Review
1Anglia Ruskin University, Cambridge, United Kingdom
2University of Applied Sciences Northwestern Switzerland, Brugg, Switzerland
3Innovation and Management Practice Research Centre, Anglia Ruskin University, Cambridge, United Kingdom
Corresponding Author:
Christine Jacob, BSc, MSc
Anglia Ruskin University
Cambridge Campus
East Rd
Cambridge, CB1 1PT
United Kingdom
Phone: 44 798769376
Email: christine.k.jacob@gmail.com
Abstract
Background: There is a growing body of evidence highlighting the potential of mobile health (mHealth) in reducing health care costs, enhancing access, and improving the quality of patient care. However, user acceptance and adoption are key prerequisites to harness this potential; hence, a deeper understanding of the factors impacting this adoption is crucial for its success.
Objective: The aim of this review was to systematically explore relevant published literature to synthesize the current understanding of the factors impacting clinicians’ adoption of mHealth tools, not only from a technological perspective but also from social and organizational perspectives.
Methods: A structured search was carried out of MEDLINE, PubMed, the Cochrane Library, and the SAGE database for studies published between January 2008 and July 2018 in the English language, yielding 4993 results, of which 171 met the inclusion criteria. The Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines and the Cochrane handbook were followed to ensure a systematic process.
Results: The technological factors impacting clinicians’ adoption of mHealth tools were categorized into eight key themes: usefulness, ease of use, design, compatibility, technical issues, content, personalization, and convenience, which were in turn divided into 14 subthemes altogether. Social and organizational factors were much more prevalent and were categorized into eight key themes: workflow related, patient related, policy and regulations, culture or attitude or social influence, monetary factors, evidence base, awareness, and user engagement. These were divided into 41 subthemes, highlighting the importance of considering these factors when addressing potential barriers to mHealth adoption and how to overcome them.
Conclusions: The study results can help inform mHealth providers and policymakers regarding the key factors impacting mHealth adoption, guiding them into making educated decisions to foster this adoption and harness the potential benefits.
doi:10.2196/15935
Keywords
Introduction
Mobile health (mHealth) is one of the key areas of medical technology innovation that hold promise for reduction of cost, enhancement of health care access, and improvement in the quality of patient care [Armstrong AW, Kwong MW, Chase EP, Ledo L, Nesbitt TS, Shewry SL. Teledermatology operational considerations, challenges, and benefits: the referring providers' perspective. Telemed J E Health 2012 Oct;18(8):580-584. [CrossRef] [Medline]1-Mileski M, Kruse CS, Catalani J, Haderer T. Adopting telemedicine for the self-management of hypertension: systematic review. JMIR Med Inform 2017 Oct 24;5(4):e41 [FREE Full text] [CrossRef] [Medline]5]. It is also helping to shift the focus of health care to a more patient-centric model that goes beyond treating disease to a more predictive and preventative approach [Pavel M, Jimison HB, Wactlar HD, Hayes TL, Barkis W, Skapik J, et al. The role of technology and engineering models in transforming healthcare. IEEE Rev Biomed Eng 2013;6:156-177. [CrossRef] [Medline]6,Payne KF, Wharrad H, Watts K. Smartphone and medical related App use among medical students and junior doctors in the United Kingdom (UK): a regional survey. BMC Med Inform Decis Mak 2012 Oct 30;12:121 [FREE Full text] [CrossRef] [Medline]7].
Although the body of evidence that proves the potential value of mHealth is growing, there are still cases where users, mostly clinicians, resist its adoption [Choi WS, Park J, Choi JY, Yang J. Stakeholders' resistance to telemedicine with focus on physicians: utilizing the Delphi technique. J Telemed Telecare 2019 Jul;25(6):378-385. [CrossRef] [Medline]8]. For example, scholars in the area of mHealth adoption, such as Gagnon et al [Gagnon MP, Ngangue P, Payne-Gagnon J, Desmartis M. m-Health adoption by healthcare professionals: a systematic review. J Am Med Inform Assoc 2016 Jan;23(1):212-220. [CrossRef] [Medline]9], found in a previous systematic review that, in reality, many studies reported that health care professionals perceive factors such as mHealth cost more as a barrier than a facilitator. Furthermore, Brewster et al [Brewster L, Mountain G, Wessels B, Kelly C, Hawley M. Factors affecting front line staff acceptance of telehealth technologies: a mixed-method systematic review. J Adv Nurs 2014 Jan;70(1):21-33. [CrossRef] [Medline]10] reported in their systematic review on the same topic that clinicians perceive some negative impacts of mHealth on elements such as their credibility and autonomy, affecting staff acceptance of such tools. This should not be overlooked, given that previous research shows that clinicians’ adoption is one of the most influential factors regarding the success of mHealth tools [Hussein R, Khalifa A. Telemedicine in Egypt: SWOT analysis and future trends. GMS Medizinische Inform Biometrie und Epidemiol 2012;8(1):1-16 [FREE Full text] [CrossRef]11-Gagnon MP, Desmartis M, Labrecque M, Car J, Pagliari C, Pluye P, et al. Systematic review of factors influencing the adoption of information and communication technologies by healthcare professionals. J Med Syst 2012 Feb;36(1):241-277 [FREE Full text] [CrossRef] [Medline]15]; hence, the need and value of better understanding the factors impacting clinicians’ adoption in this context.
The World Health Organization’s global observatory of electronic health (eHealth) considers mHealth a subcategory of eHealth and defines it as “medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, Personal Digital Assistants (PDAs), and other wireless devices.” Telemedicine is, in turn, a subcategory of mHealth and defined as “the communication or consultation between health professionals about patients using voice, text, data, imaging, or video functions of a mobile device. But it can be applied to other situations; the management of chronic diseases of patients living at home is one example.” [World Health Organization. mHealth: New Horizons for Health through Mobile Technologies. Switzerland: World Health Organization; 2011.16].
According to the diffusion of innovations theory [Rogers EM. Diffusion of Innovations. Fifth Edition. New York, NY: Free Press; 2003.17], technology adoption studies should look into not only users’ acceptance or rejection of specific innovations but also to what extent innovation is incorporated into a suitable context. Straub [Straub ET. Understanding technology adoption: theory and future directions for informal learning. Rev Educ Res 2009;79(2):625-649. [CrossRef]18] examined the most prevalent technology adoption theories—Rogers's innovation adoption and diffusion theories, the Concerns-Based Adoption Model, the Technology Acceptance Model (TAM), and the unified theory of acceptance and use of technology (UTAUT)—and concluded that the process of user adoption of new technologies is complex, fundamentally social, and progressive. This complexity results from the users’ unique views of technology that impact their decision to adopt or reject new technology, highlighting the importance of considering social and organizational factors to enable the successful adoption of new technological tools.
We were guided in our thinking about technology adoption by the field of social studies of technology; we view technology, roles, and practices and organizational structures as interacting parts of a mutually constituting ensemble of elements [Goffman E. The Presentation of Self in Everyday Life. New York: Doubleday; 1956.19-Leonardi PM. Methodological guidelines for the study of materiality and affordances. In: Raza M, Jain S, editors. Routledge Companion to Qualitative Research in Organization Studies. New York: Routledge; 2017:279-290.22]. It follows that it is not simply a matter of factors affecting the decision to adopt a technology or not but also of the use of technologies enabling and triggering new forms of organizing and new work practices [Bélanger F, Watson-Manheim MB. Virtual teams and multiple media: Structuring media use to attain strategic goals. Group Decis Negot 2006;15(4):299-321. [CrossRef]23,Chudoba K, Wynn E, Lu M, Watson-Manheim MB. How virtual are we? Measuring virtuality and understanding its impact in a global organization. Inf Syst J 2005 Oct;15(4):279-306. [CrossRef]24]. A mutually constituting sensibility alerts the researcher to the fact that the adoption of technology can be part of a deliberate change process and can result in new practices and different uses and interpretations of the technology itself. We are mindful of how such things as organizational culture and existing roles and practices are implicated not just in the decision to adopt but how the decision to adopt can lead to experimentation with new practices and organizational forms. The scope of our literature review engages in more depth with these broader concerns and interests than previous reviews.
A systematic review of relevant literature was carried out to provide an accurate and up to date account of factors that impact clinicians’ adoption of mHealth tools both from a technology and a social and organizational perspective. This work complements a larger ongoing research project and supplements its initial findings, which have already been published [Jacob C, Sanchez-Vazquez A, Ivory C. Clinicians' role in the adoption of an oncology decision support app in Europe and its implications for organizational practices: qualitative case study. JMIR Mhealth Uhealth 2019 May 3;7(5):e13555 [FREE Full text] [CrossRef] [Medline]25].
In light of Leonardi’s Methodological Guidelines for the Study of Materiality and Affordances [Leonardi PM. Methodological guidelines for the study of materiality and affordances. In: Raza M, Jain S, editors. Routledge Companion to Qualitative Research in Organization Studies. New York: Routledge; 2017:279-290.22], the authors analyzed the included studies following three key steps: (1) identifying utility and limitations of the studied solutions, (2) recognizing the real constraints upon opportunities faced by clinicians when using them, and (3) understanding the workflow advantages and disadvantages related to them, as reported in the included articles.
Findings from this review should benefit mHealth providers and policymakers by presenting them with an up to date and comprehensive review of key factors impacting clinicians’ adoption of mHealth tools, as reported in the academic literature. This can inform and guide them in the development of a strategy for promoting the adoption of these tools and enable them to realize their potential benefits.
Methods
Overview
The methods for this review were drawn from the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines [Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009 Jul 21;6(7):e1000097 [FREE Full text] [CrossRef] [Medline]26]and the Cochrane Handbook [Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions. New Jeresey: Wiley; 2011.27], both of which provide guidance toward a rigorous and reliable literature review methodology. The review methods were defined in advance and the protocol was published in the PROSPERO (International Prospective Register of Systematic Reviews) and is available on their website [Jacob C, Ivory C, Sánchez-Vázquez A. CRD Database. 2018. Social and Material Factors Impacting Clinicians' Adoption of mHealth Solutions: A Systematic Review of the Literature URL: http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018110175 [accessed 2019-07-30] 28]. The analysis did not necessitate any major divergence from the initial protocol.
The key question that guided this review was the following: “According to the literature, what are the social, organizational and technological factors impacting clinicians' adoption of mHealth tools?”
Search Strategy
A search of MEDLINE, PubMed, the Cochrane Library, and the SAGE database in August and September 2018 identified the relevant studies. The scope was narrowed to studies published in the English language between January 2008 and August 2018. Only original, peer-reviewed, and published papers were included. Other forms, such as editorials, unsystematic reviews, interviews, comments, unstructured observations, and position papers, were excluded.
It was decided not to include articles on the basis of on hand searches of reference lists for causes summarized in the Cochrane Handbook: “positive studies are more likely to be cited” and “retrieving literature by scanning reference lists may thus produce a biased sample of studies” [Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions. New Jeresey: Wiley; 2011.27].
The search string shown in 
Figure 1 was developed according to the participants, intervention, comparators, and outcome (PICO) framework [Schardt C, Adams MB, Owens T, Keitz S, Fontelo P. Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Med Inform Decis Mak 2007 Jun 15;7:16 [FREE Full text] [CrossRef] [Medline]29]. There were no limitations on the kinds of conditions qualified for inclusion, and both qualitative and quantitative studies were included. Comparators were not applicable to this study. Participants (Clinicians) included studies focusing on clinicians and health care professionals. For the review, the Merriam-Webster dictionary’s definition of the word clinician was used: “a person qualified in the clinical practice of medicine, psychiatry, or psychology as distinguished from one specializing in laboratory or research techniques or in theory” [Merriam-Webster. Merriam Webster's Collegiate Dictionary. Massachusetts: Merriam-webster; 1997.30]. Interventions (mHealth) included studies involving smart device use, such as mHealth apps or telehealth. Outcomes (Adoption) included studies addressing the factors impacting mHealth technology adoption or use.
Study Selection
Independent researchers, CJ and ASV, were involved in the screening, eligibility, and inclusion phases, and any divergences were agreed in discussion between the 2. In the cases where they could not reach an agreement, a third reviewer, CI, discussed it with them and took the final decision. The research team used the open-source app Rayyan QCRI (Qatar Computing Research Institute) to facilitate collaborative screening by the team [Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev 2016 Dec 5;5(1):210 [FREE Full text] [CrossRef] [Medline]31]. Screening lasted from August 2018 to February 2019. A screenshot of the app is included in Screenshot of Rayyan QCRI (Qatar Computing Research Institute).Multimedia Appendix 1
The inclusion and exclusion criteria, detailed in 
Textbox 1, were also developed according to the PICO framework. Studies were excluded if they did not involve the use of mHealth or smart devices; focused solely on, for example, patients, caregivers or technology providers, not including clinicians; were not peer-reviewed; were editorials, interviews, comments, unstructured observations, or position papers; did not address the factors impacting adoption; or if the full text was not available, freely available, or available in English.
After completing the screening, and resolving any conflicting views between the researchers, the selected full texts were assessed for eligibility by CJ and AV, independently. Any disagreements were resolved by discussing with CI.
Subsequently, the risk of bias was assessed using the Critical Appraisal Skills Program tool [Critical Appraisal Skills Program. 2018. CASP Qualitative Checklist
URL: https://casp-uk.net/casp-tools-checklists/32]. The checklist is included in Critical Appraisal Skills Program checklist. Critical appraisal of the included studies.Multimedia Appendix 2
Multimedia Appendix 3
Inclusion and exclusion criteria according to the participants, intervention, comparator, and outcome (PICO) framework.
Population (P)
- Include: Focused on health care professionals (eg, physicians and nurses).
- Exclude: Focused only on patients, caregivers, or technology providers.
Intervention (I)
- Include: Focused on solutions involving a smart device (eg, mHealth apps and telehealth).
- Exclude: Using other technologies (eg, virtual reality and machine learning).
Comparators (C)
- Does not apply.
Outcome (O)
- Include: Addresses factors impacting clinicians’ adoption, acceptance, use, experience, implementation, usability, or attitude of using mHealth for health care service delivery, regardless of the condition.
- Exclude: Focused only on mHealth success or development in general.
Publication type
- Include: Original, peer-reviewed, and published paper.
- Exclude: Editorials, interviews, comments, unstructured observations, and position papers, or similar publications.
Data Collection and Synthesis
The variety of measures and outcomes that were identified in the included articles were not homogenous enough to enable a quantitative synthesis of the data. Therefore, a narrative synthesis was used and structured around the organizational and technological factors impacting clinicians’ adoption of mHealth solutions. QSR NVivo, a computer-assisted qualitative data analysis software, was used to assist in this task.
Data coding began with an initial data extraction grid that included themes based on previous research and technology acceptance frameworks; more themes were added as they emerged during the review process. Braun and Clarke’s thematic analysis [Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006;3(2):77-101. [CrossRef]33] was used to identify and extract themes that addressed the review’s research question. The phases of the thematic analysis are explained in detail in Phases of thematic analysis after Braun and Clarke.Multimedia Appendix 4
The research themes were also guided by Leonardi’s Methodological Guidelines for the Study of Materiality and Affordances [Leonardi PM. Methodological guidelines for the study of materiality and affordances. In: Raza M, Jain S, editors. Routledge Companion to Qualitative Research in Organization Studies. New York: Routledge; 2017:279-290.22]; hence, they were split into two key groups, on the one hand, the technological factors, and on the other the social and organizational factors. There was an additional category for implications for social and organizational practices. This process lasted from February to July 2019.
Results
Overview
As shown in the study selection flow diagram, visualized in 
Figure 2, the search string yielded a total of 4993 studies, out of which 3516 from PubMed, 1296 from SAGE, and 181 from the Cochrane database. From these, 1156 studies were excluded after limiting the scope to studies published in English and published after January 2008, leaving 3837 studies for screening. Screening of the titles and abstracts excluded another 3458 articles because 493 of them did not involve mHealth or smart devices, 531 focused solely on nonclinician populations such as patients, caregivers, or technology providers, 271 were editorials, interviews, comments, unstructured observations, position, or non–peer-reviewed papers, 2 were not available as full text, 2 were not available in English, 2119 did not address factors impacting adoption, and 40 were duplicates.
In the eligibility phase, 338 articles were included for full-text assessment. In total 167 articles were excluded for the following reasons: 28 for not involving mHealth or smart devices; 9 for focusing solely on nonclinician populations such as patients, caregivers, or technology providers; 6 for being either, editorials, interviews, comments, unstructured observations, position, or non–peer-reviewed papers; 4 because the full text was not available; and 120 for not addressing the factors impacting adoption. This resulted in the inclusion of 171 studies in the qualitative synthesis.
Characteristics of Included Studies
The sample characteristics of the included articles are detailed in 
Table 1. Overall, 62 studies focused on clinicians, 41 on physicians, 21 on nurses, and 46 included clinicians and other populations such as patients or caregivers. From a specialization perspective, some were more represented than others in the included studies; 17 studies focused on primary and acute care, 12 on chronic obstructive pulmonary disease, or congestive heart failure, or cardiovascular disease, 10 on diabetes, 9 on general and family practices, 8 on psychology and mental health, whereas the other specialties were represented four times or less in the included studies.
The majority of the publications did not mention the use of a theoretical framework. Among those that used one, the TAM was the most common (n=19), followed by the theory of diffusion of innovation (n=11), and the UTAUT (n=6). Other models were used once or twice, as detailed in Table 1. From a geographical perspective, 38 studies were conducted in the United States, 22 in the United Kingdom, 15 in Australia, 9 in Canada, 7 in Germany, 7 in Spain, whereas other geographies were covered in 4 studies or less.
Finally, 31 studies were identified as pilot projects. Such studies can be particularly relevant to mHealth providers when rolling out a new tool, as they provide insights into the potential teething problems that they can avoid to have better chances for success.
| Study characteristic | References | |
| Study Design | ||
| Qualitative (n=64) | [Armstrong AW, Kwong MW, Chase EP, Ledo L, Nesbitt TS, Shewry SL. Teledermatology operational considerations, challenges, and benefits: the referring providers' perspective. Telemed J E Health 2012 Oct;18(8):580-584. [CrossRef] [Medline]1,Avey JP, Hobbs RL. Dial in: fostering the use of telebehavioral health services in frontier Alaska. Psychol Serv 2013 Aug;10(3):289-297. [CrossRef] [Medline]2,Bhatta R, Aryal K, Ellingsen G. Opportunities and challenges of a rural-telemedicine program in Nepal. J Nepal Health Res Counc 2015;13(30):149-153. [Medline]4,Catan G, Espanha R, Mendes RV, Toren O, Chinitz D. Health information technology implementation - impacts and policy considerations: a comparison between Israel and Portugal. Isr J Health Policy Res 2015;4:41 [FREE Full text] [CrossRef] [Medline]34-Casey M, Shaw S, Swinglehurst D. Experiences with online consultation systems in primary care: case study of one early adopter site. Br J Gen Pract 2017 Nov;67(664):e736-e743 [FREE Full text] [CrossRef] [Medline]94] | |
| Quantitative (n=58) | [Anderson K, Francis T, Ibanez-Carrasco F, Globerman J. Physician's perceptions of telemedicine in HIV care provision: a cross-sectional web-based survey. JMIR Public Health Surveill 2017 May 30;3(2):e31 [FREE Full text] [CrossRef] [Medline]3,Ghani MK, Jaber MM. Willingness to adopt telemedicine in major iraqi hospitals: a pilot study. Int J Telemed Appl 2015;2015:136591 [FREE Full text] [CrossRef] [Medline]95-Duhm J, Fleischmann R, Schmidt S, Hupperts H, Brandt SA. Mobile electronic medical records promote workflow: physicians' perspective from a survey. JMIR Mhealth Uhealth 2016 Jun 6;4(2):e70 [FREE Full text] [CrossRef] [Medline]150] | |
| Mixed methods (n=32) | [Alajlani M, Clarke M. Effect of culture on acceptance of telemedicine in Middle Eastern countries: case study of Jordan and Syria. Telemed J E Health 2013 Apr;19(4):305-311. [CrossRef] [Medline]151-Ehrler F, Ducloux P, Wu DT, Lovis C, Blondon K. Acceptance of a mobile application supporting nurses workflow at patient bedside: results from a pilot study. Stud Health Technol Inform 2018;247:506-510. [Medline]181] | |
| Systematic review (n=11) | [Mileski M, Kruse CS, Catalani J, Haderer T. Adopting telemedicine for the self-management of hypertension: systematic review. JMIR Med Inform 2017 Oct 24;5(4):e41 [FREE Full text] [CrossRef] [Medline]5,Gagnon MP, Ngangue P, Payne-Gagnon J, Desmartis M. m-Health adoption by healthcare professionals: a systematic review. J Am Med Inform Assoc 2016 Jan;23(1):212-220. [CrossRef] [Medline]9,Brewster L, Mountain G, Wessels B, Kelly C, Hawley M. Factors affecting front line staff acceptance of telehealth technologies: a mixed-method systematic review. J Adv Nurs 2014 Jan;70(1):21-33. [CrossRef] [Medline]10,Radhakrishnan K, Xie B, Berkley A, Kim M. Barriers and facilitators for sustainability of tele-homecare programs: a systematic review. Health Serv Res 2016 Feb;51(1):48-75 [FREE Full text] [CrossRef] [Medline]182-Penny RA, Bradford NK, Langbecker D. Registered nurse and midwife experiences of using videoconferencing in practice: a systematic review of qualitative studies. J Clin Nurs 2018 Mar;27(5-6):e739-e752. [CrossRef] [Medline]189] | |
| Others (n=5) | [Choi WS, Park J, Choi JY, Yang J. Stakeholders' resistance to telemedicine with focus on physicians: utilizing the Delphi technique. J Telemed Telecare 2019 Jul;25(6):378-385. [CrossRef] [Medline]8,Daniel F, Jabak S, Sasso R, Chamoun Y, Tamim H. Patient-physician communication in the era of mobile phones and social media apps: cross-sectional observational study on Lebanese physicians' perceptions and attitudes. JMIR Med Inform 2018 Apr 6;6(2):e18 [FREE Full text] [CrossRef] [Medline]190-Mishori R, Anastario M, Naimer K, Varanasi S, Ferdowsian H, Abel D, et al. mJustice: preliminary development of a mobile app for medical-forensic documentation of sexual violence in low-resource environments and conflict zones. Glob Health Sci Pract 2017 Mar 24;5(1):138-151 [FREE Full text] [CrossRef] [Medline]193] | |
| Sample size | ||
| Less than 10 (n=8) | [Molfenter T, Boyle M, Holloway D, Zwick J. Trends in telemedicine use in addiction treatment. Addict Sci Clin Pract 2015 May 28;10:14 [FREE Full text] [CrossRef] [Medline]67,Odeh B, Kayyali R, Nabhani-Gebara S, Philip N. Implementing a telehealth service: nurses' perceptions and experiences. Br J Nurs 2014;23(21):1133-1137. [CrossRef] [Medline]71,Beauregard P, Arnaert A, Ponzoni N. Nursing students' perceptions of using smartphones in the community practicum: a qualitative study. Nurse Educ Today 2017 Jun;53:1-6. [CrossRef] [Medline]76,Varsi C, Ekstedt M, Gammon D, Børøsund E, Ruland CM. Middle managers' experiences and role in implementing an interactive tailored patient assessment eHealth intervention in clinical practice. Comput Inform Nurs 2015;33(6):249-257. [CrossRef] [Medline]85,Vest BM, Hall VM, Kahn LS, Heider AR, Maloney N, Singh R. Nurse perspectives on the implementation of routine telemonitoring for high-risk diabetes patients in a primary care setting. Prim Health Care Res Dev 2017 Jan;18(1):3-13. [CrossRef] [Medline]88,Cary MP, Spencer M, Carroll A, Hand DH, Amis K, Karan E, et al. Benefits and challenges of delivering tele-rehabilitation services to rural veterans. Home Healthc Now 2016 Sep;34(8):440-446. [CrossRef] [Medline]93,Taylor A, Wade V, Morris G, Pech J, Rechter S, Kidd M, et al. Technology support to a telehealth in the home service: qualitative observations. J Telemed Telecare 2016 Jul;22(5):296-303. [CrossRef] [Medline]171] | |
| 10-20 (n=41) | [Armstrong AW, Kwong MW, Chase EP, Ledo L, Nesbitt TS, Shewry SL. Teledermatology operational considerations, challenges, and benefits: the referring providers' perspective. Telemed J E Health 2012 Oct;18(8):580-584. [CrossRef] [Medline]1,Avey JP, Hobbs RL. Dial in: fostering the use of telebehavioral health services in frontier Alaska. Psychol Serv 2013 Aug;10(3):289-297. [CrossRef] [Medline]2,Bhatta R, Aryal K, Ellingsen G. Opportunities and challenges of a rural-telemedicine program in Nepal. J Nepal Health Res Counc 2015;13(30):149-153. [Medline]4,Brewster L, Mountain G, Wessels B, Kelly C, Hawley M. Factors affecting front line staff acceptance of telehealth technologies: a mixed-method systematic review. J Adv Nurs 2014 Jan;70(1):21-33. [CrossRef] [Medline]10,Catan G, Espanha R, Mendes RV, Toren O, Chinitz D. Health information technology implementation - impacts and policy considerations: a comparison between Israel and Portugal. Isr J Health Policy Res 2015;4:41 [FREE Full text] [CrossRef] [Medline]34,de Souza CH, Morbeck RA, Steinman M, Hors CP, Bracco MM, Kozasa EH, et al. Barriers and benefits in telemedicine arising between a high-technology hospital service provider and remote public healthcare units: a qualitative study in Brazil. Telemed J E Health 2017 Jun;23(6):527-532. [CrossRef] [Medline]37,Egerton T, Nelligan R, Setchell J, Atkins L, Bennell KL. General practitioners' perspectives on a proposed new model of service delivery for primary care management of knee osteoarthritis: a qualitative study. BMC Fam Pract 2017 Sep 7;18(1):85 [FREE Full text] [CrossRef] [Medline]39,Esterle L, Mathieu-Fritz A. Teleconsultation in geriatrics: impact on professional practice. Int J Med Inform 2013 Aug;82(8):684-695. [CrossRef] [Medline]40,Farrell M. Use of iPhones by nurses in an acute care setting to improve communication and decision-making processes: qualitative analysis of nurses' perspectives on iPhone use. JMIR Mhealth Uhealth 2016 May 31;4(2):e43 [FREE Full text] [CrossRef] [Medline]42,Grünloh C, Cajander A, Myreteg G. 'The Record is Our Work Tool!'- physicians' framing of a patient portal in Sweden. J Med Internet Res 2016 Jun 27;18(6):e167 [FREE Full text] [CrossRef] [Medline]46,Hanna L, May C, Fairhurst K. The place of information and communication technology-mediated consultations in primary care: GPs' perspectives. Fam Pract 2012 Jun;29(3):361-366. [CrossRef] [Medline]49,Hines M, Lincoln M, Ramsden R, Martinovich J, Fairweather C. Speech pathologists' perspectives on transitioning to telepractice: what factors promote acceptance? J Telemed Telecare 2015 Dec;21(8):469-473. [CrossRef] [Medline]50,Armstrong AW, Kwong MW, Ledo L, Nesbitt TS, Shewry SL. Practice models and challenges in teledermatology: a study of collective experiences from teledermatologists. PLoS One 2011;6(12):e28687 [FREE Full text] [CrossRef] [Medline]54,Khan NU, Rasheed S, Sharmin T, Ahmed T, Mahmood SS, Khatun F, et al. Experience of using mHealth to link village doctors with physicians: lessons from Chakaria, Bangladesh. BMC Med Inform Decis Mak 2015 Aug 5;15:62 [FREE Full text] [CrossRef] [Medline]56,Kim JW, Tiyyagura G, Langhan M. A qualitative analysis of general emergency medicine providers' perceptions on pediatric emergency telemedicine. Pediatr Emerg Care 2019 Dec;35(12):856-861. [CrossRef] [Medline]57,Lord S, Moore SK, Ramsey A, Dinauer S, Johnson K. Implementation of a substance use recovery support mobile phone app in community settings: qualitative study of clinician and staff perspectives of facilitators and barriers. JMIR Ment Health 2016 Jun 28;3(2):e24 [FREE Full text] [CrossRef] [Medline]61,McNally G, Frey R, Crossan M. 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[CrossRef] [Medline]72,Sandberg J, Trief PM, Izquierdo R, Goland R, Morin PC, Palmas W, et al. A qualitative study of the experiences and satisfaction of direct telemedicine providers in diabetes case management. Telemed J E Health 2009 Oct;15(8):742-750. [CrossRef] [Medline]75,Sharma U, Barnett J, Clarke M. Clinical users' perspective on telemonitoring of patients with long term conditions: understood through concepts of Giddens's structuration theory & consequence of modernity. Stud Health Technol Inform 2010;160(Pt 1):545-549. [Medline]79,Sharma U, Clarke M. Nurses' and community support workers' experience of telehealth: a longitudinal case study. BMC Health Serv Res 2014 Apr 10;14:164 [FREE Full text] [CrossRef] [Medline]80,Sturesson L, Groth K. Effects of the digital transformation: qualitative study on the disturbances and limitations of using video visits in outpatient care. 