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      Mapping Factors That Affect the Uptake of Digital Therapeutics Within Health Systems: Scoping Review

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          Abstract

          Background

          Digital therapeutics are patient-facing digital health interventions that can significantly alter the health care landscape. Despite digital therapeutics being used to successfully treat a range of conditions, their uptake in health systems remains limited. Understanding the full spectrum of uptake factors is essential to identify ways in which policy makers and providers can facilitate the adoption of effective digital therapeutics within a health system, as well as the steps developers can take to assist in the deployment of products.

          Objective

          In this review, we aimed to map the most frequently discussed factors that determine the integration of digital therapeutics into health systems and practical use of digital therapeutics by patients and professionals.

          Methods

          A scoping review was conducted in MEDLINE, Web of Science, Cochrane Database of Systematic Reviews, and Google Scholar. Relevant data were extracted and synthesized using a thematic analysis.

          Results

          We identified 35,541 academic and 221 gray literature reports, with 244 (0.69%) included in the review, covering 35 countries. Overall, 85 factors that can impact the uptake of digital therapeutics were extracted and pooled into 5 categories: policy and system, patient characteristics, properties of digital therapeutics, characteristics of health professionals, and outcomes. The need for a regulatory framework for digital therapeutics was the most stated factor at the policy level. Demographic characteristics formed the most iterated patient-related factor, whereas digital literacy was considered the most important factor for health professionals. Among the properties of digital therapeutics, their interoperability across the broader health system was most emphasized. Finally, the ability to expand access to health care was the most frequently stated outcome measure.

          Conclusions

          The map of factors developed in this review offers a multistakeholder approach to recognizing the uptake factors of digital therapeutics in the health care pathway and provides an analytical tool for policy makers to assess their health system’s readiness for digital therapeutics.

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          Most cited references286

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          PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation

          Scoping reviews, a type of knowledge synthesis, follow a systematic approach to map evidence on a topic and identify main concepts, theories, sources, and knowledge gaps. Although more scoping reviews are being done, their methodological and reporting quality need improvement. This document presents the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist and explanation. The checklist was developed by a 24-member expert panel and 2 research leads following published guidance from the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network. The final checklist contains 20 essential reporting items and 2 optional items. The authors provide a rationale and an example of good reporting for each item. The intent of the PRISMA-ScR is to help readers (including researchers, publishers, commissioners, policymakers, health care providers, guideline developers, and patients or consumers) develop a greater understanding of relevant terminology, core concepts, and key items to report for scoping reviews.
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            The Measurement of Observer Agreement for Categorical Data

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              Scoping studies: towards a methodological framework

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                Author and article information

                Contributors
                Journal
                J Med Internet Res
                J Med Internet Res
                JMIR
                Journal of Medical Internet Research
                JMIR Publications (Toronto, Canada )
                1439-4456
                1438-8871
                2023
                25 July 2023
                : 25
                : e48000
                Affiliations
                [1 ] LSE Health Department of Health Policy London School of Economics and Political Science London United Kingdom
                [2 ] Department of International Health Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences Maastricht University Maastricht Netherlands
                [3 ] Department of Psychiatry University of Cambridge Cambridge United Kingdom
                [4 ] Department of Psychiatry and Behavioral Sciences Stanford University Stanford, CA United States
                [5 ] Department of Health Services Research and Policy London School of Hygiene and Tropical Medicine London United Kingdom
                [6 ] Duke Clinical Research Institute Duke University School of Medicine Durham, NC United States
                [7 ] Department of Health Services Research Care and Public Health Research Institute, Faculty of Health Medicine and Life Science Maastricht University Maastricht Netherlands
                [8 ] Institute of Global Health Innovation Imperial College London London United Kingdom
                Author notes
                Corresponding Author: Elias Mossialos e.a.mossialos@ 123456lse.ac.uk
                Author information
                https://orcid.org/0000-0001-6309-6343
                https://orcid.org/0000-0002-2405-9432
                https://orcid.org/0000-0002-8454-4640
                https://orcid.org/0000-0002-3932-8228
                https://orcid.org/0009-0003-9901-9069
                https://orcid.org/0009-0001-1198-7889
                https://orcid.org/0000-0002-7654-4464
                https://orcid.org/0000-0002-6082-8446
                https://orcid.org/0000-0001-6544-3636
                https://orcid.org/0000-0001-8664-9297
                Article
                v25i1e48000
                10.2196/48000
                10410406
                37490322
                a1231d66-09bf-4d2e-b805-677d3f2d4ec8
                ©Robin van Kessel, Andres Roman-Urrestarazu, Michael Anderson, Ilias Kyriopoulos, Samantha Field, Giovanni Monti, Shelby D Reed, Milena Pavlova, George Wharton, Elias Mossialos. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 25.07.2023.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.

                History
                : 7 April 2023
                : 23 May 2023
                : 31 May 2023
                : 16 June 2023
                Categories
                Review
                Review

                Medicine
                digital health,uptake,implementation,adoption,framework,digital therapeutics,scoping review,thematic analysis,digital medicine,policy

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