Stakeholder engagement in digital health: a relational, system-level and process-oriented approach

Purpose The term stakeholder engagement (SE) is widely used in digital health. Yet, empirical research remains fragmented regarding who contributes, how engagement is enacted, and how stakeholder input relates to implementation and governance. This study aims to synthesise this evidence and develop a framework for understanding SE within digitally mediated healthcare services. Design/methodology/approach The study combines a systematic scoping review of 54 empirical studies published up to 31 December 2025 with reflexive thematic analysis and a service research-informed conceptual synthesis. Two consultation workshops involving eight digital health stakeholders refined the framework's conceptual boundaries, internal relationships and contextual relevance. Findings The review identifies four themes: SE framings; recurring stakeholder role–contribution logics; practices ranging from informing to collaborating; and relational, technological, organisational, resource, and institutional conditions shaping engagement. The conceptual synthesis integrates these themes into a three-dimensional framework. The relational dimension connects stakeholder contributions, participatory practices, and decision influence. The system-level dimension configures stakeholder groups, roles, and contributions across interdependent micro, meso, and macro levels. The processual dimension represents SE as a non-linear journey in which practices and influence may intensify, weaken, or be reconfigured over time. Originality/value The study moves beyond treating SE as the inclusion of stakeholders or the application of participatory methods by explaining how stakeholder contributions acquire influence through participatory practices and relationships and how these dynamics are embedded in wider organisational and institutional arrangements. For service research, the framework specifies how these relationships are configured across interconnected levels of the service system and how they evolve as digital health initiatives are developed, implemented, and adapted.