Application of frameworks for health technology implementation in primary and secondary care - a mixed methods systematic review

Abstract

Health technology (tech) has the potential to transform patient outcomes. Frameworks can be used to help guide health tech implementation for improving evidence translation and patient outcomes. Some frameworks for health tech implementation exist, however success remains inconsistent. We synthesised evidence on the use of frameworks in primary and secondary care, examining health tech implementation strategies, challenges and outcomes. The databases Embase, Medline, Scopus and Web of Science were searched for articles (2018–2025), on framework usage for health tech implementation. No language restrictions were imposed. This review was registered with PROSPERO, followed PRISMA guidelines, with keywords like ‘framework’, ‘health technology’ and ‘implementation’. Two researchers independently extracted data, performed thematic analysis, appraised study quality using the Mixed Methods Appraisal Tool (MMAT), adhered to the Joanna Briggs Institute (JBI) standards and presented findings through narrative synthesis. From four databases and handsearching, 8,275 publications (2018–2025) were retrieved. Titles and abstracts were screened, and a final 95 studies (quantitative (20%), qualitative (56%), trials (2%) and mixed methods (22%) with 228,734 adult participants were synthesised. Geographically, 95% of the studies were conducted in medium- to high-income countries, with the USA accounting for the majority (40%). Five themes emerged: (i) framework applicability (ii) implementation strategies (iii) benefits and facilitators (iv) challenges and barriers, and (v) equitable access and sustainability. Existing frameworks like CFIR, RE-AIM, NASSS, TAM and NPT were used in ≥ 50% studies, and some were new frameworks. Frameworks supported stakeholder involvement, integration, collaboration and sustainability. While AI shows promise for clinical decision-making, barriers like low digital literacy and training gaps, inadequacies in safety, equity and organisational support, remain. Combining frameworks can identify barriers, workflow integration and sustainability, but gaps also highlighted the need for adaptable and equity-focused frameworks. Adaptive frameworks are essential for implementing health tech and AI in primary and secondary care. Co-design, stakeholder engagement and evaluation may ensure safe and ethical adoption, although AI raises safety and equity concerns. Further research and collaboration could refine frameworks and strengthen evidence translation. The protocol of this systematic review is registered with the International Prospective Register of Systematic Reviews (PROSPERO) (ID: CRD420251042112). Not applicable.