Navigating the complexities of digital health technology implementation: a scoping review of barriers and...

The implementation of digital health technologies (DHTs) is a strategic priority for many health systems, yet integrating them into routine clinical use remains challenging. While numerous studies explore DHT adoption, few provide a comprehensive perspective across technologies and stakeholder groups. This review synthesises the most prevalent barriers and facilitators to DHT implementation in high-income healthcare settings.

A scoping review was conducted following Joanna Briggs Institute and PRISMA-ScR guidelines. Publications from 2019 to 2024 reporting barriers or facilitators to DHT implementation in upper-middle and high-income countries were identified through systematic searches in PubMed and Scopus. An inductive approach guided iterative coding and thematic categorisation. Findings were synthesised based on frequency, overlap, and variation across technologies and stakeholder groups.

From 15,327 unique records screened, 238 publications were included. In total, 2538 barriers and 1433 facilitators were identified, grouped into three overarching dimensions: human and social dynamics, organisational structure and management, and infrastructure and data security. Human and social factors such as resistance to change, scepticism, and limited digital literacy were the most frequently reported across the majority of technologies and stakeholder groups. Organisational barriers, including funding constraints, workflow misalignment, and limited leadership engagement, along with infrastructure-related challenges such as poor usability, data privacy concerns, and interoperability issues, were also substantial but were comparatively less frequent. Patterns varied by technology type (e.g., telehealth, mobile health apps, AI tools) and stakeholder group (e.g., healthcare professionals, health system managers, users of health services), highlighting the complex, context-dependent nature of DHT implementation.

Successful DHT implementation demands more than technical readiness. It requires organisational leadership, robust infrastructure, and system-wide alignment. While human and social dynamics remain central, leadership, resource allocation, and robust infrastructures are equally critical. Current evidence often underemphasises structural barriers such as governance gaps, misaligned incentives, and technical limitations. Sustainable digital transformation requires a balanced approach combining top-down strategic guidance for regulatory clarity with bottom-up engagement to foster cultural change. Future research should operationalise governance strategies, leadership practices, and monitoring indicators that support long-term digital health integration.

A prospective protocol was uploaded to the Open Science Framework: https://osf.io/vr7d9/ ( https://doi.org/10.17605/OSF.IO/VR7D9 ).