Drivers of and barriers to adoption of digital therapeutics in five European countries
Amelie Fassbender, Mitchell Silva, Elisio Costa, Tonya Winders, Didier Tranchier, Pieter van Galen, Wouter Verhoeye, Alain Cornet, Nigel Olisa, Falk Schuster, Alessandro Monaco, Eider Zabaleta, Shaantanu DondeBackground
Digital therapeutics (DTx) are evidence-based software interventions with potential to complement conventional care; however, their adoption across European healthcare systems remains limited. Evidence on patient-level drivers, barriers, and implementation requirements is still scarce, especially regarding awareness, usability, reimbursement, and stakeholder engagement.
Methods
This mixed-methods study combined an online survey in five European countries — the United Kingdom, France, Germany, Italy, and Spain — with a qualitative advisory board. Of 915 survey respondents, 682 surveys were included. Respondents were adults who had visited a healthcare professional in the previous 12 months. Survey findings were complemented by an advisory board involving 13 opinion leaders, patient experts, representatives of patient organizations, and industry professionals.
Results
Awareness and prior use of DTx were limited: 51.03% of respondents were unaware of DTx before the survey, while only 3.40% had previously used DTx. Nevertheless, 63.20% expressed interest in using DTx to better manage their condition. The main drivers of adoption were interest in testing tools (35.63%), physician recommendation (35.48%), 24/7 access to support (26.54%), nurse recommendation (19.21%), and additional support beyond conventional treatments (15.10%). Integration with wearables or health apps (52.49%) and involvement of patients or patient organizations in development (47.65%) further increased willingness to use DTx. Major barriers were lack of awareness (31.52%), doubts about effectiveness (21.11%), high out-of-pocket costs (19.50%), perceived complexity (16.72%), low motivation (15.54%), and data privacy concerns (15.25%). Advisory board participants identified education, trust-building, patient co-design, clinical endorsement, workflow integration, reimbursement clarity, and multidisciplinary ecosystem development as critical enablers.
Conclusions
DTx adoption in Europe is constrained less by lack of interest than by limited awareness, trust, usability, evidence perception, and reimbursement uncertainty. Implementation will require patient-centered design, structured education for patients and healthcare professionals, transparent evidence generation, integration into clinical workflows, and harmonized regulatory and reimbursement pathways.