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| 21-40 (n=30) | [Gagnon MP, Ngangue P, Payne-Gagnon J, Desmartis M. m-Health adoption by healthcare professionals: a systematic review. J Am Med Inform Assoc 2016 Jan;23(1):212-220. [CrossRef] [Medline]9,Chiang KF, Wang HH, Chien IK, Liou JK, Hung CL, Huang CM, et al. Healthcare providers' perceptions of barriers in implementing of home telecare in Taiwan: a qualitative study. Int J Med Inform 2015 Apr;84(4):277-287. [CrossRef] [Medline]35,Chung C, Cook J, Bales E, Zia J, Munson SA. More than telemonitoring: health provider use and nonuse of life-log data in irritable bowel syndrome and weight management. J Med Internet Res 2015 Aug 21;17(8):e203 [FREE Full text] [CrossRef] [Medline]36,Fairbrother P, Ure J, Hanley J, McCloughan L, Denvir M, Sheikh A, Telescot programme team. Telemonitoring for chronic heart failure: the views of patients and healthcare professionals - a qualitative study. J Clin Nurs 2014 Jan;23(1-2):132-144. [CrossRef] [Medline]41,Giraldo L, Schachner B, Luna D, Benítez S. Exploring nurses' perceptions and expectations toward a BCMA implementation using a mobile app and workstations as a change management strategy. Stud Health Technol Inform 2018;250:134-138. [Medline]44,Goedken CC, Moeckli J, Cram PM, Reisinger HS. Introduction of Tele-ICU in rural hospitals: changing organisational culture to harness benefits. Intensive Crit Care Nurs 2017 Jun;40:51-56. [CrossRef] [Medline]45,Han KJ, Subramanian R, Cameron GT. Listen before you leap: Sri Lankan health professionals' perspectives on m-health. Health Informatics J 2019 Sep;25(3):858-866. [CrossRef] [Medline]47,James S, Perry L, Gallagher R, Lowe J. Diabetes educators: perceived experiences, supports and barriers to use of common diabetes-related technologies. J Diabetes Sci Technol 2016 Sep;10(5):1115-1121 [FREE Full text] [CrossRef] [Medline]51,Jimbo M, Shultz CG, Nease DE, Fetters MD, Power D, Ruffin MT. Perceived barriers and facilitators of using a Web-based interactive decision aid for colorectal cancer screening in community practice settings: findings from focus groups with primary care clinicians and medical office staff. J Med Internet Res 2013 Dec 18;15(12):e286 [FREE Full text] [CrossRef] [Medline]53,Kayyali R, Hesso I, Mahdi A, Hamzat O, Adu A, Nabhani Gebara S. Telehealth: misconceptions and experiences of healthcare professionals in England. Int J Pharm Pract 2017 Jun;25(3):203-209. [CrossRef] [Medline]55,Levine M, Richardson JE, Granieri E, Reid MC. Novel telemedicine technologies in geriatric chronic non-cancer pain: primary care providers' perspectives. Pain Med 2014 Feb;15(2):206-213 [FREE Full text] [CrossRef] [Medline]60,MacNeill V, Sanders C, Fitzpatrick R, Hendy J, Barlow J, Knapp M, et al. Experiences of front-line health professionals in the delivery of telehealth: a qualitative study. Br J Gen Pract 2014 Jul;64(624):e401-e407 [FREE Full text] [CrossRef] [Medline]62,Moloczij N, Mosley I, Moss KM, Bagot KL, Bladin CF, Cadilhac DA. Is telemedicine helping or hindering the delivery of stroke thrombolysis in rural areas? A qualitative analysis. Intern Med J 2015 Sep;45(9):957-964. [CrossRef] [Medline]69,Morrow S, Daines L, Wiener-Ogilvie S, Steed L, McKee L, Caress A, et al. Exploring the perspectives of clinical professionals and support staff on implementing supported self-management for asthma in UK general practice: an IMPART qualitative study. NPJ Prim Care Respir Med 2017 Jul 18;27(1):45 [FREE Full text] [CrossRef] [Medline]70,Puszka S, Dingwall KM, Sweet M, Nagel T. E-Mental health innovations for aboriginal and Torres Strait Islander Australians: a qualitative study of implementation needs in health services. JMIR Ment Health 2016 Sep 19;3(3):e43 [FREE Full text] [CrossRef] [Medline]73,Rothstein JD, Jennings L, Moorthy A, Yang F, Gee L, Romano K, et al. Qualitative assessment of the feasibility, usability, and acceptability of a mobile client data app for community-based maternal, neonatal, and child care in rural Ghana. Int J Telemed Appl 2016;2016:2515420 [FREE Full text] [CrossRef] [Medline]74,Schneider T, Panzera AD, Martinasek M, McDermott R, Couluris M, Lindenberger J, et al. Physicians' perceptions of mobile technology for enhancing asthma care for youth. J Child Health Care 2016 Jun;20(2):153-163. [CrossRef] [Medline]77,Seto E, Leonard KJ, Cafazzo JA, Barnsley J, Masino C, Ross HJ. Perceptions and experiences of heart failure patients and clinicians on the use of mobile phone-based telemonitoring. J Med Internet Res 2012 Feb 10;14(1):e25 [FREE Full text] [CrossRef] [Medline]78,Sinclair C, Holloway K, Riley G, Auret K. Online mental health resources in rural Australia: clinician perceptions of acceptability. J Med Internet Res 2013 Sep 5;15(9):e193 [FREE Full text] [CrossRef] [Medline]81,Ghani MK, Jaber MM. Willingness to adopt telemedicine in major iraqi hospitals: a pilot study. Int J Telemed Appl 2015;2015:136591 [FREE Full text] [CrossRef] [Medline]95,Jefee-Bahloul H, Duchen D, Barkil-Oteo A. Attitudes towards implementation of Store-and-Forward telemental health in humanitarian settings: survey of Syrian healthcare providers. Telemed J E Health 2016 Jan;22(1):31-35. [CrossRef] [Medline]101,Koval PG, Kim JJ, Makhlouf T. Pharmacist perception of a mobile application audience response system for remote pharmacy continuing education participants. J Pharm Pract 2018 Aug 13:897190018792391. [CrossRef] [Medline]110,Sadoughi F, Erfannia L, Sancholi M, Salmani F, Sarsarshahi A. Teleradiology in Southeast Iran: Evaluating the Views of Senior Executives and Radiologists. Health Care Manag (Frederick) 2017;36(3):301-307. [CrossRef] [Medline]131,Schmeer R, Behrends M, Kupka T, Meyenburg-Altwarg I, Marschollek M. Use and acceptance of mobile technology by hospital nurses in Germany. Stud Health Technol Inform 2016;225:944-945. [Medline]135,Jeon J, Taneva S, Kukreti V, Trbovich P, Easty AC, Rossos PG, et al. Toward successful migration to computerized physician order entry for chemotherapy. Curr Oncol 2014 Apr;21(2):e221-e228 [FREE Full text] [CrossRef] [Medline]155,Payne KF, Weeks L, Dunning P. A mixed methods pilot study to investigate the impact of a hospital-specific iPhone application (iTreat) within a British junior doctor cohort. Health Informatics J 2014 Mar;20(1):59-73. [CrossRef] [Medline]165,Possemato K, Kuhn E, Johnson EM, Hoffman JE, Brooks E. Development and refinement of a clinician intervention to facilitate primary care patient use of the PTSD Coach app. Transl Behav Med 2017 Mar;7(1):116-126 [FREE Full text] [CrossRef] [Medline]166,Walker L, Clendon J. The case for end-user involvement in design of health technologies. J Telemed Telecare 2016 Dec;22(8):443-446. [CrossRef] [Medline]172,Bramley G, Mangan C, Conroy M. 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| 41-60 (n=11) | [Anderson K, Francis T, Ibanez-Carrasco F, Globerman J. Physician's perceptions of telemedicine in HIV care provision: a cross-sectional web-based survey. JMIR Public Health Surveill 2017 May 30;3(2):e31 [FREE Full text] [CrossRef] [Medline]3,Hanley J, Ure J, Pagliari C, Sheikh A, McKinstry B. Experiences of patients and professionals participating in the HITS home blood pressure telemonitoring trial: a qualitative study. BMJ Open 2013 May 28;3(5):pii: e002671 [FREE Full text] [CrossRef] [Medline]48,Jarvis-Selinger S, Bates J, Araki Y, Lear SA. Internet-based support for cardiovascular disease management. Int J Telemed Appl 2011;2011:342582 [FREE Full text] [CrossRef] [Medline]52,Kopanitsa G, Yampolsky V. Exploring barriers and opportunities for adoption of web portals in Russia. Stud Health Technol Inform 2016;221:87-91. [Medline]58,Tintorer DL, Domínguez JM, Pujol-Rivera E, Beneyto SF, Tuduri XM, Saigí-Rubió F. Keys to success of a community of clinical practice in primary care: a qualitative evaluation of the ECOPIH project. BMC Fam Pract 2018 May 9;19(1):56 [FREE Full text] [CrossRef] [Medline]59,van Gaalen JL, van Bodegom-Vos L, Bakker MJ, Snoeck-Stroband JB, Sont JK. Internet-based self-management support for adults with asthma: a qualitative study among patients, general practitioners and practice nurses on barriers to implementation. BMJ Open 2016 Aug 26;6(8):e010809 [FREE Full text] [CrossRef] [Medline]84,Mairesse GH, Braunschweig F, Klersy K, Cowie MR, Leyva F. Implementation and reimbursement of remote monitoring for cardiac implantable electronic devices in Europe: a survey from the health economics committee of the European Heart Rhythm Association. Europace 2015 May;17(5):814-818. [CrossRef] [Medline]119,Iacono T, Dissanayake C, Trembath D, Hudry K, Erickson S, Spong J. Family and practitioner perspectives on telehealth for services to young children with autism. Stud Health Technol Inform 2016;231:63-73. [Medline]153,Loh P, Flicker L, Horner B. Attitudes toward information and communication technology (ICT) in residential aged care in Western Australia. J Am Med Dir Assoc 2009 Jul;10(6):408-413. [CrossRef] [Medline]156,Zhang Y, Koch S. Mobile health apps in Sweden: what do physicians recommend? Stud Health Technol Inform 2015;210:793-797. [Medline]175,Ahmad F, Norman C, O'Campo P. What is needed to implement a computer-assisted health risk assessment tool? An exploratory concept mapping study. BMC Med Inform Decis Mak 2012 Dec 19;12:149 [FREE Full text] [CrossRef] [Medline]192] | |
| 61-80 (n=8) | [de Vries ST, Wong L, Sutcliffe A, Houÿez F, Ruiz CL, Mol PG, IMI Web-RADR Work Package 3b Consortium. Factors influencing the use of a mobile app for reporting adverse drug reactions and receiving safety information: a qualitative study. Drug Saf 2017 May;40(5):443-455 [FREE Full text] [CrossRef] [Medline]38,Bello AK, Molzahn AE, Girard LP, Osman MA, Okpechi IG, Glassford J, et al. Patient and provider perspectives on the design and implementation of an electronic consultation system for kidney care delivery in Canada: a focus group study. BMJ Open 2017 Mar 2;7(3):e014784 [FREE Full text] [CrossRef] [Medline]87,Lee SI, Park H, Kim JW, Hwang H, Cho EY, Kim Y, et al. Physicians' perceptions and use of a health information exchange: a pilot program in South Korea. Telemed J E Health 2012 Oct;18(8):604-612 [FREE Full text] [CrossRef] [Medline]114,L'Esperance ST, Perry DJ. Assessing advantages and barriers to telemedicine adoption in the practice setting: A MyCareTeam(TM) exemplar. J Am Assoc Nurse Pract 2016 Jun;28(6):311-319. [CrossRef] [Medline]115,Sims MH, Fagnano M, Halterman JS, Halterman MW. Provider impressions of the use of a mobile crowdsourcing app in medical practice. Health Informatics J 2016 Jun;22(2):221-231. [CrossRef] [Medline]137,Bidmead E, Marshall A. A case study of stakeholder perceptions of patient held records: the Patients Know Best (PKB) solution. Digit Health 2016;2:2055207616668431 [FREE Full text] [CrossRef] [Medline]174,Jungwirth D, Haluza D. Information and communication technology and the future of healthcare: results of a multi-scenario Delphi survey. Health Informatics J 2019 Mar;25(1):161-173. [CrossRef] [Medline]191,Putzer GJ, Park Y. The effects of innovation factors on smartphone adoption among nurses in community hospitals. Perspect Health Inf Manag 2010 Jan 1;7:1b [FREE Full text] [Medline]196] | |
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| Sample composition | ||
| Clinicians (n=62) | [Gagnon MP, Ngangue P, Payne-Gagnon J, Desmartis M. m-Health adoption by healthcare professionals: a systematic review. J Am Med Inform Assoc 2016 Jan;23(1):212-220. [CrossRef] [Medline]9,Chiang KF, Wang HH, Chien IK, Liou JK, Hung CL, Huang CM, et al. Healthcare providers' perceptions of barriers in implementing of home telecare in Taiwan: a qualitative study. Int J Med Inform 2015 Apr;84(4):277-287. [CrossRef] [Medline]35,Chung C, Cook J, Bales E, Zia J, Munson SA. More than telemonitoring: health provider use and nonuse of life-log data in irritable bowel syndrome and weight management. J Med Internet Res 2015 Aug 21;17(8):e203 [FREE Full text] [CrossRef] [Medline]36,Esterle L, Mathieu-Fritz A. Teleconsultation in geriatrics: impact on professional practice. Int J Med Inform 2013 Aug;82(8):684-695. [CrossRef] [Medline]40,Goedken CC, Moeckli J, Cram PM, Reisinger HS. Introduction of Tele-ICU in rural hospitals: changing organisational culture to harness benefits. Intensive Crit Care Nurs 2017 Jun;40:51-56. [CrossRef] [Medline]45,Han KJ, Subramanian R, Cameron GT. Listen before you leap: Sri Lankan health professionals' perspectives on m-health. Health Informatics J 2019 Sep;25(3):858-866. [CrossRef] [Medline]47,Jimbo M, Shultz CG, Nease DE, Fetters MD, Power D, Ruffin MT. Perceived barriers and facilitators of using a Web-based interactive decision aid for colorectal cancer screening in community practice settings: findings from focus groups with primary care clinicians and medical office staff. J Med Internet Res 2013 Dec 18;15(12):e286 [FREE Full text] [CrossRef] [Medline]53,Kayyali R, Hesso I, Mahdi A, Hamzat O, Adu A, Nabhani Gebara S. Telehealth: misconceptions and experiences of healthcare professionals in England. Int J Pharm Pract 2017 Jun;25(3):203-209. 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Clinical users' perspective on telemonitoring of patients with long term conditions: understood through concepts of Giddens's structuration theory & consequence of modernity. Stud Health Technol Inform 2010;160(Pt 1):545-549. [Medline]79,Sinclair C, Holloway K, Riley G, Auret K. Online mental health resources in rural Australia: clinician perceptions of acceptability. J Med Internet Res 2013 Sep 5;15(9):e193 [FREE Full text] [CrossRef] [Medline]81,Sturesson L, Groth K. Effects of the digital transformation: qualitative study on the disturbances and limitations of using video visits in outpatient care. J Med Internet Res 2018 Jun 27;20(6):e221 [FREE Full text] [CrossRef] [Medline]82,Varsi C, Ekstedt M, Gammon D, Børøsund E, Ruland CM. Middle managers' experiences and role in implementing an interactive tailored patient assessment eHealth intervention in clinical practice. Comput Inform Nurs 2015;33(6):249-257. [CrossRef] [Medline]85,Varsi C, Ekstedt M, Gammon D, Ruland CM. Using the consolidated framework for implementation research to identify barriers and facilitators for the implementation of an internet-based patient-provider communication service in five settings: a qualitative study. J Med Internet Res 2015 Nov 18;17(11):e262 [FREE Full text] [CrossRef] [Medline]86,Wynn R, Bergvik S, Pettersen G, Fossum S. Clinicians' experiences with videoconferencing in psychiatry. Stud Health Technol Inform 2012;180:1218-1220. [Medline]90,Zilliacus E, Meiser B, Lobb E, Dudding TE, Barlow-Stewart K, Tucker K. The virtual consultation: practitioners' experiences of genetic counseling by videoconferencing in Australia. Telemed J E Health 2010 Apr;16(3):350-357. [CrossRef] [Medline]91,Cary MP, Spencer M, Carroll A, Hand DH, Amis K, Karan E, et al. Benefits and challenges of delivering tele-rehabilitation services to rural veterans. Home Healthc Now 2016 Sep;34(8):440-446. [CrossRef] [Medline]93,Gagnon MP, Orruño E, Asua J, Abdeljelil AB, Emparanza J. 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[CrossRef] [Medline]103,L'Esperance ST, Perry DJ. Assessing advantages and barriers to telemedicine adoption in the practice setting: A MyCareTeam(TM) exemplar. J Am Assoc Nurse Pract 2016 Jun;28(6):311-319. [CrossRef] [Medline]115,Albrecht UV, Afshar K, Illiger K, Becker S, Hartz T, Breil B, et al. Expectancy, usage and acceptance by general practitioners and patients: exploratory results from a study in the German outpatient sector. Digit Health 2017;3:2055207617695135 [FREE Full text] [CrossRef] [Medline]117,Alajlani M, Clarke M. Effect of culture on acceptance of telemedicine in Middle Eastern countries: case study of Jordan and Syria. Telemed J E Health 2013 Apr;19(4):305-311. [CrossRef] [Medline]151-Iacono T, Dissanayake C, Trembath D, Hudry K, Erickson S, Spong J. Family and practitioner perspectives on telehealth for services to young children with autism. Stud Health Technol Inform 2016;231:63-73. 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| Physicians (n=41) | [Armstrong AW, Kwong MW, Chase EP, Ledo L, Nesbitt TS, Shewry SL. Teledermatology operational considerations, challenges, and benefits: the referring providers' perspective. Telemed J E Health 2012 Oct;18(8):580-584. [CrossRef] [Medline]1,Anderson K, Francis T, Ibanez-Carrasco F, Globerman J. Physician's perceptions of telemedicine in HIV care provision: a cross-sectional web-based survey. JMIR Public Health Surveill 2017 May 30;3(2):e31 [FREE Full text] [CrossRef] [Medline]3,de Souza CH, Morbeck RA, Steinman M, Hors CP, Bracco MM, Kozasa EH, et al. Barriers and benefits in telemedicine arising between a high-technology hospital service provider and remote public healthcare units: a qualitative study in Brazil. Telemed J E Health 2017 Jun;23(6):527-532. [CrossRef] [Medline]37,Egerton T, Nelligan R, Setchell J, Atkins L, Bennell KL. 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Telemedical versus conventional heart patient monitoring: a survey study with German physicians. Int J Technol Assess Health Care 2013 Oct;29(4):378-383. [CrossRef] [Medline]108,Kuo KM, Talley PC, Lee C, Yen Y. The influence of telemedicine experience on physicians' perceptions regarding adoption. Telemed J E Health 2015 May;21(5):388-394. [CrossRef] [Medline]113,Lee SI, Park H, Kim JW, Hwang H, Cho EY, Kim Y, et al. Physicians' perceptions and use of a health information exchange: a pilot program in South Korea. Telemed J E Health 2012 Oct;18(8):604-612 [FREE Full text] [CrossRef] [Medline]114,Liu CF, Cheng TJ. Exploring critical factors influencing physicians' acceptance of mobile electronic medical records based on the dual-factor model: a validation in Taiwan. BMC Med Inform Decis Mak 2015 Feb 7;15:4 [FREE Full text] [CrossRef] [Medline]116,Ly BA, Kristjansson E, Labonté R, Bourgeault IL. 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| Nurses (n=21) | [Brewster L, Mountain G, Wessels B, Kelly C, Hawley M. Factors affecting front line staff acceptance of telehealth technologies: a mixed-method systematic review. J Adv Nurs 2014 Jan;70(1):21-33. [CrossRef] [Medline]10,Farrell M. Use of iPhones by nurses in an acute care setting to improve communication and decision-making processes: qualitative analysis of nurses' perspectives on iPhone use. JMIR Mhealth Uhealth 2016 May 31;4(2):e43 [FREE Full text] [CrossRef] [Medline]42,Giraldo L, Schachner B, Luna D, Benítez S. Exploring nurses' perceptions and expectations toward a BCMA implementation using a mobile app and workstations as a change management strategy. Stud Health Technol Inform 2018;250:134-138. [Medline]44,McNally G, Frey R, Crossan M. Nurse manager and student nurse perceptions of the use of personal smartphones or tablets and the adjunct applications, as an educational tool in clinical settings. Nurse Educ Pract 2017 Mar;23:1-7. [CrossRef] [Medline]63,Odeh B, Kayyali R, Nabhani-Gebara S, Philip N. Implementing a telehealth service: nurses' perceptions and experiences. Br J Nurs 2014;23(21):1133-1137. [CrossRef] [Medline]71,Öberg U, Orre CJ, Isaksson U, Schimmer R, Larsson H, Hörnsten Å. Swedish primary healthcare nurses' perceptions of using digital eHealth services in support of patient self-management. Scand J Caring Sci 2018 Jun;32(2):961-970. [CrossRef] [Medline]72,Beauregard P, Arnaert A, Ponzoni N. Nursing students' perceptions of using smartphones in the community practicum: a qualitative study. Nurse Educ Today 2017 Jun;53:1-6. [CrossRef] [Medline]76,Vest BM, Hall VM, Kahn LS, Heider AR, Maloney N, Singh R. Nurse perspectives on the implementation of routine telemonitoring for high-risk diabetes patients in a primary care setting. Prim Health Care Res Dev 2017 Jan;18(1):3-13. [CrossRef] [Medline]88,Duplaga M. Searching for a role of nursing personnel in developing landscape of eHealth: factors determining attitudes toward key patient empowering applications. PLoS One 2016;11(4):e0153173 [FREE Full text] [CrossRef] [Medline]96,Kleinpell R, Barden C, Rincon T, McCarthy M, Rufo RJ. Assessing the impact of telemedicine on nursing care in intensive care units. Am J Crit Care 2016 Jan;25(1):e14-e20. [CrossRef] [Medline]109,Kowitlawakul Y. The technology acceptance model: predicting nurses' intention to use telemedicine technology (eICU). Comput Inform Nurs 2011 Jul;29(7):411-418. [CrossRef] [Medline]111,O'Connor S, Andrews T. Smartphones and mobile applications (apps) in clinical nursing education: a student perspective. Nurse Educ Today 2018 Oct;69:172-178. [CrossRef] [Medline]124,Schmeer R, Behrends M, Kupka T, Meyenburg-Altwarg I, Marschollek M. Use and acceptance of mobile technology by hospital nurses in Germany. Stud Health Technol Inform 2016;225:944-945. [Medline]135,van Houwelingen CT, Barakat A, Best R, Boot WR, Charness N, Kort HS. Dutch nurses' willingness to use home telehealth: implications for practice and education. J Gerontol Nurs 2015 Apr;41(4):47-56. [CrossRef] [Medline]142,Zhang H, Cocosila M, Archer N. Factors of adoption of mobile information technology by homecare nurses: a technology acceptance model 2 approach. Comput Inform Nurs 2010;28(1):49-56. [CrossRef] [Medline]146,Walker L, Clendon J. The case for end-user involvement in design of health technologies. J Telemed Telecare 2016 Dec;22(8):443-446. [CrossRef] [Medline]172,Williamson KM, Muckle J. Students' perception of technology use in nursing education. Comput Inform Nurs 2018 Feb;36(2):70-76. [CrossRef] [Medline]173,Ehrler F, Ducloux P, Wu DT, Lovis C, Blondon K. Acceptance of a mobile application supporting nurses workflow at patient bedside: results from a pilot study. Stud Health Technol Inform 2018;247:506-510. [Medline]181,Koivunen M, Saranto K. Nursing professionals' experiences of the facilitators and barriers to the use of telehealth applications: a systematic review of qualitative studies. Scand J Caring Sci 2018 Mar;32(1):24-44. [CrossRef] [Medline]185,Li L, Cotton A. A systematic review of nurses' perspectives toward the telemedicine intensive care unit: a basis for supporting its future implementation in China? Telemed J E Health 2019 May;25(5):343-350. [CrossRef] [Medline]188,Putzer GJ, Park Y. The effects of innovation factors on smartphone adoption among nurses in community hospitals. Perspect Health Inf Manag 2010 Jan 1;7:1b [FREE Full text] [Medline]196] | |
| Specialty or condition | ||
| Primary or acute care (n=17) | [Armstrong AW, Kwong MW, Chase EP, Ledo L, Nesbitt TS, Shewry SL. Teledermatology operational considerations, challenges, and benefits: the referring providers' perspective. Telemed J E Health 2012 Oct;18(8):580-584. [CrossRef] [Medline]1,Farrell M. Use of iPhones by nurses in an acute care setting to improve communication and decision-making processes: qualitative analysis of nurses' perspectives on iPhone use. JMIR Mhealth Uhealth 2016 May 31;4(2):e43 [FREE Full text] [CrossRef] [Medline]42,Flynn D, Gregory P, Makki H, Gabbay M. Expectations and experiences of eHealth in primary care: a qualitative practice-based investigation. Int J Med Inform 2009 Sep;78(9):588-604. [CrossRef] [Medline]43,Hanley J, Ure J, Pagliari C, Sheikh A, McKinstry B. Experiences of patients and professionals participating in the HITS home blood pressure telemonitoring trial: a qualitative study. BMJ Open 2013 May 28;3(5):pii: e002671 [FREE Full text] [CrossRef] [Medline]48,Tintorer DL, Domínguez JM, Pujol-Rivera E, Beneyto SF, Tuduri XM, Saigí-Rubió F. Keys to success of a community of clinical practice in primary care: a qualitative evaluation of the ECOPIH project. BMC Fam Pract 2018 May 9;19(1):56 [FREE Full text] [CrossRef] [Medline]59,Molleda L, Bahamon M, St George SM, Perrino T, Estrada Y, Herrera DC, et al. Clinic personnel, facilitator, and parent perspectives of eHealth Familias Unidas in primary care. J Pediatr Health Care 2017;31(3):350-361 [FREE Full text] [CrossRef] [Medline]68,Öberg U, Orre CJ, Isaksson U, Schimmer R, Larsson H, Hörnsten Å. Swedish primary healthcare nurses' perceptions of using digital eHealth services in support of patient self-management. Scand J Caring Sci 2018 Jun;32(2):961-970. [CrossRef] [Medline]72,Casey M, Shaw S, Swinglehurst D. Experiences with online consultation systems in primary care: case study of one early adopter site. Br J Gen Pract 2017 Nov;67(664):e736-e743 [FREE Full text] [CrossRef] [Medline]94,Jury SC, Walker AM, Kornberg AJ. The introduction of web-based video-consultation in a paediatric acute care setting. J Telemed Telecare 2013 Oct;19(7):383-387. [CrossRef] [Medline]103,Rogove HJ, McArthur D, Demaerschalk BM, Vespa PM. Barriers to telemedicine: survey of current users in acute care units. Telemed J E Health 2012;18(1):48-53. [CrossRef] [Medline]130,Saigi-Rubió F, Jiménez-Zarco A, Torrent-Sellens J. Determinants of the intention to use telemedicine: evidence from primary care physicians. Int J Technol Assess Health Care 2016 Jan;32(1-2):29-36. [CrossRef] [Medline]132,Asua J, Orruño E, Reviriego E, Gagnon MP. Healthcare professional acceptance of telemonitoring for chronic care patients in primary care. BMC Med Inform Decis Mak 2012 Nov 30;12:139 [FREE Full text] [CrossRef] [Medline]139,Shaw RJ, Kaufman MA, Bosworth HB, Weiner BJ, Zullig LL, Lee SD, et al. Organizational factors associated with readiness to implement and translate a primary care based telemedicine behavioral program to improve blood pressure control: the HTN-IMPROVE study. Implement Sci 2013 Sep 8;8:106 [FREE Full text] [CrossRef] [Medline]169,Davis MM, Freeman M, Kaye J, Vuckovic N, Buckley DI. A systematic review of clinician and staff views on the acceptability of incorporating remote monitoring technology into primary care. Telemed J E Health 2014 May;20(5):428-438 [FREE Full text] [CrossRef] [Medline]183,Hickson R, Talbert J, Thornbury WC, Perin NR, Goodin AJ. Online medical care: the current state of 'eVisits' in acute primary care delivery. Telemed J E Health 2015 Feb;21(2):90-96. [CrossRef] [Medline]184,Lewis ER, Thomas CA, Wilson ML, Mbarika VW. Telemedicine in acute-phase injury management: a review of practice and advancements. Telemed J E Health 2012;18(6):434-445 [FREE Full text] [CrossRef] [Medline]187,Ahmad F, Norman C, O'Campo P. What is needed to implement a computer-assisted health risk assessment tool? An exploratory concept mapping study. BMC Med Inform Decis Mak 2012 Dec 19;12:149 [FREE Full text] [CrossRef] [Medline]192] | |
| Chronic obstructive pulmonary disease, congestive heart failure, and cardiovascular disease (n=12) | [Brewster L, Mountain G, Wessels B, Kelly C, Hawley M. Factors affecting front line staff acceptance of telehealth technologies: a mixed-method systematic review. J Adv Nurs 2014 Jan;70(1):21-33. [CrossRef] [Medline]10,Fairbrother P, Ure J, Hanley J, McCloughan L, Denvir M, Sheikh A, Telescot programme team. Telemonitoring for chronic heart failure: the views of patients and healthcare professionals - a qualitative study. J Clin Nurs 2014 Jan;23(1-2):132-144. [CrossRef] [Medline]41,Jarvis-Selinger S, Bates J, Araki Y, Lear SA. Internet-based support for cardiovascular disease management. Int J Telemed Appl 2011;2011:342582 [FREE Full text] [CrossRef] [Medline]52,Odeh B, Kayyali R, Nabhani-Gebara S, Philip N. Implementing a telehealth service: nurses' perceptions and experiences. Br J Nurs 2014;23(21):1133-1137. [CrossRef] [Medline]71,Seto E, Leonard KJ, Cafazzo JA, Barnsley J, Masino C, Ross HJ. Perceptions and experiences of heart failure patients and clinicians on the use of mobile phone-based telemonitoring. J Med Internet Res 2012 Feb 10;14(1):e25 [FREE Full text] [CrossRef] [Medline]78,Sharma U, Clarke M. Nurses' and community support workers' experience of telehealth: a longitudinal case study. BMC Health Serv Res 2014 Apr 10;14:164 [FREE Full text] [CrossRef] [Medline]80,Taylor J, Coates L. Caring from a distance: the role of telehealth. Nurs Times 2015;111(28-29):18-20. [Medline]83,Gagnon MP, Orruño E, Asua J, Abdeljelil AB, Emparanza J. Using a modified technology acceptance model to evaluate healthcare professionals' adoption of a new telemonitoring system. Telemed J E Health 2012;18(1):54-59 [FREE Full text] [CrossRef] [Medline]97,Kato NP, Johansson P, Okada I, de Vries AE, Kinugawa K, Strömberg A, et al. Heart failure telemonitoring in Japan and Sweden: a cross-sectional survey. J Med Internet Res 2015 Nov 13;17(11):e258 [FREE Full text] [CrossRef] [Medline]104,Klack L, Ziefle M, Wilkowska W, Kluge J. Telemedical versus conventional heart patient monitoring: a survey study with German physicians. Int J Technol Assess Health Care 2013 Oct;29(4):378-383. [CrossRef] [Medline]108,Mairesse GH, Braunschweig F, Klersy K, Cowie MR, Leyva F. Implementation and reimbursement of remote monitoring for cardiac implantable electronic devices in Europe: a survey from the health economics committee of the European Heart Rhythm Association. Europace 2015 May;17(5):814-818. [CrossRef] [Medline]119,Orchard J, Lowres N, Freedman SB, Ladak L, Lee W, Zwar N, et al. Screening for atrial fibrillation during influenza vaccinations by primary care nurses using a smartphone electrocardiograph (iECG): A feasibility study. Eur J Prev Cardiol 2016 Oct;23(2 suppl):13-20. [CrossRef] [Medline]164] | |
| Diabetes (n=10) | [de Vries ST, Wong L, Sutcliffe A, Houÿez F, Ruiz CL, Mol PG, IMI Web-RADR Work Package 3b Consortium. Factors influencing the use of a mobile app for reporting adverse drug reactions and receiving safety information: a qualitative study. Drug Saf 2017 May;40(5):443-455 [FREE Full text] [CrossRef] [Medline]38,James S, Perry L, Gallagher R, Lowe J. Diabetes educators: perceived experiences, supports and barriers to use of common diabetes-related technologies. J Diabetes Sci Technol 2016 Sep;10(5):1115-1121 [FREE Full text] [CrossRef] [Medline]51,Sandberg J, Trief PM, Izquierdo R, Goland R, Morin PC, Palmas W, et al. A qualitative study of the experiences and satisfaction of direct telemedicine providers in diabetes case management. Telemed J E Health 2009 Oct;15(8):742-750. [CrossRef] [Medline]75,Vest BM, Hall VM, Kahn LS, Heider AR, Maloney N, Singh R. Nurse perspectives on the implementation of routine telemonitoring for high-risk diabetes patients in a primary care setting. Prim Health Care Res Dev 2017 Jan;18(1):3-13. [CrossRef] [Medline]88,Carlisle K, Warren R. A qualitative case study of telehealth for in-home monitoring to support the management of type 2 diabetes. J Telemed Telecare 2013 Oct;19(7):372-375. [CrossRef] [Medline]92,L'Esperance ST, Perry DJ. Assessing advantages and barriers to telemedicine adoption in the practice setting: A MyCareTeam(TM) exemplar. J Am Assoc Nurse Pract 2016 Jun;28(6):311-319. [CrossRef] [Medline]115,Okazaki S, Castañeda JA, Sanz S, Henseler J. Factors affecting mobile diabetes monitoring adoption among physicians: questionnaire study and path model. J Med Internet Res 2012 Dec 21;14(6):e183 [FREE Full text] [CrossRef] [Medline]125,Ayatollahi H, Mirani N, Nazari F, Razavi N. Iranian healthcare professionals' perspectives about factors influencing the use of telemedicine in diabetes management. World J Diabetes 2018 Jun 15;9(6):92-98 [FREE Full text] [CrossRef] [Medline]147,Muigg D, Kastner P, Modre-Osprian R, Haluza D, Duftschmid G. Is Austria ready for telemonitoring? A readiness assessment among doctors and patients in the field of diabetes. Stud Health Technol Inform 2018;248:322-329. [Medline]160,Odnoletkova I, Buysse H, Nobels F, Goderis G, Aertgeerts B, Annemans L, et al. Patient and provider acceptance of telecoaching in type 2 diabetes: a mixed-method study embedded in a randomised clinical trial. BMC Med Inform Decis Mak 2016 Nov 9;16(1):142 [FREE Full text] [CrossRef] [Medline]162] | |
| General and family practice (n=9) | [Egerton T, Nelligan R, Setchell J, Atkins L, Bennell KL. General practitioners' perspectives on a proposed new model of service delivery for primary care management of knee osteoarthritis: a qualitative study. BMC Fam Pract 2017 Sep 7;18(1):85 [FREE Full text] [CrossRef] [Medline]39,Hanna L, May C, Fairhurst K. The place of information and communication technology-mediated consultations in primary care: GPs' perspectives. Fam Pract 2012 Jun;29(3):361-366. [CrossRef] [Medline]49,Wilhelmsen M, Høifødt RS, Kolstrup N, Waterloo K, Eisemann M, Chenhall R, et al. Norwegian general practitioners' perspectives on implementation of a guided web-based cognitive behavioral therapy for depression: a qualitative study. J Med Internet Res 2014 Sep 10;16(9):e208 [FREE Full text] [CrossRef] [Medline]89,Jetty A, Moore MA, Coffman M, Petterson S, Bazemore A. Rural family physicians are twice as likely to use telehealth as urban family physicians. Telemed J E Health 2018 Apr;24(4):268-276. [CrossRef] [Medline]102,Albrecht UV, Afshar K, Illiger K, Becker S, Hartz T, Breil B, et al. Expectancy, usage and acceptance by general practitioners and patients: exploratory results from a study in the German outpatient sector. Digit Health 2017;3:2055207617695135 [FREE Full text] [CrossRef] [Medline]117,Moore MA, Coffman M, Jetty A, Klink K, Petterson S, Bazemore A. Family physicians report considerable interest in, but limited use of, telehealth services. J Am Board Fam Med 2017;30(3):320-330 [FREE Full text] [CrossRef] [Medline]121,El Amrani L, Engberink AO, Ninot G, Hayot M, Carbonnel F. Connected health devices for health care in French general medicine practice: cross-sectional study. JMIR Mhealth Uhealth 2017 Dec 21;5(12):e193 [FREE Full text] [CrossRef] [Medline]128,Sandholzer M, Deutsch T, Frese T, Winter A. Predictors of students' self-reported adoption of a smartphone application for medical education in general practice. BMC Med Educ 2015 May 21;15:91 [FREE Full text] [CrossRef] [Medline]134,Yaman H, Yavuz E, Er A, Vural R, Albayrak Y, Yardimci A, et al. The use of mobile smart devices and medical apps in the family practice setting. J Eval Clin Pract 2016 Apr;22(2):290-296. [CrossRef] [Medline]144] | |
| Psychology and mental health (n=8) | [Avey JP, Hobbs RL. Dial in: fostering the use of telebehavioral health services in frontier Alaska. Psychol Serv 2013 Aug;10(3):289-297. [CrossRef] [Medline]2,Puszka S, Dingwall KM, Sweet M, Nagel T. E-Mental health innovations for aboriginal and Torres Strait Islander Australians: a qualitative study of implementation needs in health services. JMIR Ment Health 2016 Sep 19;3(3):e43 [FREE Full text] [CrossRef] [Medline]73,Sinclair C, Holloway K, Riley G, Auret K. Online mental health resources in rural Australia: clinician perceptions of acceptability. J Med Internet Res 2013 Sep 5;15(9):e193 [FREE Full text] [CrossRef] [Medline]81,Wynn R, Bergvik S, Pettersen G, Fossum S. Clinicians' experiences with videoconferencing in psychiatry. Stud Health Technol Inform 2012;180:1218-1220. [Medline]90,Kuhn E, Eftekhari A, Hoffman JE, Crowley JJ, Ramsey KM, Reger GM, et al. Clinician perceptions of using a smartphone app with prolonged exposure therapy. Adm Policy Ment Health 2014 Nov;41(6):800-807. [CrossRef] [Medline]112,Iacono T, Dissanayake C, Trembath D, Hudry K, Erickson S, Spong J. Family and practitioner perspectives on telehealth for services to young children with autism. Stud Health Technol Inform 2016;231:63-73. [Medline]153,Possemato K, Kuhn E, Johnson EM, Hoffman JE, Brooks E. Development and refinement of a clinician intervention to facilitate primary care patient use of the PTSD Coach app. Transl Behav Med 2017 Mar;7(1):116-126 [FREE Full text] [CrossRef] [Medline]166,Cunningham DL, Connors EH, Lever N, Stephan SH. Providers' perspectives: utilizing telepsychiatry in schools. Telemed J E Health 2013 Oct;19(10):794-799. [CrossRef] [Medline]194] | |
| Dermatology (n=4) | [Armstrong AW, Kwong MW, Chase EP, Ledo L, Nesbitt TS, Shewry SL. Teledermatology operational considerations, challenges, and benefits: the referring providers' perspective. Telemed J E Health 2012 Oct;18(8):580-584. [CrossRef] [Medline]1,Armstrong AW, Kwong MW, Ledo L, Nesbitt TS, Shewry SL. Practice models and challenges in teledermatology: a study of collective experiences from teledermatologists. PLoS One 2011;6(12):e28687 [FREE Full text] [CrossRef] [Medline]54,Orruño E, Gagnon MP, Asua J, Abdeljelil AB. Evaluation of teledermatology adoption by health-care professionals using a modified Technology Acceptance Model. J Telemed Telecare 2011;17(6):303-307. [CrossRef] [Medline]126,Ariens LF, Schussler-Raymakers FM, Frima C, Flinterman A, Hamminga E, Arents BW, et al. Barriers and facilitators to eHealth use in daily practice: perspectives of patients and professionals in dermatology. J Med Internet Res 2017 Sep 5;19(9):e300 [FREE Full text] [CrossRef] [Medline]152] | |
