BACKGROUND: Non-communicable diseases (NCDs) represent a leading cause of global mortality, demanding innovative approaches to management. Voice assistants (VAs) have emerged as promising tools in healthcare, offering support for self-management, behavioral engagement, and patient care. This systematic review evaluates the role of VAs in NCD management, analyzing their impact on clinical and behavioral outcomes, quality of life, usability, and user experiences while identifying barriers to their adoption. METHODS: A systematic search was conducted in PubMed, Scopus, and Web of Science from January 2014 to October 2024. Studies were selected based on predefined inclusion and exclusion criteria using the PRISMA guidelines. Data extraction focused on outcomes such as usability, acceptability, adherence, clinical metrics, and quality of life. The risk of bias was assessed using the Cochrane Risk of Bias (RoB) 2 and ROBINS-I tools. RESULTS: Eight studies involving 541 participants were included, examining VAs across various NCD contexts such as diabetes, cardiovascular diseases, and mental health. While VAs demonstrated good usability and moderate adherence, their clinical and quality-of-life outcomes were modest. Behavioral improvements, such as increased physical activity and problem-solving skills, were noted in some interventions. Key challenges included privacy concerns, speech recognition errors, and accessibility issues. CONCLUSIONS: VAs show potential as supportive tools in NCD management, especially for enhancing patient engagement and self-management, and their impact on clinical outcomes and long-term usability requires further investigation. Future research should focus on diverse populations, standardized metrics, and comparative studies with alternative technologies.