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Cited by 114Mobile Health and mHealth ApplicationsHealth, Technology, Consumer BehaviorDigital Mental Health Interventions

The Challenges Toward Real-world Implementation of Digital Health Design Approaches: Narrative Review

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Duffy, Anthony, Christie, Gregory J, Moreno, Sylvain·2022·JMIR Human Factors
DOI 10.2196/35693PMC PMC9508664
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Abstract

Background: Digital health represents an important strategy in the future of health care delivery. Over the past decade, mobile health has accelerated the agency of health care users. Despite prevailing excitement about the potential of digital health, questions remain on efficacy, uptake, usability, and patient outcome. This challenge is confounded by 2 industries, digital and health, which have vastly different approaches to research, design, testing, and implementation. In this regard, there is a need to examine prevailing design approaches, weigh their benefits and challenges toward implementation, and recommend a path forward that synthesizes the needs of this complex stakeholder group. Objective: In this review, we aimed to study prominent digital health intervention design approaches that mediate the digital health space. In doing so, we sought to examine the origins, perceived benefits, contrasting nuances, challenges, and typical use-case scenarios of each methodology. Methods: A narrative review of digital health design approaches was performed between September 2020 and April 2021 by referencing keywords such as “digital health design,” “mHealth design,” “e-Health design,” “agile health,” and “agile healthcare.” The studies selected after screening were those that discussed the design and implementation of digital health design approaches. A total of 120 studies were selected for full-text review, of which 62 (51.6%) were selected for inclusion in this review. Results: A review identifying the 5 overarching digital health design approaches was compiled: user-centered design, person-based design, human-centered design, patient-centered design, and patient-led design. The findings were synthesized in a narrative structure discussing the origins, advantages, disadvantages, challenges, and potential use-case scenarios. Conclusions: Digital health is experiencing the growing pains of rapid expansion. Currently, numerous design approaches are being implemented to harmonize the needs of a complex stakeholder group. Whether the end user is positioned as a person, patient, or user, the challenge to synthesize the constraints and affordances of both digital design and health care, built equally around user satisfaction and clinical efficacy, remains paramount. Further research that works toward a transdisciplinarity in digital health may help break down friction in this field. Until digital health is viewed as a hybridized industry with unique requirements rather than one with competing interests, the nuances that each design approach posits will be difficult to realize in a real-world context. We encourage the collaboration of digital and health experts within hybrid design teams, through all stages of intervention design, to create a better digital health culture and design ethos.

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  • In the broader digital health literature, many interventions are tested in laboratory- or pilot-type settings, and very few report robust real-world deployment, maintenance, or adoption over time.

    “This pattern reflects broader digital health literature, where many interventions are tested in laboratory- or pilot-type settings, very few report robust real-world deployment, maintenance, or adoption over time [52].”

    From User-Centered Design for Digital Patient-Navigation Tools in Oncology: Scoping Review (2026) · cites this paper as [52]

    The Results (Digital Industry and Emergence of Digital Health; pages unavailable) contrast short-cycle user testing with long-term health evaluation, and the Discussion (The Promise of Digital Health) identifies an implementation gap. The paper does not establish that many interventions are tested in laboratory or pilot settings, or that very few report sustained real-world deployment, maintenance, or adoption. (LLM, conf=0.83)

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Cited by

Sorted by citations

Authors
Duffy, A., Christie, G. J., & Moreno, S.
Affiliations
Simon Fraser University (CA)
Corresponding author
Moreno, Sylvain
ORCID
Venue
JMIR Human Factors
Publisher
JMIR Publications Inc.
Published
2022-09-09
Volume
9
Issue
3
Pages
e35693
ISSN
2292-9495 (ISSN-L)
DOI
10.2196/35693
PMC
PMC9508664
OpenAlex
W4285745615
Cited by
114
References
11
Citations by year
2026: 45 · 2025: 34 · 2024: 27 · 2023: 8
FWCI
3.34
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JMIR Human Factors (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders
  • AGE-WELL
  • Simon Fraser University
  • SFU Community Trust Endowment Fund
Topics
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
  • Health Sciences › Health Professions › Health Information Management › Health, Technology, Consumer Behavior
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Keywords
mobile health, e-health, user-centered design, human-centered design, patient-centered design, transdisciplinarity, stakeholder needs, real-world implementation, usability, clinical efficacy

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