Blockchain in Portuguese healthcare: Perceived usefulness, trust, and readiness: A qualitative case study

Abstract

Blockchain is frequently promoted for improving data integrity, auditability, and secure interoperability in healthcare, yet evidence from clinical settings - particularly in Southern Europe - remains scarce. This study case explores Portuguese healthcare professionals' perceptions of the opportunities and barriers to blockchain implementation. Six semi-structured interviews were conducted in a healthcare institution setting and analysed thematically, guided by three analytical dimensions: digital literacy, trust, and organisational readiness. The findings show that participants recognised blockchain's potential to improve data traceability, consent management, and security. At the same time, however, they also expressed concerns regarding legal compliance, the technical integration of blockchain with existing systems, and the capacity of institutions to support change. Most interviewees reported limited familiarity with blockchain technology, which contributed to uncertainty. Discussions frequently highlighted the need for role-specific training and transparent governance frameworks and challenges with GDPR compliance (including the "right to be forgotten"). Taken together, these perspectives suggest that professionals understand blockchain implementation in healthcare not only in technical terms, but also in terms of institutional and human factors. This suggests that its implementation should be approached as a sociotechnical process requiring alignment between technological design, governance structures, and user capabilities. By offering qualitative insights from a Southern European healthcare, the study contributes to the ongoing debate on digital transformation with empirical evidence and highlights the importance of inclusive planning, capacity building, and regulatory clarity for sustainable implementation.