| Substance use recovery (n=4) | [Lord S, Moore SK, Ramsey A, Dinauer S, Johnson K. Implementation of a substance use recovery support mobile phone app in community settings: qualitative study of clinician and staff perspectives of facilitators and barriers. JMIR Ment Health 2016 Jun 28;3(2):e24 [FREE Full text] [CrossRef] [Medline]61,Molfenter T, Boyle M, Holloway D, Zwick J. Trends in telemedicine use in addiction treatment. Addict Sci Clin Pract 2015 May 28;10:14 [FREE Full text] [CrossRef] [Medline]67,Lygidakis C, Wallace P, Tersar C, Marcatto F, Ferrante D, Vedova RD, et al. Download Your Doctor: implementation of a digitally mediated personal physician presence to enhance patient engagement with a health-promoting internet application. JMIR Res Protoc 2016 Mar 4;5(1):e36 [FREE Full text] [CrossRef] [Medline]158,Quanbeck A, Gustafson DH, Marsch LA, Chih M, Kornfield R, McTavish F, et al. Implementing a mobile health system to integrate the treatment of addiction into primary care: a hybrid implementation-effectiveness study. J Med Internet Res 2018 Jan 30;20(1):e37 [FREE Full text] [CrossRef] [Medline]167] | |
| Residential aged care, home health nursing (n=4) | [Zhang H, Cocosila M, Archer N. Factors of adoption of mobile information technology by homecare nurses: a technology acceptance model 2 approach. Comput Inform Nurs 2010;28(1):49-56. [CrossRef] [Medline]146,Loh P, Flicker L, Horner B. Attitudes toward information and communication technology (ICT) in residential aged care in Western Australia. J Am Med Dir Assoc 2009 Jul;10(6):408-413. [CrossRef] [Medline]156,Taylor A, Wade V, Morris G, Pech J, Rechter S, Kidd M, et al. Technology support to a telehealth in the home service: qualitative observations. J Telemed Telecare 2016 Jul;22(5):296-303. [CrossRef] [Medline]171,Radhakrishnan K, Xie B, Berkley A, Kim M. Barriers and facilitators for sustainability of tele-homecare programs: a systematic review. Health Serv Res 2016 Feb;51(1):48-75 [FREE Full text] [CrossRef] [Medline]182] | |
| Pediatric, maternal (n=4) | [Kim JW, Tiyyagura G, Langhan M. A qualitative analysis of general emergency medicine providers' perceptions on pediatric emergency telemedicine. Pediatr Emerg Care 2019 Dec;35(12):856-861. [CrossRef] [Medline]57,Rothstein JD, Jennings L, Moorthy A, Yang F, Gee L, Romano K, et al. Qualitative assessment of the feasibility, usability, and acceptability of a mobile client data app for community-based maternal, neonatal, and child care in rural Ghana. Int J Telemed Appl 2016;2016:2515420 [FREE Full text] [CrossRef] [Medline]74,Uscher-Pines L, Kahn JM. Barriers and facilitators to pediatric emergency telemedicine in the United States. Telemed J E Health 2014 Nov;20(11):990-996 [FREE Full text] [CrossRef] [Medline]141,Ray KN, Felmet KA, Hamilton MF, Kuza CC, Saladino RA, Schultz BR, et al. Clinician attitudes toward adoption of pediatric emergency telemedicine in rural hospitals. Pediatr Emerg Care 2017 Apr;33(4):250-257. [CrossRef] [Medline]168] | |
| Neurology, stroke (n=4) | [Moloczij N, Mosley I, Moss KM, Bagot KL, Bladin CF, Cadilhac DA. Is telemedicine helping or hindering the delivery of stroke thrombolysis in rural areas? A qualitative analysis. Intern Med J 2015 Sep;45(9):957-964. [CrossRef] [Medline]69,Moskowitz A, Chan YY, Bruns J, Levine SR. Emergency physician and stroke specialist beliefs and expectations regarding telestroke. Stroke 2010 Apr;41(4):805-809 [FREE Full text] [CrossRef] [Medline]123,Duhm J, Fleischmann R, Schmidt S, Hupperts H, Brandt SA. Mobile electronic medical records promote workflow: physicians' perspective from a survey. JMIR Mhealth Uhealth 2016 Jun 6;4(2):e70 [FREE Full text] [CrossRef] [Medline]150,Bramley G, Mangan C, Conroy M. Using telemonitoring to support personal care planning for adults with learning disabilities. J Telemed Telecare 2019 Dec;25(10):602-610. [CrossRef] [Medline]176] | |
| Intensive care unit (n=4) | [Kleinpell R, Barden C, Rincon T, McCarthy M, Rufo RJ. Assessing the impact of telemedicine on nursing care in intensive care units. Am J Crit Care 2016 Jan;25(1):e14-e20. [CrossRef] [Medline]109,Kowitlawakul Y. The technology acceptance model: predicting nurses' intention to use telemedicine technology (eICU). Comput Inform Nurs 2011 Jul;29(7):411-418. [CrossRef] [Medline]111,Kumar S, Merchant S, Reynolds R. Tele-ICU: efficacy and cost-effectiveness approach of remotely managing the critical care. Open Med Inform J 2013;7:24-29 [FREE Full text] [CrossRef] [Medline]186,Li L, Cotton A. A systematic review of nurses' perspectives toward the telemedicine intensive care unit: a basis for supporting its future implementation in China? Telemed J E Health 2019 May;25(5):343-350. [CrossRef] [Medline]188] | |
| Asthma (n=3) | [Morrow S, Daines L, Wiener-Ogilvie S, Steed L, McKee L, Caress A, et al. Exploring the perspectives of clinical professionals and support staff on implementing supported self-management for asthma in UK general practice: an IMPART qualitative study. NPJ Prim Care Respir Med 2017 Jul 18;27(1):45 [FREE Full text] [CrossRef] [Medline]70,Schneider T, Panzera AD, Martinasek M, McDermott R, Couluris M, Lindenberger J, et al. Physicians' perceptions of mobile technology for enhancing asthma care for youth. J Child Health Care 2016 Jun;20(2):153-163. [CrossRef] [Medline]77,van Gaalen JL, van Bodegom-Vos L, Bakker MJ, Snoeck-Stroband JB, Sont JK. Internet-based self-management support for adults with asthma: a qualitative study among patients, general practitioners and practice nurses on barriers to implementation. BMJ Open 2016 Aug 26;6(8):e010809 [FREE Full text] [CrossRef] [Medline]84] | |
| Oncology (n=3) | [Jimbo M, Shultz CG, Nease DE, Fetters MD, Power D, Ruffin MT. Perceived barriers and facilitators of using a Web-based interactive decision aid for colorectal cancer screening in community practice settings: findings from focus groups with primary care clinicians and medical office staff. J Med Internet Res 2013 Dec 18;15(12):e286 [FREE Full text] [CrossRef] [Medline]53,Jeon J, Taneva S, Kukreti V, Trbovich P, Easty AC, Rossos PG, et al. Toward successful migration to computerized physician order entry for chemotherapy. Curr Oncol 2014 Apr;21(2):e221-e228 [FREE Full text] [CrossRef] [Medline]155,Cox A, Illsley M, Knibb W, Lucas C, O'Driscoll M, Potter C, et al. The acceptability of e-technology to monitor and assess patient symptoms following palliative radiotherapy for lung cancer. Palliat Med 2011 Oct;25(7):675-681. [CrossRef] [Medline]180] | |
| Sexual health, HIV (n=3) | [Smith PB, Buzi RS. Reproductive health professionals' adoption of emerging technologies for health promotion. Health Informatics J 2014 Dec;20(4):250-260. [CrossRef] [Medline]138,Bailey JV, Tomlinson N, Hobbs LJ, Webster R. Challenges and opportunities in evaluating a digital sexual health intervention in a clinic setting: Staff and patient views. Digit Health 2017;3:2055207617704272 [FREE Full text] [CrossRef] [Medline]163,Brown W, Giguere R, Sheinfil A, Ibitoye M, Balan I, Ho T, et al. Challenges and solutions implementing an SMS text message-based survey CASI and adherence reminders in an international biomedical HIV PrEP study (MTN 017). J Biomed Inform 2018 Apr;80:78-86 [FREE Full text] [CrossRef] [Medline]177] | |
| Others (n=13) | Ambulatory care [Dünnebeil S, Sunyaev A, Blohm I, Leimeister JM, Krcmar H. Determinants of physicians' technology acceptance for e-health in ambulatory care. Int J Med Inform 2012 Nov;81(11):746-760. [CrossRef] [Medline]149], cognitive behavioral therapy [Miller KE, Kuhn E, Owen JE, Taylor K, Yu JS, Weiss BJ, et al. Clinician perceptions related to the use of the CBT-I Coach Mobile App. Behav Sleep Med 2019;17(4):481-491. [CrossRef] [Medline]120], emergency [Mueller KJ, Potter AJ, MacKinney AC, Ward MM. Lessons from tele-emergency: improving care quality and health outcomes by expanding support for rural care systems. Health Aff (Millwood) 2014 Feb;33(2):228-234. [CrossRef] [Medline]159], genetics [Zilliacus E, Meiser B, Lobb E, Dudding TE, Barlow-Stewart K, Tucker K. The virtual consultation: practitioners' experiences of genetic counseling by videoconferencing in Australia. Telemed J E Health 2010 Apr;16(3):350-357. [CrossRef] [Medline]91], geriatrics [Esterle L, Mathieu-Fritz A. Teleconsultation in geriatrics: impact on professional practice. Int J Med Inform 2013 Aug;82(8):684-695. [CrossRef] [Medline]40,Levine M, Richardson JE, Granieri E, Reid MC. Novel telemedicine technologies in geriatric chronic non-cancer pain: primary care providers' perspectives. Pain Med 2014 Feb;15(2):206-213 [FREE Full text] [CrossRef] [Medline]60], hypertension [Mileski M, Kruse CS, Catalani J, Haderer T. Adopting telemedicine for the self-management of hypertension: systematic review. JMIR Med Inform 2017 Oct 24;5(4):e41 [FREE Full text] [CrossRef] [Medline]5], nephrology [Bello AK, Molzahn AE, Girard LP, Osman MA, Okpechi IG, Glassford J, et al. Patient and provider perspectives on the design and implementation of an electronic consultation system for kidney care delivery in Canada: a focus group study. BMJ Open 2017 Mar 2;7(3):e014784 [FREE Full text] [CrossRef] [Medline]87], obesity and irritable bowel syndrome [Chung C, Cook J, Bales E, Zia J, Munson SA. More than telemonitoring: health provider use and nonuse of life-log data in irritable bowel syndrome and weight management. J Med Internet Res 2015 Aug 21;17(8):e203 [FREE Full text] [CrossRef] [Medline]36], otolaryngology [Holderried M, Hoeper A, Holderried F, Blumenstock G, Ernst C, Tropitzsch A. Attitudes toward e-Health: the otolaryngologists' point of view. Telemed J E Health 2018 Jun;24(6):425-432. [CrossRef] [Medline]100], radiology [Sadoughi F, Erfannia L, Sancholi M, Salmani F, Sarsarshahi A. Teleradiology in Southeast Iran: Evaluating the Views of Senior Executives and Radiologists. Health Care Manag (Frederick) 2017;36(3):301-307. [CrossRef] [Medline]131], speech-language pathology [Hines M, Lincoln M, Ramsden R, Martinovich J, Fairweather C. Speech pathologists' perspectives on transitioning to telepractice: what factors promote acceptance? J Telemed Telecare 2015 Dec;21(8):469-473. [CrossRef] [Medline]50], tuberculosis [Kopanitsa G, Yampolsky V. Exploring barriers and opportunities for adoption of web portals in Russia. Stud Health Technol Inform 2016;221:87-91. [Medline]58] | |
| Location | ||
| The United States (n=38) | [Armstrong AW, Kwong MW, Chase EP, Ledo L, Nesbitt TS, Shewry SL. Teledermatology operational considerations, challenges, and benefits: the referring providers' perspective. Telemed J E Health 2012 Oct;18(8):580-584. [CrossRef] [Medline]1,Avey JP, Hobbs RL. Dial in: fostering the use of telebehavioral health services in frontier Alaska. Psychol Serv 2013 Aug;10(3):289-297. [CrossRef] [Medline]2,Chung C, Cook J, Bales E, Zia J, Munson SA. More than telemonitoring: health provider use and nonuse of life-log data in irritable bowel syndrome and weight management. J Med Internet Res 2015 Aug 21;17(8):e203 [FREE Full text] [CrossRef] [Medline]36,Goedken CC, Moeckli J, Cram PM, Reisinger HS. Introduction of Tele-ICU in rural hospitals: changing organisational culture to harness benefits. Intensive Crit Care Nurs 2017 Jun;40:51-56. [CrossRef] [Medline]45,Jimbo M, Shultz CG, Nease DE, Fetters MD, Power D, Ruffin MT. Perceived barriers and facilitators of using a Web-based interactive decision aid for colorectal cancer screening in community practice settings: findings from focus groups with primary care clinicians and medical office staff. J Med Internet Res 2013 Dec 18;15(12):e286 [FREE Full text] [CrossRef] [Medline]53,Armstrong AW, Kwong MW, Ledo L, Nesbitt TS, Shewry SL. Practice models and challenges in teledermatology: a study of collective experiences from teledermatologists. PLoS One 2011;6(12):e28687 [FREE Full text] [CrossRef] [Medline]54,Kim JW, Tiyyagura G, Langhan M. A qualitative analysis of general emergency medicine providers' perceptions on pediatric emergency telemedicine. Pediatr Emerg Care 2019 Dec;35(12):856-861. [CrossRef] [Medline]57,Levine M, Richardson JE, Granieri E, Reid MC. Novel telemedicine technologies in geriatric chronic non-cancer pain: primary care providers' perspectives. Pain Med 2014 Feb;15(2):206-213 [FREE Full text] [CrossRef] [Medline]60,Lord S, Moore SK, Ramsey A, Dinauer S, Johnson K. Implementation of a substance use recovery support mobile phone app in community settings: qualitative study of clinician and staff perspectives of facilitators and barriers. JMIR Ment Health 2016 Jun 28;3(2):e24 [FREE Full text] [CrossRef] [Medline]61,Molfenter T, Boyle M, Holloway D, Zwick J. Trends in telemedicine use in addiction treatment. Addict Sci Clin Pract 2015 May 28;10:14 [FREE Full text] [CrossRef] [Medline]67,Molleda L, Bahamon M, St George SM, Perrino T, Estrada Y, Herrera DC, et al. Clinic personnel, facilitator, and parent perspectives of eHealth Familias Unidas in primary care. J Pediatr Health Care 2017;31(3):350-361 [FREE Full text] [CrossRef] [Medline]68,Sandberg J, Trief PM, Izquierdo R, Goland R, Morin PC, Palmas W, et al. A qualitative study of the experiences and satisfaction of direct telemedicine providers in diabetes case management. Telemed J E Health 2009 Oct;15(8):742-750. [CrossRef] [Medline]75,Schneider T, Panzera AD, Martinasek M, McDermott R, Couluris M, Lindenberger J, et al. Physicians' perceptions of mobile technology for enhancing asthma care for youth. J Child Health Care 2016 Jun;20(2):153-163. [CrossRef] [Medline]77,Vest BM, Hall VM, Kahn LS, Heider AR, Maloney N, Singh R. Nurse perspectives on the implementation of routine telemonitoring for high-risk diabetes patients in a primary care setting. Prim Health Care Res Dev 2017 Jan;18(1):3-13. [CrossRef] [Medline]88,Cary MP, Spencer M, Carroll A, Hand DH, Amis K, Karan E, et al. Benefits and challenges of delivering tele-rehabilitation services to rural veterans. Home Healthc Now 2016 Sep;34(8):440-446. [CrossRef] [Medline]93,Hao H, Padman R. An empirical study of opinion leader effects on mobile technology implementation by physicians in an American community health system. Health Informatics J 2018 Sep;24(3):323-333. [CrossRef] [Medline]99,Jetty A, Moore MA, Coffman M, Petterson S, Bazemore A. Rural family physicians are twice as likely to use telehealth as urban family physicians. Telemed J E Health 2018 Apr;24(4):268-276. [CrossRef] [Medline]102,Kleinpell R, Barden C, Rincon T, McCarthy M, Rufo RJ. Assessing the impact of telemedicine on nursing care in intensive care units. Am J Crit Care 2016 Jan;25(1):e14-e20. [CrossRef] [Medline]109-Kuhn E, Eftekhari A, Hoffman JE, Crowley JJ, Ramsey KM, Reger GM, et al. Clinician perceptions of using a smartphone app with prolonged exposure therapy. Adm Policy Ment Health 2014 Nov;41(6):800-807. [CrossRef] [Medline]112,Miller KE, Kuhn E, Owen JE, Taylor K, Yu JS, Weiss BJ, et al. Clinician perceptions related to the use of the CBT-I Coach Mobile App. Behav Sleep Med 2019;17(4):481-491. [CrossRef] [Medline]120,Moore MA, Coffman M, Jetty A, Klink K, Petterson S, Bazemore A. Family physicians report considerable interest in, but limited use of, telehealth services. J Am Board Fam Med 2017;30(3):320-330 [FREE Full text] [CrossRef] [Medline]121,Moskowitz A, Chan YY, Bruns J, Levine SR. Emergency physician and stroke specialist beliefs and expectations regarding telestroke. Stroke 2010 Apr;41(4):805-809 [FREE Full text] [CrossRef] [Medline]123,Putzer GJ, Park Y. Are physicians likely to adopt emerging mobile technologies? Attitudes and innovation factors affecting smartphone use in the Southeastern United States. Perspect Health Inf Manag 2012;9:1b [FREE Full text] [Medline]127,Sims MH, Fagnano M, Halterman JS, Halterman MW. Provider impressions of the use of a mobile crowdsourcing app in medical practice. Health Informatics J 2016 Jun;22(2):221-231. [CrossRef] [Medline]137,Smith PB, Buzi RS. Reproductive health professionals' adoption of emerging technologies for health promotion. Health Informatics J 2014 Dec;20(4):250-260. [CrossRef] [Medline]138,Uscher-Pines L, Kahn JM. Barriers and facilitators to pediatric emergency telemedicine in the United States. Telemed J E Health 2014 Nov;20(11):990-996 [FREE Full text] [CrossRef] [Medline]141,Mueller KJ, Potter AJ, MacKinney AC, Ward MM. Lessons from tele-emergency: improving care quality and health outcomes by expanding support for rural care systems. Health Aff (Millwood) 2014 Feb;33(2):228-234. [CrossRef] [Medline]159,Possemato K, Kuhn E, Johnson EM, Hoffman JE, Brooks E. Development and refinement of a clinician intervention to facilitate primary care patient use of the PTSD Coach app. Transl Behav Med 2017 Mar;7(1):116-126 [FREE Full text] [CrossRef] [Medline]166-Shaw RJ, Kaufman MA, Bosworth HB, Weiner BJ, Zullig LL, Lee SD, et al. Organizational factors associated with readiness to implement and translate a primary care based telemedicine behavioral program to improve blood pressure control: the HTN-IMPROVE study. Implement Sci 2013 Sep 8;8:106 [FREE Full text] [CrossRef] [Medline]169, Williamson KM, Muckle J. Students' perception of technology use in nursing education. Comput Inform Nurs 2018 Feb;36(2):70-76. [CrossRef] [Medline]173,Cunningham DL, Connors EH, Lever N, Stephan SH. Providers' perspectives: utilizing telepsychiatry in schools. Telemed J E Health 2013 Oct;19(10):794-799. [CrossRef] [Medline]194-Putzer GJ, Park Y. The effects of innovation factors on smartphone adoption among nurses in community hospitals. Perspect Health Inf Manag 2010 Jan 1;7:1b [FREE Full text] [Medline]196] | |
| The United Kingdom (n=22) | [Brewster L, Mountain G, Wessels B, Kelly C, Hawley M. Factors affecting front line staff acceptance of telehealth technologies: a mixed-method systematic review. J Adv Nurs 2014 Jan;70(1):21-33. [CrossRef] [Medline]10,Fairbrother P, Ure J, Hanley J, McCloughan L, Denvir M, Sheikh A, Telescot programme team. Telemonitoring for chronic heart failure: the views of patients and healthcare professionals - a qualitative study. J Clin Nurs 2014 Jan;23(1-2):132-144. [CrossRef] [Medline]41,Flynn D, Gregory P, Makki H, Gabbay M. Expectations and experiences of eHealth in primary care: a qualitative practice-based investigation. Int J Med Inform 2009 Sep;78(9):588-604. [CrossRef] [Medline]43,Hanley J, Ure J, Pagliari C, Sheikh A, McKinstry B. Experiences of patients and professionals participating in the HITS home blood pressure telemonitoring trial: a qualitative study. BMJ Open 2013 May 28;3(5):pii: e002671 [FREE Full text] [CrossRef] [Medline]48,Hanna L, May C, Fairhurst K. The place of information and communication technology-mediated consultations in primary care: GPs' perspectives. Fam Pract 2012 Jun;29(3):361-366. [CrossRef] [Medline]49,Kayyali R, Hesso I, Mahdi A, Hamzat O, Adu A, Nabhani Gebara S. Telehealth: misconceptions and experiences of healthcare professionals in England. Int J Pharm Pract 2017 Jun;25(3):203-209. [CrossRef] [Medline]55,MacNeill V, Sanders C, Fitzpatrick R, Hendy J, Barlow J, Knapp M, et al. Experiences of front-line health professionals in the delivery of telehealth: a qualitative study. Br J Gen Pract 2014 Jul;64(624):e401-e407 [FREE Full text] [CrossRef] [Medline]62,Morrow S, Daines L, Wiener-Ogilvie S, Steed L, McKee L, Caress A, et al. Exploring the perspectives of clinical professionals and support staff on implementing supported self-management for asthma in UK general practice: an IMPART qualitative study. NPJ Prim Care Respir Med 2017 Jul 18;27(1):45 [FREE Full text] [CrossRef] [Medline]70,Odeh B, Kayyali R, Nabhani-Gebara S, Philip N. Implementing a telehealth service: nurses' perceptions and experiences. Br J Nurs 2014;23(21):1133-1137. [CrossRef] [Medline]71,Sharma U, Barnett J, Clarke M. Clinical users' perspective on telemonitoring of patients with long term conditions: understood through concepts of Giddens's structuration theory & consequence of modernity. Stud Health Technol Inform 2010;160(Pt 1):545-549. [Medline]79,Sharma U, Clarke M. Nurses' and community support workers' experience of telehealth: a longitudinal case study. BMC Health Serv Res 2014 Apr 10;14:164 [FREE Full text] [CrossRef] [Medline]80,Taylor J, Coates L. Caring from a distance: the role of telehealth. Nurs Times 2015;111(28-29):18-20. [Medline]83,Casey M, Shaw S, Swinglehurst D. Experiences with online consultation systems in primary care: case study of one early adopter site. Br J Gen Pract 2017 Nov;67(664):e736-e743 [FREE Full text] [CrossRef] [Medline]94,L'Esperance ST, Perry DJ. Assessing advantages and barriers to telemedicine adoption in the practice setting: A MyCareTeam(TM) exemplar. J Am Assoc Nurse Pract 2016 Jun;28(6):311-319. [CrossRef] [Medline]115,O'Connor S, Andrews T. Smartphones and mobile applications (apps) in clinical nursing education: a student perspective. Nurse Educ Today 2018 Oct;69:172-178. [CrossRef] [Medline]124,Jamu JT, Lowi-Jones H, Mitchell C. Just in time? Using QR codes for multi-professional learning in clinical practice. Nurse Educ Pract 2016 Jul;19:107-112. [CrossRef] [Medline]154,Bailey JV, Tomlinson N, Hobbs LJ, Webster R. Challenges and opportunities in evaluating a digital sexual health intervention in a clinic setting: Staff and patient views. Digit Health 2017;3:2055207617704272 [FREE Full text] [CrossRef] [Medline]163,Payne KF, Weeks L, Dunning P. A mixed methods pilot study to investigate the impact of a hospital-specific iPhone application (iTreat) within a British junior doctor cohort. Health Informatics J 2014 Mar;20(1):59-73. [CrossRef] [Medline]165,Bidmead E, Marshall A. A case study of stakeholder perceptions of patient held records: the Patients Know Best (PKB) solution. Digit Health 2016;2:2055207616668431 [FREE Full text] [CrossRef] [Medline]174,Bramley G, Mangan C, Conroy M. Using telemonitoring to support personal care planning for adults with learning disabilities. J Telemed Telecare 2019 Dec;25(10):602-610. [CrossRef] [Medline]176,Charani E, Kyratsis Y, Lawson W, Wickens H, Brannigan ET, Moore LS, et al. An analysis of the development and implementation of a smartphone application for the delivery of antimicrobial prescribing policy: lessons learnt. J Antimicrob Chemother 2013 Apr;68(4):960-967 [FREE Full text] [CrossRef] [Medline]179,Cox A, Illsley M, Knibb W, Lucas C, O'Driscoll M, Potter C, et al. The acceptability of e-technology to monitor and assess patient symptoms following palliative radiotherapy for lung cancer. Palliat Med 2011 Oct;25(7):675-681. [CrossRef] [Medline]180] | |
| Australia (n=15) | [Egerton T, Nelligan R, Setchell J, Atkins L, Bennell KL. General practitioners' perspectives on a proposed new model of service delivery for primary care management of knee osteoarthritis: a qualitative study. BMC Fam Pract 2017 Sep 7;18(1):85 [FREE Full text] [CrossRef] [Medline]39,Farrell M. Use of iPhones by nurses in an acute care setting to improve communication and decision-making processes: qualitative analysis of nurses' perspectives on iPhone use. JMIR Mhealth Uhealth 2016 May 31;4(2):e43 [FREE Full text] [CrossRef] [Medline]42,Hines M, Lincoln M, Ramsden R, Martinovich J, Fairweather C. Speech pathologists' perspectives on transitioning to telepractice: what factors promote acceptance? J Telemed Telecare 2015 Dec;21(8):469-473. [CrossRef] [Medline]50,James S, Perry L, Gallagher R, Lowe J. Diabetes educators: perceived experiences, supports and barriers to use of common diabetes-related technologies. J Diabetes Sci Technol 2016 Sep;10(5):1115-1121 [FREE Full text] [CrossRef] [Medline]51,Moloczij N, Mosley I, Moss KM, Bagot KL, Bladin CF, Cadilhac DA. Is telemedicine helping or hindering the delivery of stroke thrombolysis in rural areas? A qualitative analysis. Intern Med J 2015 Sep;45(9):957-964. [CrossRef] [Medline]69,Puszka S, Dingwall KM, Sweet M, Nagel T. E-Mental health innovations for aboriginal and Torres Strait Islander Australians: a qualitative study of implementation needs in health services. JMIR Ment Health 2016 Sep 19;3(3):e43 [FREE Full text] [CrossRef] [Medline]73,Sinclair C, Holloway K, Riley G, Auret K. Online mental health resources in rural Australia: clinician perceptions of acceptability. J Med Internet Res 2013 Sep 5;15(9):e193 [FREE Full text] [CrossRef] [Medline]81,Zilliacus E, Meiser B, Lobb E, Dudding TE, Barlow-Stewart K, Tucker K. The virtual consultation: practitioners' experiences of genetic counseling by videoconferencing in Australia. Telemed J E Health 2010 Apr;16(3):350-357. [CrossRef] [Medline]91,Carlisle K, Warren R. A qualitative case study of telehealth for in-home monitoring to support the management of type 2 diabetes. J Telemed Telecare 2013 Oct;19(7):372-375. [CrossRef] [Medline]92,Jury SC, Walker AM, Kornberg AJ. The introduction of web-based video-consultation in a paediatric acute care setting. J Telemed Telecare 2013 Oct;19(7):383-387. [CrossRef] [Medline]103,Iacono T, Dissanayake C, Trembath D, Hudry K, Erickson S, Spong J. Family and practitioner perspectives on telehealth for services to young children with autism. Stud Health Technol Inform 2016;231:63-73. [Medline]153,Loh P, Flicker L, Horner B. Attitudes toward information and communication technology (ICT) in residential aged care in Western Australia. J Am Med Dir Assoc 2009 Jul;10(6):408-413. [CrossRef] [Medline]156,Nerminathan A, Harrison A, Phelps M, Alexander S, Scott KM. Doctors' use of mobile devices in the clinical setting: a mixed methods study. Intern Med J 2017 Mar;47(3):291-298. [CrossRef] [Medline]161,Orchard J, Lowres N, Freedman SB, Ladak L, Lee W, Zwar N, et al. Screening for atrial fibrillation during influenza vaccinations by primary care nurses using a smartphone electrocardiograph (iECG): A feasibility study. Eur J Prev Cardiol 2016 Oct;23(2 suppl):13-20. [CrossRef] [Medline]164,Taylor A, Wade V, Morris G, Pech J, Rechter S, Kidd M, et al. Technology support to a telehealth in the home service: qualitative observations. J Telemed Telecare 2016 Jul;22(5):296-303. [CrossRef] [Medline]171] | |
| Canada (n=9) | [Anderson K, Francis T, Ibanez-Carrasco F, Globerman J. Physician's perceptions of telemedicine in HIV care provision: a cross-sectional web-based survey. JMIR Public Health Surveill 2017 May 30;3(2):e31 [FREE Full text] [CrossRef] [Medline]3,Jarvis-Selinger S, Bates J, Araki Y, Lear SA. Internet-based support for cardiovascular disease management. Int J Telemed Appl 2011;2011:342582 [FREE Full text] [CrossRef] [Medline]52,Beauregard P, Arnaert A, Ponzoni N. Nursing students' perceptions of using smartphones in the community practicum: a qualitative study. Nurse Educ Today 2017 Jun;53:1-6. [CrossRef] [Medline]76,Seto E, Leonard KJ, Cafazzo JA, Barnsley J, Masino C, Ross HJ. Perceptions and experiences of heart failure patients and clinicians on the use of mobile phone-based telemonitoring. J Med Internet Res 2012 Feb 10;14(1):e25 [FREE Full text] [CrossRef] [Medline]78,Bello AK, Molzahn AE, Girard LP, Osman MA, Okpechi IG, Glassford J, et al. Patient and provider perspectives on the design and implementation of an electronic consultation system for kidney care delivery in Canada: a focus group study. BMJ Open 2017 Mar 2;7(3):e014784 [FREE Full text] [CrossRef] [Medline]87,Zhang H, Cocosila M, Archer N. Factors of adoption of mobile information technology by homecare nurses: a technology acceptance model 2 approach. Comput Inform Nurs 2010;28(1):49-56. [CrossRef] [Medline]146,Jeon J, Taneva S, Kukreti V, Trbovich P, Easty AC, Rossos PG, et al. Toward successful migration to computerized physician order entry for chemotherapy. Curr Oncol 2014 Apr;21(2):e221-e228 [FREE Full text] [CrossRef] [Medline]155,Chang F, Paramsothy T, Roche M, Gupta NS. Patient, staff, and clinician perspectives on implementing electronic communications in an interdisciplinary rural family health practice. Prim Health Care Res Dev 2017 Mar;18(2):149-160. [CrossRef] [Medline]178,Ahmad F, Norman C, O'Campo P. What is needed to implement a computer-assisted health risk assessment tool? An exploratory concept mapping study. BMC Med Inform Decis Mak 2012 Dec 19;12:149 [FREE Full text] [CrossRef] [Medline]192] | |
| Germany (n=7) | [Holderried M, Hoeper A, Holderried F, Blumenstock G, Ernst C, Tropitzsch A. Attitudes toward e-Health: the otolaryngologists' point of view. Telemed J E Health 2018 Jun;24(6):425-432. [CrossRef] [Medline]100,Klack L, Ziefle M, Wilkowska W, Kluge J. Telemedical versus conventional heart patient monitoring: a survey study with German physicians. Int J Technol Assess Health Care 2013 Oct;29(4):378-383. [CrossRef] [Medline]108,Albrecht UV, Afshar K, Illiger K, Becker S, Hartz T, Breil B, et al. Expectancy, usage and acceptance by general practitioners and patients: exploratory results from a study in the German outpatient sector. Digit Health 2017;3:2055207617695135 [FREE Full text] [CrossRef] [Medline]117,Sandholzer M, Deutsch T, Frese T, Winter A. Predictors of students' self-reported adoption of a smartphone application for medical education in general practice. BMC Med Educ 2015 May 21;15:91 [FREE Full text] [CrossRef] [Medline]134,Schmeer R, Behrends M, Kupka T, Meyenburg-Altwarg I, Marschollek M. Use and acceptance of mobile technology by hospital nurses in Germany. Stud Health Technol Inform 2016;225:944-945. [Medline]135,Dünnebeil S, Sunyaev A, Blohm I, Leimeister JM, Krcmar H. Determinants of physicians' technology acceptance for e-health in ambulatory care. Int J Med Inform 2012 Nov;81(11):746-760. [CrossRef] [Medline]149,Duhm J, Fleischmann R, Schmidt S, Hupperts H, Brandt SA. Mobile electronic medical records promote workflow: physicians' perspective from a survey. JMIR Mhealth Uhealth 2016 Jun 6;4(2):e70 [FREE Full text] [CrossRef] [Medline]150] | |
| Spain (n=7) | [Tintorer DL, Domínguez JM, Pujol-Rivera E, Beneyto SF, Tuduri XM, Saigí-Rubió F. Keys to success of a community of clinical practice in primary care: a qualitative evaluation of the ECOPIH project. BMC Fam Pract 2018 May 9;19(1):56 [FREE Full text] [CrossRef] [Medline]59,Gagnon MP, Orruño E, Asua J, Abdeljelil AB, Emparanza J. Using a modified technology acceptance model to evaluate healthcare professionals' adoption of a new telemonitoring system. Telemed J E Health 2012;18(1):54-59 [FREE Full text] [CrossRef] [Medline]97,Morilla MD, Sans M, Casasa A, Giménez N. Implementing technology in healthcare: insights from physicians. BMC Med Inform Decis Mak 2017 Jun 27;17(1):92 [FREE Full text] [CrossRef] [Medline]122,Orruño E, Gagnon MP, Asua J, Abdeljelil AB. Evaluation of teledermatology adoption by health-care professionals using a modified Technology Acceptance Model. J Telemed Telecare 2011;17(6):303-307. [CrossRef] [Medline]126,Saigi-Rubió F, Jiménez-Zarco A, Torrent-Sellens J. Determinants of the intention to use telemedicine: evidence from primary care physicians. Int J Technol Assess Health Care 2016 Jan;32(1-2):29-36. [CrossRef] [Medline]132,Asua J, Orruño E, Reviriego E, Gagnon MP. Healthcare professional acceptance of telemonitoring for chronic care patients in primary care. BMC Med Inform Decis Mak 2012 Nov 30;12:139 [FREE Full text] [CrossRef] [Medline]139,Villalba-Mora E, Casas I, Lupiañez-Villanueva F, Maghiros I. Adoption of health information technologies by physicians for clinical practice: the Andalusian case. Int J Med Inform 2015 Jul;84(7):477-485. [CrossRef] [Medline]143] | |
| Norway (n=4) | [Varsi C, Ekstedt M, Gammon D, Børøsund E, Ruland CM. Middle managers' experiences and role in implementing an interactive tailored patient assessment eHealth intervention in clinical practice. Comput Inform Nurs 2015;33(6):249-257. [CrossRef] [Medline]85,Varsi C, Ekstedt M, Gammon D, Ruland CM. Using the consolidated framework for implementation research to identify barriers and facilitators for the implementation of an internet-based patient-provider communication service in five settings: a qualitative study. J Med Internet Res 2015 Nov 18;17(11):e262 [FREE Full text] [CrossRef] [Medline]86,Wilhelmsen M, Høifødt RS, Kolstrup N, Waterloo K, Eisemann M, Chenhall R, et al. Norwegian general practitioners' perspectives on implementation of a guided web-based cognitive behavioral therapy for depression: a qualitative study. J Med Internet Res 2014 Sep 10;16(9):e208 [FREE Full text] [CrossRef] [Medline]89,Wynn R, Bergvik S, Pettersen G, Fossum S. Clinicians' experiences with videoconferencing in psychiatry. Stud Health Technol Inform 2012;180:1218-1220. [Medline]90] | |
| South Korea (n=4) | [Choi WS, Park J, Choi JY, Yang J. Stakeholders' resistance to telemedicine with focus on physicians: utilizing the Delphi technique. J Telemed Telecare 2019 Jul;25(6):378-385. [CrossRef] [Medline]8,Kim S, Lee KH, Hwang H, Yoo S. Analysis of the factors influencing healthcare professionals' adoption of mobile electronic medical record (EMR) using the unified theory of acceptance and use of technology (UTAUT) in a tertiary hospital. BMC Med Inform Decis Mak 2016 Jan 30;16:12 [FREE Full text] [CrossRef] [Medline]107,Lee SI, Park H, Kim JW, Hwang H, Cho EY, Kim Y, et al. Physicians' perceptions and use of a health information exchange: a pilot program in South Korea. Telemed J E Health 2012 Oct;18(8):604-612 [FREE Full text] [CrossRef] [Medline]114,Rho MJ, Choi IY, Lee J. Predictive factors of telemedicine service acceptance and behavioral intention of physicians. Int J Med Inform 2014 Aug;83(8):559-571. [CrossRef] [Medline]129] | |
| Sweden (n=4) | [Grünloh C, Cajander A, Myreteg G. 'The Record is Our Work Tool!'- physicians' framing of a patient portal in Sweden. J Med Internet Res 2016 Jun 27;18(6):e167 [FREE Full text] [CrossRef] [Medline]46,Öberg U, Orre CJ, Isaksson U, Schimmer R, Larsson H, Hörnsten Å. Swedish primary healthcare nurses' perceptions of using digital eHealth services in support of patient self-management. Scand J Caring Sci 2018 Jun;32(2):961-970. [CrossRef] [Medline]72,Sturesson L, Groth K. Effects of the digital transformation: qualitative study on the disturbances and limitations of using video visits in outpatient care. J Med Internet Res 2018 Jun 27;20(6):e221 [FREE Full text] [CrossRef] [Medline]82,Zhang Y, Koch S. Mobile health apps in Sweden: what do physicians recommend? Stud Health Technol Inform 2015;210:793-797. [Medline]175] | |
