Scoping review studies map key concepts and evidence in a research area and can stand alone, particularly in complex or underreviewed domains [17]. For our scoping review focusing on studies or reports on transitioning social health care tools from traditional paper-based to web-based formats, we adopted the methodological framework outlined by Arksey and O’Malley [17], with no critical appraisal of the studies. This framework involves 5 stages: identifying the research question, locating relevant studies, selecting studies, charting the data, and collating and summarizing the results. The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist guided the reporting of this scoping review (Checklist 1) [18]. In addition, the search strategy and reporting were documented according to the PRISMA-S (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Literature Search Extension) extension to strengthen transparency and reproducibility of each component of the search [18]. No prior protocol was established or published.

Eligibility criteria were defined using the Population-Concept-Context framework recommended for scoping reviews [19]. Studies were eligible if they reported on the following criteria:

Social health care tools were defined as structured instruments intended to support communication, reflection, informed decision-making, self-management, coordination, or psychosocial support within social or health care settings.

Empirical qualitative, quantitative, or mixed methods studies conducted in any clinical, community, or organizational context were eligible (Context), provided they reported on adaptations made during the transition process and/or strategies, methodologies, challenges, or solutions related to digitalization.

Studies were excluded if they did not involve information on the paper-to-web transition, focused exclusively on physical health without a social or communicative component, were not original empirical research, or described transitions in tools delivered via non–internet-based formats (eg, CD-ROM only). Only English-language publications were included. Gray literature was consulted solely to supplement missing information on included tools.

To ensure a thorough exploration of the relevant literature, we used a comprehensive search strategy. This strategy involved systematic searches of electronic databases (Multimedia Appendix 1), including PubMed, PsycINFO, Scopus, and Web of Science, to identify peer-reviewed articles and scholarly publications. The full electronic search strategies for each database, including all search terms, Boolean operators, applied limits, and the date on which each search was performed, are provided in Multimedia Appendix 1 in accordance with PRISMA-S [18]. Searches were limited to English-language publications.

In addition, we supplemented the database searches with backward citation searching, consistent with Joanna Briggs Institute recommendations for scoping reviews [20]. After full-text screening, the reference lists of all included articles were examined to identify additional potentially relevant sources describing the transition of social health care tools from paper-based to web-based formats. Records identified through this process were retrieved and assessed against the same eligibility criteria as database-derived records. Eligible studies identified through citation searching were included in the review and integrated into data extraction and synthesis.

Additionally, recognizing the potential significance of nonacademic sources, we searched for extra information on the included tools in gray literature, such as conference proceedings, reports, theses, and dissertations. Two researchers (CD and ES) independently conducted the searches, using the name of the included tool or other identifiers (author names, institution names, etc). Each researcher conducted the searches on separate computers, ensuring privacy by clearing browser history and cookies and avoiding logins to Google accounts. The content of the search results, such as executive summaries, was examined to determine missing information on adapting a web-based support tool, such as the adaptation process and challenges encountered during the transition.

First, CD searched all aforementioned databases and screened records based on their titles. All records retrieved from the database searches were imported into an Excel file, where duplicates were removed, and the deduplicated records were imported to Rayyan software. After deduplication, 2 reviewers (CD and ES) independently screened the titles and abstracts of retrieved articles for relevance to the research questions and eligibility criteria. Full texts of potentially relevant articles were assessed for final inclusion. Any discrepancies in screening and selection were resolved through discussion and consensus with all authors. Records identified through backward citation searching were screened using the same process.

For each included tool, targeted gray literature searches (eg, via Google) were performed using the tool name, author names, or institutional affiliations to retrieve additional publicly available information on the adaptation process. These searches were used solely to supplement missing details when needed and did not lead to the inclusion of additional tools.

Data extraction was conducted independently by 2 researchers (CD and ES) using a standardized data extraction form. The form was piloted and refined before full extraction. Data were extracted to address the 4 research questions, including study and tool characteristics, target groups, reasons for transition, adaptations made during the transition, development methodologies and strategies, and reported challenges and solutions. Where relevant, targeted gray literature searches were used to supplement missing information on included tools. Extracted data were synthesized per research question and presented narratively and in tables.

