The Determinants of Digital Health Implementation: A Systematic Review

Abstract

This systematic review identifies and synthesises determinants that shape the implementation of digital health technologies across clinical, organisational, and health-system settings. A PRISMA-informed evidence reconstruction was conducted using a publicly archived corpus derived from documented PubMed/MEDLINE and Scopus searches and supplementary citation tracking. The present review independently re-screened the corpus, restricted inclusion to primary empirical reports published within the 2015-2025 window and included 64 studies for MMAT-informed appraisal and narrative synthesis. Fourteen recurrent determinants were coded: acceptance, digital skills, perceived value, workflow fit, leadership, organisational readiness, training, financing, governance, usability, interoperability, infrastructure, privacy and security, and equity and access. Acceptance was examined in 56 studies, infrastructure in 46, equity and access in 44, digital skills in 43, perceived value in 41, workflow fit and financing in 37 each, governance in 35, training in 30, privacy and security in 27, leadership in 25, usability in 23, organisational readiness in 14, and interoperability in nine. The evidence indicates that implementation is rarely shaped by a single factor. Sustainable integration depends on alignment among user confidence, clinical usefulness, workflow compatibility, leadership, resourcing, regulation, secure and interoperable infrastructure, and equitable access. The synthesis distinguishes frequency of examination from evidential weight and identifies priorities for longitudinal, multilevel, implementation-stage-specific, and comparative research.