Developing a Global Framework for Digital Health in Traumatic Brain Injury (TBI): Clinician Perspectives of the Use of Digital Technologies in the TBI Care Pathway

Background

Traumatic brain injury (TBI) affects 69 million individuals globally each year, yet care remains fragmented across complex, multi-specialty pathways and settings. Digital health technologies offer potential to bridge care gaps, particularly in resource-limited settings, yet existing frameworks do not adequately address the complexities of the TBI care pathway or the diverse global contexts in which care occurs.

Methods

A cross-sectional qualitative study using critical realist-informed thematic analysis was conducted with practising neurosurgeons recruited internationally via National Institute for Health and Care Global Health Research Group on Acquired Brain and Spine Injury (NIHR ABSI) collaborating centres, social media, and society newsletters. Semi-structured interviews were conducted by a single researcher (OM) via Microsoft Teams (March-July 2024), exploring technology availability, healthcare infrastructure, clinical pathways, and contextual challenges, with a systems thinking approach guiding identification of current and potential technology integration points. Fourteen neurosurgeons from twelve countries participated, representing six lower-middle, two upper-middle, and four high-income countries.

Results

Six inductive themes emerged: Availability, Acceptability, Applicability, Capability, Feasibility, and Possibility- forming a novel conceptual framework visualised as a hexagonal chart for guiding digital health technology design and implementation in TBI care. Marked disparities in technology availability and utilisation were identified across urban/rural settings and income levels.

Conclusions

This framework offers a practical, context-sensitive tool for researchers, policymakers, and clinicians developing or implementing digital health technologies in TBI care globally. Visualisation in a similar style to a radar-chart enables simultaneous consideration of factors- including digital literacy, infrastructure, and cultural attitudes- whose neglect frequently underlies implementation failures.

Author Summary

Traumatic brain injury affects millions of people every year, yet the care patients receive after their injury is often fragmented and inconsistent- particularly in lower-income countries where resources vary in quantity and accessibility. Digital technologies, from smartphone apps to telemedicine platforms, have the potential to bridge these gaps, but there is little practical guidance on how to design and implement them in ways that work across different healthcare settings around the world.

We interviewed neurosurgeons from twelve countries across three income settings to understand how digital technologies are currently used in traumatic brain injury care, and where they could make the biggest difference. We found that access to technology, attitudes towards it, the practicalities of healthcare systems, and the specific challenges of different settings all shape whether digital tools succeed or fail in practice.

From these conversations, a new framework, presented like a hexagonal radar chart, was developed to help researchers, clinicians, and policymakers think through the key factors that determine whether a digital health technology will work in each context. This tool supports more thoughtful, context-sensitive technology development and implementation in traumatic brain injury care worldwide, ultimately improving outcomes for patients regardless of where they live.