Patients' perspectives on digital health tools

Healthcare systems face increasing strain due to an ageing population and shortages of clinical specialists, creating an imbalance between demand and service capacity. Digital technologies (e.g., smart devices, wearables, AI-enabled tools) are transforming access to and delivery of care, enabling remote monitoring and online consultations while aiming to enhance patient empowerment and engagement. Despite this, many solutions have been designed from a technical perspective with limited early involvement of patients, leading to low uptake and acceptance. There is a growing shift toward involving clinicians and industry in development, yet a gap remains in integrating patients' voices throughout design. Participatory design—actively involving end users (patients and clinicians)—has been proposed to increase relevance, usability, and sustained use, as shown in examples where co-design revealed differing needs of patients and clinicians. This review aims to integrate available knowledge on patients' perspectives of digital health tools and identify facilitators and barriers to their uptake, extract trends, identify gaps, and suggest future directions.

Prior literature emphasizes involving patients early in the development of digital health tools through participatory design to enhance acceptance and alignment with user needs. Studies indicate patient portals and mHealth can foster empowerment by supporting shared decision-making, data access, and visualization of health metrics. However, mismatches between patient and clinician expectations (e.g., symptom tracking content) can hinder adoption, underscoring the need to balance perspectives. Research reports varied patient views and criteria across contexts, with calls for co-creation approaches to address usability, relevance, and sustained engagement.

A critical (narrative) review was conducted to aggregate and critically analyze literature and provide new interpretations. Searches covered English-language articles published from January 2010 to November 2021 in Scopus and Google Scholar using Boolean combinations of keywords such as patient, perspective, technology, telemedicine, patient engagement, and eHealth. Reference lists of included articles were also screened. Inclusion criteria focused on studies of digital health tools that included patient perspectives across geographies. From 1722 potentially relevant articles, title/abstract screening reduced the set to 319; full-text review yielded 71 articles for analysis. Data analysis was iterative, employing thematic analysis to identify and code patterns across studies, followed by qualitative content analysis to interpret and present findings.

• Study selection: 1722 records identified; 319 screened in by title/abstract; 71 included after full-text review (2010–2021, English).
• Facilitators of uptake: Patient empowerment (greater control, informed decision-making, improved patient–provider collaboration), self-management (enhanced understanding via data access/visualization, increased motivation, autonomy), and personalisation (tailored communication, interfaces, and services aligned to patient needs/preferences).
• Barriers to uptake: Digital literacy (especially older adults; fears of technology use and complexity), health literacy (difficulty understanding clinical information and test results; potential anxiety), and privacy concerns (fear of data misuse/discrimination by third parties; variable tolerance to privacy–personalization trade-offs).
• Additional insights: Patients value integrated portals aggregating records across providers; timely two-way communication is important but may increase clinician workload; personalization in messaging increases engagement; some users may discontinue use over time; participatory co-design with patients and clinicians is recommended to align tools with user needs and contexts.

The review addresses the research aim by synthesizing patients' reported facilitators and barriers to digital health tool uptake. Empowerment, self-management, and personalized experiences can shift care from paternalistic to patient-centered models, strengthening patient–provider collaboration and engagement. However, practical tensions emerge: managing multiple portals for multimorbidity, the desire to retain human contact alongside digital interactions, and potential increases in clinician workload from portal communications. Barriers such as limited digital and health literacy and privacy concerns can undermine engagement; evidence suggests these can be mitigated through support, education, thoughtful information design, and trust-building personalization. The literature also indicates waning motivation over time and limited exploration of why engagement drops, highlighting the need for deeper qualitative inquiry. Overall, aligning development with patients' lived experiences through participatory design can reduce the disconnect between technology creation and real-world patient use.

This review integrates current knowledge on patients' perspectives of digital health tools and identifies six themes grouped as facilitators (empowerment, self-management, personalization) and barriers (digital literacy, health literacy, privacy). To enhance uptake and sustained engagement, future research and development should employ participatory design methods that involve patients alongside clinicians and technologists to co-create patient-centered digital solutions.

The review synthesizes studies published in English between 2010 and 2021 identified via Scopus and Google Scholar, which may limit comprehensiveness. Many included studies did not explore in depth the reasons for declining motivation and continued engagement barriers, constraining the ability to draw firm conclusions about long-term use. Reported barriers and facilitators varied across contexts and populations, contributing to heterogeneity in findings.