Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: May 12, 2025
Date Accepted: Aug 20, 2025
Understanding Adherence to Digital Health Technologies: A Systematic Review of Predictive Factors
ABSTRACT
Background:
Digital health technologies (DHTs) are transformative solutions for healthcare challenges, yet sustaining long-term adherence remains a significant barrier, limiting their effectiveness.
Objective:
This systematic review aims to identify and categorise factors influencing adherence to DHTs, and to identify theories, models, frameworks, and tools used to predict it.
Methods:
This review was conducted according to the PICO strategy and following Cochrane and PRISMA guidelines. Four databases (PubMed, PsycINFO, Scopus, and IEEE Xplore) were searched for articles published in the last five years. After applying inclusion and exclusion criteria, 61 studies were included. Factors influencing adherence were extracted, analysed and categorised.
Results:
The findings highlight a complex and multifaceted range of factors influencing adherence, which were categorised into four key domains: personal factors (sociodemographic characteristics, health status, user characteristics and personal beliefs and perceptions), technology and intervention content factors (infrastructure and accessibility, user experience and performance, and content and features of the intervention), social and support system factors (family and informal support and healthcare professional support) and contextual factors. Among the theories, models and frameworks identified, the UTAUT emerged as the most frequently applied.
Conclusions:
The findings highlight the need for integrative, health-specific models that combine behavioural, technological, and clinical aspects. Future research should focus on developing standardised adherence metrics and exploring the interactions between these factors to improve predictive models. Clinical Trial: PROSPERO: CRD42024628168
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