JMIR Publications

ABSTRACT

Background:

Increasing reliance on digital health interventions (DHIs) may inadvertently deepen some health inequalities, as access to digital technologies and online services remains unequal across populations. Public libraries offer wider access and support to digital technology and are frequently used to support health in the community, particularly for underserved populations. Hence, public libraries are ideally positioned to improve access to DHIs, mitigating the inequalities resulting from the increasing digitalization of health care. Despite this potential, systematic ways of optimizing DHI implementation in public libraries remain under-explored.

Objective:

This study addressed two research questions: 1) What are the barriers and facilitators to implementing DHIs in public libraries in the published literature? 2) How can the behaviour change wheel (BCW) approach be applied to systematically develop recommendations to optimize the implementation of DHIs in public libraries?

Methods:

1) Verbatim barriers and facilitators from a scoping review were synthesized into barrier/facilitator themes and organized into 3 levels: the system, organizational and individual levels of influence. 2) A multi-level BCW analysis was conducted on selected synthesized barrier/facilitator themes to develop actionable recommendations for implementation at the system, organizational and individual levels. The analysis was iteratively refined with input from behavior change experts.

Results:

1) Synthesized barriers/facilitators themes (n = 15) were highly varied. System-level barrier/facilitator themes (n = 4) primarily related to structural challenges, including financial constraints and the availability of essential IT components for implementation of DHIs; organizational-level barrier/facilitator themes (n = 7) centered implementation challenges within the library including staff workload, skills and confidence, and private space; individual-level barrier/facilitator themes (n = 4) related to library staff perceptions and beliefs, including concerns around, and motivations for, supporting access to DHIs in libraries. 2) Recommendations from the BCW (n = 26), were organized into recommendation themes (n = 11). System-level recommendation themes included promoting libraries as trustworthy public-serving spaces. Organizational-level recommendation themes included introducing implementation champions, providing minimal, tailored staff training, and employing practical strategies to reduce workload burden. Individual-level recommendation themes included communicating to library staff their expected role of facilitating technological access to DHIs, and the benefits offered by library–based DHI delivery.

Conclusions:

This study is the first to synthesize barriers and facilitators to the implementation of DHIs in public libraries, and to offer evidence-based and theory-informed recommendations optimizing implementation. By advancing the literature beyond description of implementation to offering actionable and practical recommendations, this study lays the groundwork for future implementation efforts, tailored to local contexts. This paper therefore represents a practical roadmap for positioning public libraries as a crucial avenue to advance digital health equity amidst the increasing digitalization of health care intervention delivery.