Although eligibility screening was performed at the level of published papers, synthesis was conducted at the level of the tool. This approach was chosen because multiple publications may describe the same tool, and the aim of this review was to analyze tool characteristics and adaptation processes rather than publication outcomes.

The search across academic databases resulted in a total of 1302 peer-reviewed articles: 491 from PubMed, 486 from Web of Science, 198 from PsycINFO, and 127 from Scopus. All results were imported into an Excel file to remove duplicates. After removing duplicates, CD screened the records based on titles, and 591 articles remained. These articles were screened by CD and ES based on abstracts, after which 134 articles were selected for full-text review. Based on this full-text screening, 15 tools were initially included. However, following a discussion among all authors on the eligibility criteria and the included tools, 4 of these tools were excluded. One was a duplicate already included from another source, 2 focused exclusively on physical health and did not address social or communicative aspects of health care, and 1 tool was delivered via CD-ROM rather than a web-based format. No additional tools were included based on backward citation searching. An overview of the selection process is shown in Figure 1.

Table 1 provides an overview of the 11 included social health care tools (hereafter called tools), including their aims, formats, target groups, countries of development, and reported reasons for the transition from paper-based to web-based delivery [21-31]. Most tools were developed as web-based platforms (n=8; [22,23,25-27,30,31]), with newer tools delivered as mobile apps (n=2; [24,29]) or in a game-based format (n=1; [21]).

The tools addressed a range of aims within social and health care settings, with most focusing on psychosocial support, self-management, communication, or screening. Target groups included patients with chronic or life-limiting conditions, family caregivers, adolescents, parents, pregnant women, and health care professionals. While several tools were primarily intended for patients or caregivers, a smaller subset targeted health care professionals and focused on clinical or administrative processes.

Tools were developed across multiple countries, predominantly in Europe and North America. Across studies, the most frequently reported reasons for transitioning to digital formats were to improve accessibility and availability (eg, enabling use from home and outside clinical appointments), enhance user engagement through interactive features (eg, videos, quizzes, tailored feedback, automated scoring, or reminders), and increase efficiency or scalability. In some cases, external contextual factors, such as the COVID-19 pandemic, were reported as contributing to the decision to digitalize existing tools.

In general, information on the transition process was limited. Information provided described the transition from paper-based to web-based formats as an approach to address limitations of paper tools, such as limited opportunities for remote use, reduced flexibility, or challenges in routine implementation, while preserving the core purpose and content of the original tools.

A range of adaptations were made during the transition from paper-based to web-based formats, tailored to the function, delivery setting, and target audience of each intervention (see Table 2). In 5 tools [21,22,24,26,27], the original intervention content was largely retained, while the format and delivery were modified to include digital features such as videos, online modules, quizzes, or interactive exercises. In 3 tools [21,22,30], the structure and delivery of sessions were also redesigned, for example, moving from face-to-face or nurse-led delivery to self-guided or asynchronous modules [30]. Five tools [21,22,25,27,31] integrated features that allowed users to navigate content adaptively or receive tailored feedback, such as adaptive navigation, customized feedback, or emotionally responsive content. Design changes to improve usability, such as font adjustments, simplified navigation, and tailored login systems, were also reported.

All 11 tools described a structured process to support the transition from paper-based to web-based formats, although the level of detail and the guiding frameworks varied (see Table 3). User-centered design was explicitly reported in 4 studies [22,24,25,30], while several additional tools applied closely related participatory or cocreation approaches [25,29,31]. This included strategies that involved users, such as patients, caregivers, and health care professionals, in interviews, workshops, think-aloud sessions, and cocreation exercises to ensure the digital tools were aligned with users’ needs and practical contexts of use. These approaches involved patients, caregivers, health care professionals, or other stakeholders in workshops, interviews, think-aloud sessions, prototype reviews, and co-design activities to ensure alignment with users’ needs and real-world contexts of use.

