Understanding and overcoming barriers to digital health adoption: a patient and public involvement study.

Background: Digital health (DH) technologies provide scalable and cost-effective solutions to improve population health but face challenges of uneven adoption and high attrition, particularly among vulnerable and minority groups.

Purpose: This study explores factors influencing DH adoption in a multicultural population and identifies strategies to improve equitable access.

Methods: Using a Patient and Public Involvement approach, lay facilitators engaged adults at public eateries in Singapore to discuss motivations and barriers to DH adoption. A semi-structured guide facilitated discussions, followed by an optional socio-demographic survey. Data were analyzed through inductive thematic analysis and mapped to behavior change theory to identify mechanisms of action (MoA) and behavior change techniques (BCTs) to support adoption.

Results: Facilitators engaged 118 participants between November 2022 and February 2023. Five key themes were identified from the discussions: (a) awareness of DH solutions, (b) weighing benefits against burdens, (c) accessibility, (d) trust in DH developers and technology, and (e) the impact of user experience. These themes were mapped to 13 MoA and 26 BCTs, informing five key strategies to enhance DH adoption: community-based promotion of credible DH solutions and digital literacy training, brief counselling at opportune moments in healthcare settings, variable rewards tied to personal values, policies ensuring accessibility and regulation, and gamified, user-friendly designs emphasizing feedback and behavioral cues.

Conclusion: Designing and implementing DH solutions that are accessible, trustworthy, and motivating-integrated within healthcare services and promoted through community efforts-can address barriers to adoption by diverse communities and may help to narrow the digital divide.