Common barriers and facilitators to the implementation of digital medicine in chronic respiratory diseases: a systematic review of reviews

Abstract

Background and research question Digital Medicine offers significant potential for improving care in Respiratory Medicine, yet its full uptake remains limited. Barriers and facilitators involve multiple stakeholders and are likely shared across diseases and technologies. This study had the following research question: What are the common barriers, facilitators, and transferable concepts for implementing Digital Medicine in respiratory diseases, exemplified by bronchial asthma, cystic fibrosis (CF), chronic obstructive pulmonary disease (COPD), and COVID-19? Study design and methods Systematic review of reviews. Three electronic databases (PubMed, Scopus, and Web of Science), as well as Cochrane Library were searched for review publications from September 2019 through May 2026. Nine included reviews were appraised using AMSTAR-2. Original publications referenced within these reviews were additionally screened for suitability for data extraction, leading to inclusion of 18 original publications. Extracted barriers and facilitators were visualized as disease- and actor-stratified co-occurrence networks and mapped to two implementation frameworks (CFIR and Chaudoir et al. 2013). Results No COVID-19 publication met inclusion criteria. Asthma and, partially, CF evidence was rich and included institution-level data, while COPD evidence was less diverse. One CF program survey had structured its data according to the CFIR framework, enabling uniquely complete mapping of barriers and facilitators. Conclusion High-quality, framework-structured, network-visualizable evidence on barriers and facilitators to Digital Medicine exists in bronchial asthma and, partially, CF. In contrast, evidence on barriers and facilitators in COPD is not yet systematic. Future studies should be anchored in frameworks for sufficient comprehensiveness and facilitated knowledge translation into implementability. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251070944 , PROSPERO, CRD420251070944.