Developing a Global Framework for Digital Health in Traumatic Brain Injury (TBI): Clinician Perspectives of the Use of Digital Technologies in the TBI Care Pathway

Background Traumatic brain injury (TBI) affects 69 million individuals globally each year, yet care remains fragmented across complex, multi-specialty pathways and settings. Digital health technologies offer potential to bridge care gaps, particularly in resource-limited settings, yet existing frameworks do not adequately address the complexities of the TBI care pathway or the diverse global contexts in which care occurs. Methods A cross-sectional qualitative study using critical realist-informed thematic analysis was conducted with practising neurosurgeons recruited internationally via National Institute for Health and Care Global Health Research Group on Acquired Brain and Spine Injury (NIHR ABSI) collaborating centres, social media, and society newsletters. Semi-structured interviews were conducted by a single researcher (OM) via Microsoft Teams (March-July 2024), exploring technology availability, healthcare infrastructure, clinical pathways, and contextual challenges, with a systems thinking approach guiding identification of current and potential technology integration points. Fourteen neurosurgeons from twelve countries participated, representing six lower-middle, two upper-middle, and four high-income countries. Results Six inductive themes emerged: Availability, Acceptability, Applicability, Capability, Feasibility, and Possibility- forming a novel conceptual framework visualised as a hexagonal chart for guiding digital health technology design and implementation in TBI care. Marked disparities in technology availability and utilisation were identified across urban/rural settings and income levels. Conclusions This framework offers a practical, context-sensitive tool for researchers, policymakers, and clinicians developing or implementing digital health technologies in TBI care globally. Visualisation in a similar style to a radar-chart enables simultaneous consideration of factors- including digital literacy, infrastructure, and cultural attitudes- whose neglect frequently underlies implementation failures.