The behavioral mechanisms that underpin the adoption of digital health interventions by a diverse multicultural population: a patient and public involvement study

Purpose: Digital health interventions (DHIs) offer scalable and cost-effective solutions for preventive healthcare, yet their adoption remains uneven, particularly among vulnerable and minority groups. High attrition rates also challenge their long-term effectiveness. This study aims to explore the factors and behavioural mechanisms influencing DHI adoption in a diverse, multicultural population, while identifying strategies to enhance equitable access to DHIs for all.Methods: Using a Patient and Public Involvement (PPI) methodology, lay facilitators approached adult patrons at public eateries (hawker centres) in residential areas of Singapore for an informal discussion on digital health. A semi-structured topic guide was used to explore the daily motivations and barriers towards uptake and sustained use of DHIs. An optional sociodemographic survey was administered at the end of each encounter. Data were analysed using inductive thematic analysis followed by deductive mapping to behaviour change theory to identify relevant mechanisms of action (MoA) and behaviour change techniques (BCTs) that, based on current evidence, may increase DHI adoption. Results: Facilitators engaged with 118 individuals, broadly representative of the Singaporean population, between November 2022 and February 2023. Participants shared both positive and negative perceptions and experiences of DHIs, described within five key themes: (1) awareness of DHIs and their offerings, (2) weighing the needs and benefits against the burdens of using a DHI, (3) accessibility, (4) trust in the entity behind the DHI and its capabilities, and (5) the impact of user experience. These themes were mapped to 13 MoA and 26 corresponding BCTs, which informed five key strategies to enhance DHI adoption. First, community-based promotion of credible DHIs combined with digital literacy training may address barriers to DHI uptake. Second, brief counselling integrated into healthcare services could help individuals assess the value of DHIs and encourage adoption. Third, using variable rewards tied to individuals’ core values could increase engagement. Fourth, policies to ensure DHIs are accessible and regulatory approved may facilitate trust and adoption. Finally, a focus on simple, gamified user experiences, along with features that support feedback and behavioural cueing, were emphasized as essential for sustained use.Conclusion: Our findings indicate that the design and wide-scale implementation of accessible, motivating, trustworthy, and user-friendly DHIs, that are integrated within healthcare services and promoted widely in community settings, will address barriers to adoption by diverse communities and may help narrow the digital divide.