Healthcare consumers’ acceptance and use of digital health technology in LMICs and the role of self-efficacy and facilitating conditions: a systematic review and meta-analysis

Background: The implementation of digital health technology (DHT) has not reached its full potential. Research on the factors influencing the acceptance and use of DHTs in low- and middle-income countries (LMICs) is fragmented and sparse. This study aimed to identify the facilitators and barriers to DHT acceptance and use in healthcare consumers. Methods: The systematic review and meta-analysis were conducted using PubMed, Embase, and Web of Science from inception to July 1st, 2025. Facilitators and barriers to the acceptance and use of DHT were extracted, and a modified framework was developed based on the Unified Theory of Acceptance and Use of Technology. The strength of each pathway recorded in the framework was estimated through meta-analysis. Findings: A total of 78 publications were included in the systematic review, comprising 64 quantitative studies and 14 qualitative studies. Twelve dimensions were summarized. Factors demonstrating the highest positive associations with intentions to use DHTs included attitude (r = 0.5644; 95% CI: 0.4498, 0.6607), trust (r = 0.5239; 95% CI: 0.4243, 0.6109), performance expectancy (r = 0.4851; 95% CI: 0.4335, 0.5335), technology self-efficacy (r = 0.4430; 95% CI: 0.2504, 0.6018), facilitating conditions (r = 0.4345; 95% CI: 0.3526, 0.5098), effort expectancy (r = 0.4171; 95% CI: 0.3508, 0.4793), and habit (r = 0.4213; 95% CI: 0.1684, 0.6222). Social influence was also positively associated (r = 0.3582; 95% CI: 0.2823, 0.4297), as well as hedonic motivation (r = 0.3963, 95% CI: 0.2280, 0.5416). Price value showed a near-null, imprecise association (r = 0.0304; 95% CI: -0.1483, 0.2072). Perceived risk to patient privacy, patient security and telemedicine systems security, showed a small negative but imprecise association with intentions (r = -0.0402; 95% CI: -0.2169, 0.1391). Anxiety showed a non-significant negative association (r = -0.2071; 95% CI: -0.5108, 0.1426). Interpretation: The barriers identified in this analysis highlight the necessity of establishing and sustaining an integrated enabling environment as well as investing in digital health literacy to enhance healthcare consumers' self-efficacy. Findings of the study will facilitate the improvement of DHT implementation to address health concerns. Funding: This study was funded by Noncommunicable Chronic Diseases-National Science and Technology Major Project (2024ZD0524500, 2024ZD0524501), National Natural Science Foundation of China (72274005 and 72304013), Beijing Nova Program (20230484284).