Table 4 Factors affecting digital health engagement and recruitment
Barriers | Facilitators | ||
Themes 1: Personal Agency and Motivation | |||
 Barrier  Subtheme 1.1:  Lack of Motivation | Lack of motivation to understand or improve health | Facilitator Subtheme 1.1: Personal Motivation | Motivation to understand and improve health |
 Barrier  Subtheme 1.2:  Awareness and understanding | Unaware of or lacks understanding of how a DHI could be helpful | Facilitator Subtheme 1.2: Awareness and understanding | Ability to understand a DHI and personal health data |
 Barrier  Subtheme 1.3:  Personal Agency (choice and control) | Alternative ways of documenting health information and managing illness | Facilitator Subtheme 1.3: Personal Agency (choice and control) | Ability to choose time and location of interaction with a DHI Ability to control electronic personal health data |
Themes 2: Personal Life and Values | |||
 Barrier  Subtheme 2.1:  Personal lifestyle | Busy lifestyle with competing priorities | Facilitator Subtheme 2.1: Personal lifestyle | DHI fits with personal lifestyle |
 Barrier Subtheme 2.2:  Skills and equipment | Poor digital literacy | Facilitator Subtheme 2.2: Skills and equipment | Good digital literacy |
Lack of access to equipment and the Internet | Has or can afford computer equipment or mobile device, network connectivity and a data plan | ||
Cost of a DHI | |||
 Barrier Subtheme 2.3:  Privacy and security | Concern over the security and privacy of DHI information or interaction | Facilitator Subtheme 2.3: Privacy and security | Values the privacy and anonymity of DHI information or interaction |
Theme 3: Engagement and Recruitment Approach | |||
 Barrier  Subtheme 3.1:  Recruitment strategy | Difficulty understanding the recruitment message | Facilitator Subtheme 3.1: Recruitment strategy | Active promotion and engagement strategies |
Health professional acts as a gatekeeper | |||
 Barrier  Subtheme 3.2:  Direct support | Lack of support from family members, friends or peers | Facilitator Subtheme 3.2: Direct support | Support from family members, friends or peers offline |
 Barrier  Subtheme 3.3:  Personal advice | Lack of advice and recommendations from trusted sources | Facilitator Subtheme 3.3: Personal advice | Recommended by family members, friends or peers |
 Barrier  Subtheme 3.4:  Clinical endorsement | Lack of clinical endorsement and support for a DHI | Facilitator Subtheme 3.4: Clinical endorsement | Clinical accreditation and support for a DHI |
Theme 4: Quality of the Digital Health Intervention | |||
 Barrier Subtheme 4.1 and 4.2:  Negative digital health experience (quality of information or interaction) | Impersonal DHI (poor quality information or interaction) | Facilitator Subtheme 4.1 and 4.2: Positive digital health experience (quality of information or interaction) | Open, honest digital interaction with healthcare provider |
Lack of trust in DHI information or interaction | Previous negative experience of health services without a DHI | ||
Digital health interaction could be abusive | Social support from peers online | ||
 Barrier Subtheme 4.3:  Usability of the DHI | DHI is difficult to use | Facilitator Subtheme 4.3: Usability of the DHI | DHI is easy to enrol in and use (automated and integrated) |
Complex registration process | |||