Huey Yu Ng, Shamala Ramasamy, Saravanan Muthaiyah, Asnina Anandan, Seong Ting Chen, Thulasi Munohsamy, Gunasekar Thangarasu
Abstract
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.
Introduction
DHTs such as digital health platforms, patient portals, mobile health (mHealth) applications, electronic health records (EHRs) and appointment scheduling applications are increasingly recognised for their potential to help address pressing challenges in health systems worldwide. These DHTs provide broader access to health information, support self-health management and enhance communication among healthcare providers, patients and caregivers [1,2]. With rapid global uptake, digital health has become an essential strategy for the future of healthcare delivery. Patients increasingly generate large volumes of health data outside clinical settings, raising the need for secure and user-friendly integration [1,3].
Materials and methods
This systematic literature review examines factors influencing DHT adoption from conceptual, theoretical and multidisciplinary perspectives, highlighting technological, psychological, social, cultural, health-related and environmental factors that complement existing technology adoption models. The review was conducted in accordance with the PRISMA 2020 guidelines across the identification, screening, eligibility and synthesis stages [74]. The protocol was registered in PROSPERO (CRD420251056883; S1 Text) on 26 May 2025 [75].
Results
Study selection and screening
A total of 692 records were identified through database retrieval. After duplicate removal and screening of titles, abstracts and full texts, 82 studies met the inclusion criteria. The selection process and exclusion reasons are illustrated in Fig 1.
Study characteristics
A descriptive overview of the included studies is presented in Table 4, summarising their distribution by publication year, country or region, study population and methodological approach. The number of included studies increased over time, with a peak observed in 2024. Qualitative approaches were the most commonly employed methodology, followed by cross-sectional survey designs, while mixed methods, longitudinal studies, Delphi consensus techniques and policy analyses were less frequently reported
Discussion
This review synthesised multidisciplinary factors influencing DHT adoption and identified five higher-order synthesis themes. Five higher-order synthesis 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. Together, these findings demonstrate that DHT adoption is shaped by interacting individual-level, relational, and system-level determinants rather than isolated cognitive perceptions.
Conclusion
Acknowledgments
The author(s) express gratitude to the IMU University for its support, including access to technical resources and software platforms, and thanks to the staff of these platforms for their valuable assistance throughout the study.
Citation: Ng HY, Ramasamy S, Muthaiyah S, Anandan A, Chen ST, Munohsamy T, et al. (2026) Advancing foundational models in digital health technology adoption: A systematic literature review of multidisciplinary factors. PLOS Digit Health 5(9): e0001690. https://doi.org/10.1371/journal.pdig.0001690
Editor: Harry Hochheiser, University of Pittsburgh School of Medicine, UNITED STATES OF AMERICA
Received: October 3, 2025; Accepted: August 10, 2026; Published: September 2, 2026
Copyright: © 2026 Ng et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: No primary human datasets were generated or analysed in this study. All the raw data underlying the findings, including the data extraction tables and the details of quotations and codes used for thematic analysis, are provided as Supporting Information.
Funding: The author(s) received no specific funding for this work.
Competing interests: The authors declare that no competing interests exist.
