The ABC of digital health: A framework for translating digital health interventions into real-world applications

David Grüning, Vincent Beermann, Jan Enkmann, Rose Hoch, Ralph Hertwig, Paul Schmiedmayer

Research-based digital health interventions are often presented as potential solutions for extending health care in the real world. Yet the vast majority of these interventions fails to move beyond controlled studies. Existing frameworks offer valuable guidance for intervention development and testing, but provide less concrete support for translating these evidenced intervention mechanisms into sustained real-world applications. This paper introduces the ABC framework, referring to Accessibility, Buildability, and Continuity, as a practical model for a successful translation. Accessibility captures whether diverse users can find, understand, and begin using an application with minimal friction. Buildability refers to the development of an app that supports the iteration, integration, and personalization of features. Continuity describes both sustained user engagement and the operational capacity to maintain an application over time without disproportionate increases in cost, infrastructure, or human support. Different combinations of the ABC-dimensions make an application scalable (AB), automated (BC), and adherent (AC). By linking design decisions to these features, ABC offers a shared language for researchers, designers, and policymakers seeking to build or evaluate digital health interventions that work beyond trials and are viable applications in everyday life.