Stakeholder Perspectives on Digital Health Technologies in Poststroke Self-Management and Rehabilitation: Systematic Review Based on the NASSS Framework.

Background: Digital health technologies (DHTs) offer opportunities to support poststroke self-management and rehabilitation, but their implementation may be hindered by mismatches between technological design, stakeholder needs, and care contexts. Synthesizing stakeholder perspectives can clarify implementation priorities and gaps in the evidence. Objective: This study aimed to synthesize stakeholders' perceptions, experiences, and recommendations regarding DHT implementation in poststroke self-management and rehabilitation and to map the findings to the NASSS (Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability) framework. Methods: Six databases (PubMed, MEDLINE, Embase, Scopus, CINAHL, and Web of Science) were searched from inception through October 2025. Eligible studies were English-language, peer-reviewed primary studies using qualitative, quantitative, or mixed methods designs to report stakeholder perspectives on DHTs in poststroke care. Two reviewers independently screened studies, extracted data, and assessed methodological quality using the Mixed Methods Appraisal Tool (MMAT). A convergent integrated synthesis was conducted: quantitative findings were transformed into textual descriptors, combined with qualitative findings, coded inductively, and subsequently mapped deductively to NASSS domains and subdomains. Disagreements were resolved through consensus or by third-reviewer adjudication. Results: Of 15,262 records identified, 42 studies published between 2019 and 2025 were included: 24 qualitative, 8 quantitative, and 10 mixed methods studies. Patients, health care professionals, caregivers, and members of the public were represented in 32, 19, 8, and 3 studies, respectively, with some studies including multiple groups. Evidence concentrated on the condition, technology, value proposition, and adopter-system domains. Stakeholders valued personalized functions, intuitive interfaces, timely feedback, and digital support that complemented human care. Barriers included stroke-related motor, cognitive, communication, and sensory impairments; unequal digital access and literacy; caregiver demands; staff workload and training needs; and poor integration with clinical routines. Data privacy and unclear payment arrangements also raised concerns. Evidence on organizational readiness and wider-system determinants was limited, and no eligible study directly examined interaction and adaptation over time. Methodological concerns included nonresponse bias and insufficient interpretation of integrated findings in mixed methods studies. Conclusions: Stakeholder perspectives indicate that DHT implementation in poststroke care should combine accessible, personalized design with support for patients, caregivers, and health care professionals, alongside integration into clinical workflows and clear data governance and financing arrangements. The NASSS mapping identified priorities beyond usability, but current evidence does not establish sustained adoption, scale-up, or spread. Longitudinal studies in routine care are needed to evaluate adaptation and sustainability.