Iterative development processes were common. Agile or Scrum-based methodologies were described in 3 studies [24,25,30], while other tools incorporated iterative prototype testing and refinement cycles supported by usability testing and stakeholder feedback [22,29,31]. “What Should We Tell the Children?” (WSWTTC) applied Intervention Mapping to ensure theoretical alignment and structured adaptation to a game format [21]. Other studies reported phased development, mixed methods pretesting, pilot implementation, or randomized evaluation designs to assess the feasibility, usability, or effectiveness of the digital adaptation [23,26,28]. While these studies did not specify a formal design framework, they described systematic evaluation strategies to support and assess the transition process.

Usability was a frequently reported barrier (n=6; [22,25-27,30,31]), especially in tools aimed at older adults or people with limited digital skills. Users experienced difficulties with navigation, unclear instructions, small fonts, or confusing icons. Other tools (n=2; [21,32]) struggled with user engagement, reporting high dropout rates or limited adherence, often linked to overly long text, limited interactive elements (eg, quizzes or exercises), or cognitive burden. Technical challenges (n=4; [22,28,30,31]) included bugs, login issues, and difficulties integrating the tools into existing clinical systems. Administrative and implementation delays, such as navigating complex information and communication technology systems or securing institutional approvals, further complicated the transition process.

To address usability issues, several teams adopted iterative design strategies informed by user testing [22,26,30,31], resulting in clearer interfaces, instructional videos, customizable font sizes, and more intuitive navigation. Tools with engagement problems revised their content and structure, for example, reducing text volume, simplifying feedback messages, and adding interactive components such as videos, exercises, or tailored feedback. Technical bugs were tracked and resolved through internal reporting systems and regular meetings with development teams. In some tools [24,26,29], more pragmatic solutions, such as combining digital and print components or retaining the original structure with only minor digital adaptations, were adopted to stay within project constraints.

This scoping review examined how social health care tools have been adapted from paper-based to web-based formats. While the content of most tools remained largely unchanged, the transition often involved adding specific digital features, such as videos, online modules, quizzes, interactive exercises, adaptive navigation, and tailored feedback. User-centered and iterative development approaches were central to the transition processes, helping to identify usability barriers and refine the layout, navigation, and content presentation. At the same time, the shift to a web-based format introduced new challenges, particularly related to digital literacy, login procedures, navigation difficulties, and sustained user engagement. Most solutions to mitigate these challenges were pragmatic and context-specific, including simplifying interfaces, reducing text volume, adjusting font sizes, and combining digital components with existing workflows, highlighting the importance of adaptable and context-sensitive design when moving tools into digital environments.

This scoping review contributes to the field by focusing on the transition process from paper-based to web-based social and health care tools, rather than on effectiveness outcomes or digital tools as end products. Unlike existing reviews, it synthesizes how adaptations are made in practice and which strategies and challenges are reported. These insights can inform developers, researchers, and policymakers seeking to plan more usable, inclusive, and context-sensitive digital transitions in social and health care settings.

User-centered and iterative design approaches were frequently reported across the tools included in this scoping review, describing transitions from paper-based to web-based formats. In the included studies, these approaches were associated with reported improvements in usability, acceptability, or feasibility of the adapted tools. By involving users early and repeatedly throughout the development and usability testing process, developers were able to identify practical challenges and refine digital features accordingly. These approaches are supported by the existing literature. For instance, a recent scoping review by Evans et al [33] reported that digital health interventions developed using user-centered design methodologies were more likely to be perceived as acceptable and feasible in real-world settings, particularly among vulnerable populations. Similarly, a study by Williams and Villa [34] found that involving patients and caregivers in the cocreation process was associated with the development of digital health tools that better aligned with user needs and usability requirements.

