JMIR Publications

ABSTRACT

Background:

Digital health offers opportunities for safe, equitable, and accessible care, and its integration into respiratory care is a strategic priority for the European Respiratory Society. However, sustainable implementation remains complex, and guidance for healthcare systems is limited.

Objective:

Using respiratory care as an exemplar, we aimed to undertake a systematic scoping review of the published initiatives that have implemented digital respiratory technologies into real world routine clinical practice over the past decade, identify the technologies used, implementation strategies employed, the challenges and supports they encountered, and the lessons they reported for making care more equitable, strengthening patient-professional relationships, improving the patient journey, and reducing environmental impact.

Methods:

Following Arksey and O’Malley’s methodology, we searched ten databases (Dec 2013-2023 (updated April 2025 and February 2026)): MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Library, Web of Science, Scopus, IEEE Xplore, C ABI Global Health, and WHO Medicus; and used key domains in the commonly used implementation frameworks such as the Consolidated Framework for Implementation Research (CFIR), Nonadaptation, Abandonment, and Challenges to the Scale-up, Spread and Sustainability of Health and Care Technologies (NASSS), and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to categorise results and understand methodologies used. As a scoping review, we mapped the available evidence, rather than synthesising outcomes, appraising study quality, or estimating effectiveness. To broaden coverage and strengthen interpretation, we crowdsourced additional studies and sought feedback on our preliminary findings from a network of respiratory experts across 17 countries.

Results:

24,672 studies were identified; after de-duplication 14,811 were screened; 84 studies from 31 countries were included in the final review. The digital respiratory technologies comprised apps, platforms, chatbots and smart devices. Reported technological functionalities encompassed remote consultation, clinician monitoring, video Directly Observed Therapy (vDOT), remote rehabilitation training, self-management support, education, monitoring medication adherence and a school-based remote clinic. CFIR, RE-AIM and the Plan-Do-Study-Act (PDSA) cycle were the most widely used frameworks. Successful implementation used simple technologies that fitted existing workflows and avoided additional workload. Co-development and trust-building with end-users influenced motivation and adoption, while leadership, team cohesion, and communication facilitated success. Barriers included insufficient resources, poor interoperability, lack of funding/reimbursement, and limited technical support.

Conclusions:

This systematic scoping review provides an innovative, cross‑condition review of digital respiratory technologies implemented in routine clinical practice. Unlike previous disease‑specific or experimental‑focused reviews, it used established implementation frameworks to identify shared barriers and enablers across diverse populations and healthcare systems. We summarise key implementation domains in state-of-the-art digital respiratory care and identify major gaps related to health equity, patient–clinician trust, continuity of support across the patient journey, and reduction of environmental impacts for long-term sustainability. These findings offer practical guidance for scaling effective, patient‑centred digital respiratory care in real‑world settings.