Barriers and facilitators for implementation of lifestyle related blended care interventions for overweight, obesity and type 2 diabetes mellitus: a scoping review

Abstract Background Blended care, referring to the combination of digital health interventions (DHI) with in-person care, has proven cost-effective in promoting healthy behaviours, especially for lifestyle related conditions like type 2 diabetes mellitus. However, despite positive results, many interventions fail during the clinical implementation. A successful implementation of blended care interventions requires a systematic approach including appropriate implementation strategies that address relevant barriers and facilitators. Therefore, this study explores barriers and facilitators for implementation of lifestyle related blended care interventions for weight management and type 2 diabetes mellitus. Methods Following PRISMA-ScR guidelines, a scoping review was conducted using PubMed, Scopus, and Web of Science, covering studies from January 1, 2000, to February 4, 2025. The search included terms related to ‘overweight,’ ‘obesity,’ ‘diabetes mellitus type 2’, ‘eHealth’, ‘blended care’, ‘setting’ and ‘implementation’. Studies were included if they focused on lifestyle changes (e.g. weight loss, physical activity, or self-management) and reported barriers or facilitators for implementing blended care, defined in this review as the integration of DHI with at least one in-person care-focused interaction between a health care provider and an adult patient. No risk of bias assessment was performed. Data were extracted on study characteristics, participants demographics, DHI delivery methods, and implementation barriers and facilitators. Data was analysed using a narrative synthesis structured by the Consolidated Framework for Implementation Research (CFIR). Results From 1329 screened studies, nine met the inclusion criteria. The findings indicate that implementation challenges cluster around financial constraints, increased workload for healthcare providers, and disparities in digital skills, which collectively limit the feasibility and sustained use of blended DHIs. The other way around, successful implementation is supported by adequate training, user-centred design, and strong alignment with existing clinical workflows. Tailoring interventions to organisational context and ensuring regulatory compliance further strengthen adoption. Conclusions Blended DHIs offer opportunities to enhance personalization, patient involvement, and continuity of care. However, their sustainable implementation requires addressing these overarching barrier and facilitator domains rather than isolated factors: Healthcare organisations can act to reduce organisational burden by providing sufficient resources, policymakers can support regulatory alignment, developers can prioritize user-centred design, and healthcare professionals can integrate blended care intro routine practice and support patients in its use.