Abstract
<sec> <title>BACKGROUND</title> <p>While digital health interventions (DHIs) have considerable potential to improve healthcare delivery, many fail to achieve sustained adoption beyond initial implementation. Sustainability has been suggested to be built through individual, social, economic, environmental, and technical factors, yet existing adoption frameworks address these dimensions only partially. Consequently, there is a need for a practical framework that enables stakeholders to systematically integrate sustainability considerations into the design, implementation, and evaluation of DHIs.</p> </sec> <sec> <title>OBJECTIVE</title> <p>To develop a structured planning and evaluation framework, the Digital Health Sustainability Canvas (DHSC) that is suitable for systematic assessment of the sustainability of DHIs.</p> </sec> <sec> <title>METHODS</title> <p>The DHSC was developed using an iterative three-step design science approach comprising: (1) identification of mechanisms that undermine the long-term sustainability of DHIs, (2) development of an initial version of the canvas, and (3) pilot application to three DHIs followed by iterative refinement.</p> </sec> <sec> <title>RESULTS</title> <p>The final DHSC comprises 21 assessment items organized into five sustainability dimensions: individual, social, environmental, economic, and technical. The individual dimension addresses psychosocial, usability, motivational, and behavioural determinants of sustained use. The social dimension evaluates user engagement within social contexts, including cultural adaptation, peer support, training, equity, ethics, privacy, governance, and social impact. The environmental dimension assesses how the DHI interacts with its physical and organizational environments. The economic dimension examines financial sustainability through business models, affordability, and long-term value. The technical dimension evaluates system reliability, interoperability, usability, and implementation capacity to support sustainable deployment and maintenance. Guiding questions for each item help users of the DHSC to assess their DHI regarding these sustainability aspects.</p> </sec> <sec> <title>CONCLUSIONS</title> <p>The DHSC provides a comprehensive and practical framework for integrating sustainability considerations throughout the planning, implementation, and evaluation of DHIs. By adopting a multidimensional perspective, the DHSC can support researchers, developers, healthcare organizations, and policymakers in designing DHIs that are not only effective but also sustainable over the long term.</p> </sec>