Abstract
BACKGROUND: MedlinePlus, developed by the National Library of Medicine (NLM) in the United States, is one of the most widely used, authoritative, consumer-grade health information resources on the web. Although extensively used and discussed in scholarly work for health literacy and patient education, it is unclear how MedlinePlus has been integrated into clinical care or embedded within health informatics applications. OBJECTIVE: This study aimed to understand how MedlinePlus has supported patients and caregivers by increasing access to health information for clinical care and illness management. The insights on this topic will inform the design and development of patient-facing digital health intervention tools for improved health communication, decision engagement, informed decision-making, and health outcomes. METHODS: We conducted a systematic literature review following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. First, we developed a comprehensive literature search strategy, searched 9 citation databases, and aggregated and deduplicated search results before importing them into Covidence for manual screening using predefined inclusion and exclusion criteria. Second, reviewers independently assessed all studies at the title-abstract and full-text levels, resolving discrepancies through ongoing discussions. Third, we applied the PICO (problem/population, intervention, comparison, and outcome) and the Collaborative Chronic Care Model as guiding frameworks for data extraction and analysis. All included studies underwent quality assessment using the Mixed Methods Appraisal Tool. RESULTS: In total, 28 studies reported in 27 sources met our inclusion criteria. We categorized the extracted data into 4 areas. First, regarding bibliometrics, the studies were reported between 2004 and 2024, with 2010 having the highest number of studies. Of these studies, 25 were conducted in the United States, 2 were conducted in Iran, and 1 was conducted in Argentina. Health informatics journals and conference proceedings, as well as library science journals, were prominent publishing venues. The NLM funded half of the studies. Second, regarding participants, most studies focused on outpatients. Other participant roles included physicians, nurses, hospital staff, pharmacists, and librarians. Fewer than half of the studies addressed the social determinants of health. Third, regarding intervention, most studies implemented MedlinePlus information interventions within clinical settings. Other interventions occurred in community pharmacies, community organizations, libraries, online health platforms, or patient portals. Fourth, regarding outcome, only 4 studies assessed clinical outcomes, and the findings were mixed and inconsistent. However, 24 of 28 studies reported positive nonclinical outcomes, including improved attitudes toward and satisfaction with MedlinePlus and enhancements in patients' information-seeking behaviors, confidence, and willingness to engage in decision-making, physician-patient communication, self-management, and self-efficacy. CONCLUSIONS: This systematic literature review is the first comprehensive examination of how MedlinePlus has been integrated into clinical care, supporting patients and caregivers with enhanced access to health information. Our findings offer evidence and insights through the Collaborative Chronic Care Model lens and can guide the development of digital health interventions to improve patient health.