| Austria (n=3) | [Hackl WO, Hoerbst A, Duftschmid G, Gall W, Janzek-Hawlat S, Jung M, et al. Crucial factors for the acceptance of a computerized national medication list: insights into findings from the evaluation of the Austrian e-Medikation pilot. Appl Clin Inform 2014;5(2):527-537 [FREE Full text] [CrossRef] [Medline]98,Muigg D, Kastner P, Modre-Osprian R, Haluza D, Duftschmid G. Is Austria ready for telemonitoring? A readiness assessment among doctors and patients in the field of diabetes. Stud Health Technol Inform 2018;248:322-329. [Medline]160,Jungwirth D, Haluza D. Information and communication technology and the future of healthcare: results of a multi-scenario Delphi survey. Health Informatics J 2019 Mar;25(1):161-173. [CrossRef] [Medline]191] | |
| Iran (n=3) | [Sadoughi F, Erfannia L, Sancholi M, Salmani F, Sarsarshahi A. Teleradiology in Southeast Iran: Evaluating the Views of Senior Executives and Radiologists. Health Care Manag (Frederick) 2017;36(3):301-307. [CrossRef] [Medline]131,Ayatollahi H, Mirani N, Nazari F, Razavi N. Iranian healthcare professionals' perspectives about factors influencing the use of telemedicine in diabetes management. World J Diabetes 2018 Jun 15;9(6):92-98 [FREE Full text] [CrossRef] [Medline]147,Tahamtan I, Pajouhanfar S, Sedghi S, Azad M, Roudbari M. Factors affecting smartphone adoption for accessing information in medical settings. Health Info Libr J 2017 Jun;34(2):134-145. [CrossRef] [Medline]170] | |
| The Netherlands (n=3) | [van Gaalen JL, van Bodegom-Vos L, Bakker MJ, Snoeck-Stroband JB, Sont JK. Internet-based self-management support for adults with asthma: a qualitative study among patients, general practitioners and practice nurses on barriers to implementation. BMJ Open 2016 Aug 26;6(8):e010809 [FREE Full text] [CrossRef] [Medline]84,van Houwelingen CT, Barakat A, Best R, Boot WR, Charness N, Kort HS. Dutch nurses' willingness to use home telehealth: implications for practice and education. J Gerontol Nurs 2015 Apr;41(4):47-56. [CrossRef] [Medline]142,Ariens LF, Schussler-Raymakers FM, Frima C, Flinterman A, Hamminga E, Arents BW, et al. Barriers and facilitators to eHealth use in daily practice: perspectives of patients and professionals in dermatology. J Med Internet Res 2017 Sep 5;19(9):e300 [FREE Full text] [CrossRef] [Medline]152] | |
| Taiwan (n=3) | [Chiang KF, Wang HH, Chien IK, Liou JK, Hung CL, Huang CM, et al. Healthcare providers' perceptions of barriers in implementing of home telecare in Taiwan: a qualitative study. Int J Med Inform 2015 Apr;84(4):277-287. [CrossRef] [Medline]35,Kuo KM, Talley PC, Lee C, Yen Y. The influence of telemedicine experience on physicians' perceptions regarding adoption. Telemed J E Health 2015 May;21(5):388-394. [CrossRef] [Medline]113,Liu CF, Cheng TJ. Exploring critical factors influencing physicians' acceptance of mobile electronic medical records based on the dual-factor model: a validation in Taiwan. BMC Med Inform Decis Mak 2015 Feb 7;15:4 [FREE Full text] [CrossRef] [Medline]116] | |
| Others (n=39) | Argentina [Giraldo L, Schachner B, Luna D, Benítez S. Exploring nurses' perceptions and expectations toward a BCMA implementation using a mobile app and workstations as a change management strategy. Stud Health Technol Inform 2018;250:134-138. [Medline]44], Australia–United Kingdom [Bagot KL, Cadilhac DA, Bladin CF, Watkins CL, Vu M, Donnan GA, VSTASTUTE investigators. Integrating acute stroke telemedicine consultations into specialists' usual practice: a qualitative analysis comparing the experience of Australia and the United Kingdom. BMC Health Serv Res 2017 Nov 21;17(1):751 [FREE Full text] [CrossRef] [Medline]65], Austria–Sweden [Steinschaden T, Petersson G, Astrand B. Physicians' attitudes towards eprescribing: a comparative web survey in Austria and Sweden. Inform Prim Care 2009;17(4):241-248 [FREE Full text] [CrossRef] [Medline]140], Bangladesh [Khan NU, Rasheed S, Sharmin T, Ahmed T, Mahmood SS, Khatun F, et al. Experience of using mHealth to link village doctors with physicians: lessons from Chakaria, Bangladesh. BMC Med Inform Decis Mak 2015 Aug 5;15:62 [FREE Full text] [CrossRef] [Medline]56], Belgium [Odnoletkova I, Buysse H, Nobels F, Goderis G, Aertgeerts B, Annemans L, et al. Patient and provider acceptance of telecoaching in type 2 diabetes: a mixed-method study embedded in a randomised clinical trial. BMC Med Inform Decis Mak 2016 Nov 9;16(1):142 [FREE Full text] [CrossRef] [Medline]162], Brazil [de Souza CH, Morbeck RA, Steinman M, Hors CP, Bracco MM, Kozasa EH, et al. Barriers and benefits in telemedicine arising between a high-technology hospital service provider and remote public healthcare units: a qualitative study in Brazil. Telemed J E Health 2017 Jun;23(6):527-532. [CrossRef] [Medline]37], Congo [Mishori R, Anastario M, Naimer K, Varanasi S, Ferdowsian H, Abel D, et al. mJustice: preliminary development of a mobile app for medical-forensic documentation of sexual violence in low-resource environments and conflict zones. Glob Health Sci Pract 2017 Mar 24;5(1):138-151 [FREE Full text] [CrossRef] [Medline]193], Ethiopia [Kifle M, Payton FC, Mbarika V, Meso P. Transfer and adoption of advanced information technology solutions in resource-poor environments: the case of telemedicine systems adoption in Ethiopia. Telemed J E Health 2010 Apr;16(3):327-343. [CrossRef] [Medline]105], Europe [Moharra M, Almazán C, Decool M, Nilsson A, Allegretti N, Seven M. Implementation of a cross-border health service: physician and pharmacists' opinions from the epSOS project. Fam Pract 2015 Oct;32(5):564-567. [CrossRef] [Medline]66,Mairesse GH, Braunschweig F, Klersy K, Cowie MR, Leyva F. Implementation and reimbursement of remote monitoring for cardiac implantable electronic devices in Europe: a survey from the health economics committee of the European Heart Rhythm Association. Europace 2015 May;17(5):814-818. [CrossRef] [Medline]119], France [Esterle L, Mathieu-Fritz A. Teleconsultation in geriatrics: impact on professional practice. Int J Med Inform 2013 Aug;82(8):684-695. [CrossRef] [Medline]40,El Amrani L, Engberink AO, Ninot G, Hayot M, Carbonnel F. Connected health devices for health care in French general medicine practice: cross-sectional study. JMIR Mhealth Uhealth 2017 Dec 21;5(12):e193 [FREE Full text] [CrossRef] [Medline]128], Ghana [Rothstein JD, Jennings L, Moorthy A, Yang F, Gee L, Romano K, et al. Qualitative assessment of the feasibility, usability, and acceptability of a mobile client data app for community-based maternal, neonatal, and child care in rural Ghana. Int J Telemed Appl 2016;2016:2515420 [FREE Full text] [CrossRef] [Medline]74], Iraq [Ghani MK, Jaber MM. Willingness to adopt telemedicine in major iraqi hospitals: a pilot study. Int J Telemed Appl 2015;2015:136591 [FREE Full text] [CrossRef] [Medline]95], Israel–Portugal [Catan G, Espanha R, Mendes RV, Toren O, Chinitz D. Health information technology implementation - impacts and policy considerations: a comparison between Israel and Portugal. Isr J Health Policy Res 2015;4:41 [FREE Full text] [CrossRef] [Medline]34], Italy [Lygidakis C, Wallace P, Tersar C, Marcatto F, Ferrante D, Vedova RD, et al. Download Your Doctor: implementation of a digitally mediated personal physician presence to enhance patient engagement with a health-promoting internet application. JMIR Res Protoc 2016 Mar 4;5(1):e36 [FREE Full text] [CrossRef] [Medline]158], Japan [Okazaki S, Castañeda JA, Sanz S, Henseler J. Factors affecting mobile diabetes monitoring adoption among physicians: questionnaire study and path model. J Med Internet Res 2012 Dec 21;14(6):e183 [FREE Full text] [CrossRef] [Medline]125], Japan–Sweden [Kato NP, Johansson P, Okada I, de Vries AE, Kinugawa K, Strömberg A, et al. Heart failure telemonitoring in Japan and Sweden: a cross-sectional survey. J Med Internet Res 2015 Nov 13;17(11):e258 [FREE Full text] [CrossRef] [Medline]104], Jordan–Syria [Alajlani M, Clarke M. Effect of culture on acceptance of telemedicine in Middle Eastern countries: case study of Jordan and Syria. Telemed J E Health 2013 Apr;19(4):305-311. [CrossRef] [Medline]151], Lebanon [Daniel F, Jabak S, Sasso R, Chamoun Y, Tamim H. Patient-physician communication in the era of mobile phones and social media apps: cross-sectional observational study on Lebanese physicians' perceptions and attitudes. JMIR Med Inform 2018 Apr 6;6(2):e18 [FREE Full text] [CrossRef] [Medline]190], Malaysia [Zailani S, Gilani MS, Nikbin D, Iranmanesh M. Determinants of telemedicine acceptance in selected public hospitals in Malaysia: clinical perspective. J Med Syst 2014 Sep;38(9):111. [CrossRef] [Medline]145], Nepal [Bhatta R, Aryal K, Ellingsen G. Opportunities and challenges of a rural-telemedicine program in Nepal. J Nepal Health Res Counc 2015;13(30):149-153. [Medline]4], the Netherlands–Spain–United Kingdom [de Vries ST, Wong L, Sutcliffe A, Houÿez F, Ruiz CL, Mol PG, IMI Web-RADR Work Package 3b Consortium. Factors influencing the use of a mobile app for reporting adverse drug reactions and receiving safety information: a qualitative study. Drug Saf 2017 May;40(5):443-455 [FREE Full text] [CrossRef] [Medline]38], New Zealand [McNally G, Frey R, Crossan M. Nurse manager and student nurse perceptions of the use of personal smartphones or tablets and the adjunct applications, as an educational tool in clinical settings. Nurse Educ Pract 2017 Mar;23:1-7. [CrossRef] [Medline]63,Walker L, Clendon J. The case for end-user involvement in design of health technologies. J Telemed Telecare 2016 Dec;22(8):443-446. [CrossRef] [Medline]172], Nigeria [Adenuga KI, Iahad NA, Miskon S. Towards reinforcing telemedicine adoption amongst clinicians in Nigeria. Int J Med Inform 2017 Aug;104:84-96. [CrossRef] [Medline]106], North America–Europe [Rogove HJ, McArthur D, Demaerschalk BM, Vespa PM. Barriers to telemedicine: survey of current users in acute care units. Telemed J E Health 2012;18(1):48-53. [CrossRef] [Medline]130], Poland [Duplaga M. Searching for a role of nursing personnel in developing landscape of eHealth: factors determining attitudes toward key patient empowering applications. PLoS One 2016;11(4):e0153173 [FREE Full text] [CrossRef] [Medline]96], Portugal [Lapão LV, da Silva MM, Gregório J. Implementing an online pharmaceutical service using design science research. BMC Med Inform Decis Mak 2017 Mar 27;17(1):31 [FREE Full text] [CrossRef] [Medline]157], Russia [Kopanitsa G, Yampolsky V. Exploring barriers and opportunities for adoption of web portals in Russia. Stud Health Technol Inform 2016;221:87-91. [Medline]58], Senegal [Ly BA, Kristjansson E, Labonté R, Bourgeault IL. Determinants of the intention of Senegal's physicians to use telemedicine in their professional activities. Telemed J E Health 2018 Nov;24(11):897-898. [CrossRef] [Medline]118], South–North America [Brieux HM, Benitez S, Otero C, Luna D, Masud JH, Marcelo A, et al. Cultural problems associated with the implementation of eHealth. Stud Health Technol Inform 2017;245:1213. [Medline]148], Spain–Colombia–Bolivia [Saigí-Rubió F, Torrent-Sellens J, Jiménez-Zarco A. Drivers of telemedicine use: comparative evidence from samples of Spanish, Colombian and Bolivian physicians. Implement Sci 2014 Oct 8;9:128 [FREE Full text] [CrossRef] [Medline]133], Sri Lanka [Han KJ, Subramanian R, Cameron GT. Listen before you leap: Sri Lankan health professionals' perspectives on m-health. Health Informatics J 2019 Sep;25(3):858-866. [CrossRef] [Medline]47], Switzerland [Ehrler F, Ducloux P, Wu DT, Lovis C, Blondon K. Acceptance of a mobile application supporting nurses workflow at patient bedside: results from a pilot study. Stud Health Technol Inform 2018;247:506-510. [Medline]181], Syria [Jefee-Bahloul H, Duchen D, Barkil-Oteo A. Attitudes towards implementation of Store-and-Forward telemental health in humanitarian settings: survey of Syrian healthcare providers. Telemed J E Health 2016 Jan;22(1):31-35. [CrossRef] [Medline]101], Turkey [Sezgin E, Özkan-Yildirim S, Yildirim S. Understanding the perception towards using mHealth applications in practice. Inf Dev 2018;34(2):182-200. [CrossRef]136,Yaman H, Yavuz E, Er A, Vural R, Albayrak Y, Yardimci A, et al. The use of mobile smart devices and medical apps in the family practice setting. J Eval Clin Pract 2016 Apr;22(2):290-296. [CrossRef] [Medline]144], the United States–South Africa–Thailand–Peru [Brown W, Giguere R, Sheinfil A, Ibitoye M, Balan I, Ho T, et al. Challenges and solutions implementing an SMS text message-based survey CASI and adherence reminders in an international biomedical HIV PrEP study (MTN 017). J Biomed Inform 2018 Apr;80:78-86 [FREE Full text] [CrossRef] [Medline]177] | |
| Theoretical framework | ||
| TAMa was the most used theoretical framework (n=19) | [Wynn R, Bergvik S, Pettersen G, Fossum S. Clinicians' experiences with videoconferencing in psychiatry. Stud Health Technol Inform 2012;180:1218-1220. [Medline]90,Gagnon MP, Orruño E, Asua J, Abdeljelil AB, Emparanza J. Using a modified technology acceptance model to evaluate healthcare professionals' adoption of a new telemonitoring system. Telemed J E Health 2012;18(1):54-59 [FREE Full text] [CrossRef] [Medline]97,Jetty A, Moore MA, Coffman M, Petterson S, Bazemore A. Rural family physicians are twice as likely to use telehealth as urban family physicians. Telemed J E Health 2018 Apr;24(4):268-276. [CrossRef] [Medline]102,Kowitlawakul Y. The technology acceptance model: predicting nurses' intention to use telemedicine technology (eICU). Comput Inform Nurs 2011 Jul;29(7):411-418. [CrossRef] [Medline]111,Orruño E, Gagnon MP, Asua J, Abdeljelil AB. Evaluation of teledermatology adoption by health-care professionals using a modified Technology Acceptance Model. J Telemed Telecare 2011;17(6):303-307. [CrossRef] [Medline]126,Putzer GJ, Park Y. Are physicians likely to adopt emerging mobile technologies? Attitudes and innovation factors affecting smartphone use in the Southeastern United States. Perspect Health Inf Manag 2012;9:1b [FREE Full text] [Medline]127,Rho MJ, Choi IY, Lee J. Predictive factors of telemedicine service acceptance and behavioral intention of physicians. Int J Med Inform 2014 Aug;83(8):559-571. [CrossRef] [Medline]129,Saigi-Rubió F, Jiménez-Zarco A, Torrent-Sellens J. Determinants of the intention to use telemedicine: evidence from primary care physicians. Int J Technol Assess Health Care 2016 Jan;32(1-2):29-36. [CrossRef] [Medline]132-Sezgin E, Özkan-Yildirim S, Yildirim S. Understanding the perception towards using mHealth applications in practice. Inf Dev 2018;34(2):182-200. [CrossRef]136,Asua J, Orruño E, Reviriego E, Gagnon MP. Healthcare professional acceptance of telemonitoring for chronic care patients in primary care. BMC Med Inform Decis Mak 2012 Nov 30;12:139 [FREE Full text] [CrossRef] [Medline]139,Zhang H, Cocosila M, Archer N. Factors of adoption of mobile information technology by homecare nurses: a technology acceptance model 2 approach. Comput Inform Nurs 2010;28(1):49-56. [CrossRef] [Medline]146,Dünnebeil S, Sunyaev A, Blohm I, Leimeister JM, Krcmar H. Determinants of physicians' technology acceptance for e-health in ambulatory care. Int J Med Inform 2012 Nov;81(11):746-760. [CrossRef] [Medline]149,Ray KN, Felmet KA, Hamilton MF, Kuza CC, Saladino RA, Schultz BR, et al. Clinician attitudes toward adoption of pediatric emergency telemedicine in rural hospitals. Pediatr Emerg Care 2017 Apr;33(4):250-257. [CrossRef] [Medline]168,Tahamtan I, Pajouhanfar S, Sedghi S, Azad M, Roudbari M. Factors affecting smartphone adoption for accessing information in medical settings. Health Info Libr J 2017 Jun;34(2):134-145. [CrossRef] [Medline]170,Williamson KM, Muckle J. Students' perception of technology use in nursing education. Comput Inform Nurs 2018 Feb;36(2):70-76. [CrossRef] [Medline]173,Putzer GJ, Park Y. The effects of innovation factors on smartphone adoption among nurses in community hospitals. Perspect Health Inf Manag 2010 Jan 1;7:1b [FREE Full text] [Medline]196] | |
| The theory of diffusion of innovation (n=11) | [Han KJ, Subramanian R, Cameron GT. Listen before you leap: Sri Lankan health professionals' perspectives on m-health. Health Informatics J 2019 Sep;25(3):858-866. [CrossRef] [Medline]47,Jarvis-Selinger S, Bates J, Araki Y, Lear SA. Internet-based support for cardiovascular disease management. Int J Telemed Appl 2011;2011:342582 [FREE Full text] [CrossRef] [Medline]52,Puszka S, Dingwall KM, Sweet M, Nagel T. E-Mental health innovations for aboriginal and Torres Strait Islander Australians: a qualitative study of implementation needs in health services. JMIR Ment Health 2016 Sep 19;3(3):e43 [FREE Full text] [CrossRef] [Medline]73,L'Esperance ST, Perry DJ. Assessing advantages and barriers to telemedicine adoption in the practice setting: A MyCareTeam(TM) exemplar. J Am Assoc Nurse Pract 2016 Jun;28(6):311-319. [CrossRef] [Medline]115,Miller KE, Kuhn E, Owen JE, Taylor K, Yu JS, Weiss BJ, et al. Clinician perceptions related to the use of the CBT-I Coach Mobile App. Behav Sleep Med 2019;17(4):481-491. [CrossRef] [Medline]120,Putzer GJ, Park Y. Are physicians likely to adopt emerging mobile technologies? Attitudes and innovation factors affecting smartphone use in the Southeastern United States. Perspect Health Inf Manag 2012;9:1b [FREE Full text] [Medline]127,Saigí-Rubió F, Torrent-Sellens J, Jiménez-Zarco A. Drivers of telemedicine use: comparative evidence from samples of Spanish, Colombian and Bolivian physicians. Implement Sci 2014 Oct 8;9:128 [FREE Full text] [CrossRef] [Medline]133,Sandholzer M, Deutsch T, Frese T, Winter A. Predictors of students' self-reported adoption of a smartphone application for medical education in general practice. BMC Med Educ 2015 May 21;15:91 [FREE Full text] [CrossRef] [Medline]134,Smith PB, Buzi RS. Reproductive health professionals' adoption of emerging technologies for health promotion. Health Informatics J 2014 Dec;20(4):250-260. [CrossRef] [Medline]138,Zhang Y, Koch S. Mobile health apps in Sweden: what do physicians recommend? Stud Health Technol Inform 2015;210:793-797. [Medline]175,Putzer GJ, Park Y. The effects of innovation factors on smartphone adoption among nurses in community hospitals. Perspect Health Inf Manag 2010 Jan 1;7:1b [FREE Full text] [Medline]196] | |
| UTAUTb (n=6) | [de Vries ST, Wong L, Sutcliffe A, Houÿez F, Ruiz CL, Mol PG, IMI Web-RADR Work Package 3b Consortium. Factors influencing the use of a mobile app for reporting adverse drug reactions and receiving safety information: a qualitative study. Drug Saf 2017 May;40(5):443-455 [FREE Full text] [CrossRef] [Medline]38,Hackl WO, Hoerbst A, Duftschmid G, Gall W, Janzek-Hawlat S, Jung M, et al. Crucial factors for the acceptance of a computerized national medication list: insights into findings from the evaluation of the Austrian e-Medikation pilot. Appl Clin Inform 2014;5(2):527-537 [FREE Full text] [CrossRef] [Medline]98,Adenuga KI, Iahad NA, Miskon S. Towards reinforcing telemedicine adoption amongst clinicians in Nigeria. Int J Med Inform 2017 Aug;104:84-96. [CrossRef] [Medline]106,Kim S, Lee KH, Hwang H, Yoo S. Analysis of the factors influencing healthcare professionals' adoption of mobile electronic medical record (EMR) using the unified theory of acceptance and use of technology (UTAUT) in a tertiary hospital. BMC Med Inform Decis Mak 2016 Jan 30;16:12 [FREE Full text] [CrossRef] [Medline]107,van Houwelingen CT, Barakat A, Best R, Boot WR, Charness N, Kort HS. Dutch nurses' willingness to use home telehealth: implications for practice and education. J Gerontol Nurs 2015 Apr;41(4):47-56. [CrossRef] [Medline]142,Ehrler F, Ducloux P, Wu DT, Lovis C, Blondon K. Acceptance of a mobile application supporting nurses workflow at patient bedside: results from a pilot study. Stud Health Technol Inform 2018;247:506-510. [Medline]181] | |
| Others (n=23) | Affordability, practicability, effectiveness, acceptability, safety or side effects, and equity criteria [Egerton T, Nelligan R, Setchell J, Atkins L, Bennell KL. General practitioners' perspectives on a proposed new model of service delivery for primary care management of knee osteoarthritis: a qualitative study. BMC Fam Pract 2017 Sep 7;18(1):85 [FREE Full text] [CrossRef] [Medline]39]; Consolidated Framework for Implementation Research [Lord S, Moore SK, Ramsey A, Dinauer S, Johnson K. Implementation of a substance use recovery support mobile phone app in community settings: qualitative study of clinician and staff perspectives of facilitators and barriers. JMIR Ment Health 2016 Jun 28;3(2):e24 [FREE Full text] [CrossRef] [Medline]61,Varsi C, Ekstedt M, Gammon D, Ruland CM. Using the consolidated framework for implementation research to identify barriers and facilitators for the implementation of an internet-based patient-provider communication service in five settings: a qualitative study. J Med Internet Res 2015 Nov 18;17(11):e262 [FREE Full text] [CrossRef] [Medline]86,Possemato K, Kuhn E, Johnson EM, Hoffman JE, Brooks E. Development and refinement of a clinician intervention to facilitate primary care patient use of the PTSD Coach app. Transl Behav Med 2017 Mar;7(1):116-126 [FREE Full text] [CrossRef] [Medline]166]; design science research methodology [Lapão LV, da Silva MM, Gregório J. Implementing an online pharmaceutical service using design science research. BMC Med Inform Decis Mak 2017 Mar 27;17(1):31 [FREE Full text] [CrossRef] [Medline]157]; Giddens’s concepts from structuration theory and consequence of modernity [Sharma U, Barnett J, Clarke M. Clinical users' perspective on telemonitoring of patients with long term conditions: understood through concepts of Giddens's structuration theory & consequence of modernity. Stud Health Technol Inform 2010;160(Pt 1):545-549. [Medline]79]; organizational readiness for change model [Ray KN, Felmet KA, Hamilton MF, Kuza CC, Saladino RA, Schultz BR, et al. Clinician attitudes toward adoption of pediatric emergency telemedicine in rural hospitals. Pediatr Emerg Care 2017 Apr;33(4):250-257. [CrossRef] [Medline]168]; organizational theory of implementation effectiveness [Shaw RJ, Kaufman MA, Bosworth HB, Weiner BJ, Zullig LL, Lee SD, et al. Organizational factors associated with readiness to implement and translate a primary care based telemedicine behavioral program to improve blood pressure control: the HTN-IMPROVE study. Implement Sci 2013 Sep 8;8:106 [FREE Full text] [CrossRef] [Medline]169]; reach, effectiveness, adoption, implementation, and maintenance framework [Quanbeck A, Gustafson DH, Marsch LA, Chih M, Kornfield R, McTavish F, et al. Implementing a mobile health system to integrate the treatment of addiction into primary care: a hybrid implementation-effectiveness study. J Med Internet Res 2018 Jan 30;20(1):e37 [FREE Full text] [CrossRef] [Medline]167]; sociotechnical theory [Casey M, Shaw S, Swinglehurst D. Experiences with online consultation systems in primary care: case study of one early adopter site. Br J Gen Pract 2017 Nov;67(664):e736-e743 [FREE Full text] [CrossRef] [Medline]94,Ahmad F, Norman C, O'Campo P. What is needed to implement a computer-assisted health risk assessment tool? An exploratory concept mapping study. BMC Med Inform Decis Mak 2012 Dec 19;12:149 [FREE Full text] [CrossRef] [Medline]192]; stakeholder empowered adoption model [Bidmead E, Marshall A. A case study of stakeholder perceptions of patient held records: the Patients Know Best (PKB) solution. Digit Health 2016;2:2055207616668431 [FREE Full text] [CrossRef] [Medline]174]; the technology-organization-environment framework [Ghani MK, Jaber MM. Willingness to adopt telemedicine in major iraqi hospitals: a pilot study. Int J Telemed Appl 2015;2015:136591 [FREE Full text] [CrossRef] [Medline]95]; technological frames [Grünloh C, Cajander A, Myreteg G. 'The Record is Our Work Tool!'- physicians' framing of a patient portal in Sweden. J Med Internet Res 2016 Jun 27;18(6):e167 [FREE Full text] [CrossRef] [Medline]46]; the dual-factor model [Liu CF, Cheng TJ. Exploring critical factors influencing physicians' acceptance of mobile electronic medical records based on the dual-factor model: a validation in Taiwan. BMC Med Inform Decis Mak 2015 Feb 7;15:4 [FREE Full text] [CrossRef] [Medline]116]; the normalization process theory [Bagot KL, Cadilhac DA, Bladin CF, Watkins CL, Vu M, Donnan GA, VSTASTUTE investigators. Integrating acute stroke telemedicine consultations into specialists' usual practice: a qualitative analysis comparing the experience of Australia and the United Kingdom. BMC Health Serv Res 2017 Nov 21;17(1):751 [FREE Full text] [CrossRef] [Medline]65]; theory of change [Bramley G, Mangan C, Conroy M. Using telemonitoring to support personal care planning for adults with learning disabilities. J Telemed Telecare 2019 Dec;25(10):602-610. [CrossRef] [Medline]176]; theory of planned behavior [Kuo KM, Talley PC, Lee C, Yen Y. The influence of telemedicine experience on physicians' perceptions regarding adoption. Telemed J E Health 2015 May;21(5):388-394. [CrossRef] [Medline]113,Saigi-Rubió F, Jiménez-Zarco A, Torrent-Sellens J. Determinants of the intention to use telemedicine: evidence from primary care physicians. Int J Technol Assess Health Care 2016 Jan;32(1-2):29-36. [CrossRef] [Medline]132]; theory of reasoned action [Saigi-Rubió F, Jiménez-Zarco A, Torrent-Sellens J. Determinants of the intention to use telemedicine: evidence from primary care physicians. Int J Technol Assess Health Care 2016 Jan;32(1-2):29-36. [CrossRef] [Medline]132,Saigí-Rubió F, Torrent-Sellens J, Jiménez-Zarco A. Drivers of telemedicine use: comparative evidence from samples of Spanish, Colombian and Bolivian physicians. Implement Sci 2014 Oct 8;9:128 [FREE Full text] [CrossRef] [Medline]133]; theory of technology readiness [Saigí-Rubió F, Torrent-Sellens J, Jiménez-Zarco A. Drivers of telemedicine use: comparative evidence from samples of Spanish, Colombian and Bolivian physicians. Implement Sci 2014 Oct 8;9:128 [FREE Full text] [CrossRef] [Medline]133]; Updated DeLone and McLean Information System Success Model [Okazaki S, Castañeda JA, Sanz S, Henseler J. Factors affecting mobile diabetes monitoring adoption among physicians: questionnaire study and path model. J Med Internet Res 2012 Dec 21;14(6):e183 [FREE Full text] [CrossRef] [Medline]125] | |
| Pilot projects | ||
| Studies identified as pilot projects (n=31) | [Flynn D, Gregory P, Makki H, Gabbay M. Expectations and experiences of eHealth in primary care: a qualitative practice-based investigation. Int J Med Inform 2009 Sep;78(9):588-604. [CrossRef] [Medline]43,Hanley J, Ure J, Pagliari C, Sheikh A, McKinstry B. Experiences of patients and professionals participating in the HITS home blood pressure telemonitoring trial: a qualitative study. BMJ Open 2013 May 28;3(5):pii: e002671 [FREE Full text] [CrossRef] [Medline]48,Jimbo M, Shultz CG, Nease DE, Fetters MD, Power D, Ruffin MT. Perceived barriers and facilitators of using a Web-based interactive decision aid for colorectal cancer screening in community practice settings: findings from focus groups with primary care clinicians and medical office staff. J Med Internet Res 2013 Dec 18;15(12):e286 [FREE Full text] [CrossRef] [Medline]53,Moharra M, Almazán C, Decool M, Nilsson A, Allegretti N, Seven M. Implementation of a cross-border health service: physician and pharmacists' opinions from the epSOS project. Fam Pract 2015 Oct;32(5):564-567. [CrossRef] [Medline]66,Molleda L, Bahamon M, St George SM, Perrino T, Estrada Y, Herrera DC, et al. Clinic personnel, facilitator, and parent perspectives of eHealth Familias Unidas in primary care. J Pediatr Health Care 2017;31(3):350-361 [FREE Full text] [CrossRef] [Medline]68,Rothstein JD, Jennings L, Moorthy A, Yang F, Gee L, Romano K, et al. Qualitative assessment of the feasibility, usability, and acceptability of a mobile client data app for community-based maternal, neonatal, and child care in rural Ghana. Int J Telemed Appl 2016;2016:2515420 [FREE Full text] [CrossRef] [Medline]74,Seto E, Leonard KJ, Cafazzo JA, Barnsley J, Masino C, Ross HJ. Perceptions and experiences of heart failure patients and clinicians on the use of mobile phone-based telemonitoring. J Med Internet Res 2012 Feb 10;14(1):e25 [FREE Full text] [CrossRef] [Medline]78,Bello AK, Molzahn AE, Girard LP, Osman MA, Okpechi IG, Glassford J, et al. Patient and provider perspectives on the design and implementation of an electronic consultation system for kidney care delivery in Canada: a focus group study. BMJ Open 2017 Mar 2;7(3):e014784 [FREE Full text] [CrossRef] [Medline]87-Wilhelmsen M, Høifødt RS, Kolstrup N, Waterloo K, Eisemann M, Chenhall R, et al. Norwegian general practitioners' perspectives on implementation of a guided web-based cognitive behavioral therapy for depression: a qualitative study. J Med Internet Res 2014 Sep 10;16(9):e208 [FREE Full text] [CrossRef] [Medline]89,Casey M, Shaw S, Swinglehurst D. Experiences with online consultation systems in primary care: case study of one early adopter site. Br J Gen Pract 2017 Nov;67(664):e736-e743 [FREE Full text] [CrossRef] [Medline]94,Ghani MK, Jaber MM. Willingness to adopt telemedicine in major iraqi hospitals: a pilot study. Int J Telemed Appl 2015;2015:136591 [FREE Full text] [CrossRef] [Medline]95,Hackl WO, Hoerbst A, Duftschmid G, Gall W, Janzek-Hawlat S, Jung M, et al. Crucial factors for the acceptance of a computerized national medication list: insights into findings from the evaluation of the Austrian e-Medikation pilot. Appl Clin Inform 2014;5(2):527-537 [FREE Full text] [CrossRef] [Medline]98,Kuhn E, Eftekhari A, Hoffman JE, Crowley JJ, Ramsey KM, Reger GM, et al. Clinician perceptions of using a smartphone app with prolonged exposure therapy. Adm Policy Ment Health 2014 Nov;41(6):800-807. [CrossRef] [Medline]112,Lee SI, Park H, Kim JW, Hwang H, Cho EY, Kim Y, et al. Physicians' perceptions and use of a health information exchange: a pilot program in South Korea. Telemed J E Health 2012 Oct;18(8):604-612 [FREE Full text] [CrossRef] [Medline]114,Orruño E, Gagnon MP, Asua J, Abdeljelil AB. Evaluation of teledermatology adoption by health-care professionals using a modified Technology Acceptance Model. J Telemed Telecare 2011;17(6):303-307. [CrossRef] [Medline]126,Sims MH, Fagnano M, Halterman JS, Halterman MW. Provider impressions of the use of a mobile crowdsourcing app in medical practice. Health Informatics J 2016 Jun;22(2):221-231. [CrossRef] [Medline]137,Asua J, Orruño E, Reviriego E, Gagnon MP. Healthcare professional acceptance of telemonitoring for chronic care patients in primary care. BMC Med Inform Decis Mak 2012 Nov 30;12:139 [FREE Full text] [CrossRef] [Medline]139,Lygidakis C, Wallace P, Tersar C, Marcatto F, Ferrante D, Vedova RD, et al. Download Your Doctor: implementation of a digitally mediated personal physician presence to enhance patient engagement with a health-promoting internet application. JMIR Res Protoc 2016 Mar 4;5(1):e36 [FREE Full text] [CrossRef] [Medline]158,Odnoletkova I, Buysse H, Nobels F, Goderis G, Aertgeerts B, Annemans L, et al. Patient and provider acceptance of telecoaching in type 2 diabetes: a mixed-method study embedded in a randomised clinical trial. BMC Med Inform Decis Mak 2016 Nov 9;16(1):142 [FREE Full text] [CrossRef] [Medline]162-Quanbeck A, Gustafson DH, Marsch LA, Chih M, Kornfield R, McTavish F, et al. Implementing a mobile health system to integrate the treatment of addiction into primary care: a hybrid implementation-effectiveness study. J Med Internet Res 2018 Jan 30;20(1):e37 [FREE Full text] [CrossRef] [Medline]167,Taylor A, Wade V, Morris G, Pech J, Rechter S, Kidd M, et al. Technology support to a telehealth in the home service: qualitative observations. J Telemed Telecare 2016 Jul;22(5):296-303. [CrossRef] [Medline]171,Bidmead E, Marshall A. A case study of stakeholder perceptions of patient held records: the Patients Know Best (PKB) solution. Digit Health 2016;2:2055207616668431 [FREE Full text] [CrossRef] [Medline]174,Bramley G, Mangan C, Conroy M. Using telemonitoring to support personal care planning for adults with learning disabilities. J Telemed Telecare 2019 Dec;25(10):602-610. [CrossRef] [Medline]176,Ehrler F, Ducloux P, Wu DT, Lovis C, Blondon K. Acceptance of a mobile application supporting nurses workflow at patient bedside: results from a pilot study. Stud Health Technol Inform 2018;247:506-510. [Medline]181,Ahmad F, Norman C, O'Campo P. What is needed to implement a computer-assisted health risk assessment tool? An exploratory concept mapping study. BMC Med Inform Decis Mak 2012 Dec 19;12:149 [FREE Full text] [CrossRef] [Medline]192,Mishori R, Anastario M, Naimer K, Varanasi S, Ferdowsian H, Abel D, et al. mJustice: preliminary development of a mobile app for medical-forensic documentation of sexual violence in low-resource environments and conflict zones. Glob Health Sci Pract 2017 Mar 24;5(1):138-151 [FREE Full text] [CrossRef] [Medline]193] | |
aTAM: Technology Acceptance Model.
bUTAUT: unified theory of acceptance and use of technology.
Technological Factors
The technological factors impacting clinicians’ adoption of mHealth were categorized into 8 key themes: usefulness, ease of use, design, compatibility, technical issues, content, personalization, and convenience. These were, in turn, subdivided into a total of 14 subthemes. 
Figure 3 gives an overview of these technological factor themes and subthemes and their respective occurrence.
Technical issues were the most prominent factors, often related to matters such as connectivity (n=17), reliability (n=21), technical support (n=27), and technical difficulties in general (n=38). Features determining usefulness, such as expected benefits, performance expectancy, and added value, were also among the most prominent technological factors in the selected studies (n=64). Ease of use, determined by features such as effort expectancy and usability, was also quite central (n=55). Furthermore, several studies raised some concerns related to compatibility, such as interoperability issues (n=31), electronic health record (EHR) integration (n=20), and competition with existing programs (n=1).
