Determinants of and barriers to adoption of digital therapeutics for mental health at scale in the NHS
Open accessAbstract
Objectives: Although it is widely acknowledged that digital therapeutics will play a significant role in the future delivery of healthcare, the method by which these innovations may be commissioned by the National Health Service, at scale, remains unclear. This study explores English health commissioners’ experiences of, and attitudes towards, adopting digital healthcare innovations. Methods: 37 commissioners and decision-makers from a range of sectors within the health profession were invited to participate in structured interviews to gather relevant examples of experience and opinions. 14 commissioners participated and the notes from the resulting interviews were interpreted using qualitative content analysis. Controlled interpretation was applied to the categorised responses, paraphrasing and classifying into themes. Results: Common determinants and barriers to adoption of digital mental health expressed during the interview process included commissioners’ lack of familiarity with technology, information governance, digital literacy of users and decision-makers. Conclusions: Recognition of identified barriers may be helpful for innovators when developing engagement and market access strategies and suggest areas for focus and further development within the commissioning process to accommodate digital health solutions.
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Research on digital mental health implementation [34] and digital health interventions through health systems [37] has shown that resource availability is a major barrier.
“Research on digital mental health implementation [34] and digital health interventions through health systems [37] has shown that resource availability is a major barrier.”
This procedural diligence is equally important when adapting the delivery style, for example, when PM+ is predominantly administered through web-based communication or when the length of treatment deviates from the originally specified 5 PM+ sessions [34].
“This procedural diligence is equally important when adapting the delivery style, for example, when PM+ is predominantly administered through web-based communication or when the length of treatment deviates from the originally specified 5 PM+ sessions [34].”
From A Digital Tool (Technology-Assisted Problem Management Plus) for Lay Health Workers to Address Common Mental Health Disorders: Co-production and Usability Study in Pakistan (2025) · cites this paper as [34]
The Phase one: evaluation and selection section says evidence of clinical effectiveness matters when selecting digital therapeutics, but it does not address procedural diligence when adapting an intervention. Searches for PM+, web-based delivery, and changes to a five-session treatment found no passage addressing those claims. (LLM, conf=0.72)
Experimental — accuracy not yet measuredEven changes to peripheral components of the intervention, such as instructional materials and illustrations, require the involvement of numerous experts in planning, translation, and cultural adaptation [34].
“Even changes to peripheral components of the intervention, such as instructional materials and illustrations, require the involvement of numerous experts in planning, translation, and cultural adaptation [34].”
From A Digital Tool (Technology-Assisted Problem Management Plus) for Lay Health Workers to Address Common Mental Health Disorders: Co-production and Usability Study in Pakistan (2025) · cites this paper as [34]
The Phase three: adoption and implementation passage mentions language difficulties as a potential barrier to adopting digital therapeutics, but does not discuss changing instructional materials or illustrations. Searches for translation, cultural adaptation, and expert involvement found no passage addressing the claimed requirements. (LLM, conf=0.76)
Experimental — accuracy not yet measuredThere is also a lack of sufficient evidence for their effectiveness and cost-effectiveness in primary care settings.
“There is also a lack of sufficient evidence for their effectiveness and cost-effectiveness in primary care settings.53”
From Digital health technologies and major depressive disorder (2023) · cites this paper as [53]
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Cites
Diffusion of Innovations in Service Organizations: Systematic Review and Recommendations
GREENHALGH, T., ROBERT, G., MACFARLANE, F., BATE, P., & KYRIAKIDOU, O. (2004) · The Milbank Quarterly · doi:10.1111/j.0887-378x.2004.00325.x · Cited by 7,448 · see citing works
Greenhalgh, T., Wherton, J., Papoutsi, C., Lynch, J., Hughes, G., A'Court, C., Hinder, S., Fahy, N., Procter, R., & Shaw, S. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.8775 · Cited by 2,887 · see citing works
The emerging field of mobile health
Steinhubl, S. R., Muse, E. D., & Topol, E. J. (2015) · Science Translational Medicine · doi:10.1126/scitranslmed.aaa3487 · Cited by 822 · see citing works
Freeman, D., Sheaves, B., Goodwin, G. M., Yu, L.-M., Nickless, A., Harrison, P. J., Emsley, R., Luik, A. I., Foster, R. G., Wadekar, V., et al. (2017) · The Lancet Psychiatry · doi:10.1016/s2215-0366(17)30328-0 · Cited by 652 · see citing works
Self-citationEspie, C. A., Kyle, S. D., Williams, C., Ong, J. C., Douglas, N. J., Hames, P., & Brown, J. S. L. (2012) · Sleep · doi:10.5665/sleep.1872 · Cited by 550 · see citing works
Self-citationEspie, C. A., Emsley, R., Kyle, S. D., Gordon, C., Drake, C. L., Siriwardena, A. N., Cape, J., Ong, J. C., Sheaves, B., Foster, R., et al. (2019) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2018.2745 · Cited by 466 · see citing works
Self-citationDifferences in mobile health app use: A source of new digital inequalities?