This review also showed that even when tools transitioned from paper-based to digital formats, most retained their original content with only modest functional upgrades. Enhancements, such as incorporating multimedia elements or interactive modules, were often aimed to translate the original tool into a digital format rather than redesigning the intervention logic or user pathway. Several tools therefore focused on digitalizing delivery while keeping the core content and structure largely unchanged. At the same time, digital platforms can enable additional functionalities, such as tailored feedback, adaptive navigation, and the integration of user-entered data. Ha et al [35], for example, found that integrating patient-generated health data into digital tools was associated with improved communication and self-management in older adults. In addition, adapting paper-based interventions into digital formats can support accessibility by enabling remote access, self-paced use, and the inclusion of supportive features such as videos or structured guidance. The possibility of tailoring digital health tools to meet users’ needs, such as simplifying language and interface design, can improve engagement and may support better health-related outcomes, particularly among underserved populations [36].

This review also showed that adaptation choices were influenced by the target group. Tools for patients and family caregivers included changes related to usability and accessibility, such as simpler navigation, adapted login systems, and supportive content. Tools for health care professionals more often focused on efficiency, data management, and integration into existing digital workflows. However, these differences were rarely described explicitly, and few studies clearly linked the characteristics of the target group to specific adaptation decisions. Similar patterns are reported in the broader digital health literature, where patient-facing tools focus more on user-centered design and professional tools focus more on workflow integration and efficiency [36]. The limited reporting on target group–specific design decisions suggests that this area needs more systematic attention in future research.

The findings of this review also demonstrate a tension between the intention to improve accessibility and the emergence of new barriers following the transition from paper-based to digital formats. Several tools in our review aimed to extend accessibility by adapting existing tools to an online format. However, this shift also created unintended challenges. For example, usability issues were especially evident in tools targeting older adults or people with limited digital skills, highlighting that increased online availability does not automatically ensure equitable access or sustained use. This mirrors the observations of Veinot et al [37], who argue that digital health innovations often privilege already-resourced users, while vulnerable groups may experience these tools as exclusionary. A systematic review by Crawford and Serhal [38] emphasized that digital transitions must be guided by a digital health equity framework, one that accounts not only for infrastructure and literacy gaps but also for users’ varying emotional readiness and cognitive capacities. Considering these ethical concerns, future development should not focus solely on expanding online availability but should also incorporate inclusive design strategies and, where appropriate, complementary offline options to reduce the risk of widening existing inequities.

Lastly, an important consideration emerging from this review is the need to design digital tools that are flexible enough to function across varied digital environments and resource settings. Some tools included in our scoping review encountered implementation delays or technical issues due to rigid design or integration challenges. To support ongoing usability, digital tools should be built with adaptability in mind (eg, scalable to different systems, compatible with both high- and low-resource contexts, and structured to allow for regular updates as user needs, technologies, and care practices evolve) [39]. As Greenhalgh et al [40] highlight, sustainable digital health interventions must be both technically adaptable and socially responsive to remain relevant and usable over time.

This scoping review examined how social health care tools have transitioned from paper-based to web-based formats, a topic that remains relatively underexplored. A key strength of the review is its focus on describing how these transitions were carried out in practice. By analyzing the characteristics of the included tools, such as the design strategies, development approaches, and reported challenges, this study provides insights that may be useful for developers and implementers undertaking similar processes. The inclusion of both academic and gray literature (used to supplement missing information on tools already included) allowed for a more detailed description of the transition processes documented.

However, several limitations should be acknowledged. Many social health care tools may have undergone digital adaptation without formal publication, particularly those developed within routine clinical or community practice. As gray literature was not used to identify additional tools and was used only to supplement information on the included tools, relevant initiatives may not have been captured. In addition, the review was restricted to English-language sources, which may have resulted in the exclusion of tools developed in other linguistic or regional contexts. These limitations point to the need for more transparent and detailed reporting on the transition and implementation of digital health tools.

This scoping review highlights the importance of considering adaptability when transitioning social health care tools to digital formats, particularly in relation to different systems, resource settings, and user characteristics. Adapting tools to users’ needs, for example, by simplifying navigation, adjusting content presentation, or incorporating interactive elements, may support usability and engagement. The findings suggest that user-centered, iterative, and participatory approaches are commonly used during such transitions and may assist in identifying practical challenges during development and implementation. Continued attention to reporting design decisions and contextual factors will strengthen future research on digital transitions in social and health care settings.