Some design-related factors were also cited, such as layout, interface, culturally appropriate design (n=11), and the importance of patient-centered design (n=11). The tools’ convenience, determined by its level of mobility and flexibility, also played a role (n=17), in addition to the trustworthiness and quality of the content (n=15), and personalization possibilities through customization and adaptability (n=7). Table 2 details the technological factors impacting adoption, their occurrence, and the respective studies where they were identified.
| Factor and subthemes | References | |
| Technical issues | ||
| Technical difficulties (n=38) | [Avey JP, Hobbs RL. Dial in: fostering the use of telebehavioral health services in frontier Alaska. Psychol Serv 2013 Aug;10(3):289-297. [CrossRef] [Medline]2,Gagnon MP, Ngangue P, Payne-Gagnon J, Desmartis M. m-Health adoption by healthcare professionals: a systematic review. J Am Med Inform Assoc 2016 Jan;23(1):212-220. [CrossRef] [Medline]9,de Souza CH, Morbeck RA, Steinman M, Hors CP, Bracco MM, Kozasa EH, et al. Barriers and benefits in telemedicine arising between a high-technology hospital service provider and remote public healthcare units: a qualitative study in Brazil. Telemed J E Health 2017 Jun;23(6):527-532. [CrossRef] [Medline]37,Fairbrother P, Ure J, Hanley J, McCloughan L, Denvir M, Sheikh A, Telescot programme team. Telemonitoring for chronic heart failure: the views of patients and healthcare professionals - a qualitative study. J Clin Nurs 2014 Jan;23(1-2):132-144. [CrossRef] [Medline]41-Giraldo L, Schachner B, Luna D, Benítez S. Exploring nurses' perceptions and expectations toward a BCMA implementation using a mobile app and workstations as a change management strategy. Stud Health Technol Inform 2018;250:134-138. [Medline]44,James S, Perry L, Gallagher R, Lowe J. Diabetes educators: perceived experiences, supports and barriers to use of common diabetes-related technologies. J Diabetes Sci Technol 2016 Sep;10(5):1115-1121 [FREE Full text] [CrossRef] [Medline]51,Armstrong AW, Kwong MW, Ledo L, Nesbitt TS, Shewry SL. Practice models and challenges in teledermatology: a study of collective experiences from teledermatologists. PLoS One 2011;6(12):e28687 [FREE Full text] [CrossRef] [Medline]54-Khan NU, Rasheed S, Sharmin T, Ahmed T, Mahmood SS, Khatun F, et al. Experience of using mHealth to link village doctors with physicians: lessons from Chakaria, Bangladesh. BMC Med Inform Decis Mak 2015 Aug 5;15:62 [FREE Full text] [CrossRef] [Medline]56,Lord S, Moore SK, Ramsey A, Dinauer S, Johnson K. Implementation of a substance use recovery support mobile phone app in community settings: qualitative study of clinician and staff perspectives of facilitators and barriers. JMIR Ment Health 2016 Jun 28;3(2):e24 [FREE Full text] [CrossRef] [Medline]61,Rothstein JD, Jennings L, Moorthy A, Yang F, Gee L, Romano K, et al. Qualitative assessment of the feasibility, usability, and acceptability of a mobile client data app for community-based maternal, neonatal, and child care in rural Ghana. Int J Telemed Appl 2016;2016:2515420 [FREE Full text] [CrossRef] [Medline]74,Sandberg J, Trief PM, Izquierdo R, Goland R, Morin PC, Palmas W, et al. A qualitative study of the experiences and satisfaction of direct telemedicine providers in diabetes case management. Telemed J E Health 2009 Oct;15(8):742-750. [CrossRef] [Medline]75,Sturesson L, Groth K. Effects of the digital transformation: qualitative study on the disturbances and limitations of using video visits in outpatient care. J Med Internet Res 2018 Jun 27;20(6):e221 [FREE Full text] [CrossRef] [Medline]82,Taylor J, Coates L. Caring from a distance: the role of telehealth. Nurs Times 2015;111(28-29):18-20. [Medline]83,Varsi C, Ekstedt M, Gammon D, Ruland CM. Using the consolidated framework for implementation research to identify barriers and facilitators for the implementation of an internet-based patient-provider communication service in five settings: a qualitative study. J Med Internet Res 2015 Nov 18;17(11):e262 [FREE Full text] [CrossRef] [Medline]86,Wynn R, Bergvik S, Pettersen G, Fossum S. Clinicians' experiences with videoconferencing in psychiatry. Stud Health Technol Inform 2012;180:1218-1220. [Medline]90-Carlisle K, Warren R. A qualitative case study of telehealth for in-home monitoring to support the management of type 2 diabetes. J Telemed Telecare 2013 Oct;19(7):372-375. [CrossRef] [Medline]92,Jefee-Bahloul H, Duchen D, Barkil-Oteo A. Attitudes towards implementation of Store-and-Forward telemental health in humanitarian settings: survey of Syrian healthcare providers. Telemed J E Health 2016 Jan;22(1):31-35. [CrossRef] [Medline]101,Kleinpell R, Barden C, Rincon T, McCarthy M, Rufo RJ. Assessing the impact of telemedicine on nursing care in intensive care units. Am J Crit Care 2016 Jan;25(1):e14-e20. [CrossRef] [Medline]109,L'Esperance ST, Perry DJ. Assessing advantages and barriers to telemedicine adoption in the practice setting: A MyCareTeam(TM) exemplar. J Am Assoc Nurse Pract 2016 Jun;28(6):311-319. [CrossRef] [Medline]115,El Amrani L, Engberink AO, Ninot G, Hayot M, Carbonnel F. Connected health devices for health care in French general medicine practice: cross-sectional study. JMIR Mhealth Uhealth 2017 Dec 21;5(12):e193 [FREE Full text] [CrossRef] [Medline]128,Duhm J, Fleischmann R, Schmidt S, Hupperts H, Brandt SA. Mobile electronic medical records promote workflow: physicians' perspective from a survey. JMIR Mhealth Uhealth 2016 Jun 6;4(2):e70 [FREE Full text] [CrossRef] [Medline]150,Loh P, Flicker L, Horner B. Attitudes toward information and communication technology (ICT) in residential aged care in Western Australia. J Am Med Dir Assoc 2009 Jul;10(6):408-413. [CrossRef] [Medline]156,Odnoletkova I, Buysse H, Nobels F, Goderis G, Aertgeerts B, Annemans L, et al. Patient and provider acceptance of telecoaching in type 2 diabetes: a mixed-method study embedded in a randomised clinical trial. BMC Med Inform Decis Mak 2016 Nov 9;16(1):142 [FREE Full text] [CrossRef] [Medline]162,Bailey JV, Tomlinson N, Hobbs LJ, Webster R. Challenges and opportunities in evaluating a digital sexual health intervention in a clinic setting: Staff and patient views. Digit Health 2017;3:2055207617704272 [FREE Full text] [CrossRef] [Medline]163, Payne KF, Weeks L, Dunning P. A mixed methods pilot study to investigate the impact of a hospital-specific iPhone application (iTreat) within a British junior doctor cohort. Health Informatics J 2014 Mar;20(1):59-73. [CrossRef] [Medline]165,Walker L, Clendon J. The case for end-user involvement in design of health technologies. J Telemed Telecare 2016 Dec;22(8):443-446. [CrossRef] [Medline]172,Brown W, Giguere R, Sheinfil A, Ibitoye M, Balan I, Ho T, et al. Challenges and solutions implementing an SMS text message-based survey CASI and adherence reminders in an international biomedical HIV PrEP study (MTN 017). J Biomed Inform 2018 Apr;80:78-86 [FREE Full text] [CrossRef] [Medline]177,Ehrler F, Ducloux P, Wu DT, Lovis C, Blondon K. Acceptance of a mobile application supporting nurses workflow at patient bedside: results from a pilot study. Stud Health Technol Inform 2018;247:506-510. [Medline]181,Radhakrishnan K, Xie B, Berkley A, Kim M. 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| Technical support (n=27) | [Avey JP, Hobbs RL. Dial in: fostering the use of telebehavioral health services in frontier Alaska. Psychol Serv 2013 Aug;10(3):289-297. [CrossRef] [Medline]2,Gagnon MP, Ngangue P, Payne-Gagnon J, Desmartis M. m-Health adoption by healthcare professionals: a systematic review. J Am Med Inform Assoc 2016 Jan;23(1):212-220. [CrossRef] [Medline]9,Brewster L, Mountain G, Wessels B, Kelly C, Hawley M. Factors affecting front line staff acceptance of telehealth technologies: a mixed-method systematic review. J Adv Nurs 2014 Jan;70(1):21-33. [CrossRef] [Medline]10,Giraldo L, Schachner B, Luna D, Benítez S. Exploring nurses' perceptions and expectations toward a BCMA implementation using a mobile app and workstations as a change management strategy. Stud Health Technol Inform 2018;250:134-138. [Medline]44,Hanna L, May C, Fairhurst K. The place of information and communication technology-mediated consultations in primary care: GPs' perspectives. Fam Pract 2012 Jun;29(3):361-366. [CrossRef] [Medline]49,James S, Perry L, Gallagher R, Lowe J. Diabetes educators: perceived experiences, supports and barriers to use of common diabetes-related technologies. J Diabetes Sci Technol 2016 Sep;10(5):1115-1121 [FREE Full text] [CrossRef] [Medline]51,Kim JW, Tiyyagura G, Langhan M. A qualitative analysis of general emergency medicine providers' perceptions on pediatric emergency telemedicine. Pediatr Emerg Care 2019 Dec;35(12):856-861. [CrossRef] [Medline]57,McNally G, Frey R, Crossan M. Nurse manager and student nurse perceptions of the use of personal smartphones or tablets and the adjunct applications, as an educational tool in clinical settings. Nurse Educ Pract 2017 Mar;23:1-7. [CrossRef] [Medline]63,Molleda L, Bahamon M, St George SM, Perrino T, Estrada Y, Herrera DC, et al. Clinic personnel, facilitator, and parent perspectives of eHealth Familias Unidas in primary care. J Pediatr Health Care 2017;31(3):350-361 [FREE Full text] [CrossRef] [Medline]68,Odeh B, Kayyali R, Nabhani-Gebara S, Philip N. Implementing a telehealth service: nurses' perceptions and experiences. Br J Nurs 2014;23(21):1133-1137. [CrossRef] [Medline]71,Öberg U, Orre CJ, Isaksson U, Schimmer R, Larsson H, Hörnsten Å. Swedish primary healthcare nurses' perceptions of using digital eHealth services in support of patient self-management. Scand J Caring Sci 2018 Jun;32(2):961-970. [CrossRef] [Medline]72,Sharma U, Barnett J, Clarke M. Clinical users' perspective on telemonitoring of patients with long term conditions: understood through concepts of Giddens's structuration theory & consequence of modernity. Stud Health Technol Inform 2010;160(Pt 1):545-549. [Medline]79,Sharma U, Clarke M. Nurses' and community support workers' experience of telehealth: a longitudinal case study. 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Crucial factors for the acceptance of a computerized national medication list: insights into findings from the evaluation of the Austrian e-Medikation pilot. Appl Clin Inform 2014;5(2):527-537 [FREE Full text] [CrossRef] [Medline]98,Orruño E, Gagnon MP, Asua J, Abdeljelil AB. Evaluation of teledermatology adoption by health-care professionals using a modified Technology Acceptance Model. J Telemed Telecare 2011;17(6):303-307. [CrossRef] [Medline]126,Sezgin E, Özkan-Yildirim S, Yildirim S. Understanding the perception towards using mHealth applications in practice. Inf Dev 2018;34(2):182-200. [CrossRef]136,Asua J, Orruño E, Reviriego E, Gagnon MP. Healthcare professional acceptance of telemonitoring for chronic care patients in primary care. BMC Med Inform Decis Mak 2012 Nov 30;12:139 [FREE Full text] [CrossRef] [Medline]139,Yaman H, Yavuz E, Er A, Vural R, Albayrak Y, Yardimci A, et al. The use of mobile smart devices and medical apps in the family practice setting. 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Registered nurse and midwife experiences of using videoconferencing in practice: a systematic review of qualitative studies. J Clin Nurs 2018 Mar;27(5-6):e739-e752. [CrossRef] [Medline]189] | |
| Reliability (n=21) | [Gagnon MP, Ngangue P, Payne-Gagnon J, Desmartis M. m-Health adoption by healthcare professionals: a systematic review. J Am Med Inform Assoc 2016 Jan;23(1):212-220. [CrossRef] [Medline]9,Brewster L, Mountain G, Wessels B, Kelly C, Hawley M. Factors affecting front line staff acceptance of telehealth technologies: a mixed-method systematic review. J Adv Nurs 2014 Jan;70(1):21-33. [CrossRef] [Medline]10,Chiang KF, Wang HH, Chien IK, Liou JK, Hung CL, Huang CM, et al. Healthcare providers' perceptions of barriers in implementing of home telecare in Taiwan: a qualitative study. Int J Med Inform 2015 Apr;84(4):277-287. [CrossRef] [Medline]35,Chung C, Cook J, Bales E, Zia J, Munson SA. More than telemonitoring: health provider use and nonuse of life-log data in irritable bowel syndrome and weight management. J Med Internet Res 2015 Aug 21;17(8):e203 [FREE Full text] [CrossRef] [Medline]36,Giraldo L, Schachner B, Luna D, Benítez S. Exploring nurses' perceptions and expectations toward a BCMA implementation using a mobile app and workstations as a change management strategy. Stud Health Technol Inform 2018;250:134-138. [Medline]44,Hanna L, May C, Fairhurst K. The place of information and communication technology-mediated consultations in primary care: GPs' perspectives. Fam Pract 2012 Jun;29(3):361-366. [CrossRef] [Medline]49,Hines M, Lincoln M, Ramsden R, Martinovich J, Fairweather C. Speech pathologists' perspectives on transitioning to telepractice: what factors promote acceptance? J Telemed Telecare 2015 Dec;21(8):469-473. [CrossRef] [Medline]50,Kayyali R, Hesso I, Mahdi A, Hamzat O, Adu A, Nabhani Gebara S. Telehealth: misconceptions and experiences of healthcare professionals in England. Int J Pharm Pract 2017 Jun;25(3):203-209. [CrossRef] [Medline]55,Moloczij N, Mosley I, Moss KM, Bagot KL, Bladin CF, Cadilhac DA. Is telemedicine helping or hindering the delivery of stroke thrombolysis in rural areas? A qualitative analysis. Intern Med J 2015 Sep;45(9):957-964. [CrossRef] [Medline]69,Sharma U, Barnett J, Clarke M. Clinical users' perspective on telemonitoring of patients with long term conditions: understood through concepts of Giddens's structuration theory & consequence of modernity. Stud Health Technol Inform 2010;160(Pt 1):545-549. [Medline]79,Zilliacus E, Meiser B, Lobb E, Dudding TE, Barlow-Stewart K, Tucker K. The virtual consultation: practitioners' experiences of genetic counseling by videoconferencing in Australia. Telemed J E Health 2010 Apr;16(3):350-357. [CrossRef] [Medline]91,Carlisle K, Warren R. A qualitative case study of telehealth for in-home monitoring to support the management of type 2 diabetes. J Telemed Telecare 2013 Oct;19(7):372-375. [CrossRef] [Medline]92,Duplaga M. Searching for a role of nursing personnel in developing landscape of eHealth: factors determining attitudes toward key patient empowering applications. PLoS One 2016;11(4):e0153173 [FREE Full text] [CrossRef] [Medline]96,Klack L, Ziefle M, Wilkowska W, Kluge J. Telemedical versus conventional heart patient monitoring: a survey study with German physicians. Int J Technol Assess Health Care 2013 Oct;29(4):378-383. [CrossRef] [Medline]108,Albrecht UV, Afshar K, Illiger K, Becker S, Hartz T, Breil B, et al. Expectancy, usage and acceptance by general practitioners and patients: exploratory results from a study in the German outpatient sector. Digit Health 2017;3:2055207617695135 [FREE Full text] [CrossRef] [Medline]117,Steinschaden T, Petersson G, Astrand B. Physicians' attitudes towards eprescribing: a comparative web survey in Austria and Sweden. Inform Prim Care 2009;17(4):241-248 [FREE Full text] [CrossRef] [Medline]140,Ariens LF, Schussler-Raymakers FM, Frima C, Flinterman A, Hamminga E, Arents BW, et al. Barriers and facilitators to eHealth use in daily practice: perspectives of patients and professionals in dermatology. J Med Internet Res 2017 Sep 5;19(9):e300 [FREE Full text] [CrossRef] [Medline]152,Iacono T, Dissanayake C, Trembath D, Hudry K, Erickson S, Spong J. Family and practitioner perspectives on telehealth for services to young children with autism. Stud Health Technol Inform 2016;231:63-73. [Medline]153,Bailey JV, Tomlinson N, Hobbs LJ, Webster R. Challenges and opportunities in evaluating a digital sexual health intervention in a clinic setting: Staff and patient views. Digit Health 2017;3:2055207617704272 [FREE Full text] [CrossRef] [Medline]163,Brown W, Giguere R, Sheinfil A, Ibitoye M, Balan I, Ho T, et al. Challenges and solutions implementing an SMS text message-based survey CASI and adherence reminders in an international biomedical HIV PrEP study (MTN 017). J Biomed Inform 2018 Apr;80:78-86 [FREE Full text] [CrossRef] [Medline]177,Radhakrishnan K, Xie B, Berkley A, Kim M. Barriers and facilitators for sustainability of tele-homecare programs: a systematic review. Health Serv Res 2016 Feb;51(1):48-75 [FREE Full text] [CrossRef] [Medline]182] | |
| Connectivity (n=17) | [de Souza CH, Morbeck RA, Steinman M, Hors CP, Bracco MM, Kozasa EH, et al. Barriers and benefits in telemedicine arising between a high-technology hospital service provider and remote public healthcare units: a qualitative study in Brazil. Telemed J E Health 2017 Jun;23(6):527-532. [CrossRef] [Medline]37,de Vries ST, Wong L, Sutcliffe A, Houÿez F, Ruiz CL, Mol PG, IMI Web-RADR Work Package 3b Consortium. Factors influencing the use of a mobile app for reporting adverse drug reactions and receiving safety information: a qualitative study. Drug Saf 2017 May;40(5):443-455 [FREE Full text] [CrossRef] [Medline]38,Giraldo L, Schachner B, Luna D, Benítez S. Exploring nurses' perceptions and expectations toward a BCMA implementation using a mobile app and workstations as a change management strategy. Stud Health Technol Inform 2018;250:134-138. [Medline]44,Hines M, Lincoln M, Ramsden R, Martinovich J, Fairweather C. Speech pathologists' perspectives on transitioning to telepractice: what factors promote acceptance? J Telemed Telecare 2015 Dec;21(8):469-473. [CrossRef] [Medline]50,James S, Perry L, Gallagher R, Lowe J. Diabetes educators: perceived experiences, supports and barriers to use of common diabetes-related technologies. J Diabetes Sci Technol 2016 Sep;10(5):1115-1121 [FREE Full text] [CrossRef] [Medline]51,Kayyali R, Hesso I, Mahdi A, Hamzat O, Adu A, Nabhani Gebara S. Telehealth: misconceptions and experiences of healthcare professionals in England. Int J Pharm Pract 2017 Jun;25(3):203-209. [CrossRef] [Medline]55,Molleda L, Bahamon M, St George SM, Perrino T, Estrada Y, Herrera DC, et al. Clinic personnel, facilitator, and parent perspectives of eHealth Familias Unidas in primary care. J Pediatr Health Care 2017;31(3):350-361 [FREE Full text] [CrossRef] [Medline]68,Rothstein JD, Jennings L, Moorthy A, Yang F, Gee L, Romano K, et al. Qualitative assessment of the feasibility, usability, and acceptability of a mobile client data app for community-based maternal, neonatal, and child care in rural Ghana. Int J Telemed Appl 2016;2016:2515420 [FREE Full text] [CrossRef] [Medline]74,Zilliacus E, Meiser B, Lobb E, Dudding TE, Barlow-Stewart K, Tucker K. The virtual consultation: practitioners' experiences of genetic counseling by videoconferencing in Australia. Telemed J E Health 2010 Apr;16(3):350-357. [CrossRef] [Medline]91,Ghani MK, Jaber MM. Willingness to adopt telemedicine in major iraqi hospitals: a pilot study. Int J Telemed Appl 2015;2015:136591 [FREE Full text] [CrossRef] [Medline]95,O'Connor S, Andrews T. Smartphones and mobile applications (apps) in clinical nursing education: a student perspective. Nurse Educ Today 2018 Oct;69:172-178. [CrossRef] [Medline]124,Rogove HJ, McArthur D, Demaerschalk BM, Vespa PM. Barriers to telemedicine: survey of current users in acute care units. Telemed J E Health 2012;18(1):48-53. [CrossRef] [Medline]130,Iacono T, Dissanayake C, Trembath D, Hudry K, Erickson S, Spong J. Family and practitioner perspectives on telehealth for services to young children with autism. Stud Health Technol Inform 2016;231:63-73. [Medline]153,Orchard J, Lowres N, Freedman SB, Ladak L, Lee W, Zwar N, et al. Screening for atrial fibrillation during influenza vaccinations by primary care nurses using a smartphone electrocardiograph (iECG): A feasibility study. Eur J Prev Cardiol 2016 Oct;23(2 suppl):13-20. [CrossRef] [Medline]164,Walker L, Clendon J. The case for end-user involvement in design of health technologies. J Telemed Telecare 2016 Dec;22(8):443-446. [CrossRef] [Medline]172,Ehrler F, Ducloux P, Wu DT, Lovis C, Blondon K. Acceptance of a mobile application supporting nurses workflow at patient bedside: results from a pilot study. Stud Health Technol Inform 2018;247:506-510. [Medline]181,Radhakrishnan K, Xie B, Berkley A, Kim M. Barriers and facilitators for sustainability of tele-homecare programs: a systematic review. Health Serv Res 2016 Feb;51(1):48-75 [FREE Full text] [CrossRef] [Medline]182] | |
| Usefulness | ||
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| Ease of use | ||
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| Compatibility | ||
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A mixed methods pilot study to investigate the impact of a hospital-specific iPhone application (iTreat) within a British junior doctor cohort. Health Informatics J 2014 Mar;20(1):59-73. [CrossRef] [Medline]165,Shaw RJ, Kaufman MA, Bosworth HB, Weiner BJ, Zullig LL, Lee SD, et al. Organizational factors associated with readiness to implement and translate a primary care based telemedicine behavioral program to improve blood pressure control: the HTN-IMPROVE study. Implement Sci 2013 Sep 8;8:106 [FREE Full text] [CrossRef] [Medline]169,Walker L, Clendon J. The case for end-user involvement in design of health technologies. J Telemed Telecare 2016 Dec;22(8):443-446. [CrossRef] [Medline]172,Bidmead E, Marshall A. A case study of stakeholder perceptions of patient held records: the Patients Know Best (PKB) solution. Digit Health 2016;2:2055207616668431 [FREE Full text] [CrossRef] [Medline]174, Hickson R, Talbert J, Thornbury WC, Perin NR, Goodin AJ. 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| Electronic health record integration (n=20) | [Gagnon MP, Ngangue P, Payne-Gagnon J, Desmartis M. m-Health adoption by healthcare professionals: a systematic review. J Am Med Inform Assoc 2016 Jan;23(1):212-220. [CrossRef] [Medline]9,de Vries ST, Wong L, Sutcliffe A, Houÿez F, Ruiz CL, Mol PG, IMI Web-RADR Work Package 3b Consortium. Factors influencing the use of a mobile app for reporting adverse drug reactions and receiving safety information: a qualitative study. Drug Saf 2017 May;40(5):443-455 [FREE Full text] [CrossRef] [Medline]38,Hanley J, Ure J, Pagliari C, Sheikh A, McKinstry B. Experiences of patients and professionals participating in the HITS home blood pressure telemonitoring trial: a qualitative study. BMJ Open 2013 May 28;3(5):pii: e002671 [FREE Full text] [CrossRef] [Medline]48,Öberg U, Orre CJ, Isaksson U, Schimmer R, Larsson H, Hörnsten Å. Swedish primary healthcare nurses' perceptions of using digital eHealth services in support of patient self-management. Scand J Caring Sci 2018 Jun;32(2):961-970. [CrossRef] [Medline]72,Seto E, Leonard KJ, Cafazzo JA, Barnsley J, Masino C, Ross HJ. Perceptions and experiences of heart failure patients and clinicians on the use of mobile phone-based telemonitoring. J Med Internet Res 2012 Feb 10;14(1):e25 [FREE Full text] [CrossRef] [Medline]78,van Gaalen JL, van Bodegom-Vos L, Bakker MJ, Snoeck-Stroband JB, Sont JK. Internet-based self-management support for adults with asthma: a qualitative study among patients, general practitioners and practice nurses on barriers to implementation. BMJ Open 2016 Aug 26;6(8):e010809 [FREE Full text] [CrossRef] [Medline]84,Varsi C, Ekstedt M, Gammon D, Børøsund E, Ruland CM. Middle managers' experiences and role in implementing an interactive tailored patient assessment eHealth intervention in clinical practice. Comput Inform Nurs 2015;33(6):249-257. [CrossRef] [Medline]85,Bello AK, Molzahn AE, Girard LP, Osman MA, Okpechi IG, Glassford J, et al. Patient and provider perspectives on the design and implementation of an electronic consultation system for kidney care delivery in Canada: a focus group study. BMJ Open 2017 Mar 2;7(3):e014784 [FREE Full text] [CrossRef] [Medline]87,Rho MJ, Choi IY, Lee J. Predictive factors of telemedicine service acceptance and behavioral intention of physicians. Int J Med Inform 2014 Aug;83(8):559-571. [CrossRef] [Medline]129,Villalba-Mora E, Casas I, Lupiañez-Villanueva F, Maghiros I. Adoption of health information technologies by physicians for clinical practice: the Andalusian case. Int J Med Inform 2015 Jul;84(7):477-485. [CrossRef] [Medline]143,Alajlani M, Clarke M. Effect of culture on acceptance of telemedicine in Middle Eastern countries: case study of Jordan and Syria. Telemed J E Health 2013 Apr;19(4):305-311. [CrossRef] [Medline]151,Odnoletkova I, Buysse H, Nobels F, Goderis G, Aertgeerts B, Annemans L, et al. Patient and provider acceptance of telecoaching in type 2 diabetes: a mixed-method study embedded in a randomised clinical trial. BMC Med Inform Decis Mak 2016 Nov 9;16(1):142 [FREE Full text] [CrossRef] [Medline]162,Quanbeck A, Gustafson DH, Marsch LA, Chih M, Kornfield R, McTavish F, et al. Implementing a mobile health system to integrate the treatment of addiction into primary care: a hybrid implementation-effectiveness study. J Med Internet Res 2018 Jan 30;20(1):e37 [FREE Full text] [CrossRef] [Medline]167,Walker L, Clendon J. The case for end-user involvement in design of health technologies. J Telemed Telecare 2016 Dec;22(8):443-446. [CrossRef] [Medline]172,Bidmead E, Marshall A. A case study of stakeholder perceptions of patient held records: the Patients Know Best (PKB) solution. Digit Health 2016;2:2055207616668431 [FREE Full text] [CrossRef] [Medline]174,Zhang Y, Koch S. Mobile health apps in Sweden: what do physicians recommend? Stud Health Technol Inform 2015;210:793-797. [Medline]175,Radhakrishnan K, Xie B, Berkley A, Kim M. Barriers and facilitators for sustainability of tele-homecare programs: a systematic review. Health Serv Res 2016 Feb;51(1):48-75 [FREE Full text] [CrossRef] [Medline]182,Li L, Cotton A. A systematic review of nurses' perspectives toward the telemedicine intensive care unit: a basis for supporting its future implementation in China? Telemed J E Health 2019 May;25(5):343-350. [CrossRef] [Medline]188] | |
| Competition with existing programs (n=1) | [Shaw RJ, Kaufman MA, Bosworth HB, Weiner BJ, Zullig LL, Lee SD, et al. Organizational factors associated with readiness to implement and translate a primary care based telemedicine behavioral program to improve blood pressure control: the HTN-IMPROVE study. Implement Sci 2013 Sep 8;8:106 [FREE Full text] [CrossRef] [Medline]169] | |
| Design | ||
| Layout, interface, and culturally appropriate design (n=11) | [Gagnon MP, Ngangue P, Payne-Gagnon J, Desmartis M. m-Health adoption by healthcare professionals: a systematic review. J Am Med Inform Assoc 2016 Jan;23(1):212-220. [CrossRef] [Medline]9,de Vries ST, Wong L, Sutcliffe A, Houÿez F, Ruiz CL, Mol PG, IMI Web-RADR Work Package 3b Consortium. Factors influencing the use of a mobile app for reporting adverse drug reactions and receiving safety information: a qualitative study. Drug Saf 2017 May;40(5):443-455 [FREE Full text] [CrossRef] [Medline]38,Fairbrother P, Ure J, Hanley J, McCloughan L, Denvir M, Sheikh A, Telescot programme team. Telemonitoring for chronic heart failure: the views of patients and healthcare professionals - a qualitative study. J Clin Nurs 2014 Jan;23(1-2):132-144. [CrossRef] [Medline]41,Levine M, Richardson JE, Granieri E, Reid MC. Novel telemedicine technologies in geriatric chronic non-cancer pain: primary care providers' perspectives. Pain Med 2014 Feb;15(2):206-213 [FREE Full text] [CrossRef] [Medline]60,Puszka S, Dingwall KM, Sweet M, Nagel T. E-Mental health innovations for aboriginal and Torres Strait Islander Australians: a qualitative study of implementation needs in health services. JMIR Ment Health 2016 Sep 19;3(3):e43 [FREE Full text] [CrossRef] [Medline]73,Seto E, Leonard KJ, Cafazzo JA, Barnsley J, Masino C, Ross HJ. Perceptions and experiences of heart failure patients and clinicians on the use of mobile phone-based telemonitoring. J Med Internet Res 2012 Feb 10;14(1):e25 [FREE Full text] [CrossRef] [Medline]78,Taylor J, Coates L. Caring from a distance: the role of telehealth. Nurs Times 2015;111(28-29):18-20. [Medline]83,Jeon J, Taneva S, Kukreti V, Trbovich P, Easty AC, Rossos PG, et al. Toward successful migration to computerized physician order entry for chemotherapy. Curr Oncol 2014 Apr;21(2):e221-e228 [FREE Full text] [CrossRef] [Medline]155,Taylor A, Wade V, Morris G, Pech J, Rechter S, Kidd M, et al. Technology support to a telehealth in the home service: qualitative observations. J Telemed Telecare 2016 Jul;22(5):296-303. [CrossRef] [Medline]171,Radhakrishnan K, Xie B, Berkley A, Kim M. Barriers and facilitators for sustainability of tele-homecare programs: a systematic review. Health Serv Res 2016 Feb;51(1):48-75 [FREE Full text] [CrossRef] [Medline]182] | |
| Patient-centered design (n=7) | [Egerton T, Nelligan R, Setchell J, Atkins L, Bennell KL. General practitioners' perspectives on a proposed new model of service delivery for primary care management of knee osteoarthritis: a qualitative study. BMC Fam Pract 2017 Sep 7;18(1):85 [FREE Full text] [CrossRef] [Medline]39,Schneider T, Panzera AD, Martinasek M, McDermott R, Couluris M, Lindenberger J, et al. Physicians' perceptions of mobile technology for enhancing asthma care for youth. J Child Health Care 2016 Jun;20(2):153-163. [CrossRef] [Medline]77,Seto E, Leonard KJ, Cafazzo JA, Barnsley J, Masino C, Ross HJ. Perceptions and experiences of heart failure patients and clinicians on the use of mobile phone-based telemonitoring. J Med Internet Res 2012 Feb 10;14(1):e25 [FREE Full text] [CrossRef] [Medline]78,Mueller KJ, Potter AJ, MacKinney AC, Ward MM. Lessons from tele-emergency: improving care quality and health outcomes by expanding support for rural care systems. Health Aff (Millwood) 2014 Feb;33(2):228-234. [CrossRef] [Medline]159,Odnoletkova I, Buysse H, Nobels F, Goderis G, Aertgeerts B, Annemans L, et al. Patient and provider acceptance of telecoaching in type 2 diabetes: a mixed-method study embedded in a randomised clinical trial. BMC Med Inform Decis Mak 2016 Nov 9;16(1):142 [FREE Full text] [CrossRef] [Medline]162,Possemato K, Kuhn E, Johnson EM, Hoffman JE, Brooks E. Development and refinement of a clinician intervention to facilitate primary care patient use of the PTSD Coach app. Transl Behav Med 2017 Mar;7(1):116-126 [FREE Full text] [CrossRef] [Medline]166,Radhakrishnan K, Xie B, Berkley A, Kim M. Barriers and facilitators for sustainability of tele-homecare programs: a systematic review. Health Serv Res 2016 Feb;51(1):48-75 [FREE Full text] [CrossRef] [Medline]182] | |
| Convenience | [Mileski M, Kruse CS, Catalani J, Haderer T. Adopting telemedicine for the self-management of hypertension: systematic review. JMIR Med Inform 2017 Oct 24;5(4):e41 [FREE Full text] [CrossRef] [Medline]5,Lord S, Moore SK, Ramsey A, Dinauer S, Johnson K. Implementation of a substance use recovery support mobile phone app in community settings: qualitative study of clinician and staff perspectives of facilitators and barriers. JMIR Ment Health 2016 Jun 28;3(2):e24 [FREE Full text] [CrossRef] [Medline]61,Molleda L, Bahamon M, St George SM, Perrino T, Estrada Y, Herrera DC, et al. Clinic personnel, facilitator, and parent perspectives of eHealth Familias Unidas in primary care. J Pediatr Health Care 2017;31(3):350-361 [FREE Full text] [CrossRef] [Medline]68,Puszka S, Dingwall KM, Sweet M, Nagel T. E-Mental health innovations for aboriginal and Torres Strait Islander Australians: a qualitative study of implementation needs in health services. JMIR Ment Health 2016 Sep 19;3(3):e43 [FREE Full text] [CrossRef] [Medline]73,Sandberg J, Trief PM, Izquierdo R, Goland R, Morin PC, Palmas W, et al. A qualitative study of the experiences and satisfaction of direct telemedicine providers in diabetes case management. Telemed J E Health 2009 Oct;15(8):742-750. [CrossRef] [Medline]75,Seto E, Leonard KJ, Cafazzo JA, Barnsley J, Masino C, Ross HJ. Perceptions and experiences of heart failure patients and clinicians on the use of mobile phone-based telemonitoring. J Med Internet Res 2012 Feb 10;14(1):e25 [FREE Full text] [CrossRef] [Medline]78,Sturesson L, Groth K. Effects of the digital transformation: qualitative study on the disturbances and limitations of using video visits in outpatient care. J Med Internet Res 2018 Jun 27;20(6):e221 [FREE Full text] [CrossRef] [Medline]82,Wilhelmsen M, Høifødt RS, Kolstrup N, Waterloo K, Eisemann M, Chenhall R, et al. Norwegian general practitioners' perspectives on implementation of a guided web-based cognitive behavioral therapy for depression: a qualitative study. J Med Internet Res 2014 Sep 10;16(9):e208 [FREE Full text] [CrossRef] [Medline]89,Zilliacus E, Meiser B, Lobb E, Dudding TE, Barlow-Stewart K, Tucker K. The virtual consultation: practitioners' experiences of genetic counseling by videoconferencing in Australia. Telemed J E Health 2010 Apr;16(3):350-357. [CrossRef] [Medline]91,Liu CF, Cheng TJ. Exploring critical factors influencing physicians' acceptance of mobile electronic medical records based on the dual-factor model: a validation in Taiwan. BMC Med Inform Decis Mak 2015 Feb 7;15:4 [FREE Full text] [CrossRef] [Medline]116,O'Connor S, Andrews T. Smartphones and mobile applications (apps) in clinical nursing education: a student perspective. Nurse Educ Today 2018 Oct;69:172-178. [CrossRef] [Medline]124,Sadoughi F, Erfannia L, Sancholi M, Salmani F, Sarsarshahi A. Teleradiology in Southeast Iran: Evaluating the Views of Senior Executives and Radiologists. Health Care Manag (Frederick) 2017;36(3):301-307. [CrossRef] [Medline]131,Sezgin E, Özkan-Yildirim S, Yildirim S. Understanding the perception towards using mHealth applications in practice. Inf Dev 2018;34(2):182-200. [CrossRef]136,Nerminathan A, Harrison A, Phelps M, Alexander S, Scott KM. Doctors' use of mobile devices in the clinical setting: a mixed methods study. Intern Med J 2017 Mar;47(3):291-298. [CrossRef] [Medline]161,Odnoletkova I, Buysse H, Nobels F, Goderis G, Aertgeerts B, Annemans L, et al. Patient and provider acceptance of telecoaching in type 2 diabetes: a mixed-method study embedded in a randomised clinical trial. BMC Med Inform Decis Mak 2016 Nov 9;16(1):142 [FREE Full text] [CrossRef] [Medline]162,Payne KF, Weeks L, Dunning P. A mixed methods pilot study to investigate the impact of a hospital-specific iPhone application (iTreat) within a British junior doctor cohort. Health Informatics J 2014 Mar;20(1):59-73. [CrossRef] [Medline]165,Williamson KM, Muckle J. Students' perception of technology use in nursing education. Comput Inform Nurs 2018 Feb;36(2):70-76. [CrossRef] [Medline]173] | |
| Mobility and flexibility (n=17) | ||
| Content | [Gagnon MP, Ngangue P, Payne-Gagnon J, Desmartis M. m-Health adoption by healthcare professionals: a systematic review. J Am Med Inform Assoc 2016 Jan;23(1):212-220. [CrossRef] [Medline]9,de Vries ST, Wong L, Sutcliffe A, Houÿez F, Ruiz CL, Mol PG, IMI Web-RADR Work Package 3b Consortium. Factors influencing the use of a mobile app for reporting adverse drug reactions and receiving safety information: a qualitative study. Drug Saf 2017 May;40(5):443-455 [FREE Full text] [CrossRef] [Medline]38,Hanley J, Ure J, Pagliari C, Sheikh A, McKinstry B. Experiences of patients and professionals participating in the HITS home blood pressure telemonitoring trial: a qualitative study. BMJ Open 2013 May 28;3(5):pii: e002671 [FREE Full text] [CrossRef] [Medline]48,Tintorer DL, Domínguez JM, Pujol-Rivera E, Beneyto SF, Tuduri XM, Saigí-Rubió F. Keys to success of a community of clinical practice in primary care: a qualitative evaluation of the ECOPIH project. BMC Fam Pract 2018 May 9;19(1):56 [FREE Full text] [CrossRef] [Medline]59,Moharra M, Almazán C, Decool M, Nilsson A, Allegretti N, Seven M. Implementation of a cross-border health service: physician and pharmacists' opinions from the epSOS project. Fam Pract 2015 Oct;32(5):564-567. [CrossRef] [Medline]66,Puszka S, Dingwall KM, Sweet M, Nagel T. E-Mental health innovations for aboriginal and Torres Strait Islander Australians: a qualitative study of implementation needs in health services. JMIR Ment Health 2016 Sep 19;3(3):e43 [FREE Full text] [CrossRef] [Medline]73,Sinclair C, Holloway K, Riley G, Auret K. Online mental health resources in rural Australia: clinician perceptions of acceptability. J Med Internet Res 2013 Sep 5;15(9):e193 [FREE Full text] [CrossRef] [Medline]81,Lee SI, Park H, Kim JW, Hwang H, Cho EY, Kim Y, et al. Physicians' perceptions and use of a health information exchange: a pilot program in South Korea. Telemed J E Health 2012 Oct;18(8):604-612 [FREE Full text] [CrossRef] [Medline]114,Albrecht UV, Afshar K, Illiger K, Becker S, Hartz T, Breil B, et al. Expectancy, usage and acceptance by general practitioners and patients: exploratory results from a study in the German outpatient sector. Digit Health 2017;3:2055207617695135 [FREE Full text] [CrossRef] [Medline]117,O'Connor S, Andrews T. Smartphones and mobile applications (apps) in clinical nursing education: a student perspective. Nurse Educ Today 2018 Oct;69:172-178. [CrossRef] [Medline]124,Yaman H, Yavuz E, Er A, Vural R, Albayrak Y, Yardimci A, et al. The use of mobile smart devices and medical apps in the family practice setting. J Eval Clin Pract 2016 Apr;22(2):290-296. [CrossRef] [Medline]144,Jamu JT, Lowi-Jones H, Mitchell C. Just in time? Using QR codes for multi-professional learning in clinical practice. Nurse Educ Pract 2016 Jul;19:107-112. [CrossRef] [Medline]154,Payne KF, Weeks L, Dunning P. A mixed methods pilot study to investigate the impact of a hospital-specific iPhone application (iTreat) within a British junior doctor cohort. Health Informatics J 2014 Mar;20(1):59-73. [CrossRef] [Medline]165,Zhang Y, Koch S. Mobile health apps in Sweden: what do physicians recommend? Stud Health Technol Inform 2015;210:793-797. [Medline]175,Ahmad F, Norman C, O'Campo P. What is needed to implement a computer-assisted health risk assessment tool? An exploratory concept mapping study. BMC Med Inform Decis Mak 2012 Dec 19;12:149 [FREE Full text] [CrossRef] [Medline]192] | |
| Trustworthiness and quality (n=15) | ||
| Personalization | [de Vries ST, Wong L, Sutcliffe A, Houÿez F, Ruiz CL, Mol PG, IMI Web-RADR Work Package 3b Consortium. Factors influencing the use of a mobile app for reporting adverse drug reactions and receiving safety information: a qualitative study. Drug Saf 2017 May;40(5):443-455 [FREE Full text] [CrossRef] [Medline]38,Morrow S, Daines L, Wiener-Ogilvie S, Steed L, McKee L, Caress A, et al. Exploring the perspectives of clinical professionals and support staff on implementing supported self-management for asthma in UK general practice: an IMPART qualitative study. NPJ Prim Care Respir Med 2017 Jul 18;27(1):45 [FREE Full text] [CrossRef] [Medline]70,Öberg U, Orre CJ, Isaksson U, Schimmer R, Larsson H, Hörnsten Å. Swedish primary healthcare nurses' perceptions of using digital eHealth services in support of patient self-management. Scand J Caring Sci 2018 Jun;32(2):961-970. [CrossRef] [Medline]72,van Gaalen JL, van Bodegom-Vos L, Bakker MJ, Snoeck-Stroband JB, Sont JK. Internet-based self-management support for adults with asthma: a qualitative study among patients, general practitioners and practice nurses on barriers to implementation. BMJ Open 2016 Aug 26;6(8):e010809 [FREE Full text] [CrossRef] [Medline]84,O'Connor S, Andrews T. Smartphones and mobile applications (apps) in clinical nursing education: a student perspective. Nurse Educ Today 2018 Oct;69:172-178. [CrossRef] [Medline]124,Ehrler F, Ducloux P, Wu DT, Lovis C, Blondon K. Acceptance of a mobile application supporting nurses workflow at patient bedside: results from a pilot study. Stud Health Technol Inform 2018;247:506-510. [Medline]181,Ahmad F, Norman C, O'Campo P. What is needed to implement a computer-assisted health risk assessment tool? An exploratory concept mapping study. BMC Med Inform Decis Mak 2012 Dec 19;12:149 [FREE Full text] [CrossRef] [Medline]192] | |
| Customization and adaptability (n=7) | ||
Social and Organizational Factors
The social and organizational factors impacting clinicians’ adoption of mHealth were manifestly more numerous than the technical factors. These factors were also categorized into 8 key themes: workflow related, patient related, policy and regulations, culture or attitude or social influence, monetary factors, evidence base, awareness, and user engagement. Key themes were, in turn, divided into a total of 41 subthemes, as shown in 
Figure 4, which provides an overview of the social and organizational factors and their respective occurrence.
