Barriers and facilitators to digital health tool adoption for hypertension management: systematic review of qualitative studies
Clinical Snapshot
PICO Framework
| P — Population | Patients with hypertension, healthcare providers, and caregivers using digital health interventions |
| I — Intervention | Digital health interventions (DHIs) for hypertension self-management |
| C — Comparator | Not applicable (qualitative synthesis) |
| O — Outcomes | Barriers and facilitators to adoption, acceptance, and engagement with digital health tools |
Bottom Line
This systematic review provides valuable insights into the complex factors influencing digital health tool adoption for hypertension management. The synthesis of 15 qualitative studies reveals that successful implementation depends on multiple interconnected factors including usability, cultural relevance, trust, and social support. For Australian clinicians, these findings are particularly relevant given the expansion of Medicare telehealth services and increasing availability of TGA-approved digital health devices. The identification of seven key analytical themes offers a practical framework for selecting and implementing digital hypertension management tools. Healthcare providers should consider patient technology literacy, cultural background, and support systems when recommending digital health interventions. The research highlights the importance of involving patients, caregivers, and healthcare providers in the design and implementation process. While the evidence is compelling, clinicians should note the study's limitation to English-language research and consider local cultural factors when applying these findings to diverse Australian patient populations.
Key Findings
P Value: Not applicable for qualitative synthesis
Effect Size: Not applicable for qualitative synthesis
Primary Outcome: Seven analytical and 22 descriptive themes identifying barriers and facilitators to DHI adoption
Nnt Or Sensitivity: Thematic saturation achieved across technology utilisation, design components, cultural relevance, healthcare factors, trust, and interpersonal interactions
Confidence Interval: Not applicable for qualitative synthesis
Clinical Application
High feasibility - findings directly applicable to Australian digital health initiatives and telehealth programs Highly relevant to Australian Digital Health Strategy, Medicare telehealth items, and RACGP digital health guidelines. Insights support PBS-funded digital therapeutics implementation and TGA-approved digital health devices adoption Australian patients with hypertension, healthcare providers implementing digital health solutions, and health system administrators
Abstract
OBJECTIVES: Digital health interventions (DHIs) show considerable promise in supporting hypertension self-management by promoting preventative care and self-monitoring. While their efficacy is increasingly evident, the long-term uptake, acceptance and sustained engagement with these tools are frequently challenged by issues such as usability, trust and varying user experiences. This review aims to synthesise qualitative evidence to identify barriers and facilitators and the key factors that impact the adoption, acceptance and engagement with DHIs for hypertension self-management. DESIGN: Systematic review of qualitative literature using thematic analysis following Cochrane's qualitative and implementation methods guidance. DATA SOURCES: PubMed, PsycInfo, Web of Science and the Cochrane Library were searched in February 2025. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: The searches included relevant qualitative and mixed-methods studies on the use of digital devices for hypertension management, which described the barriers and facilitators associated with these tools. We included studies published from 2015 to 2025 to capture relevant evidence. Only studies published in English with a qualitative approach were included. RESULTS: From an initial 10 943 identified publications, 15 met our inclusion criteria, primarily originating from Europe and the USA, exploring diverse racial and ethnic group experiences. Our thematic synthesis revealed 7 analytical and 22 descriptive themes detailing barriers and facilitators encountered by patients with hypertension, healthcare providers (HCPs) and caregivers. These themes covered technology utilisation, design components, linguistic and cultural relevance, healthcare factors, trust and credibility and interpersonal interactions. CONCLUSION: Our analysis underscores that factors such as the usability, design and relevance of social support profoundly influence the uptake and acceptance of DHIs in hypertension self-management among patients, caregivers and HCPs. PROSPERO REGISTRATION NUMBER: CRD42023480389.
References
- 1.Motta-Yanac, E., Riley, V., Ellis, N. J., Mankoo, A., & Gidlow, C. J. (2026). Barriers and facilitators to digital health tool adoption for hypertension management: systematic review of qualitative studies. BMJ Open, 16(6), e116004. https://doi.org/10.1136/bmjopen-2025-116004
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