OBJECTIVES: Patient engagement is critical to the adoption of any healthcare technology including Digital Therapeutics (DTx). This review focuses on factors impacting the real-world adoption of DTx by evaluating patients’ acceptability/acceptance across different therapeutic areas.

METHODS: A literature search was conducted using PubMed for original articles, in English between 2015 to 2022, using a combination of keywords that focused on DTx, and patients’ perspective of acceptability/acceptance of disease management using DTx. Two investigators independently reviewed title/abstracts followed by full texts of studies using a predetermined study selection criterion. Data was extracted by key themes and included DTx characteristics, therapy area, evaluation metrics and responses. Acceptability and acceptance were defined as patients’ willingness to use, engage with, and adopt DTx, before and after use respectively. Patient satisfaction, engagement, and adherence were also considered as proxy measures of acceptance.

RESULTS: A total of 326 articles were identified using the search criteria and 47 were included post screening. Of those studies, 38 evaluated acceptability/acceptance. Most DTx products assessed were in areas of addiction, psychiatry, infectious disease, musculoskeletal disease, sleep medicine and oncology. Digital cognitive behavioral therapy (iCBT) was the most assessed DTx, followed by digital pills, self-management applications, wearables, and video games.

Of the 38 studies that assessed acceptability/acceptance, 30 reported positive and 8 reported mixed sentiments. Overall, most studies with comparators and real-world studies reported positive sentiments towards DTx. Digital pill users expressed negative sentiments of privacy concerns and lack of motivation to engage with system beyond logging results, and iCBT users reported challenges with sustaining long-term engagement and adherence.

CONCLUSIONS: With increasing number of DTx receiving marketing approval, there is a requirement to continuously evaluate and address acceptability/acceptance metrics to foster better real-world engagement and adoption. Additionally, future work should involve development of uniform framework or questionnaires to assess DTx across several therapeutic areas.