Workflow-related factors were the most prominent organizational factor in the included articles, with 17 subthemes. Training (n=80) was the most central workflow-related theme, followed by workload (n=66), workflow fit (n=60), time and cost efficiencies (n=51), collaboration and coordination (n=50), technical skills and experience (n=44), the impact on roles and responsibilities (n=40), the extent of leadership support (n=35), organizational or local infrastructure (n=33), process standardization and planning (n=26), staff competence (n=26), data access and management (n=25), changes to clinical practice (n=24), job security (n=22), incentives (n=15), impact on career and knowledge expansion (n=13), and decision making (n=8). Table 3 details the subthemes of the workflow-related factors impacting adoption, their occurrence, and the respective studies where they were identified.
| Factor | Subthemes | References |
| Training (n=80) | Clinicians’ training to enable an efficient use and management of the tools | [Avey JP, Hobbs RL. Dial in: fostering the use of telebehavioral health services in frontier Alaska. Psychol Serv 2013 Aug;10(3):289-297. [CrossRef] [Medline]2,Bhatta R, Aryal K, Ellingsen G. Opportunities and challenges of a rural-telemedicine program in Nepal. J Nepal Health Res Counc 2015;13(30):149-153. [Medline]4,Gagnon MP, Ngangue P, Payne-Gagnon J, Desmartis M. m-Health adoption by healthcare professionals: a systematic review. J Am Med Inform Assoc 2016 Jan;23(1):212-220. [CrossRef] [Medline]9,Brewster L, Mountain G, Wessels B, Kelly C, Hawley M. Factors affecting front line staff acceptance of telehealth technologies: a mixed-method systematic review. J Adv Nurs 2014 Jan;70(1):21-33. [CrossRef] [Medline]10,de Souza CH, Morbeck RA, Steinman M, Hors CP, Bracco MM, Kozasa EH, et al. 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Implementation of a substance use recovery support mobile phone app in community settings: qualitative study of clinician and staff perspectives of facilitators and barriers. JMIR Ment Health 2016 Jun 28;3(2):e24 [FREE Full text] [CrossRef] [Medline]61,MacNeill V, Sanders C, Fitzpatrick R, Hendy J, Barlow J, Knapp M, et al. Experiences of front-line health professionals in the delivery of telehealth: a qualitative study. Br J Gen Pract 2014 Jul;64(624):e401-e407 [FREE Full text] [CrossRef] [Medline]62,Bagot KL, Cadilhac DA, Bladin CF, Watkins CL, Vu M, Donnan GA, VSTASTUTE investigators. Integrating acute stroke telemedicine consultations into specialists' usual practice: a qualitative analysis comparing the experience of Australia and the United Kingdom. BMC Health Serv Res 2017 Nov 21;17(1):751 [FREE Full text] [CrossRef] [Medline]65,Molleda L, Bahamon M, St George SM, Perrino T, Estrada Y, Herrera DC, et al. Clinic personnel, facilitator, and parent perspectives of eHealth Familias Unidas in primary care. J Pediatr Health Care 2017;31(3):350-361 [FREE Full text] [CrossRef] [Medline]68,Morrow S, Daines L, Wiener-Ogilvie S, Steed L, McKee L, Caress A, et al. Exploring the perspectives of clinical professionals and support staff on implementing supported self-management for asthma in UK general practice: an IMPART qualitative study. NPJ Prim Care Respir Med 2017 Jul 18;27(1):45 [FREE Full text] [CrossRef] [Medline]70-Rothstein JD, Jennings L, Moorthy A, Yang F, Gee L, Romano K, et al. Qualitative assessment of the feasibility, usability, and acceptability of a mobile client data app for community-based maternal, neonatal, and child care in rural Ghana. Int J Telemed Appl 2016;2016:2515420 [FREE Full text] [CrossRef] [Medline]74,Schneider T, Panzera AD, Martinasek M, McDermott R, Couluris M, Lindenberger J, et al. Physicians' perceptions of mobile technology for enhancing asthma care for youth. J Child Health Care 2016 Jun;20(2):153-163. [CrossRef] [Medline]77,Sharma U, Barnett J, Clarke M. Clinical users' perspective on telemonitoring of patients with long term conditions: understood through concepts of Giddens's structuration theory & consequence of modernity. Stud Health Technol Inform 2010;160(Pt 1):545-549. [Medline]79-Sinclair C, Holloway K, Riley G, Auret K. Online mental health resources in rural Australia: clinician perceptions of acceptability. J Med Internet Res 2013 Sep 5;15(9):e193 [FREE Full text] [CrossRef] [Medline]81, Taylor J, Coates L. Caring from a distance: the role of telehealth. Nurs Times 2015;111(28-29):18-20. [Medline]83,Varsi C, Ekstedt M, Gammon D, Børøsund E, Ruland CM. Middle managers' experiences and role in implementing an interactive tailored patient assessment eHealth intervention in clinical practice. Comput Inform Nurs 2015;33(6):249-257. [CrossRef] [Medline]85,Wilhelmsen M, Høifødt RS, Kolstrup N, Waterloo K, Eisemann M, Chenhall R, et al. Norwegian general practitioners' perspectives on implementation of a guided web-based cognitive behavioral therapy for depression: a qualitative study. J Med Internet Res 2014 Sep 10;16(9):e208 [FREE Full text] [CrossRef] [Medline]89,Wynn R, Bergvik S, Pettersen G, Fossum S. Clinicians' experiences with videoconferencing in psychiatry. Stud Health Technol Inform 2012;180:1218-1220. [Medline]90,Carlisle K, Warren R. A qualitative case study of telehealth for in-home monitoring to support the management of type 2 diabetes. J Telemed Telecare 2013 Oct;19(7):372-375. [CrossRef] [Medline]92-Casey M, Shaw S, Swinglehurst D. Experiences with online consultation systems in primary care: case study of one early adopter site. Br J Gen Pract 2017 Nov;67(664):e736-e743 [FREE Full text] [CrossRef] [Medline]94,Duplaga M. Searching for a role of nursing personnel in developing landscape of eHealth: factors determining attitudes toward key patient empowering applications. PLoS One 2016;11(4):e0153173 [FREE Full text] [CrossRef] [Medline]96,Gagnon MP, Orruño E, Asua J, Abdeljelil AB, Emparanza J. Using a modified technology acceptance model to evaluate healthcare professionals' adoption of a new telemonitoring system. Telemed J E Health 2012;18(1):54-59 [FREE Full text] [CrossRef] [Medline]97,Jury SC, Walker AM, Kornberg AJ. The introduction of web-based video-consultation in a paediatric acute care setting. J Telemed Telecare 2013 Oct;19(7):383-387. [CrossRef] [Medline]103,Kato NP, Johansson P, Okada I, de Vries AE, Kinugawa K, Strömberg A, et al. Heart failure telemonitoring in Japan and Sweden: a cross-sectional survey. J Med Internet Res 2015 Nov 13;17(11):e258 [FREE Full text] [CrossRef] [Medline]104,Kowitlawakul Y. The technology acceptance model: predicting nurses' intention to use telemedicine technology (eICU). Comput Inform Nurs 2011 Jul;29(7):411-418. [CrossRef] [Medline]111,Kuhn E, Eftekhari A, Hoffman JE, Crowley JJ, Ramsey KM, Reger GM, et al. Clinician perceptions of using a smartphone app with prolonged exposure therapy. Adm Policy Ment Health 2014 Nov;41(6):800-807. [CrossRef] [Medline]112,Miller KE, Kuhn E, Owen JE, Taylor K, Yu JS, Weiss BJ, et al. Clinician perceptions related to the use of the CBT-I Coach Mobile App. Behav Sleep Med 2019;17(4):481-491. [CrossRef] [Medline]120,Morilla MD, Sans M, Casasa A, Giménez N. Implementing technology in healthcare: insights from physicians. BMC Med Inform Decis Mak 2017 Jun 27;17(1):92 [FREE Full text] [CrossRef] [Medline]122,Orruño E, Gagnon MP, Asua J, Abdeljelil AB. Evaluation of teledermatology adoption by health-care professionals using a modified Technology Acceptance Model. J Telemed Telecare 2011;17(6):303-307. 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J Gerontol Nurs 2015 Apr;41(4):47-56. [CrossRef] [Medline]142,Villalba-Mora E, Casas I, Lupiañez-Villanueva F, Maghiros I. Adoption of health information technologies by physicians for clinical practice: the Andalusian case. Int J Med Inform 2015 Jul;84(7):477-485. [CrossRef] [Medline]143,Dünnebeil S, Sunyaev A, Blohm I, Leimeister JM, Krcmar H. Determinants of physicians' technology acceptance for e-health in ambulatory care. Int J Med Inform 2012 Nov;81(11):746-760. [CrossRef] [Medline]149-Jamu JT, Lowi-Jones H, Mitchell C. Just in time? Using QR codes for multi-professional learning in clinical practice. Nurse Educ Pract 2016 Jul;19:107-112. [CrossRef] [Medline]154,Loh P, Flicker L, Horner B. Attitudes toward information and communication technology (ICT) in residential aged care in Western Australia. J Am Med Dir Assoc 2009 Jul;10(6):408-413. [CrossRef] [Medline]156,Lygidakis C, Wallace P, Tersar C, Marcatto F, Ferrante D, Vedova RD, et al. 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Keys to success of a community of clinical practice in primary care: a qualitative evaluation of the ECOPIH project. BMC Fam Pract 2018 May 9;19(1):56 [FREE Full text] [CrossRef] [Medline]59-Lord S, Moore SK, Ramsey A, Dinauer S, Johnson K. Implementation of a substance use recovery support mobile phone app in community settings: qualitative study of clinician and staff perspectives of facilitators and barriers. JMIR Ment Health 2016 Jun 28;3(2):e24 [FREE Full text] [CrossRef] [Medline]61,Merchant KA, Ward MM, Mueller KJ, Rural Health Research & Policy Centers, Rural Policy Research Institute‚ RUPRI Center for Rural Health Policy Analysis‚ University of Iowa College of Public Health‚ Department of Health Management and Policy. Hospital views of factors affecting telemedicine use. Rural Policy Brief 2015 Apr 1(2015 5):1-4. [Medline]64,Rothstein JD, Jennings L, Moorthy A, Yang F, Gee L, Romano K, et al. Qualitative assessment of the feasibility, usability, and acceptability of a mobile client data app for community-based maternal, neonatal, and child care in rural Ghana. Int J Telemed Appl 2016;2016:2515420 [FREE Full text] [CrossRef] [Medline]74,Schneider T, Panzera AD, Martinasek M, McDermott R, Couluris M, Lindenberger J, et al. Physicians' perceptions of mobile technology for enhancing asthma care for youth. J Child Health Care 2016 Jun;20(2):153-163. [CrossRef] [Medline]77,Seto E, Leonard KJ, Cafazzo JA, Barnsley J, Masino C, Ross HJ. Perceptions and experiences of heart failure patients and clinicians on the use of mobile phone-based telemonitoring. J Med Internet Res 2012 Feb 10;14(1):e25 [FREE Full text] [CrossRef] [Medline]78,Varsi C, Ekstedt M, Gammon D, Ruland CM. Using the consolidated framework for implementation research to identify barriers and facilitators for the implementation of an internet-based patient-provider communication service in five settings: a qualitative study. J Med Internet Res 2015 Nov 18;17(11):e262 [FREE Full text] [CrossRef] [Medline]86,Bello AK, Molzahn AE, Girard LP, Osman MA, Okpechi IG, Glassford J, et al. Patient and provider perspectives on the design and implementation of an electronic consultation system for kidney care delivery in Canada: a focus group study. BMJ Open 2017 Mar 2;7(3):e014784 [FREE Full text] [CrossRef] [Medline]87,Zilliacus E, Meiser B, Lobb E, Dudding TE, Barlow-Stewart K, Tucker K. The virtual consultation: practitioners' experiences of genetic counseling by videoconferencing in Australia. Telemed J E Health 2010 Apr;16(3):350-357. [CrossRef] [Medline]91, Casey M, Shaw S, Swinglehurst D. Experiences with online consultation systems in primary care: case study of one early adopter site. 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J Am Assoc Nurse Pract 2016 Jun;28(6):311-319. [CrossRef] [Medline]115,Mairesse GH, Braunschweig F, Klersy K, Cowie MR, Leyva F. Implementation and reimbursement of remote monitoring for cardiac implantable electronic devices in Europe: a survey from the health economics committee of the European Heart Rhythm Association. Europace 2015 May;17(5):814-818. [CrossRef] [Medline]119,Saigi-Rubió F, Jiménez-Zarco A, Torrent-Sellens J. Determinants of the intention to use telemedicine: evidence from primary care physicians. Int J Technol Assess Health Care 2016 Jan;32(1-2):29-36. [CrossRef] [Medline]132,Sims MH, Fagnano M, Halterman JS, Halterman MW. Provider impressions of the use of a mobile crowdsourcing app in medical practice. Health Informatics J 2016 Jun;22(2):221-231. [CrossRef] [Medline]137,Steinschaden T, Petersson G, Astrand B. Physicians' attitudes towards eprescribing: a comparative web survey in Austria and Sweden. 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BMC Med Inform Decis Mak 2017 Mar 27;17(1):31 [FREE Full text] [CrossRef] [Medline]157,Mueller KJ, Potter AJ, MacKinney AC, Ward MM. Lessons from tele-emergency: improving care quality and health outcomes by expanding support for rural care systems. Health Aff (Millwood) 2014 Feb;33(2):228-234. [CrossRef] [Medline]159,Nerminathan A, Harrison A, Phelps M, Alexander S, Scott KM. Doctors' use of mobile devices in the clinical setting: a mixed methods study. Intern Med J 2017 Mar;47(3):291-298. [CrossRef] [Medline]161, Odnoletkova I, Buysse H, Nobels F, Goderis G, Aertgeerts B, Annemans L, et al. Patient and provider acceptance of telecoaching in type 2 diabetes: a mixed-method study embedded in a randomised clinical trial. BMC Med Inform Decis Mak 2016 Nov 9;16(1):142 [FREE Full text] [CrossRef] [Medline]162,Payne KF, Weeks L, Dunning P. A mixed methods pilot study to investigate the impact of a hospital-specific iPhone application (iTreat) within a British junior doctor cohort. 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| Collaboration and coordination (n=50) | Coordination of health services and collaboration between health care professionals | [Armstrong AW, Kwong MW, Chase EP, Ledo L, Nesbitt TS, Shewry SL. Teledermatology operational considerations, challenges, and benefits: the referring providers' perspective. Telemed J E Health 2012 Oct;18(8):580-584. [CrossRef] [Medline]1,Avey JP, Hobbs RL. Dial in: fostering the use of telebehavioral health services in frontier Alaska. Psychol Serv 2013 Aug;10(3):289-297. [CrossRef] [Medline]2,Choi WS, Park J, Choi JY, Yang J. Stakeholders' resistance to telemedicine with focus on physicians: utilizing the Delphi technique. J Telemed Telecare 2019 Jul;25(6):378-385. [CrossRef] [Medline]8-Brewster L, Mountain G, Wessels B, Kelly C, Hawley M. Factors affecting front line staff acceptance of telehealth technologies: a mixed-method systematic review. J Adv Nurs 2014 Jan;70(1):21-33. [CrossRef] [Medline]10,Egerton T, Nelligan R, Setchell J, Atkins L, Bennell KL. 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Speech pathologists' perspectives on transitioning to telepractice: what factors promote acceptance? J Telemed Telecare 2015 Dec;21(8):469-473. [CrossRef] [Medline]50,Jarvis-Selinger S, Bates J, Araki Y, Lear SA. Internet-based support for cardiovascular disease management. Int J Telemed Appl 2011;2011:342582 [FREE Full text] [CrossRef] [Medline]52,Kayyali R, Hesso I, Mahdi A, Hamzat O, Adu A, Nabhani Gebara S. Telehealth: misconceptions and experiences of healthcare professionals in England. Int J Pharm Pract 2017 Jun;25(3):203-209. [CrossRef] [Medline]55-Kim JW, Tiyyagura G, Langhan M. A qualitative analysis of general emergency medicine providers' perceptions on pediatric emergency telemedicine. Pediatr Emerg Care 2019 Dec;35(12):856-861. [CrossRef] [Medline]57,Tintorer DL, Domínguez JM, Pujol-Rivera E, Beneyto SF, Tuduri XM, Saigí-Rubió F. Keys to success of a community of clinical practice in primary care: a qualitative evaluation of the ECOPIH project. 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Br J Nurs 2014;23(21):1133-1137. [CrossRef] [Medline]71,van Gaalen JL, van Bodegom-Vos L, Bakker MJ, Snoeck-Stroband JB, Sont JK. Internet-based self-management support for adults with asthma: a qualitative study among patients, general practitioners and practice nurses on barriers to implementation. BMJ Open 2016 Aug 26;6(8):e010809 [FREE Full text] [CrossRef] [Medline]84,Varsi C, Ekstedt M, Gammon D, Børøsund E, Ruland CM. Middle managers' experiences and role in implementing an interactive tailored patient assessment eHealth intervention in clinical practice. Comput Inform Nurs 2015;33(6):249-257. [CrossRef] [Medline]85,Bello AK, Molzahn AE, Girard LP, Osman MA, Okpechi IG, Glassford J, et al. Patient and provider perspectives on the design and implementation of an electronic consultation system for kidney care delivery in Canada: a focus group study. BMJ Open 2017 Mar 2;7(3):e014784 [FREE Full text] [CrossRef] [Medline]87,Vest BM, Hall VM, Kahn LS, Heider AR, Maloney N, Singh R. Nurse perspectives on the implementation of routine telemonitoring for high-risk diabetes patients in a primary care setting. Prim Health Care Res Dev 2017 Jan;18(1):3-13. [CrossRef] [Medline]88, Carlisle K, Warren R. A qualitative case study of telehealth for in-home monitoring to support the management of type 2 diabetes. J Telemed Telecare 2013 Oct;19(7):372-375. [CrossRef] [Medline]92,Cary MP, Spencer M, Carroll A, Hand DH, Amis K, Karan E, et al. Benefits and challenges of delivering tele-rehabilitation services to rural veterans. Home Healthc Now 2016 Sep;34(8):440-446. [CrossRef] [Medline]93,Holderried M, Hoeper A, Holderried F, Blumenstock G, Ernst C, Tropitzsch A. Attitudes toward e-Health: the otolaryngologists' point of view. Telemed J E Health 2018 Jun;24(6):425-432. [CrossRef] [Medline]100,Jetty A, Moore MA, Coffman M, Petterson S, Bazemore A. Rural family physicians are twice as likely to use telehealth as urban family physicians. Telemed J E Health 2018 Apr;24(4):268-276. [CrossRef] [Medline]102,Kleinpell R, Barden C, Rincon T, McCarthy M, Rufo RJ. Assessing the impact of telemedicine on nursing care in intensive care units. Am J Crit Care 2016 Jan;25(1):e14-e20. [CrossRef] [Medline]109,Kowitlawakul Y. The technology acceptance model: predicting nurses' intention to use telemedicine technology (eICU). Comput Inform Nurs 2011 Jul;29(7):411-418. [CrossRef] [Medline]111,Putzer GJ, Park Y. Are physicians likely to adopt emerging mobile technologies? Attitudes and innovation factors affecting smartphone use in the Southeastern United States. Perspect Health Inf Manag 2012;9:1b [FREE Full text] [Medline]127,Sims MH, Fagnano M, Halterman JS, Halterman MW. Provider impressions of the use of a mobile crowdsourcing app in medical practice. Health Informatics J 2016 Jun;22(2):221-231. [CrossRef] [Medline]137,Uscher-Pines L, Kahn JM. Barriers and facilitators to pediatric emergency telemedicine in the United States. Telemed J E Health 2014 Nov;20(11):990-996 [FREE Full text] [CrossRef] [Medline]141,Duhm J, Fleischmann R, Schmidt S, Hupperts H, Brandt SA. Mobile electronic medical records promote workflow: physicians' perspective from a survey. JMIR Mhealth Uhealth 2016 Jun 6;4(2):e70 [FREE Full text] [CrossRef] [Medline]150,Ariens LF, Schussler-Raymakers FM, Frima C, Flinterman A, Hamminga E, Arents BW, et al. Barriers and facilitators to eHealth use in daily practice: perspectives of patients and professionals in dermatology. J Med Internet Res 2017 Sep 5;19(9):e300 [FREE Full text] [CrossRef] [Medline]152,Iacono T, Dissanayake C, Trembath D, Hudry K, Erickson S, Spong J. Family and practitioner perspectives on telehealth for services to young children with autism. Stud Health Technol Inform 2016;231:63-73. [Medline]153,Jeon J, Taneva S, Kukreti V, Trbovich P, Easty AC, Rossos PG, et al. Toward successful migration to computerized physician order entry for chemotherapy. Curr Oncol 2014 Apr;21(2):e221-e228 [FREE Full text] [CrossRef] [Medline]155,Loh P, Flicker L, Horner B. Attitudes toward information and communication technology (ICT) in residential aged care in Western Australia. J Am Med Dir Assoc 2009 Jul;10(6):408-413. [CrossRef] [Medline]156,Mueller KJ, Potter AJ, MacKinney AC, Ward MM. Lessons from tele-emergency: improving care quality and health outcomes by expanding support for rural care systems. Health Aff (Millwood) 2014 Feb;33(2):228-234. [CrossRef] [Medline]159, Nerminathan A, Harrison A, Phelps M, Alexander S, Scott KM. Doctors' use of mobile devices in the clinical setting: a mixed methods study. Intern Med J 2017 Mar;47(3):291-298. [CrossRef] [Medline]161,Odnoletkova I, Buysse H, Nobels F, Goderis G, Aertgeerts B, Annemans L, et al. Patient and provider acceptance of telecoaching in type 2 diabetes: a mixed-method study embedded in a randomised clinical trial. BMC Med Inform Decis Mak 2016 Nov 9;16(1):142 [FREE Full text] [CrossRef] [Medline]162,Ray KN, Felmet KA, Hamilton MF, Kuza CC, Saladino RA, Schultz BR, et al. Clinician attitudes toward adoption of pediatric emergency telemedicine in rural hospitals. Pediatr Emerg Care 2017 Apr;33(4):250-257. [CrossRef] [Medline]168,Walker L, Clendon J. The case for end-user involvement in design of health technologies. J Telemed Telecare 2016 Dec;22(8):443-446. [CrossRef] [Medline]172,Bramley G, Mangan C, Conroy M. Using telemonitoring to support personal care planning for adults with learning disabilities. J Telemed Telecare 2019 Dec;25(10):602-610. [CrossRef] [Medline]176,Radhakrishnan K, Xie B, Berkley A, Kim M. Barriers and facilitators for sustainability of tele-homecare programs: a systematic review. Health Serv Res 2016 Feb;51(1):48-75 [FREE Full text] [CrossRef] [Medline]182,Koivunen M, Saranto K. Nursing professionals' experiences of the facilitators and barriers to the use of telehealth applications: a systematic review of qualitative studies. Scand J Caring Sci 2018 Mar;32(1):24-44. [CrossRef] [Medline]185,Kumar S, Merchant S, Reynolds R. Tele-ICU: efficacy and cost-effectiveness approach of remotely managing the critical care. Open Med Inform J 2013;7:24-29 [FREE Full text] [CrossRef] [Medline]186,Li L, Cotton A. A systematic review of nurses' perspectives toward the telemedicine intensive care unit: a basis for supporting its future implementation in China? Telemed J E Health 2019 May;25(5):343-350. [CrossRef] [Medline]188,Cunningham DL, Connors EH, Lever N, Stephan SH. Providers' perspectives: utilizing telepsychiatry in schools. Telemed J E Health 2013 Oct;19(10):794-799. [CrossRef] [Medline]194] |
| Technical skills, and experience (n=44) | Clinicians’ tech-savviness, and previous experience with technology or mHealtha | [Gagnon MP, Ngangue P, Payne-Gagnon J, Desmartis M. m-Health adoption by healthcare professionals: a systematic review. J Am Med Inform Assoc 2016 Jan;23(1):212-220. [CrossRef] [Medline]9,de Souza CH, Morbeck RA, Steinman M, Hors CP, Bracco MM, Kozasa EH, et al. Barriers and benefits in telemedicine arising between a high-technology hospital service provider and remote public healthcare units: a qualitative study in Brazil. Telemed J E Health 2017 Jun;23(6):527-532. [CrossRef] [Medline]37,Giraldo L, Schachner B, Luna D, Benítez S. Exploring nurses' perceptions and expectations toward a BCMA implementation using a mobile app and workstations as a change management strategy. Stud Health Technol Inform 2018;250:134-138. [Medline]44,Hanna L, May C, Fairhurst K. The place of information and communication technology-mediated consultations in primary care: GPs' perspectives. Fam Pract 2012 Jun;29(3):361-366. [CrossRef] [Medline]49,Kayyali R, Hesso I, Mahdi A, Hamzat O, Adu A, Nabhani Gebara S. Telehealth: misconceptions and experiences of healthcare professionals in England. Int J Pharm Pract 2017 Jun;25(3):203-209. [CrossRef] [Medline]55,Tintorer DL, Domínguez JM, Pujol-Rivera E, Beneyto SF, Tuduri XM, Saigí-Rubió F. Keys to success of a community of clinical practice in primary care: a qualitative evaluation of the ECOPIH project. BMC Fam Pract 2018 May 9;19(1):56 [FREE Full text] [CrossRef] [Medline]59-Lord S, Moore SK, Ramsey A, Dinauer S, Johnson K. Implementation of a substance use recovery support mobile phone app in community settings: qualitative study of clinician and staff perspectives of facilitators and barriers. JMIR Ment Health 2016 Jun 28;3(2):e24 [FREE Full text] [CrossRef] [Medline]61,Molfenter T, Boyle M, Holloway D, Zwick J. Trends in telemedicine use in addiction treatment. Addict Sci Clin Pract 2015 May 28;10:14 [FREE Full text] [CrossRef] [Medline]67,Öberg U, Orre CJ, Isaksson U, Schimmer R, Larsson H, Hörnsten Å. Swedish primary healthcare nurses' perceptions of using digital eHealth services in support of patient self-management. Scand J Caring Sci 2018 Jun;32(2):961-970. [CrossRef] [Medline]72,Puszka S, Dingwall KM, Sweet M, Nagel T. E-Mental health innovations for aboriginal and Torres Strait Islander Australians: a qualitative study of implementation needs in health services. JMIR Ment Health 2016 Sep 19;3(3):e43 [FREE Full text] [CrossRef] [Medline]73,Sinclair C, Holloway K, Riley G, Auret K. Online mental health resources in rural Australia: clinician perceptions of acceptability. J Med Internet Res 2013 Sep 5;15(9):e193 [FREE Full text] [CrossRef] [Medline]81,Taylor J, Coates L. Caring from a distance: the role of telehealth. Nurs Times 2015;111(28-29):18-20. [Medline]83,Duplaga M. Searching for a role of nursing personnel in developing landscape of eHealth: factors determining attitudes toward key patient empowering applications. PLoS One 2016;11(4):e0153173 [FREE Full text] [CrossRef] [Medline]96,Holderried M, Hoeper A, Holderried F, Blumenstock G, Ernst C, Tropitzsch A. Attitudes toward e-Health: the otolaryngologists' point of view. Telemed J E Health 2018 Jun;24(6):425-432. [CrossRef] [Medline]100-Jetty A, Moore MA, Coffman M, Petterson S, Bazemore A. Rural family physicians are twice as likely to use telehealth as urban family physicians. Telemed J E Health 2018 Apr;24(4):268-276. [CrossRef] [Medline]102,Kuhn E, Eftekhari A, Hoffman JE, Crowley JJ, Ramsey KM, Reger GM, et al. Clinician perceptions of using a smartphone app with prolonged exposure therapy. Adm Policy Ment Health 2014 Nov;41(6):800-807. [CrossRef] [Medline]112,Moore MA, Coffman M, Jetty A, Klink K, Petterson S, Bazemore A. 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| Job security (n=22) | Autonomy, loss of control, threat to own career, and professional identity | [Gagnon MP, Ngangue P, Payne-Gagnon J, Desmartis M. m-Health adoption by healthcare professionals: a systematic review. J Am Med Inform Assoc 2016 Jan;23(1):212-220. [CrossRef] [Medline]9,Brewster L, Mountain G, Wessels B, Kelly C, Hawley M. Factors affecting front line staff acceptance of telehealth technologies: a mixed-method systematic review. J Adv Nurs 2014 Jan;70(1):21-33. [CrossRef] [Medline]10,Kayyali R, Hesso I, Mahdi A, Hamzat O, Adu A, Nabhani Gebara S. Telehealth: misconceptions and experiences of healthcare professionals in England. Int J Pharm Pract 2017 Jun;25(3):203-209. [CrossRef] [Medline]55,MacNeill V, Sanders C, Fitzpatrick R, Hendy J, Barlow J, Knapp M, et al. Experiences of front-line health professionals in the delivery of telehealth: a qualitative study. Br J Gen Pract 2014 Jul;64(624):e401-e407 [FREE Full text] [CrossRef] [Medline]62,Öberg U, Orre CJ, Isaksson U, Schimmer R, Larsson H, Hörnsten Å. Swedish primary healthcare nurses' perceptions of using digital eHealth services in support of patient self-management. Scand J Caring Sci 2018 Jun;32(2):961-970. [CrossRef] [Medline]72,Sharma U, Barnett J, Clarke M. Clinical users' perspective on telemonitoring of patients with long term conditions: understood through concepts of Giddens's structuration theory & consequence of modernity. Stud Health Technol Inform 2010;160(Pt 1):545-549. [Medline]79,Sharma U, Clarke M. Nurses' and community support workers' experience of telehealth: a longitudinal case study. BMC Health Serv Res 2014 Apr 10;14:164 [FREE Full text] [CrossRef] [Medline]80,Klack L, Ziefle M, Wilkowska W, Kluge J. Telemedical versus conventional heart patient monitoring: a survey study with German physicians. Int J Technol Assess Health Care 2013 Oct;29(4):378-383. [CrossRef] [Medline]108,Kuo KM, Talley PC, Lee C, Yen Y. The influence of telemedicine experience on physicians' perceptions regarding adoption. Telemed J E Health 2015 May;21(5):388-394. [CrossRef] [Medline]113,Liu CF, Cheng TJ. Exploring critical factors influencing physicians' acceptance of mobile electronic medical records based on the dual-factor model: a validation in Taiwan. BMC Med Inform Decis Mak 2015 Feb 7;15:4 [FREE Full text] [CrossRef] [Medline]116,Ly BA, Kristjansson E, Labonté R, Bourgeault IL. Determinants of the intention of Senegal's physicians to use telemedicine in their professional activities. Telemed J E Health 2018 Nov;24(11):897-898. [CrossRef] [Medline]118,O'Connor S, Andrews T. Smartphones and mobile applications (apps) in clinical nursing education: a student perspective. Nurse Educ Today 2018 Oct;69:172-178. [CrossRef] [Medline]124,Rogove HJ, McArthur D, Demaerschalk BM, Vespa PM. Barriers to telemedicine: survey of current users in acute care units. Telemed J E Health 2012;18(1):48-53. [CrossRef] [Medline]130,Steinschaden T, Petersson G, Astrand B. Physicians' attitudes towards eprescribing: a comparative web survey in Austria and Sweden. Inform Prim Care 2009;17(4):241-248 [FREE Full text] [CrossRef] [Medline]140,Uscher-Pines L, Kahn JM. Barriers and facilitators to pediatric emergency telemedicine in the United States. Telemed J E Health 2014 Nov;20(11):990-996 [FREE Full text] [CrossRef] [Medline]141,Alajlani M, Clarke M. Effect of culture on acceptance of telemedicine in Middle Eastern countries: case study of Jordan and Syria. Telemed J E Health 2013 Apr;19(4):305-311. [CrossRef] [Medline]151, Mueller KJ, Potter AJ, MacKinney AC, Ward MM. Lessons from tele-emergency: improving care quality and health outcomes by expanding support for rural care systems. Health Aff (Millwood) 2014 Feb;33(2):228-234. [CrossRef] [Medline]159,Bramley G, Mangan C, Conroy M. Using telemonitoring to support personal care planning for adults with learning disabilities. J Telemed Telecare 2019 Dec;25(10):602-610. [CrossRef] [Medline]176,Radhakrishnan K, Xie B, Berkley A, Kim M. Barriers and facilitators for sustainability of tele-homecare programs: a systematic review. Health Serv Res 2016 Feb;51(1):48-75 [FREE Full text] [CrossRef] [Medline]182,Koivunen M, Saranto K. Nursing professionals' experiences of the facilitators and barriers to the use of telehealth applications: a systematic review of qualitative studies. Scand J Caring Sci 2018 Mar;32(1):24-44. [CrossRef] [Medline]185,Li L, Cotton A. A systematic review of nurses' perspectives toward the telemedicine intensive care unit: a basis for supporting its future implementation in China? Telemed J E Health 2019 May;25(5):343-350. [CrossRef] [Medline]188] |
| Incentives (n=15) | Different means to incentivize clinicians | [Bhatta R, Aryal K, Ellingsen G. Opportunities and challenges of a rural-telemedicine program in Nepal. J Nepal Health Res Counc 2015;13(30):149-153. [Medline]4,Armstrong AW, Kwong MW, Ledo L, Nesbitt TS, Shewry SL. Practice models and challenges in teledermatology: a study of collective experiences from teledermatologists. PLoS One 2011;6(12):e28687 [FREE Full text] [CrossRef] [Medline]54,Tintorer DL, Domínguez JM, Pujol-Rivera E, Beneyto SF, Tuduri XM, Saigí-Rubió F. Keys to success of a community of clinical practice in primary care: a qualitative evaluation of the ECOPIH project. BMC Fam Pract 2018 May 9;19(1):56 [FREE Full text] [CrossRef] [Medline]59,Bello AK, Molzahn AE, Girard LP, Osman MA, Okpechi IG, Glassford J, et al. Patient and provider perspectives on the design and implementation of an electronic consultation system for kidney care delivery in Canada: a focus group study. BMJ Open 2017 Mar 2;7(3):e014784 [FREE Full text] [CrossRef] [Medline]87,Vest BM, Hall VM, Kahn LS, Heider AR, Maloney N, Singh R. Nurse perspectives on the implementation of routine telemonitoring for high-risk diabetes patients in a primary care setting. Prim Health Care Res Dev 2017 Jan;18(1):3-13. [CrossRef] [Medline]88,Adenuga KI, Iahad NA, Miskon S. Towards reinforcing telemedicine adoption amongst clinicians in Nigeria. Int J Med Inform 2017 Aug;104:84-96. [CrossRef] [Medline]106,Morilla MD, Sans M, Casasa A, Giménez N. Implementing technology in healthcare: insights from physicians. BMC Med Inform Decis Mak 2017 Jun 27;17(1):92 [FREE Full text] [CrossRef] [Medline]122,Rho MJ, Choi IY, Lee J. Predictive factors of telemedicine service acceptance and behavioral intention of physicians. Int J Med Inform 2014 Aug;83(8):559-571. [CrossRef] [Medline]129,Uscher-Pines L, Kahn JM. Barriers and facilitators to pediatric emergency telemedicine in the United States. Telemed J E Health 2014 Nov;20(11):990-996 [FREE Full text] [CrossRef] [Medline]141,Lapão LV, da Silva MM, Gregório J. Implementing an online pharmaceutical service using design science research. BMC Med Inform Decis Mak 2017 Mar 27;17(1):31 [FREE Full text] [CrossRef] [Medline]157,Orchard J, Lowres N, Freedman SB, Ladak L, Lee W, Zwar N, et al. Screening for atrial fibrillation during influenza vaccinations by primary care nurses using a smartphone electrocardiograph (iECG): A feasibility study. Eur J Prev Cardiol 2016 Oct;23(2 suppl):13-20. [CrossRef] [Medline]164,Ray KN, Felmet KA, Hamilton MF, Kuza CC, Saladino RA, Schultz BR, et al. Clinician attitudes toward adoption of pediatric emergency telemedicine in rural hospitals. Pediatr Emerg Care 2017 Apr;33(4):250-257. [CrossRef] [Medline]168,Zhang Y, Koch S. Mobile health apps in Sweden: what do physicians recommend? Stud Health Technol Inform 2015;210:793-797. [Medline]175,Jungwirth D, Haluza D. Information and communication technology and the future of healthcare: results of a multi-scenario Delphi survey. Health Informatics J 2019 Mar;25(1):161-173. [CrossRef] [Medline]191] |
| Career and knowledge expansion (n=13) | Impact on professional development and expertise | [MacNeill V, Sanders C, Fitzpatrick R, Hendy J, Barlow J, Knapp M, et al. Experiences of front-line health professionals in the delivery of telehealth: a qualitative study. Br J Gen Pract 2014 Jul;64(624):e401-e407 [FREE Full text] [CrossRef] [Medline]62,Öberg U, Orre CJ, Isaksson U, Schimmer R, Larsson H, Hörnsten Å. Swedish primary healthcare nurses' perceptions of using digital eHealth services in support of patient self-management. Scand J Caring Sci 2018 Jun;32(2):961-970. [CrossRef] [Medline]72-Rothstein JD, Jennings L, Moorthy A, Yang F, Gee L, Romano K, et al. Qualitative assessment of the feasibility, usability, and acceptability of a mobile client data app for community-based maternal, neonatal, and child care in rural Ghana. Int J Telemed Appl 2016;2016:2515420 [FREE Full text] [CrossRef] [Medline]74,Varsi C, Ekstedt M, Gammon D, Ruland CM. Using the consolidated framework for implementation research to identify barriers and facilitators for the implementation of an internet-based patient-provider communication service in five settings: a qualitative study. J Med Internet Res 2015 Nov 18;17(11):e262 [FREE Full text] [CrossRef] [Medline]86,O'Connor S, Andrews T. Smartphones and mobile applications (apps) in clinical nursing education: a student perspective. Nurse Educ Today 2018 Oct;69:172-178. [CrossRef] [Medline]124,Sadoughi F, Erfannia L, Sancholi M, Salmani F, Sarsarshahi A. Teleradiology in Southeast Iran: Evaluating the Views of Senior Executives and Radiologists. Health Care Manag (Frederick) 2017;36(3):301-307. [CrossRef] [Medline]131,Sims MH, Fagnano M, Halterman JS, Halterman MW. Provider impressions of the use of a mobile crowdsourcing app in medical practice. Health Informatics J 2016 Jun;22(2):221-231. [CrossRef] [Medline]137,Nerminathan A, Harrison A, Phelps M, Alexander S, Scott KM. Doctors' use of mobile devices in the clinical setting: a mixed methods study. Intern Med J 2017 Mar;47(3):291-298. [CrossRef] [Medline]161,Odnoletkova I, Buysse H, Nobels F, Goderis G, Aertgeerts B, Annemans L, et al. Patient and provider acceptance of telecoaching in type 2 diabetes: a mixed-method study embedded in a randomised clinical trial. BMC Med Inform Decis Mak 2016 Nov 9;16(1):142 [FREE Full text] [CrossRef] [Medline]162,Shaw RJ, Kaufman MA, Bosworth HB, Weiner BJ, Zullig LL, Lee SD, et al. Organizational factors associated with readiness to implement and translate a primary care based telemedicine behavioral program to improve blood pressure control: the HTN-IMPROVE study. Implement Sci 2013 Sep 8;8:106 [FREE Full text] [CrossRef] [Medline]169,Li L, Cotton A. A systematic review of nurses' perspectives toward the telemedicine intensive care unit: a basis for supporting its future implementation in China? Telemed J E Health 2019 May;25(5):343-350. [CrossRef] [Medline]188,Penny RA, Bradford NK, Langbecker D. Registered nurse and midwife experiences of using videoconferencing in practice: a systematic review of qualitative studies. J Clin Nurs 2018 Mar;27(5-6):e739-e752. [CrossRef] [Medline]189] |
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amHealth: mobile health.
