There are high expectations for Mobile Health to transform health into a sustainable and prevention-based system. Unfortunately it has not reached its scale of adoption many had hoped for, due to the existence of adoption barriers. More insight into these barriers fosters adoption of mHealth and the innovation it can bring to worldwide healthcare. This study investigates the main barriers in the adoption of mHealth, their underlying causes and their breakthrough possibilities. All the data are gathered from an international and multi-stakeholder point of view. First of all we tried to identify the main barriers by doing an international literature study. Second of all we asked Dutch mHealth Key Opinion Leaders (KOLs) to rank the barriers to importance. These KOLs were from different stakeholder groups; policy-makers, users and developers. At last we asked the KOLs in interviews for underlying causes and breakthrough opportunities of the barriers. Eventually twelve main adoption barriers emerged. According to literature and to the KOLs the most important barriers are "Integration and interoperability" and "Business case". An underlying cause for the barrier "Integration and interoperability" might be the active closed power system of technology suppliers, which exists in the Netherlands. Furthermore there seems to be a difference in the importance of the barriers "Privacy and security" and "Conservative culture" when perceptions of Dutch KOLS and international literature are compared. Within the stakeholders-groups, the KOLs think differently about the importance of the barriers "Visionless development" and "Competing payment mechanism". The Dutch healthcare insurers could take a more leading role in the fragmented landscape of mHealth in the Netherlands, by strategically funding new initiatives that use open standards and deliver better value for end-users. Other chances might lie in the international cooperation between countries to overcome certain barriers.