Advancing foundational models in digital health technology adoption: A systematic literature review of...

Digital health technologies (DHTs) such as patient portals, mobile applications, and electronic health records can improve access to healthcare, self-management and care coordination. However, their adoption remains inconsistent. This study systematically reviews the technological, psychological, social, cultural, health-related and environmental factors influencing DHT adoption. This protocol-registered review (PROSPERO: CRD420251056883) was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines. A search of multidisciplinary databases was conducted through the EBSCO Discovery Service (EDS) to identify peer-reviewed English primary studies published between 2015 and 18 June 2025. Although studies published from 2015 onward were searched, only studies published from 2020 onward were retained for synthesis. Two researchers independently applied the Sample, Phenomenon of Interest, Design, Evaluation, Research type (SPIDER) framework to screen articles and extract data. As Covidence operationalises screening using the Population, Intervention, Comparison, Outcome, Study type (PICOS) framework, SPIDER elements were mapped to PICOS to ensure consistency across screening and extraction. Methodological quality was appraised using the Mixed Methods Appraisal Tool (MMAT) to inform interpretation. Data were synthesised using a structured thematic analysis workflow informed by the Thematic Analysis Matrix proposed by Zairul, which operationalises the thematic analysis principles described by Braun and Clarke. Coding, category development and theme generation were managed using ATLAS.ti (Version 24). Eighty-two studies published between 2020 and 2025 met the inclusion criteria. Five themes were identified: (1) access, equity and affordability; (2) usability, engagement and user empowerment; (3) trust, privacy and governance; (4) integration, workforce and sustainability; and (5) clinical effectiveness and quality of care. The findings showed that adoption of DHTs is a multi-layered process shaped by multidisciplinary factors. This review provides researchers, policymakers and healthcare providers with theoretical and practical insights to support sustainable, effective and equitable DHT adoption and to guide the development of future strategies.