Patient-related factors arose quite often in the included articles and were split into 13 subthemes. The most prevalent patient-related subtheme was the quality and efficiency of patient care, for example, treatment outcomes, clinical delivery, patient monitoring, and treatment compliance (n=77), followed by the quality and ease of communications between patients and the care team (n=53), enhancing patients’ access to care and reaching the underserved (n=41), then patients’ comfort with technology, personal preferences, and the ease of getting an informed consent from the patients (n=30). Applicability and appropriateness, meaning the suitability of patients on the basis of their needs and characteristics, also occurred quite often (n=24), seeing mHealth as an opportunity to empower and reassure patients and increase their engagement in managing their condition, which was also a key factor (n=21).
In addition to patient safety (n=19), factors included patient age, living standard, and access to technology (n=15), better patient education and awareness (n=12), patient overdependence on practitioner support (n=8), and patients’ worries and anxiety related to the understanding and interpretation of data, or the feeling of being observed (n=6). The least common subthemes were those reflecting concerns regarding patients’ long-term commitment and use (n=3) and protective or paternalistic attitudes of the care team (n=2). Table 4 details the subthemes of the patient-related factors impacting adoption, their occurrence, and the respective studies where they were identified.
| Factor | Subthemes | References |
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Physicians' perceptions of mobile technology for enhancing asthma care for youth. J Child Health Care 2016 Jun;20(2):153-163. [CrossRef] [Medline]77,Sharma U, Barnett J, Clarke M. Clinical users' perspective on telemonitoring of patients with long term conditions: understood through concepts of Giddens's structuration theory & consequence of modernity. Stud Health Technol Inform 2010;160(Pt 1):545-549. [Medline]79-Sinclair C, Holloway K, Riley G, Auret K. Online mental health resources in rural Australia: clinician perceptions of acceptability. J Med Internet Res 2013 Sep 5;15(9):e193 [FREE Full text] [CrossRef] [Medline]81,Taylor J, Coates L. Caring from a distance: the role of telehealth. Nurs Times 2015;111(28-29):18-20. [Medline]83,Varsi C, Ekstedt M, Gammon D, Børøsund E, Ruland CM. Middle managers' experiences and role in implementing an interactive tailored patient assessment eHealth intervention in clinical practice. Comput Inform Nurs 2015;33(6):249-257. [CrossRef] [Medline]85,Wilhelmsen M, Høifødt RS, Kolstrup N, Waterloo K, Eisemann M, Chenhall R, et al. Norwegian general practitioners' perspectives on implementation of a guided web-based cognitive behavioral therapy for depression: a qualitative study. J Med Internet Res 2014 Sep 10;16(9):e208 [FREE Full text] [CrossRef] [Medline]89,Wynn R, Bergvik S, Pettersen G, Fossum S. Clinicians' experiences with videoconferencing in psychiatry. Stud Health Technol Inform 2012;180:1218-1220. [Medline]90,Carlisle K, Warren R. A qualitative case study of telehealth for in-home monitoring to support the management of type 2 diabetes. J Telemed Telecare 2013 Oct;19(7):372-375. [CrossRef] [Medline]92-Casey M, Shaw S, Swinglehurst D. Experiences with online consultation systems in primary care: case study of one early adopter site. Br J Gen Pract 2017 Nov;67(664):e736-e743 [FREE Full text] [CrossRef] [Medline]94, Duplaga M. Searching for a role of nursing personnel in developing landscape of eHealth: factors determining attitudes toward key patient empowering applications. PLoS One 2016;11(4):e0153173 [FREE Full text] [CrossRef] [Medline]96,Gagnon MP, Orruño E, Asua J, Abdeljelil AB, Emparanza J. Using a modified technology acceptance model to evaluate healthcare professionals' adoption of a new telemonitoring system. Telemed J E Health 2012;18(1):54-59 [FREE Full text] [CrossRef] [Medline]97,Jury SC, Walker AM, Kornberg AJ. The introduction of web-based video-consultation in a paediatric acute care setting. J Telemed Telecare 2013 Oct;19(7):383-387. [CrossRef] [Medline]103,Kato NP, Johansson P, Okada I, de Vries AE, Kinugawa K, Strömberg A, et al. Heart failure telemonitoring in Japan and Sweden: a cross-sectional survey. J Med Internet Res 2015 Nov 13;17(11):e258 [FREE Full text] [CrossRef] [Medline]104,Kowitlawakul Y. The technology acceptance model: predicting nurses' intention to use telemedicine technology (eICU). Comput Inform Nurs 2011 Jul;29(7):411-418. [CrossRef] [Medline]111,Kuhn E, Eftekhari A, Hoffman JE, Crowley JJ, Ramsey KM, Reger GM, et al. Clinician perceptions of using a smartphone app with prolonged exposure therapy. Adm Policy Ment Health 2014 Nov;41(6):800-807. [CrossRef] [Medline]112,Miller KE, Kuhn E, Owen JE, Taylor K, Yu JS, Weiss BJ, et al. Clinician perceptions related to the use of the CBT-I Coach Mobile App. Behav Sleep Med 2019;17(4):481-491. [CrossRef] [Medline]120,Morilla MD, Sans M, Casasa A, Giménez N. Implementing technology in healthcare: insights from physicians. BMC Med Inform Decis Mak 2017 Jun 27;17(1):92 [FREE Full text] [CrossRef] [Medline]122,Orruño E, Gagnon MP, Asua J, Abdeljelil AB. Evaluation of teledermatology adoption by health-care professionals using a modified Technology Acceptance Model. J Telemed Telecare 2011;17(6):303-307. 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| Time or cost-efficiency (n=51) | Impact on efficiency and competitiveness | [Armstrong AW, Kwong MW, Chase EP, Ledo L, Nesbitt TS, Shewry SL. Teledermatology operational considerations, challenges, and benefits: the referring providers' perspective. Telemed J E Health 2012 Oct;18(8):580-584. [CrossRef] [Medline]1,Mileski M, Kruse CS, Catalani J, Haderer T. Adopting telemedicine for the self-management of hypertension: systematic review. JMIR Med Inform 2017 Oct 24;5(4):e41 [FREE Full text] [CrossRef] [Medline]5,Gagnon MP, Ngangue P, Payne-Gagnon J, Desmartis M. m-Health adoption by healthcare professionals: a systematic review. J Am Med Inform Assoc 2016 Jan;23(1):212-220. [CrossRef] [Medline]9,de Vries ST, Wong L, Sutcliffe A, Houÿez F, Ruiz CL, Mol PG, IMI Web-RADR Work Package 3b Consortium. Factors influencing the use of a mobile app for reporting adverse drug reactions and receiving safety information: a qualitative study. 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Keys to success of a community of clinical practice in primary care: a qualitative evaluation of the ECOPIH project. BMC Fam Pract 2018 May 9;19(1):56 [FREE Full text] [CrossRef] [Medline]59-Lord S, Moore SK, Ramsey A, Dinauer S, Johnson K. Implementation of a substance use recovery support mobile phone app in community settings: qualitative study of clinician and staff perspectives of facilitators and barriers. JMIR Ment Health 2016 Jun 28;3(2):e24 [FREE Full text] [CrossRef] [Medline]61,Merchant KA, Ward MM, Mueller KJ, Rural Health Research & Policy Centers, Rural Policy Research Institute‚ RUPRI Center for Rural Health Policy Analysis‚ University of Iowa College of Public Health‚ Department of Health Management and Policy. Hospital views of factors affecting telemedicine use. Rural Policy Brief 2015 Apr 1(2015 5):1-4. [Medline]64,Rothstein JD, Jennings L, Moorthy A, Yang F, Gee L, Romano K, et al. Qualitative assessment of the feasibility, usability, and acceptability of a mobile client data app for community-based maternal, neonatal, and child care in rural Ghana. Int J Telemed Appl 2016;2016:2515420 [FREE Full text] [CrossRef] [Medline]74,Schneider T, Panzera AD, Martinasek M, McDermott R, Couluris M, Lindenberger J, et al. Physicians' perceptions of mobile technology for enhancing asthma care for youth. J Child Health Care 2016 Jun;20(2):153-163. [CrossRef] [Medline]77,Seto E, Leonard KJ, Cafazzo JA, Barnsley J, Masino C, Ross HJ. Perceptions and experiences of heart failure patients and clinicians on the use of mobile phone-based telemonitoring. J Med Internet Res 2012 Feb 10;14(1):e25 [FREE Full text] [CrossRef] [Medline]78,Varsi C, Ekstedt M, Gammon D, Ruland CM. Using the consolidated framework for implementation research to identify barriers and facilitators for the implementation of an internet-based patient-provider communication service in five settings: a qualitative study. J Med Internet Res 2015 Nov 18;17(11):e262 [FREE Full text] [CrossRef] [Medline]86,Bello AK, Molzahn AE, Girard LP, Osman MA, Okpechi IG, Glassford J, et al. Patient and provider perspectives on the design and implementation of an electronic consultation system for kidney care delivery in Canada: a focus group study. BMJ Open 2017 Mar 2;7(3):e014784 [FREE Full text] [CrossRef] [Medline]87,Zilliacus E, Meiser B, Lobb E, Dudding TE, Barlow-Stewart K, Tucker K. The virtual consultation: practitioners' experiences of genetic counseling by videoconferencing in Australia. Telemed J E Health 2010 Apr;16(3):350-357. [CrossRef] [Medline]91,Casey M, Shaw S, Swinglehurst D. Experiences with online consultation systems in primary care: case study of one early adopter site. 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J Am Assoc Nurse Pract 2016 Jun;28(6):311-319. [CrossRef] [Medline]115,Mairesse GH, Braunschweig F, Klersy K, Cowie MR, Leyva F. Implementation and reimbursement of remote monitoring for cardiac implantable electronic devices in Europe: a survey from the health economics committee of the European Heart Rhythm Association. Europace 2015 May;17(5):814-818. [CrossRef] [Medline]119,Saigi-Rubió F, Jiménez-Zarco A, Torrent-Sellens J. Determinants of the intention to use telemedicine: evidence from primary care physicians. Int J Technol Assess Health Care 2016 Jan;32(1-2):29-36. [CrossRef] [Medline]132,Sims MH, Fagnano M, Halterman JS, Halterman MW. Provider impressions of the use of a mobile crowdsourcing app in medical practice. Health Informatics J 2016 Jun;22(2):221-231. [CrossRef] [Medline]137,Steinschaden T, Petersson G, Astrand B. Physicians' attitudes towards eprescribing: a comparative web survey in Austria and Sweden. 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Patient-physician communication in the era of mobile phones and social media apps: cross-sectional observational study on Lebanese physicians' perceptions and attitudes. JMIR Med Inform 2018 Apr 6;6(2):e18 [FREE Full text] [CrossRef] [Medline]190,Bishop TF, Press MJ, Mendelsohn JL, Casalino LP. Electronic communication improves access, but barriers to its widespread adoption remain. Health Aff (Millwood) 2013 Aug;32(8):1361-1367 [FREE Full text] [CrossRef] [Medline]195] |
| Collaboration and coordination (n=50) | Coordination of health services and collaboration between health care professionals | [Armstrong AW, Kwong MW, Chase EP, Ledo L, Nesbitt TS, Shewry SL. Teledermatology operational considerations, challenges, and benefits: the referring providers' perspective. Telemed J E Health 2012 Oct;18(8):580-584. [CrossRef] [Medline]1,Avey JP, Hobbs RL. Dial in: fostering the use of telebehavioral health services in frontier Alaska. Psychol Serv 2013 Aug;10(3):289-297. [CrossRef] [Medline]2,Choi WS, Park J, Choi JY, Yang J. Stakeholders' resistance to telemedicine with focus on physicians: utilizing the Delphi technique. J Telemed Telecare 2019 Jul;25(6):378-385. [CrossRef] [Medline]8-Brewster L, Mountain G, Wessels B, Kelly C, Hawley M. Factors affecting front line staff acceptance of telehealth technologies: a mixed-method systematic review. J Adv Nurs 2014 Jan;70(1):21-33. [CrossRef] [Medline]10,Egerton T, Nelligan R, Setchell J, Atkins L, Bennell KL. General practitioners' perspectives on a proposed new model of service delivery for primary care management of knee osteoarthritis: a qualitative study. BMC Fam Pract 2017 Sep 7;18(1):85 [FREE Full text] [CrossRef] [Medline]39,Esterle L, Mathieu-Fritz A. Teleconsultation in geriatrics: impact on professional practice. Int J Med Inform 2013 Aug;82(8):684-695. [CrossRef] [Medline]40,Farrell M. Use of iPhones by nurses in an acute care setting to improve communication and decision-making processes: qualitative analysis of nurses' perspectives on iPhone use. JMIR Mhealth Uhealth 2016 May 31;4(2):e43 [FREE Full text] [CrossRef] [Medline]42,Grünloh C, Cajander A, Myreteg G. 'The Record is Our Work Tool!'- physicians' framing of a patient portal in Sweden. J Med Internet Res 2016 Jun 27;18(6):e167 [FREE Full text] [CrossRef] [Medline]46,Hines M, Lincoln M, Ramsden R, Martinovich J, Fairweather C. Speech pathologists' perspectives on transitioning to telepractice: what factors promote acceptance? J Telemed Telecare 2015 Dec;21(8):469-473. [CrossRef] [Medline]50,Jarvis-Selinger S, Bates J, Araki Y, Lear SA. Internet-based support for cardiovascular disease management. Int J Telemed Appl 2011;2011:342582 [FREE Full text] [CrossRef] [Medline]52,Kayyali R, Hesso I, Mahdi A, Hamzat O, Adu A, Nabhani Gebara S. Telehealth: misconceptions and experiences of healthcare professionals in England. Int J Pharm Pract 2017 Jun;25(3):203-209. [CrossRef] [Medline]55-Kim JW, Tiyyagura G, Langhan M. A qualitative analysis of general emergency medicine providers' perceptions on pediatric emergency telemedicine. Pediatr Emerg Care 2019 Dec;35(12):856-861. [CrossRef] [Medline]57,Tintorer DL, Domínguez JM, Pujol-Rivera E, Beneyto SF, Tuduri XM, Saigí-Rubió F. Keys to success of a community of clinical practice in primary care: a qualitative evaluation of the ECOPIH project. BMC Fam Pract 2018 May 9;19(1):56 [FREE Full text] [CrossRef] [Medline]59,Lord S, Moore SK, Ramsey A, Dinauer S, Johnson K. Implementation of a substance use recovery support mobile phone app in community settings: qualitative study of clinician and staff perspectives of facilitators and barriers. JMIR Ment Health 2016 Jun 28;3(2):e24 [FREE Full text] [CrossRef] [Medline]61,Molleda L, Bahamon M, St George SM, Perrino T, Estrada Y, Herrera DC, et al. Clinic personnel, facilitator, and parent perspectives of eHealth Familias Unidas in primary care. J Pediatr Health Care 2017;31(3):350-361 [FREE Full text] [CrossRef] [Medline]68,Moloczij N, Mosley I, Moss KM, Bagot KL, Bladin CF, Cadilhac DA. Is telemedicine helping or hindering the delivery of stroke thrombolysis in rural areas? A qualitative analysis. Intern Med J 2015 Sep;45(9):957-964. [CrossRef] [Medline]69,Odeh B, Kayyali R, Nabhani-Gebara S, Philip N. Implementing a telehealth service: nurses' perceptions and experiences. Br J Nurs 2014;23(21):1133-1137. [CrossRef] [Medline]71,van Gaalen JL, van Bodegom-Vos L, Bakker MJ, Snoeck-Stroband JB, Sont JK. Internet-based self-management support for adults with asthma: a qualitative study among patients, general practitioners and practice nurses on barriers to implementation. BMJ Open 2016 Aug 26;6(8):e010809 [FREE Full text] [CrossRef] [Medline]84,Varsi C, Ekstedt M, Gammon D, Børøsund E, Ruland CM. Middle managers' experiences and role in implementing an interactive tailored patient assessment eHealth intervention in clinical practice. Comput Inform Nurs 2015;33(6):249-257. [CrossRef] [Medline]85,Bello AK, Molzahn AE, Girard LP, Osman MA, Okpechi IG, Glassford J, et al. Patient and provider perspectives on the design and implementation of an electronic consultation system for kidney care delivery in Canada: a focus group study. BMJ Open 2017 Mar 2;7(3):e014784 [FREE Full text] [CrossRef] [Medline]87,Vest BM, Hall VM, Kahn LS, Heider AR, Maloney N, Singh R. Nurse perspectives on the implementation of routine telemonitoring for high-risk diabetes patients in a primary care setting. Prim Health Care Res Dev 2017 Jan;18(1):3-13. [CrossRef] [Medline]88,Carlisle K, Warren R. A qualitative case study of telehealth for in-home monitoring to support the management of type 2 diabetes. J Telemed Telecare 2013 Oct;19(7):372-375. [CrossRef] [Medline]92,Cary MP, Spencer M, Carroll A, Hand DH, Amis K, Karan E, et al. Benefits and challenges of delivering tele-rehabilitation services to rural veterans. Home Healthc Now 2016 Sep;34(8):440-446. [CrossRef] [Medline]93,Holderried M, Hoeper A, Holderried F, Blumenstock G, Ernst C, Tropitzsch A. Attitudes toward e-Health: the otolaryngologists' point of view. Telemed J E Health 2018 Jun;24(6):425-432. [CrossRef] [Medline]100,Jetty A, Moore MA, Coffman M, Petterson S, Bazemore A. Rural family physicians are twice as likely to use telehealth as urban family physicians. Telemed J E Health 2018 Apr;24(4):268-276. [CrossRef] [Medline]102,Kleinpell R, Barden C, Rincon T, McCarthy M, Rufo RJ. Assessing the impact of telemedicine on nursing care in intensive care units. Am J Crit Care 2016 Jan;25(1):e14-e20. [CrossRef] [Medline]109,Kowitlawakul Y. The technology acceptance model: predicting nurses' intention to use telemedicine technology (eICU). Comput Inform Nurs 2011 Jul;29(7):411-418. [CrossRef] [Medline]111, Putzer GJ, Park Y. Are physicians likely to adopt emerging mobile technologies? Attitudes and innovation factors affecting smartphone use in the Southeastern United States. Perspect Health Inf Manag 2012;9:1b [FREE Full text] [Medline]127,Sims MH, Fagnano M, Halterman JS, Halterman MW. Provider impressions of the use of a mobile crowdsourcing app in medical practice. Health Informatics J 2016 Jun;22(2):221-231. [CrossRef] [Medline]137,Uscher-Pines L, Kahn JM. Barriers and facilitators to pediatric emergency telemedicine in the United States. Telemed J E Health 2014 Nov;20(11):990-996 [FREE Full text] [CrossRef] [Medline]141,Duhm J, Fleischmann R, Schmidt S, Hupperts H, Brandt SA. Mobile electronic medical records promote workflow: physicians' perspective from a survey. JMIR Mhealth Uhealth 2016 Jun 6;4(2):e70 [FREE Full text] [CrossRef] [Medline]150,Ariens LF, Schussler-Raymakers FM, Frima C, Flinterman A, Hamminga E, Arents BW, et al. Barriers and facilitators to eHealth use in daily practice: perspectives of patients and professionals in dermatology. J Med Internet Res 2017 Sep 5;19(9):e300 [FREE Full text] [CrossRef] [Medline]152,Iacono T, Dissanayake C, Trembath D, Hudry K, Erickson S, Spong J. Family and practitioner perspectives on telehealth for services to young children with autism. Stud Health Technol Inform 2016;231:63-73. [Medline]153,Jeon J, Taneva S, Kukreti V, Trbovich P, Easty AC, Rossos PG, et al. Toward successful migration to computerized physician order entry for chemotherapy. Curr Oncol 2014 Apr;21(2):e221-e228 [FREE Full text] [CrossRef] [Medline]155,Loh P, Flicker L, Horner B. Attitudes toward information and communication technology (ICT) in residential aged care in Western Australia. J Am Med Dir Assoc 2009 Jul;10(6):408-413. [CrossRef] [Medline]156,Mueller KJ, Potter AJ, MacKinney AC, Ward MM. Lessons from tele-emergency: improving care quality and health outcomes by expanding support for rural care systems. Health Aff (Millwood) 2014 Feb;33(2):228-234. [CrossRef] [Medline]159,Nerminathan A, Harrison A, Phelps M, Alexander S, Scott KM. Doctors' use of mobile devices in the clinical setting: a mixed methods study. Intern Med J 2017 Mar;47(3):291-298. [CrossRef] [Medline]161,Odnoletkova I, Buysse H, Nobels F, Goderis G, Aertgeerts B, Annemans L, et al. Patient and provider acceptance of telecoaching in type 2 diabetes: a mixed-method study embedded in a randomised clinical trial. BMC Med Inform Decis Mak 2016 Nov 9;16(1):142 [FREE Full text] [CrossRef] [Medline]162,Ray KN, Felmet KA, Hamilton MF, Kuza CC, Saladino RA, Schultz BR, et al. Clinician attitudes toward adoption of pediatric emergency telemedicine in rural hospitals. Pediatr Emerg Care 2017 Apr;33(4):250-257. [CrossRef] [Medline]168,Walker L, Clendon J. The case for end-user involvement in design of health technologies. J Telemed Telecare 2016 Dec;22(8):443-446. [CrossRef] [Medline]172,Bramley G, Mangan C, Conroy M. Using telemonitoring to support personal care planning for adults with learning disabilities. J Telemed Telecare 2019 Dec;25(10):602-610. [CrossRef] [Medline]176,Radhakrishnan K, Xie B, Berkley A, Kim M. Barriers and facilitators for sustainability of tele-homecare programs: a systematic review. Health Serv Res 2016 Feb;51(1):48-75 [FREE Full text] [CrossRef] [Medline]182,Koivunen M, Saranto K. Nursing professionals' experiences of the facilitators and barriers to the use of telehealth applications: a systematic review of qualitative studies. Scand J Caring Sci 2018 Mar;32(1):24-44. [CrossRef] [Medline]185,Kumar S, Merchant S, Reynolds R. Tele-ICU: efficacy and cost-effectiveness approach of remotely managing the critical care. Open Med Inform J 2013;7:24-29 [FREE Full text] [CrossRef] [Medline]186,Li L, Cotton A. A systematic review of nurses' perspectives toward the telemedicine intensive care unit: a basis for supporting its future implementation in China? Telemed J E Health 2019 May;25(5):343-350. [CrossRef] [Medline]188,Cunningham DL, Connors EH, Lever N, Stephan SH. Providers' perspectives: utilizing telepsychiatry in schools. Telemed J E Health 2013 Oct;19(10):794-799. [CrossRef] [Medline]194] |
| Technical skills, and experience (n=44) | Clinicians’ tech-savviness, and previous experience with technology or mHealtha | [Gagnon MP, Ngangue P, Payne-Gagnon J, Desmartis M. m-Health adoption by healthcare professionals: a systematic review. J Am Med Inform Assoc 2016 Jan;23(1):212-220. [CrossRef] [Medline]9,de Souza CH, Morbeck RA, Steinman M, Hors CP, Bracco MM, Kozasa EH, et al. Barriers and benefits in telemedicine arising between a high-technology hospital service provider and remote public healthcare units: a qualitative study in Brazil. Telemed J E Health 2017 Jun;23(6):527-532. [CrossRef] [Medline]37,Giraldo L, Schachner B, Luna D, Benítez S. Exploring nurses' perceptions and expectations toward a BCMA implementation using a mobile app and workstations as a change management strategy. Stud Health Technol Inform 2018;250:134-138. [Medline]44,Hanna L, May C, Fairhurst K. The place of information and communication technology-mediated consultations in primary care: GPs' perspectives. Fam Pract 2012 Jun;29(3):361-366. [CrossRef] [Medline]49,Kayyali R, Hesso I, Mahdi A, Hamzat O, Adu A, Nabhani Gebara S. Telehealth: misconceptions and experiences of healthcare professionals in England. Int J Pharm Pract 2017 Jun;25(3):203-209. [CrossRef] [Medline]55,Tintorer DL, Domínguez JM, Pujol-Rivera E, Beneyto SF, Tuduri XM, Saigí-Rubió F. Keys to success of a community of clinical practice in primary care: a qualitative evaluation of the ECOPIH project. BMC Fam Pract 2018 May 9;19(1):56 [FREE Full text] [CrossRef] [Medline]59-Lord S, Moore SK, Ramsey A, Dinauer S, Johnson K. Implementation of a substance use recovery support mobile phone app in community settings: qualitative study of clinician and staff perspectives of facilitators and barriers. JMIR Ment Health 2016 Jun 28;3(2):e24 [FREE Full text] [CrossRef] [Medline]61,Molfenter T, Boyle M, Holloway D, Zwick J. 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| Incentives (n=15) | Different means to incentivize clinicians | [Bhatta R, Aryal K, Ellingsen G. Opportunities and challenges of a rural-telemedicine program in Nepal. J Nepal Health Res Counc 2015;13(30):149-153. [Medline]4,Armstrong AW, Kwong MW, Ledo L, Nesbitt TS, Shewry SL. Practice models and challenges in teledermatology: a study of collective experiences from teledermatologists. PLoS One 2011;6(12):e28687 [FREE Full text] [CrossRef] [Medline]54,Tintorer DL, Domínguez JM, Pujol-Rivera E, Beneyto SF, Tuduri XM, Saigí-Rubió F. Keys to success of a community of clinical practice in primary care: a qualitative evaluation of the ECOPIH project. BMC Fam Pract 2018 May 9;19(1):56 [FREE Full text] [CrossRef] [Medline]59,Bello AK, Molzahn AE, Girard LP, Osman MA, Okpechi IG, Glassford J, et al. Patient and provider perspectives on the design and implementation of an electronic consultation system for kidney care delivery in Canada: a focus group study. BMJ Open 2017 Mar 2;7(3):e014784 [FREE Full text] [CrossRef] [Medline]87,Vest BM, Hall VM, Kahn LS, Heider AR, Maloney N, Singh R. Nurse perspectives on the implementation of routine telemonitoring for high-risk diabetes patients in a primary care setting. Prim Health Care Res Dev 2017 Jan;18(1):3-13. [CrossRef] [Medline]88,Adenuga KI, Iahad NA, Miskon S. Towards reinforcing telemedicine adoption amongst clinicians in Nigeria. Int J Med Inform 2017 Aug;104:84-96. [CrossRef] [Medline]106,Morilla MD, Sans M, Casasa A, Giménez N. Implementing technology in healthcare: insights from physicians. BMC Med Inform Decis Mak 2017 Jun 27;17(1):92 [FREE Full text] [CrossRef] [Medline]122,Rho MJ, Choi IY, Lee J. Predictive factors of telemedicine service acceptance and behavioral intention of physicians. Int J Med Inform 2014 Aug;83(8):559-571. [CrossRef] [Medline]129,Uscher-Pines L, Kahn JM. Barriers and facilitators to pediatric emergency telemedicine in the United States. Telemed J E Health 2014 Nov;20(11):990-996 [FREE Full text] [CrossRef] [Medline]141,Lapão LV, da Silva MM, Gregório J. Implementing an online pharmaceutical service using design science research. BMC Med Inform Decis Mak 2017 Mar 27;17(1):31 [FREE Full text] [CrossRef] [Medline]157,Orchard J, Lowres N, Freedman SB, Ladak L, Lee W, Zwar N, et al. Screening for atrial fibrillation during influenza vaccinations by primary care nurses using a smartphone electrocardiograph (iECG): A feasibility study. Eur J Prev Cardiol 2016 Oct;23(2 suppl):13-20. [CrossRef] [Medline]164,Ray KN, Felmet KA, Hamilton MF, Kuza CC, Saladino RA, Schultz BR, et al. Clinician attitudes toward adoption of pediatric emergency telemedicine in rural hospitals. Pediatr Emerg Care 2017 Apr;33(4):250-257. [CrossRef] [Medline]168,Zhang Y, Koch S. Mobile health apps in Sweden: what do physicians recommend? Stud Health Technol Inform 2015;210:793-797. [Medline]175,Jungwirth D, Haluza D. Information and communication technology and the future of healthcare: results of a multi-scenario Delphi survey. Health Informatics J 2019 Mar;25(1):161-173. [CrossRef] [Medline]191] |
| Career and knowledge expansion (n=13) | Impact on professional development and expertise | [MacNeill V, Sanders C, Fitzpatrick R, Hendy J, Barlow J, Knapp M, et al. Experiences of front-line health professionals in the delivery of telehealth: a qualitative study. Br J Gen Pract 2014 Jul;64(624):e401-e407 [FREE Full text] [CrossRef] [Medline]62,Öberg U, Orre CJ, Isaksson U, Schimmer R, Larsson H, Hörnsten Å. Swedish primary healthcare nurses' perceptions of using digital eHealth services in support of patient self-management. Scand J Caring Sci 2018 Jun;32(2):961-970. [CrossRef] [Medline]72-Rothstein JD, Jennings L, Moorthy A, Yang F, Gee L, Romano K, et al. Qualitative assessment of the feasibility, usability, and acceptability of a mobile client data app for community-based maternal, neonatal, and child care in rural Ghana. Int J Telemed Appl 2016;2016:2515420 [FREE Full text] [CrossRef] [Medline]74,Varsi C, Ekstedt M, Gammon D, Ruland CM. Using the consolidated framework for implementation research to identify barriers and facilitators for the implementation of an internet-based patient-provider communication service in five settings: a qualitative study. J Med Internet Res 2015 Nov 18;17(11):e262 [FREE Full text] [CrossRef] [Medline]86,O'Connor S, Andrews T. Smartphones and mobile applications (apps) in clinical nursing education: a student perspective. Nurse Educ Today 2018 Oct;69:172-178. [CrossRef] [Medline]124,Sadoughi F, Erfannia L, Sancholi M, Salmani F, Sarsarshahi A. Teleradiology in Southeast Iran: Evaluating the Views of Senior Executives and Radiologists. Health Care Manag (Frederick) 2017;36(3):301-307. [CrossRef] [Medline]131,Sims MH, Fagnano M, Halterman JS, Halterman MW. Provider impressions of the use of a mobile crowdsourcing app in medical practice. Health Informatics J 2016 Jun;22(2):221-231. [CrossRef] [Medline]137,Nerminathan A, Harrison A, Phelps M, Alexander S, Scott KM. Doctors' use of mobile devices in the clinical setting: a mixed methods study. Intern Med J 2017 Mar;47(3):291-298. [CrossRef] [Medline]161,Odnoletkova I, Buysse H, Nobels F, Goderis G, Aertgeerts B, Annemans L, et al. Patient and provider acceptance of telecoaching in type 2 diabetes: a mixed-method study embedded in a randomised clinical trial. BMC Med Inform Decis Mak 2016 Nov 9;16(1):142 [FREE Full text] [CrossRef] [Medline]162,Shaw RJ, Kaufman MA, Bosworth HB, Weiner BJ, Zullig LL, Lee SD, et al. Organizational factors associated with readiness to implement and translate a primary care based telemedicine behavioral program to improve blood pressure control: the HTN-IMPROVE study. Implement Sci 2013 Sep 8;8:106 [FREE Full text] [CrossRef] [Medline]169,Li L, Cotton A. A systematic review of nurses' perspectives toward the telemedicine intensive care unit: a basis for supporting its future implementation in China? Telemed J E Health 2019 May;25(5):343-350. [CrossRef] [Medline]188,Penny RA, Bradford NK, Langbecker D. Registered nurse and midwife experiences of using videoconferencing in practice: a systematic review of qualitative studies. J Clin Nurs 2018 Mar;27(5-6):e739-e752. [CrossRef] [Medline]189] |
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Other social and organizational factors included policy and regulations related to privacy or security or medico-legal issues (n=66) and the need for clearer guidelines or protocols or policies (n=44). Cultural and social factors also prevailed quite often and were mostly linked to perceptions and attitudes toward technology and mHealth (n=57), organizational culture and context (n=21), and endorsement or peer influence (n=21).
