Adapted systematic review of implementation science strategies applied to digital health interventions (DHIs) in low middle income countries (LMICs): Impact on adoption and utilisation

Background Post the COVID-19 pandemic and with rising connectivity, digital health Interventions (DHIs) are being leveraged by innovators in Low middle-income countries (LMICs), to address healthcare challenges. Despite huge investments, interventions are poorly utilised due to health systems complexities, limited digital readiness and socioeconomic factors. Evolving evidence suggests that implementation science strategies can play a significant role in reducing the complexities within the sociotechnical domains. This study aims to understand how implementation science strategies are being applied to patient-focused DHIs in LMICs, its impact on adoption and utilisation. Methods A triangulated search was conducted on five electronic databases using a pretested strategy. A heterogeneous range of study types on patient-focused DHIs was included to capture different research methodologies used to describe implementation. The screening was done by two reviewers using inclusion/exclusion criteria registered on PROSPERO. Quality was accessed using the JBI appraisal tool for case studies, the CASP quality assessment tool for systematic reviews and qualitative studies, and the ROBIN-I tool for quasi-experimental studies. Synthesis was by Popay et al's guidance on narrative synthesis. Results Eleven studies from eight countries met the inclusion criteria. Through the lens of the NASSS framework and the ERIC clusters, forty-five implementation science strategies out of seventy-three were identified of which only twenty-seven percent of included studies applied more than fifty percent of the identified strategies. Conclusions The trend revealed that DHIs with higher and strategic application patterns tackled more sociotechnical system complexities and experienced better adoption/ utilisation. For the basics, we identified four heavy weight favorability factors that should be considered when choosing implementation strategies in this context. Large scale randomised interventional studies are however recommended to further measure impact. PROSPERO Registration number: CRD42023388786