Table 1 Mapping findings with literature... | Emerald Publishing

Table 1

Mapping findings with literature

Theme	Interview evidence	Literature evidence	Interpretation / link to RQs
1. Technical barriers and application failures	Practitioners reported frequent app crashes, login failures, and server downtime. Differences were observed between hospital types, with private hospitals reporting better connectivity and application stability than public facilities	UK NHS COVID-19 app required repeated updates; intermittent electricity and limited 4G exacerbated service downtime in LMICs (Polzer and Goncharenko, 2022; Ahmed et al., 2023; OECD, 2023)	Technical reliability is essential for adoption. Functionality failures reduce engagement and trust. RQ1: Shows how infrastructure and technical failures inhibit equitable uptake
2. Patient digital skills gap	Patients struggled with uploading documents, creating accounts, troubleshooting; older adults and low-education groups most affected; reliance on family intermediaries	Older adults in US remain less likely to engage with portals (Walker et al., 2020), rural Turkey users had higher eHealth literacy than non-users (Sariyildiz et al., 2022; OECD 2023) highlights that digital health adoption depends on general digital readiness, including user skills and capacity; building workforce capacity is crucial for meaningful digital health adoption Fellner et al. (2025)	Digital literacy is central for adoption. Addressing skills gaps requires patient education and simplified interfaces. RQ2: Highlights socio-technical mediation of uptake
3. Cultural and language barriers	Many COVID-era applications were available only in English. Practitioners reported that wording changes in Urdu or Sindhi improved patient comprehension	English dominance in health information excludes non-speakers (Kickbusch, 2001); Qatar Ehteraz app excluded some migrant workers (Hafizh et al., 2022)	Localization and cultural tailoring are crucial. RQ2 & RQ3: Impacts adoption and sustainability through cultural fit
4. Trust and data privacy concerns	Patients rarely asked about data safety; functional reliability prioritized	UK NHS app abandoned over surveillance concerns (Polzer and Goncharenko, 2022), trust predicts engagement with digital health platforms (Dowthwaite et al., 2021; OECD 2023)	Trust concerns are context-dependent; in low-resource settings, practical utility dominates. RQ2: Shows interaction of trust and socio-technical readiness
5. Policy and systemic alignment	Need for digital literacy programs, affordable internet, government-backed support; apps fail without institutional backing	WHO (2025) and Wilson et al. (2024) emphasize co-design; Palumbo et al. (2022) stress community customization; Fellner et al. (2025) highlight governance, infrastructure, skills, and engagement	System-level support and policy frameworks enable sustainable integration. RQ3: Highlights strategies for long-term adoption

Theme	Interview evidence	Literature evidence	Interpretation / link to RQs
1. Technical barriers and application failures	Practitioners reported frequent app crashes, login failures, and server downtime. Differences were observed between hospital types, with private hospitals reporting better connectivity and application stability than public facilities	UK NHS COVID-19 app required repeated updates; intermittent electricity and limited 4G exacerbated service downtime in LMICs (Polzer and Goncharenko, 2022; Ahmed et al., 2023; OECD, 2023)	Technical reliability is essential for adoption. Functionality failures reduce engagement and trust. RQ1: Shows how infrastructure and technical failures inhibit equitable uptake
2. Patient digital skills gap	Patients struggled with uploading documents, creating accounts, troubleshooting; older adults and low-education groups most affected; reliance on family intermediaries	Older adults in US remain less likely to engage with portals (Walker et al., 2020), rural Turkey users had higher eHealth literacy than non-users (Sariyildiz et al., 2022; OECD 2023) highlights that digital health adoption depends on general digital readiness, including user skills and capacity; building workforce capacity is crucial for meaningful digital health adoption Fellner et al. (2025)	Digital literacy is central for adoption. Addressing skills gaps requires patient education and simplified interfaces. RQ2: Highlights socio-technical mediation of uptake
3. Cultural and language barriers	Many COVID-era applications were available only in English. Practitioners reported that wording changes in Urdu or Sindhi improved patient comprehension	English dominance in health information excludes non-speakers (Kickbusch, 2001); Qatar Ehteraz app excluded some migrant workers (Hafizh et al., 2022)	Localization and cultural tailoring are crucial. RQ2 & RQ3: Impacts adoption and sustainability through cultural fit
4. Trust and data privacy concerns	Patients rarely asked about data safety; functional reliability prioritized	UK NHS app abandoned over surveillance concerns (Polzer and Goncharenko, 2022), trust predicts engagement with digital health platforms (Dowthwaite et al., 2021; OECD 2023)	Trust concerns are context-dependent; in low-resource settings, practical utility dominates. RQ2: Shows interaction of trust and socio-technical readiness
5. Policy and systemic alignment	Need for digital literacy programs, affordable internet, government-backed support; apps fail without institutional backing	WHO (2025) and Wilson et al. (2024) emphasize co-design; Palumbo et al. (2022) stress community customization; Fellner et al. (2025) highlight governance, infrastructure, skills, and engagement	System-level support and policy frameworks enable sustainable integration. RQ3: Highlights strategies for long-term adoption