Bol, N., Helberger, N., & Weert, J. C. M. (2018) · The Information Society · doi:10.1080/01972243.2018.1438550 · Cited by 350 · see citing works
Cheng, P., Luik, A. I., Fellman-Couture, C., Peterson, E. L., Joseph, C. L. M., Tallent, G., Tran, K. M., Ahmedani, B. K., Roehrs, T., Roth, T. G., et al. (2018) · Psychological Medicine · doi:10.1017/s0033291718001113 · Cited by 183 · see citing works
Security Concerns in Android mHealth Apps.
He, D., Naveed, M., Gunter, C. A., & Nahrstedt, K. (2014) · PubMed Central · Cited by 101 · see citing works
Espie, C. A., Kyle, S. D., Miller, C. B., Ong, J. C., Hames, P., & Fleming, L. (2014) · Sleep Medicine · doi:10.1016/j.sleep.2014.03.001 · Cited by 88 · see citing works
Self-citationSleep to Lower Elevated Blood Pressure: A Randomized Controlled Trial (SLEPT)
McGrath, E. R., Espie, C. A., Power, A., Murphy, A. W., Newell, J., Kelly, C., Duffy, N., Gunning, P., Gibson, I., Bostock, S., et al. (2016) · American Journal of Hypertension · doi:10.1093/ajh/hpw132 · Cited by 88 · see citing works
Self-citationSleep and Productivity Benefits of Digital Cognitive Behavioral Therapy for Insomnia
Bostock, S., Luik, A. I., & Espie, C. A. (2016) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0000000000000778 · Cited by 84 · see citing works
Self-citationLuik, A. I., Bostock, S., Chisnall, L., Kyle, S. D., Lidbetter, N., Baldwin, N., & Espie, C. A. (2016) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465816000369 · Cited by 72 · see citing works
Self-citationPillai, V., Anderson, J. R., Cheng, P., Bazan, L. F., Bostock, S., Espie, C. A., Roth, T. G., & Drake, C. L. (2015) · PubMed · Cited by 44 · see citing works
Self-citationFreeman, D., Sheaves, B., Goodwin, G. M., Yu, L.-M., Harrison, P. J., Emsley, R., Bostock, S., Foster, R. G., Wadekar, V., Hinds, C., et al. (2015) · Trials · doi:10.1186/s13063-015-0756-4 · Cited by 35 · see citing works
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Flagged first, then by citations
Research works printed but not linked: 1
- NHS. Nhs APP library, 2019. Available: https://www. nhs. uk/ apps-library/ 12 Independent. Accelerated Access Review -Final Report 2016.
Cited by
Sorted by citations
Bell, I. H., Thompson, A., Valentine, L., Adams, S., Alvarez-Jimenez, M., & Nicholas, J. (2022) · JMIR Mental Health · doi:10.2196/30716 · Cited by 60 · see citing works
“Therefore, the level of clinician interest is a positive finding, as the field seeks to promote the adoption of technologies within care systems, traditionally a challenge partly because of staff resistance [42,43].”
BackgroundDigital health technologies and major depressive disorder
McIntyre, R. S., Greenleaf, W., Bulaj, G., Taylor, S. T., Mitsi, G., Saliu, D., Czysz, A., Silvesti, G., Garcia, M., & Jain, R. (2023) · CNS Spectrums · doi:10.1017/s1092852923002225 · Cited by 38 · see citing works
Brantnell, A., Temiz, S., Baraldi, E., Woodford, J., & von Essen, L. (2023) · JMIR Human Factors · doi:10.2196/44688 · Cited by 25 · see citing works
Saleem, M., Zafar, S., Klein, T., Koesters, M., Bashir, A., Fuhr, D. C., Sikander, S., & Zeeb, H. (2025) · JMIR Formative Research · doi:10.2196/59414 · Cited by 5 · see citing works
“This procedural diligence is equally important when adapting the delivery style, for example, when PM+ is predominantly administered through web-based communication or when the length of treatment deviates from the originally specified 5 PM+ sessions [34].”
- Authors
- Williams, M. G., Stott, R., Bromwich, N., Oblak, S. K., Espie, C. A., & Rose, J. B.
- Affiliations
- Oxford Academic Health Science Network (GB)
- King's College London (GB)
- University of Oxford (GB)
- Corresponding author
- Williams, Matt G
- Venue
- BMJ Innovations
- Publisher
- BMJ
- Published
- 2020-05-07
- Volume
- 6
- Issue
- 3
- Pages
- 92-98
- ISSN
- 2055-642X (ISSN-L)
- 2055-8074
- OpenAlex
- W3022649855
- Cited by
- 42
- References
- 15
- Citations by year
- 2026: 6 · 2025: 10 · 2024: 6 · 2023: 7 · 2022: 8 · 2021: 5
- FWCI
- 4.52
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ Innovations (publishedVersion)
- Research Portal (King's College London) (submittedVersion, other-oa)
- Funders
- Innovate UK (DHTC 3542)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Health Professions › Health Information Management › Health, Technology, Consumer Behavior
- Keywords
- digital therapeutics, digital mental health, health service commissioning, National Health Service, barriers to adoption, adoption factors, health commissioner, digital literacy, information governance, technology adoption, market access strategy
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