strong association between pre-operative physical and psychological preparedness, and improved post-operative outcomes. Health behaviour changes made in the pre- and post-operative periods can be fundamental in determining the outcomes and success of elective surgeries. Understanding the potential unmet needs of elective surgical patients is central to motivating health behaviour changes. Integrating digital and mobile health technologies within the elective surgical pathway could be one strategy to remotely deliver behavioural change advice and offer lifestyle support to patients. OBJECTIVE We conducted a meta-ethnographic systematic review to explore digital and mobile interventions supporting elective surgical patients in health behaviour change, specifically: physical activity, weight loss, dietary intake, and mental health support. METHODS A literature search was conducted in October 2019 across six electronic databases (PROSPERO: CRD42020157813). Qualitative studies were included if they evaluated the use of digital health technologies supporting behaviour change(s) in adult elective surgical patients during the pre- or post-operative period. Study quality was assessed using the Critical Appraisal Skills Programme (CASP) tool. A meta-ethnographic approach was used to synthesise existing qualitative data, using the ‘seven phases of meta-ethnography’ according to Noblit and Hare. Using this approach, along with reciprocal translation, enabled the development of four overarching themes and sub-themes from the data. RESULTS Nineteen studies were included, covering bariatric (11%), cancer (73%), and orthopaedic surgeries (16%). The four overarching themes and sub-themes appear key in understanding and determining the effectiveness of digital and mobile health interventions to support behavioural change in surgical patients. Notably, the themes concern an interventions ability to: 1) provide motivation and support, 2) enable patient engagement, 3) facilitate peer-support, and 4) meet individualised patient needs. CONCLUSIONS Our novel findings have the potential to influence future design features of patient-centred digital and mobile health technologies. This study also demonstrates the important role of digital and mobile health technologies in the elective surgical pathway; not only can they help to motivate physical behaviour change, such as improved activity levels and dietary intake, but they can successfully provide psychological support too. We believe there is significant rationale for involving patients in the co-creation of digital health technologies to enhance engagement, better support behaviour change, and improve surgical outcomes.