Elements of Trust in Digital Health Systems: Scoping Review

Abstract

BackgroundInformation and communication technologies have long become prominent components of health systems. Rapid advances in digital technologies and data science over the last few years are predicted to have a vast impact on health care services, configuring a paradigm shift into what is now commonly referred to as digital health. Forecasted to curb rising health costs as well as to improve health system efficiency and safety, digital health success heavily relies on trust from professional end users, administrators, and patients. Yet, what counts as the building blocks of trust in digital health systems has so far remained underexplored.ObjectiveThe objective of this study was to analyze what relevant stakeholders consider as enablers and impediments of trust in digital health.MethodsWe performed a scoping review to map out trust in digital health. To identify relevant digital health studies, we searched 5 electronic databases. Using keywords and Medical Subject Headings, we targeted all relevant studies and set no boundaries for publication year to allow a broad range of studies to be identified. The studies were screened by 2 reviewers after which a predefined data extraction strategy was employed and relevant themes documented.ResultsOverall, 278 qualitative, quantitative, mixed-methods, and intervention studies in English, published between 1998 and 2017 and conducted in 40 countries were included in this review. Patients and health care professionals were the two most prominent stakeholders of trust in digital health; a third—health administrators—was substantially less prominent. Our analysis identified cross-cutting personal, institutional, and technological elements of trust that broadly cluster into 16 enablers (altruism, fair data access, ease of use, self-efficacy, sociodemographic factors, recommendation by other users, usefulness, customizable design features, interoperability, privacy, initial face-to-face contact, guidelines for standardized use, stakeholder engagement, improved communication, decreased workloads, and service provider reputation) and 10 impediments (excessive costs, limited accessibility, sociodemographic factors, fear of data exploitation, insufficient training, defective technology, poor information quality, inadequate publicity, time-consuming, and service provider reputation) to trust in digital health.ConclusionsTrust in digital health technologies and services depends on the interplay of a complex set of enablers and impediments. This study is a contribution to ongoing efforts to understand what determines trust in digital health according to different stakeholders. Therefore, it offers valuable points of reference for the implementation of innovative digital health services. Building on insights from this study, actionable metrics can be developed to assess the trustworthiness of digital technologies in health care.

Futures for Health Research Data Platforms From the Participants’ Perspectives

“…Individuals may start to collect data for themselves but agree to share it for research afterwards. For instance, Achievement [2] is a commercial mobile app for personal health Acceptance and Trust People trust some institutions more than others [34,39,118,132] Trust can be hindered by previous experiences [3,5,34] Acceptance decreases if data collection is hard [32,71] Acceptance decreases if the purpose is not useful [75,78,137,152] Willingness to share People worry about data misuse [78,95,96] People want to preserve their reputation [65,77,111,119,121] Some types of data are more sensitive [14,47,61,86,123,146] Some people are more concerned than others [8,63,86] Consent and Ethics Consent forms are lengthy and complex [84,110] People cannot understand the risks [31,94,115,131] Lack of flexible sharing options and control [5,27,57,64,73,91,106] Lack of transparenc...…”

“…However, the development of trust is a continuous process, and trust can change over time [34]. Some enablers of trust in digital systems have been listed as fair data access, recommendation by others, customised design features, initial face-to-face contact, stakeholder engagement and improved communication [3].…”

Development of the mHealth App Trustworthiness checklist

“…Lessons from a previous review, conducted by some of the authors of this article, were useful in structuring the review process. 31 Procedure. To derive search terms related to trust and trustworthiness, we developed and conducted test runs of relevant keywords, synonyms, medical subject heading (MeSH) terms in several electronic databases.…”

A Scientific Overview of Smartphone Applications and Electronic Devices for Weight Management in Adults

“…By now, there is no harmonized definition for terms like “digital health” or “mobile (m) Health” [8,9,10], thus leading to multiple operational definitions [9]. For instance, a systematic review on published definitions of electronic (e) Health showed that there are 51 unique definitions of eHealth [11].…”