Toward Participatory Precision Health With Co-Designed Recommendations: Systematic Review of Just-in-Time Adaptive Interventions in Adolescents and Young Adults

Clinical Snapshot

Key Findings

• P Value: Not applicable - descriptive review

• Effect Size: Not applicable - narrative synthesis only

• Primary Outcome: Characterization of JITAI adaptive mechanisms for AYAs across health domains

• Nnt Or Sensitivity: 61 unique interventions identified: 24 (39.3%) substance use, 23 (37.7%) mental health, 14 (23%) physical health

• Confidence Interval: Not applicable - no meta-analysis conducted

Clinical Application

Limited by methodological concerns in existing evidence; requires more rigorous evaluation frameworks Relevant to Australian digital health initiatives and youth mental health programs; aligns with TGA mobile medical device regulations and RACGP digital health guidelines Australian adolescents and young adults aged 10-25 years across various health conditions

Abstract

BACKGROUND: The transition from adolescence to young adulthood (age 10-25 years) constitutes a sensitive developmental period marked by rapid biological, psychological, and social change, during which preventive health interventions can shape long-term outcomes. Mobile health tools offer accessible opportunities for tailored support for this population, but often adapt poorly to dynamic contexts, resulting in inconsistent engagement and effects. Just-in-time adaptive interventions (JITAIs), which tailor support in real time using ongoing data, are increasingly explored as precision health strategies. However, how these mechanisms are designed, implemented, and evaluated for adolescents and young adults (AYAs) has not been systematically reviewed. OBJECTIVE: This review aimed to synthesize the evidence on JITAIs developed for AYAs, examine how their adaptive mechanisms have been designed to support specific health goals and changing AYA contexts, and assess methodological reporting quality to inform future precision health intervention development. METHODS: We conducted a systematic review in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and SWiM (Synthesis Without Meta-Analysis) reporting guidelines. Twelve databases were searched for peer-reviewed studies published from 2013 to 2025. Eligible studies focused on participants aged 10 to 25 years and reported real-time adaptive mobile health interventions consistent with JITAI design principles. Two reviewers independently conducted screening, data extraction, and methodological quality appraisal using the Joanna Briggs Institute checklists. AYA coauthors contributed to all phases. Due to substantial heterogeneity in study populations, intervention content, adaptive mechanisms, comparators, and outcome measurements, findings were synthesized narratively, and no meta-analysis was conducted. RESULTS: A total of 61 unique interventions were included. JITAIs for AYAs addressed substance use (n=24, 39.3%), mental health (n=23, 37.7%), and physical health or chronic conditions (n=14, 23%). JITAI tailoring mechanisms relied predominantly on self-reported behavioral data. Decision rules were typically symptom threshold-based, and decision points were commonly daily or event-triggered. Methodological concerns with reporting on intervention administration, participant selection, and outcome measurement reliability were pervasive across all studies, limiting the interpretability of observed effects and cross-study comparisons. Ethical considerations, including researcher positioning and reflexivity, alongside the depth of reporting around participatory AYA engagement in design and implementation, were also inconsistent. CONCLUSIONS: This review contributes a novel perspective to AYA digital health by moving beyond intervention outcomes to examine how core adaptive mechanisms are operationalized for AYAs across multiple health domains, while also integrating AYA perspectives into the interpretation of findings and recommendations. Unlike prior reviews focused primarily on adults or specific conditions, it identifies broader contextual, methodological, and ethical considerations relevant to AYA precision health. These findings highlight the need for more transparent, contextually responsive, and youth-centered adaptive interventions, alongside more rigorous designs for evaluating adaptive intervention components in daily life contexts.

References

1. 1.Guan, K. W., Amara, M., Cortiana, V., Khan, I., Gürbüz, S., Iorio, C., Ali, R., Adlung, C., Smit, C. R., Vreeker, A., Thalassinou, E., van Roekel, E., Keijsers, L., de Reuver, M., & Figueroa, C. A. (2026). Toward participatory precision health with co-designed recommendations: Systematic review of just-in-time adaptive interventions in adolescents and young adults. Journal of Medical Internet Research. https://doi.org/10.1038/s41746-025-02147-3