key: cord-0032004-gpabnuzl
authors: Jacob, Christine; Sezgin, Emre; Sanchez-Vazquez, Antonio; Ivory, Chris
title: Sociotechnical Factors Affecting Patients’ Adoption of Mobile Health Tools: Systematic Literature Review and Narrative Synthesis
date: 2022-05-05
journal: JMIR Mhealth Uhealth
DOI: 10.2196/36284
sha: ea6d3a6bd30fcc2d74d0327fcc360afbada4fc75
doc_id: 32004
cord_uid: gpabnuzl

BACKGROUND: Mobile health (mHealth) tools have emerged as a promising health care technology that may contribute to cost savings, better access to care, and enhanced clinical outcomes; however, it is important to ensure their acceptance and adoption to harness this potential. Patient adoption has been recognized as a key challenge that requires further exploration. OBJECTIVE: The aim of this review was to systematically investigate the literature to understand the factors affecting patients’ adoption of mHealth tools by considering sociotechnical factors (from technical, social, and health perspectives). METHODS: A structured search was completed following the participants, intervention, comparators, and outcomes framework. We searched the MEDLINE, PubMed, Cochrane Library, and SAGE databases for studies published between January 2011 and July 2021 in the English language, yielding 5873 results, of which 147 studies met the inclusion criteria. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and the Cochrane Handbook were followed to ensure a systematic process. Extracted data were analyzed using NVivo (QSR International), with thematic analysis and narrative synthesis of emergent themes. RESULTS: The technical factors affecting patients’ adoption of mHealth tools were categorized into six key themes, which in turn were divided into 20 subthemes: usefulness, ease of use, data-related, monetary factors, technical issues, and user experience. Health-related factors were categorized into six key themes: the disease or health condition, the care team’s role, health consciousness and literacy, health behavior, relation to other therapies, integration into patient journey, and the patients’ insurance status. Social and personal factors were divided into three key clusters: demographic factors, personal characteristics, and social and cultural aspects; these were divided into 19 subthemes, highlighting the importance of considering these factors when addressing potential barriers to mHealth adoption and how to overcome them. CONCLUSIONS: This review builds on the growing body of research that investigates patients’ adoption of mHealth services and highlights the complexity of the factors affecting adoption, including personal, social, technical, organizational, and health care aspects. We recommend a more patient-centered approach by ensuring the tools’ fit into the overall patient journey and treatment plan, emphasizing inclusive design, and warranting comprehensive patient education and support. Moreover, empowering and mobilizing clinicians and care teams, addressing ethical data management issues, and focusing on health care policies may facilitate adoption.

; mixed results [35, 49, 69, 77, 94, 95, 125] ; not a factor [36, 40, 45, 50, 53, 62, 68, 73, [89] [90] [91] Education (34) Lower level of education a barrier [35, [42] [43] [44] 46, 49, 55, 57, 64, 65, 72, 84, [89] [90] [91] [92] [93] [96] [97] [98] 125] ; facilitator [45, 88, 99] ; mixed results [39, 41, 51, 56, 78, 82, 83, 95] ; not a factor

[68]

Tech skills (30) Lack of tech skills a barrier [43, 52, 61, 62, 69, 72, 74, 77, 79, 80, 88, [100] [101] [102] [103] [104] [105] 108, 113, 114, 127, 131, 132, 172] 

Attitudes / preferences (29) [36, 37, 41, 43, 45, 55, 56, 58, 60, 62, 69, 77, 83, 87, [101] [102] [103] 114, 115, 119, [127] [128] [129] [130] [131] [132] [133] [134] [135] Psychological factors (17) [67, 69, 73, 79, 80, 85, 101, 107, 112, 115, 118, [136] [137] [138] [139] [140] 178] Time constraint / distraction (16) [55, 69, 80, 91, 100, 110, 112, 115, 116, 118, 120, 132, 137, 138, 140, 14 1]

Motivation (12) [100, 101, 107, 114, 130, 140, [142] [143] [144] [145] [146] [147] Locus of control / self-efficacy (7) [ 80, 110, 140, 143, 167, 178, 180] Awareness (6) [58, 60, 78, 102, 127, 135] Habits (5) [57, 70, 110, 140, 142] 

Social influence (30) [36,57,67,70,78,81,95,102,104,107,108,110,113,115,118,128,1 29,131,132,140,142,149-157] Language (8) [44, 61, 78, 106, 110, [158] [159] [160] Culture (4) [95, 118, 121, 155] 

Early detection of symptoms

Life quality and well-being

Technical Factors Technical issues (43) Technical failure or difficulties

Monetary Factors (35) Monetary and cost aspects a barrier

Data related Privacy and security (51) Privacy and security a barrier

Appendix 5.B. Technical and material factors and their occurrence. Factors (n) Appendix 5.C. Health related factors and their occurrence.

Worse condition as a barrier (21) [52, 57, [64] [65] [66] 68, 73, 76, 80, 104, 107, 112, 114, 115, 117, 119, 121, 148, 159, 161, 171] Worse condition as a facilitator (11) [39, 41, 49, 55, 79, 83, 89, 98, 132, 138, 177] Disease type as a factor (7) 

Facilitator (14) [59, 60, 70, 78, 81, 85, 93, 97, 132, 134, 136, 143, 164, 180] Barrier (8) [44, 62, 80, 101, 107, 118, 154, 169] Mixed results (4) [72, 125, 142, 175] Health consciousness and literacy (17) [40, 49, 51, 65, 72, 73, 81, 86, 93, 98, 107, 110, 121, 134, 142, 156, 159] Relation to other therapies (15) [52, 54, 57, 80, 85, 96, 98, 100, 102, [112] [113] [114] 141, 162, 179] Health behavior (7) [41, 48, 49, 67, 75, 98, 106] Insurance status (5) [37, 71, 82, 90, 126]