The Determinants of Digital Health Immunization Technology; A Systematic Review

Abstract

Digital health technologies have become central to modern immunization systems, replacing paper-based processes with electronic registries, mobile health applications, interoperable platforms, and digital decision-support tools. While these innovations promise improvements in vaccination coverage, data quality, and program efficiency, their adoption and effectiveness vary widely across health system contexts. Fragmented evidence, diverse technologies, and inconsistent outcomes have made it difficult to understand what truly enables or constrains successful digital immunization implementation. This study therefore aimed to systematically identify and synthesize the key determinants of digital health immunization technology across global settings. A systematic review was conducted following PRISMA 2020 guidelines, drawing on multiple academic databases and applying clear inclusion and exclusion criteria to select empirical studies relevant to digital immunization systems. Thirty peer-reviewed studies were analysed using thematic synthesis to categorize determinants into technological, behavioural, organizational, and contextual domains. The findings reveal that electronic immunization registries, community-based mHealth tools, system interoperability, workforce capacity, governance structures, and digital infrastructure are the most influential determinants of performance. Positive outcomes were most consistently observed in vaccination coverage, timeliness, data reliability, and workflow efficiency, particularly when digital tools were embedded within well-coordinated health systems. The review concludes that digital immunization technologies are most effective when technological innovation is accompanied by strong leadership, sustained investment, user-cantered design, and supportive policy environments, rather than being implemented as isolated technical solutions