Monetary factors, such as funding or reimbursement or fees (n=51) and the tools’ cost (n=35), were also central, followed by the strength and quality of clinical evidence (n=22), lack of awareness and promotion (n=20), and user involvement in development and planning (n=12). Table 5 details the other social and organizational factors impacting adoption, their subthemes, occurrence, and the respective studies where they were identified.
| Factor and subthemes | References | |
| Policy and regulations | ||
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| Culture, attitude, and social influence | ||
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| Endorsement, peer influence, and key opinion leaders (n=21) | [Avey JP, Hobbs RL. Dial in: fostering the use of telebehavioral health services in frontier Alaska. Psychol Serv 2013 Aug;10(3):289-297. [CrossRef] [Medline]2,Gagnon MP, Ngangue P, Payne-Gagnon J, Desmartis M. m-Health adoption by healthcare professionals: a systematic review. J Am Med Inform Assoc 2016 Jan;23(1):212-220. [CrossRef] [Medline]9,de Vries ST, Wong L, Sutcliffe A, Houÿez F, Ruiz CL, Mol PG, IMI Web-RADR Work Package 3b Consortium. Factors influencing the use of a mobile app for reporting adverse drug reactions and receiving safety information: a qualitative study. Drug Saf 2017 May;40(5):443-455 [FREE Full text] [CrossRef] [Medline]38,James S, Perry L, Gallagher R, Lowe J. Diabetes educators: perceived experiences, supports and barriers to use of common diabetes-related technologies. J Diabetes Sci Technol 2016 Sep;10(5):1115-1121 [FREE Full text] [CrossRef] [Medline]51,Lord S, Moore SK, Ramsey A, Dinauer S, Johnson K. Implementation of a substance use recovery support mobile phone app in community settings: qualitative study of clinician and staff perspectives of facilitators and barriers. JMIR Ment Health 2016 Jun 28;3(2):e24 [FREE Full text] [CrossRef] [Medline]61,Molfenter T, Boyle M, Holloway D, Zwick J. Trends in telemedicine use in addiction treatment. Addict Sci Clin Pract 2015 May 28;10:14 [FREE Full text] [CrossRef] [Medline]67,Hao H, Padman R. An empirical study of opinion leader effects on mobile technology implementation by physicians in an American community health system. Health Informatics J 2018 Sep;24(3):323-333. [CrossRef] [Medline]99,Kifle M, Payton FC, Mbarika V, Meso P. Transfer and adoption of advanced information technology solutions in resource-poor environments: the case of telemedicine systems adoption in Ethiopia. Telemed J E Health 2010 Apr;16(3):327-343. [CrossRef] [Medline]105,Kuo KM, Talley PC, Lee C, Yen Y. The influence of telemedicine experience on physicians' perceptions regarding adoption. Telemed J E Health 2015 May;21(5):388-394. [CrossRef] [Medline]113,Okazaki S, Castañeda JA, Sanz S, Henseler J. Factors affecting mobile diabetes monitoring adoption among physicians: questionnaire study and path model. J Med Internet Res 2012 Dec 21;14(6):e183 [FREE Full text] [CrossRef] [Medline]125,El Amrani L, Engberink AO, Ninot G, Hayot M, Carbonnel F. Connected health devices for health care in French general medicine practice: cross-sectional study. JMIR Mhealth Uhealth 2017 Dec 21;5(12):e193 [FREE Full text] [CrossRef] [Medline]128,Saigi-Rubió F, Jiménez-Zarco A, Torrent-Sellens J. Determinants of the intention to use telemedicine: evidence from primary care physicians. Int J Technol Assess Health Care 2016 Jan;32(1-2):29-36. [CrossRef] [Medline]132,van Houwelingen CT, Barakat A, Best R, Boot WR, Charness N, Kort HS. Dutch nurses' willingness to use home telehealth: implications for practice and education. J Gerontol Nurs 2015 Apr;41(4):47-56. [CrossRef] [Medline]142,Zhang H, Cocosila M, Archer N. Factors of adoption of mobile information technology by homecare nurses: a technology acceptance model 2 approach. Comput Inform Nurs 2010;28(1):49-56. [CrossRef] [Medline]146,Nerminathan A, Harrison A, Phelps M, Alexander S, Scott KM. Doctors' use of mobile devices in the clinical setting: a mixed methods study. Intern Med J 2017 Mar;47(3):291-298. [CrossRef] [Medline]161,Bailey JV, Tomlinson N, Hobbs LJ, Webster R. Challenges and opportunities in evaluating a digital sexual health intervention in a clinic setting: Staff and patient views. Digit Health 2017;3:2055207617704272 [FREE Full text] [CrossRef] [Medline]163,Tahamtan I, Pajouhanfar S, Sedghi S, Azad M, Roudbari M. Factors affecting smartphone adoption for accessing information in medical settings. Health Info Libr J 2017 Jun;34(2):134-145. [CrossRef] [Medline]170,Zhang Y, Koch S. Mobile health apps in Sweden: what do physicians recommend? Stud Health Technol Inform 2015;210:793-797. [Medline]175,Ehrler F, Ducloux P, Wu DT, Lovis C, Blondon K. Acceptance of a mobile application supporting nurses workflow at patient bedside: results from a pilot study. Stud Health Technol Inform 2018;247:506-510. [Medline]181,Putzer GJ, Park Y. The effects of innovation factors on smartphone adoption among nurses in community hospitals. Perspect Health Inf Manag 2010 Jan 1;7:1b [FREE Full text] [Medline]196] | |
| Infringing into personal life (n=6) | [Han KJ, Subramanian R, Cameron GT. Listen before you leap: Sri Lankan health professionals' perspectives on m-health. Health Informatics J 2019 Sep;25(3):858-866. [CrossRef] [Medline]47,Bagot KL, Cadilhac DA, Bladin CF, Watkins CL, Vu M, Donnan GA, VSTASTUTE investigators. Integrating acute stroke telemedicine consultations into specialists' usual practice: a qualitative analysis comparing the experience of Australia and the United Kingdom. BMC Health Serv Res 2017 Nov 21;17(1):751 [FREE Full text] [CrossRef] [Medline]65,Schneider T, Panzera AD, Martinasek M, McDermott R, Couluris M, Lindenberger J, et al. Physicians' perceptions of mobile technology for enhancing asthma care for youth. J Child Health Care 2016 Jun;20(2):153-163. [CrossRef] [Medline]77,Nerminathan A, Harrison A, Phelps M, Alexander S, Scott KM. Doctors' use of mobile devices in the clinical setting: a mixed methods study. Intern Med J 2017 Mar;47(3):291-298. [CrossRef] [Medline]161,Li L, Cotton A. A systematic review of nurses' perspectives toward the telemedicine intensive care unit: a basis for supporting its future implementation in China? Telemed J E Health 2019 May;25(5):343-350. [CrossRef] [Medline]188,Daniel F, Jabak S, Sasso R, Chamoun Y, Tamim H. Patient-physician communication in the era of mobile phones and social media apps: cross-sectional observational study on Lebanese physicians' perceptions and attitudes. JMIR Med Inform 2018 Apr 6;6(2):e18 [FREE Full text] [CrossRef] [Medline]190] | |
| Monetary factors | ||
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| Tool’s cost (n=35) | [Armstrong AW, Kwong MW, Chase EP, Ledo L, Nesbitt TS, Shewry SL. Teledermatology operational considerations, challenges, and benefits: the referring providers' perspective. Telemed J E Health 2012 Oct;18(8):580-584. [CrossRef] [Medline]1,Avey JP, Hobbs RL. Dial in: fostering the use of telebehavioral health services in frontier Alaska. Psychol Serv 2013 Aug;10(3):289-297. [CrossRef] [Medline]2,Mileski M, Kruse CS, Catalani J, Haderer T. Adopting telemedicine for the self-management of hypertension: systematic review. JMIR Med Inform 2017 Oct 24;5(4):e41 [FREE Full text] [CrossRef] [Medline]5,Gagnon MP, Ngangue P, Payne-Gagnon J, Desmartis M. m-Health adoption by healthcare professionals: a systematic review. J Am Med Inform Assoc 2016 Jan;23(1):212-220. [CrossRef] [Medline]9,Catan G, Espanha R, Mendes RV, Toren O, Chinitz D. Health information technology implementation - impacts and policy considerations: a comparison between Israel and Portugal. 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Pain Med 2014 Feb;15(2):206-213 [FREE Full text] [CrossRef] [Medline]60,Lord S, Moore SK, Ramsey A, Dinauer S, Johnson K. Implementation of a substance use recovery support mobile phone app in community settings: qualitative study of clinician and staff perspectives of facilitators and barriers. JMIR Ment Health 2016 Jun 28;3(2):e24 [FREE Full text] [CrossRef] [Medline]61,McNally G, Frey R, Crossan M. Nurse manager and student nurse perceptions of the use of personal smartphones or tablets and the adjunct applications, as an educational tool in clinical settings. Nurse Educ Pract 2017 Mar;23:1-7. [CrossRef] [Medline]63,Merchant KA, Ward MM, Mueller KJ, Rural Health Research & Policy Centers, Rural Policy Research Institute‚ RUPRI Center for Rural Health Policy Analysis‚ University of Iowa College of Public Health‚ Department of Health Management and Policy. Hospital views of factors affecting telemedicine use. Rural Policy Brief 2015 Apr 1(2015 5):1-4. [Medline]64,Molfenter T, Boyle M, Holloway D, Zwick J. Trends in telemedicine use in addiction treatment. Addict Sci Clin Pract 2015 May 28;10:14 [FREE Full text] [CrossRef] [Medline]67,Puszka S, Dingwall KM, Sweet M, Nagel T. E-Mental health innovations for aboriginal and Torres Strait Islander Australians: a qualitative study of implementation needs in health services. JMIR Ment Health 2016 Sep 19;3(3):e43 [FREE Full text] [CrossRef] [Medline]73,Seto E, Leonard KJ, Cafazzo JA, Barnsley J, Masino C, Ross HJ. Perceptions and experiences of heart failure patients and clinicians on the use of mobile phone-based telemonitoring. J Med Internet Res 2012 Feb 10;14(1):e25 [FREE Full text] [CrossRef] [Medline]78,van Gaalen JL, van Bodegom-Vos L, Bakker MJ, Snoeck-Stroband JB, Sont JK. Internet-based self-management support for adults with asthma: a qualitative study among patients, general practitioners and practice nurses on barriers to implementation. BMJ Open 2016 Aug 26;6(8):e010809 [FREE Full text] [CrossRef] [Medline]84,Zilliacus E, Meiser B, Lobb E, Dudding TE, Barlow-Stewart K, Tucker K. The virtual consultation: practitioners' experiences of genetic counseling by videoconferencing in Australia. Telemed J E Health 2010 Apr;16(3):350-357. [CrossRef] [Medline]91,Ghani MK, Jaber MM. Willingness to adopt telemedicine in major iraqi hospitals: a pilot study. Int J Telemed Appl 2015;2015:136591 [FREE Full text] [CrossRef] [Medline]95,Koval PG, Kim JJ, Makhlouf T. Pharmacist perception of a mobile application audience response system for remote pharmacy continuing education participants. J Pharm Pract 2018 Aug 13:897190018792391. [CrossRef] [Medline]110,Lee SI, Park H, Kim JW, Hwang H, Cho EY, Kim Y, et al. Physicians' perceptions and use of a health information exchange: a pilot program in South Korea. Telemed J E Health 2012 Oct;18(8):604-612 [FREE Full text] [CrossRef] [Medline]114,Moskowitz A, Chan YY, Bruns J, Levine SR. Emergency physician and stroke specialist beliefs and expectations regarding telestroke. Stroke 2010 Apr;41(4):805-809 [FREE Full text] [CrossRef] [Medline]123,Rogove HJ, McArthur D, Demaerschalk BM, Vespa PM. Barriers to telemedicine: survey of current users in acute care units. Telemed J E Health 2012;18(1):48-53. [CrossRef] [Medline]130-Saigi-Rubió F, Jiménez-Zarco A, Torrent-Sellens J. Determinants of the intention to use telemedicine: evidence from primary care physicians. Int J Technol Assess Health Care 2016 Jan;32(1-2):29-36. [CrossRef] [Medline]132,van Houwelingen CT, Barakat A, Best R, Boot WR, Charness N, Kort HS. Dutch nurses' willingness to use home telehealth: implications for practice and education. J Gerontol Nurs 2015 Apr;41(4):47-56. [CrossRef] [Medline]142, Yaman H, Yavuz E, Er A, Vural R, Albayrak Y, Yardimci A, et al. The use of mobile smart devices and medical apps in the family practice setting. J Eval Clin Pract 2016 Apr;22(2):290-296. [CrossRef] [Medline]144,Ayatollahi H, Mirani N, Nazari F, Razavi N. Iranian healthcare professionals' perspectives about factors influencing the use of telemedicine in diabetes management. World J Diabetes 2018 Jun 15;9(6):92-98 [FREE Full text] [CrossRef] [Medline]147,Loh P, Flicker L, Horner B. Attitudes toward information and communication technology (ICT) in residential aged care in Western Australia. J Am Med Dir Assoc 2009 Jul;10(6):408-413. [CrossRef] [Medline]156,Mueller KJ, Potter AJ, MacKinney AC, Ward MM. Lessons from tele-emergency: improving care quality and health outcomes by expanding support for rural care systems. Health Aff (Millwood) 2014 Feb;33(2):228-234. [CrossRef] [Medline]159,Brown W, Giguere R, Sheinfil A, Ibitoye M, Balan I, Ho T, et al. Challenges and solutions implementing an SMS text message-based survey CASI and adherence reminders in an international biomedical HIV PrEP study (MTN 017). J Biomed Inform 2018 Apr;80:78-86 [FREE Full text] [CrossRef] [Medline]177,Radhakrishnan K, Xie B, Berkley A, Kim M. Barriers and facilitators for sustainability of tele-homecare programs: a systematic review. Health Serv Res 2016 Feb;51(1):48-75 [FREE Full text] [CrossRef] [Medline]182,Jungwirth D, Haluza D. Information and communication technology and the future of healthcare: results of a multi-scenario Delphi survey. Health Informatics J 2019 Mar;25(1):161-173. [CrossRef] [Medline]191] | |
| Evidence base | ||
| Strength and quality of clinical evidence (n=22) | [Mileski M, Kruse CS, Catalani J, Haderer T. Adopting telemedicine for the self-management of hypertension: systematic review. JMIR Med Inform 2017 Oct 24;5(4):e41 [FREE Full text] [CrossRef] [Medline]5,Flynn D, Gregory P, Makki H, Gabbay M. Expectations and experiences of eHealth in primary care: a qualitative practice-based investigation. Int J Med Inform 2009 Sep;78(9):588-604. [CrossRef] [Medline]43,Kayyali R, Hesso I, Mahdi A, Hamzat O, Adu A, Nabhani Gebara S. Telehealth: misconceptions and experiences of healthcare professionals in England. Int J Pharm Pract 2017 Jun;25(3):203-209. [CrossRef] [Medline]55,Levine M, Richardson JE, Granieri E, Reid MC. Novel telemedicine technologies in geriatric chronic non-cancer pain: primary care providers' perspectives. Pain Med 2014 Feb;15(2):206-213 [FREE Full text] [CrossRef] [Medline]60,Molfenter T, Boyle M, Holloway D, Zwick J. Trends in telemedicine use in addiction treatment. Addict Sci Clin Pract 2015 May 28;10:14 [FREE Full text] [CrossRef] [Medline]67,Moloczij N, Mosley I, Moss KM, Bagot KL, Bladin CF, Cadilhac DA. Is telemedicine helping or hindering the delivery of stroke thrombolysis in rural areas? A qualitative analysis. Intern Med J 2015 Sep;45(9):957-964. [CrossRef] [Medline]69,Morrow S, Daines L, Wiener-Ogilvie S, Steed L, McKee L, Caress A, et al. Exploring the perspectives of clinical professionals and support staff on implementing supported self-management for asthma in UK general practice: an IMPART qualitative study. NPJ Prim Care Respir Med 2017 Jul 18;27(1):45 [FREE Full text] [CrossRef] [Medline]70,Puszka S, Dingwall KM, Sweet M, Nagel T. E-Mental health innovations for aboriginal and Torres Strait Islander Australians: a qualitative study of implementation needs in health services. JMIR Ment Health 2016 Sep 19;3(3):e43 [FREE Full text] [CrossRef] [Medline]73,van Gaalen JL, van Bodegom-Vos L, Bakker MJ, Snoeck-Stroband JB, Sont JK. Internet-based self-management support for adults with asthma: a qualitative study among patients, general practitioners and practice nurses on barriers to implementation. BMJ Open 2016 Aug 26;6(8):e010809 [FREE Full text] [CrossRef] [Medline]84,Varsi C, Ekstedt M, Gammon D, Børøsund E, Ruland CM. Middle managers' experiences and role in implementing an interactive tailored patient assessment eHealth intervention in clinical practice. Comput Inform Nurs 2015;33(6):249-257. [CrossRef] [Medline]85,Wilhelmsen M, Høifødt RS, Kolstrup N, Waterloo K, Eisemann M, Chenhall R, et al. Norwegian general practitioners' perspectives on implementation of a guided web-based cognitive behavioral therapy for depression: a qualitative study. J Med Internet Res 2014 Sep 10;16(9):e208 [FREE Full text] [CrossRef] [Medline]89,Klack L, Ziefle M, Wilkowska W, Kluge J. Telemedical versus conventional heart patient monitoring: a survey study with German physicians. Int J Technol Assess Health Care 2013 Oct;29(4):378-383. [CrossRef] [Medline]108,Kleinpell R, Barden C, Rincon T, McCarthy M, Rufo RJ. Assessing the impact of telemedicine on nursing care in intensive care units. Am J Crit Care 2016 Jan;25(1):e14-e20. [CrossRef] [Medline]109,L'Esperance ST, Perry DJ. Assessing advantages and barriers to telemedicine adoption in the practice setting: A MyCareTeam(TM) exemplar. J Am Assoc Nurse Pract 2016 Jun;28(6):311-319. [CrossRef] [Medline]115,Jeon J, Taneva S, Kukreti V, Trbovich P, Easty AC, Rossos PG, et al. Toward successful migration to computerized physician order entry for chemotherapy. Curr Oncol 2014 Apr;21(2):e221-e228 [FREE Full text] [CrossRef] [Medline]155,Mueller KJ, Potter AJ, MacKinney AC, Ward MM. Lessons from tele-emergency: improving care quality and health outcomes by expanding support for rural care systems. Health Aff (Millwood) 2014 Feb;33(2):228-234. [CrossRef] [Medline]159,Muigg D, Kastner P, Modre-Osprian R, Haluza D, Duftschmid G. Is Austria ready for telemonitoring? A readiness assessment among doctors and patients in the field of diabetes. Stud Health Technol Inform 2018;248:322-329. [Medline]160,Odnoletkova I, Buysse H, Nobels F, Goderis G, Aertgeerts B, Annemans L, et al. Patient and provider acceptance of telecoaching in type 2 diabetes: a mixed-method study embedded in a randomised clinical trial. BMC Med Inform Decis Mak 2016 Nov 9;16(1):142 [FREE Full text] [CrossRef] [Medline]162,Shaw RJ, Kaufman MA, Bosworth HB, Weiner BJ, Zullig LL, Lee SD, et al. Organizational factors associated with readiness to implement and translate a primary care based telemedicine behavioral program to improve blood pressure control: the HTN-IMPROVE study. Implement Sci 2013 Sep 8;8:106 [FREE Full text] [CrossRef] [Medline]169,Zhang Y, Koch S. Mobile health apps in Sweden: what do physicians recommend? Stud Health Technol Inform 2015;210:793-797. [Medline]175,Kumar S, Merchant S, Reynolds R. Tele-ICU: efficacy and cost-effectiveness approach of remotely managing the critical care. Open Med Inform J 2013;7:24-29 [FREE Full text] [CrossRef] [Medline]186,Li L, Cotton A. A systematic review of nurses' perspectives toward the telemedicine intensive care unit: a basis for supporting its future implementation in China? Telemed J E Health 2019 May;25(5):343-350. [CrossRef] [Medline]188] | |
| Awareness | ||
| Lack of awareness and promotion (n=20) | [Avey JP, Hobbs RL. Dial in: fostering the use of telebehavioral health services in frontier Alaska. Psychol Serv 2013 Aug;10(3):289-297. [CrossRef] [Medline]2,Gagnon MP, Ngangue P, Payne-Gagnon J, Desmartis M. m-Health adoption by healthcare professionals: a systematic review. J Am Med Inform Assoc 2016 Jan;23(1):212-220. [CrossRef] [Medline]9,de Vries ST, Wong L, Sutcliffe A, Houÿez F, Ruiz CL, Mol PG, IMI Web-RADR Work Package 3b Consortium. Factors influencing the use of a mobile app for reporting adverse drug reactions and receiving safety information: a qualitative study. Drug Saf 2017 May;40(5):443-455 [FREE Full text] [CrossRef] [Medline]38,Flynn D, Gregory P, Makki H, Gabbay M. Expectations and experiences of eHealth in primary care: a qualitative practice-based investigation. Int J Med Inform 2009 Sep;78(9):588-604. [CrossRef] [Medline]43,Kayyali R, Hesso I, Mahdi A, Hamzat O, Adu A, Nabhani Gebara S. Telehealth: misconceptions and experiences of healthcare professionals in England. Int J Pharm Pract 2017 Jun;25(3):203-209. [CrossRef] [Medline]55,Khan NU, Rasheed S, Sharmin T, Ahmed T, Mahmood SS, Khatun F, et al. Experience of using mHealth to link village doctors with physicians: lessons from Chakaria, Bangladesh. BMC Med Inform Decis Mak 2015 Aug 5;15:62 [FREE Full text] [CrossRef] [Medline]56,Lord S, Moore SK, Ramsey A, Dinauer S, Johnson K. Implementation of a substance use recovery support mobile phone app in community settings: qualitative study of clinician and staff perspectives of facilitators and barriers. JMIR Ment Health 2016 Jun 28;3(2):e24 [FREE Full text] [CrossRef] [Medline]61,Puszka S, Dingwall KM, Sweet M, Nagel T. E-Mental health innovations for aboriginal and Torres Strait Islander Australians: a qualitative study of implementation needs in health services. JMIR Ment Health 2016 Sep 19;3(3):e43 [FREE Full text] [CrossRef] [Medline]73,Wilhelmsen M, Høifødt RS, Kolstrup N, Waterloo K, Eisemann M, Chenhall R, et al. Norwegian general practitioners' perspectives on implementation of a guided web-based cognitive behavioral therapy for depression: a qualitative study. J Med Internet Res 2014 Sep 10;16(9):e208 [FREE Full text] [CrossRef] [Medline]89,Miller KE, Kuhn E, Owen JE, Taylor K, Yu JS, Weiss BJ, et al. Clinician perceptions related to the use of the CBT-I Coach Mobile App. Behav Sleep Med 2019;17(4):481-491. [CrossRef] [Medline]120,Sadoughi F, Erfannia L, Sancholi M, Salmani F, Sarsarshahi A. Teleradiology in Southeast Iran: Evaluating the Views of Senior Executives and Radiologists. Health Care Manag (Frederick) 2017;36(3):301-307. [CrossRef] [Medline]131,Smith PB, Buzi RS. Reproductive health professionals' adoption of emerging technologies for health promotion. Health Informatics J 2014 Dec;20(4):250-260. [CrossRef] [Medline]138,Dünnebeil S, Sunyaev A, Blohm I, Leimeister JM, Krcmar H. Determinants of physicians' technology acceptance for e-health in ambulatory care. Int J Med Inform 2012 Nov;81(11):746-760. [CrossRef] [Medline]149-Alajlani M, Clarke M. Effect of culture on acceptance of telemedicine in Middle Eastern countries: case study of Jordan and Syria. Telemed J E Health 2013 Apr;19(4):305-311. [CrossRef] [Medline]151,Loh P, Flicker L, Horner B. Attitudes toward information and communication technology (ICT) in residential aged care in Western Australia. J Am Med Dir Assoc 2009 Jul;10(6):408-413. [CrossRef] [Medline]156,Ray KN, Felmet KA, Hamilton MF, Kuza CC, Saladino RA, Schultz BR, et al. Clinician attitudes toward adoption of pediatric emergency telemedicine in rural hospitals. Pediatr Emerg Care 2017 Apr;33(4):250-257. [CrossRef] [Medline]168,Zhang Y, Koch S. Mobile health apps in Sweden: what do physicians recommend? Stud Health Technol Inform 2015;210:793-797. [Medline]175,Cox A, Illsley M, Knibb W, Lucas C, O'Driscoll M, Potter C, et al. The acceptability of e-technology to monitor and assess patient symptoms following palliative radiotherapy for lung cancer. Palliat Med 2011 Oct;25(7):675-681. [CrossRef] [Medline]180,Radhakrishnan K, Xie B, Berkley A, Kim M. Barriers and facilitators for sustainability of tele-homecare programs: a systematic review. Health Serv Res 2016 Feb;51(1):48-75 [FREE Full text] [CrossRef] [Medline]182] | |
| User engagement | ||
| Involvement in development and planning (n=12) | [Brewster L, Mountain G, Wessels B, Kelly C, Hawley M. Factors affecting front line staff acceptance of telehealth technologies: a mixed-method systematic review. J Adv Nurs 2014 Jan;70(1):21-33. [CrossRef] [Medline]10,de Vries ST, Wong L, Sutcliffe A, Houÿez F, Ruiz CL, Mol PG, IMI Web-RADR Work Package 3b Consortium. Factors influencing the use of a mobile app for reporting adverse drug reactions and receiving safety information: a qualitative study. Drug Saf 2017 May;40(5):443-455 [FREE Full text] [CrossRef] [Medline]38,Jarvis-Selinger S, Bates J, Araki Y, Lear SA. Internet-based support for cardiovascular disease management. Int J Telemed Appl 2011;2011:342582 [FREE Full text] [CrossRef] [Medline]52,Lord S, Moore SK, Ramsey A, Dinauer S, Johnson K. Implementation of a substance use recovery support mobile phone app in community settings: qualitative study of clinician and staff perspectives of facilitators and barriers. JMIR Ment Health 2016 Jun 28;3(2):e24 [FREE Full text] [CrossRef] [Medline]61,Molleda L, Bahamon M, St George SM, Perrino T, Estrada Y, Herrera DC, et al. Clinic personnel, facilitator, and parent perspectives of eHealth Familias Unidas in primary care. J Pediatr Health Care 2017;31(3):350-361 [FREE Full text] [CrossRef] [Medline]68,Öberg U, Orre CJ, Isaksson U, Schimmer R, Larsson H, Hörnsten Å. Swedish primary healthcare nurses' perceptions of using digital eHealth services in support of patient self-management. Scand J Caring Sci 2018 Jun;32(2):961-970. [CrossRef] [Medline]72,Varsi C, Ekstedt M, Gammon D, Ruland CM. Using the consolidated framework for implementation research to identify barriers and facilitators for the implementation of an internet-based patient-provider communication service in five settings: a qualitative study. J Med Internet Res 2015 Nov 18;17(11):e262 [FREE Full text] [CrossRef] [Medline]86,Schmeer R, Behrends M, Kupka T, Meyenburg-Altwarg I, Marschollek M. Use and acceptance of mobile technology by hospital nurses in Germany. Stud Health Technol Inform 2016;225:944-945. [Medline]135,Shaw RJ, Kaufman MA, Bosworth HB, Weiner BJ, Zullig LL, Lee SD, et al. Organizational factors associated with readiness to implement and translate a primary care based telemedicine behavioral program to improve blood pressure control: the HTN-IMPROVE study. Implement Sci 2013 Sep 8;8:106 [FREE Full text] [CrossRef] [Medline]169,Walker L, Clendon J. The case for end-user involvement in design of health technologies. J Telemed Telecare 2016 Dec;22(8):443-446. [CrossRef] [Medline]172,Radhakrishnan K, Xie B, Berkley A, Kim M. Barriers and facilitators for sustainability of tele-homecare programs: a systematic review. Health Serv Res 2016 Feb;51(1):48-75 [FREE Full text] [CrossRef] [Medline]182,Davis MM, Freeman M, Kaye J, Vuckovic N, Buckley DI. A systematic review of clinician and staff views on the acceptability of incorporating remote monitoring technology into primary care. Telemed J E Health 2014 May;20(5):428-438 [FREE Full text] [CrossRef] [Medline]183] | |
amHealth: mobile health.
Discussion
The main findings of this review emphasize the principal factors impacting clinicians’ adoption of mHealth tools. Factors’ prevalence sheds light on the clear importance of social and organizational factors that go beyond the technical features, highlighting the importance of taking them into account during the development and deployment of these tools.
Technological Factors
Technical difficulties were the most cited technical barriers identified in the included articles. Studies reported technical difficulties and limitations in general, besides other issues, such as failing to update the system or testing and installation issues [Avey JP, Hobbs RL. Dial in: fostering the use of telebehavioral health services in frontier Alaska. Psychol Serv 2013 Aug;10(3):289-297. [CrossRef] [Medline]2,Brewster L, Mountain G, Wessels B, Kelly C, Hawley M. Factors affecting front line staff acceptance of telehealth technologies: a mixed-method systematic review. J Adv Nurs 2014 Jan;70(1):21-33. [CrossRef] [Medline]10,James S, Perry L, Gallagher R, Lowe J. Diabetes educators: perceived experiences, supports and barriers to use of common diabetes-related technologies. J Diabetes Sci Technol 2016 Sep;10(5):1115-1121 [FREE Full text] [CrossRef] [Medline]51], system errors [Rothstein JD, Jennings L, Moorthy A, Yang F, Gee L, Romano K, et al. Qualitative assessment of the feasibility, usability, and acceptability of a mobile client data app for community-based maternal, neonatal, and child care in rural Ghana. Int J Telemed Appl 2016;2016:2515420 [FREE Full text] [CrossRef] [Medline]74,Bailey JV, Tomlinson N, Hobbs LJ, Webster R. Challenges and opportunities in evaluating a digital sexual health intervention in a clinic setting: Staff and patient views. Digit Health 2017;3:2055207617704272 [FREE Full text] [CrossRef] [Medline]163], poor output quality (eg, poor images or video quality) [de Souza CH, Morbeck RA, Steinman M, Hors CP, Bracco MM, Kozasa EH, et al. Barriers and benefits in telemedicine arising between a high-technology hospital service provider and remote public healthcare units: a qualitative study in Brazil. Telemed J E Health 2017 Jun;23(6):527-532. [CrossRef] [Medline]37,Sturesson L, Groth K. Effects of the digital transformation: qualitative study on the disturbances and limitations of using video visits in outpatient care. J Med Internet Res 2018 Jun 27;20(6):e221 [FREE Full text] [CrossRef] [Medline]82,Zilliacus E, Meiser B, Lobb E, Dudding TE, Barlow-Stewart K, Tucker K. The virtual consultation: practitioners' experiences of genetic counseling by videoconferencing in Australia. Telemed J E Health 2010 Apr;16(3):350-357. [CrossRef] [Medline]91,Penny RA, Bradford NK, Langbecker D. Registered nurse and midwife experiences of using videoconferencing in practice: a systematic review of qualitative studies. J Clin Nurs 2018 Mar;27(5-6):e739-e752. [CrossRef] [Medline]189], login issues [Farrell M. Use of iPhones by nurses in an acute care setting to improve communication and decision-making processes: qualitative analysis of nurses' perspectives on iPhone use. JMIR Mhealth Uhealth 2016 May 31;4(2):e43 [FREE Full text] [CrossRef] [Medline]42,Varsi C, Ekstedt M, Gammon D, Ruland CM. Using the consolidated framework for implementation research to identify barriers and facilitators for the implementation of an internet-based patient-provider communication service in five settings: a qualitative study. J Med Internet Res 2015 Nov 18;17(11):e262 [FREE Full text] [CrossRef] [Medline]86,Duhm J, Fleischmann R, Schmidt S, Hupperts H, Brandt SA. Mobile electronic medical records promote workflow: physicians' perspective from a survey. JMIR Mhealth Uhealth 2016 Jun 6;4(2):e70 [FREE Full text] [CrossRef] [Medline]150,Walker L, Clendon J. The case for end-user involvement in design of health technologies. J Telemed Telecare 2016 Dec;22(8):443-446. [CrossRef] [Medline]172], and missing functionalities [Ehrler F, Ducloux P, Wu DT, Lovis C, Blondon K. Acceptance of a mobile application supporting nurses workflow at patient bedside: results from a pilot study. Stud Health Technol Inform 2018;247:506-510. [Medline]181]. It was reported that such issues sometimes impacted the recruitment of eligible participants [Bailey JV, Tomlinson N, Hobbs LJ, Webster R. Challenges and opportunities in evaluating a digital sexual health intervention in a clinic setting: Staff and patient views. Digit Health 2017;3:2055207617704272 [FREE Full text] [CrossRef] [Medline]163], created a feeling of frustration among users [Giraldo L, Schachner B, Luna D, Benítez S. Exploring nurses' perceptions and expectations toward a BCMA implementation using a mobile app and workstations as a change management strategy. Stud Health Technol Inform 2018;250:134-138. [Medline]44,Sandberg J, Trief PM, Izquierdo R, Goland R, Morin PC, Palmas W, et al. A qualitative study of the experiences and satisfaction of direct telemedicine providers in diabetes case management. Telemed J E Health 2009 Oct;15(8):742-750. [CrossRef] [Medline]75,Odnoletkova I, Buysse H, Nobels F, Goderis G, Aertgeerts B, Annemans L, et al. Patient and provider acceptance of telecoaching in type 2 diabetes: a mixed-method study embedded in a randomised clinical trial. BMC Med Inform Decis Mak 2016 Nov 9;16(1):142 [FREE Full text] [CrossRef] [Medline]162], or made the staff more reluctant to promote the tool, as it might not work properly [Flynn D, Gregory P, Makki H, Gabbay M. Expectations and experiences of eHealth in primary care: a qualitative practice-based investigation. Int J Med Inform 2009 Sep;78(9):588-604. [CrossRef] [Medline]43], and resulted in interruption of care [Sandberg J, Trief PM, Izquierdo R, Goland R, Morin PC, Palmas W, et al. A qualitative study of the experiences and satisfaction of direct telemedicine providers in diabetes case management. Telemed J E Health 2009 Oct;15(8):742-750. [CrossRef] [Medline]75,Wynn R, Bergvik S, Pettersen G, Fossum S. Clinicians' experiences with videoconferencing in psychiatry. Stud Health Technol Inform 2012;180:1218-1220. [Medline]90,Kleinpell R, Barden C, Rincon T, McCarthy M, Rufo RJ. Assessing the impact of telemedicine on nursing care in intensive care units. Am J Crit Care 2016 Jan;25(1):e14-e20. [CrossRef] [Medline]109,Li L, Cotton A. A systematic review of nurses' perspectives toward the telemedicine intensive care unit: a basis for supporting its future implementation in China? Telemed J E Health 2019 May;25(5):343-350. [CrossRef] [Medline]188].
Technical support availability and cooperation from the information technology (IT) department can also impact clinicians’ intention to use mHealth tools. Support is, moreover, expected to be available whenever a clinical shift is active such as during the night, weekends, and holidays [Giraldo L, Schachner B, Luna D, Benítez S. Exploring nurses' perceptions and expectations toward a BCMA implementation using a mobile app and workstations as a change management strategy. Stud Health Technol Inform 2018;250:134-138. [Medline]44]. The lack of technical support can create difficulties for the adoption, as clinical staff do not want to be expected to do the technical installation and troubleshooting themselves [Brewster L, Mountain G, Wessels B, Kelly C, Hawley M. Factors affecting front line staff acceptance of telehealth technologies: a mixed-method systematic review. J Adv Nurs 2014 Jan;70(1):21-33. [CrossRef] [Medline]10]. Some concerns were raised regarding outsourced offshore technical support models that were deemed impersonal and script-driven and not very useful [James S, Perry L, Gallagher R, Lowe J. Diabetes educators: perceived experiences, supports and barriers to use of common diabetes-related technologies. J Diabetes Sci Technol 2016 Sep;10(5):1115-1121 [FREE Full text] [CrossRef] [Medline]51]. Furthermore, IT departments in hospitals may not be fully prepared for supporting staff’s mobile phones when these are used to access mHealth tools [McNally G, Frey R, Crossan M. Nurse manager and student nurse perceptions of the use of personal smartphones or tablets and the adjunct applications, as an educational tool in clinical settings. Nurse Educ Pract 2017 Mar;23:1-7. [CrossRef] [Medline]63]. Although some studies reported staff’s satisfaction with the technical support offered to them, there were still some concerns about delayed delivery of the service because of lack of technical support staff [Odeh B, Kayyali R, Nabhani-Gebara S, Philip N. Implementing a telehealth service: nurses' perceptions and experiences. Br J Nurs 2014;23(21):1133-1137. [CrossRef] [Medline]71,Öberg U, Orre CJ, Isaksson U, Schimmer R, Larsson H, Hörnsten Å. Swedish primary healthcare nurses' perceptions of using digital eHealth services in support of patient self-management. Scand J Caring Sci 2018 Jun;32(2):961-970. [CrossRef] [Medline]72,Sharma U, Barnett J, Clarke M. Clinical users' perspective on telemonitoring of patients with long term conditions: understood through concepts of Giddens's structuration theory & consequence of modernity. Stud Health Technol Inform 2010;160(Pt 1):545-549. [Medline]79,Wynn R, Bergvik S, Pettersen G, Fossum S. Clinicians' experiences with videoconferencing in psychiatry. Stud Health Technol Inform 2012;180:1218-1220. [Medline]90].
System reliability can also cause challenges that affect clinicians’ intentions to use mHealth. System failures and malfunctions raised concern for staff [Chiang KF, Wang HH, Chien IK, Liou JK, Hung CL, Huang CM, et al. Healthcare providers' perceptions of barriers in implementing of home telecare in Taiwan: a qualitative study. Int J Med Inform 2015 Apr;84(4):277-287. [CrossRef] [Medline]35,Steinschaden T, Petersson G, Astrand B. Physicians' attitudes towards eprescribing: a comparative web survey in Austria and Sweden. Inform Prim Care 2009;17(4):241-248 [FREE Full text] [CrossRef] [Medline]140,Brown W, Giguere R, Sheinfil A, Ibitoye M, Balan I, Ho T, et al. Challenges and solutions implementing an SMS text message-based survey CASI and adherence reminders in an international biomedical HIV PrEP study (MTN 017). J Biomed Inform 2018 Apr;80:78-86 [FREE Full text] [CrossRef] [Medline]177], and clinicians who are skeptical about the reliability of the service might refrain from using it altogether [Kayyali R, Hesso I, Mahdi A, Hamzat O, Adu A, Nabhani Gebara S. Telehealth: misconceptions and experiences of healthcare professionals in England. Int J Pharm Pract 2017 Jun;25(3):203-209. [CrossRef] [Medline]55,Klack L, Ziefle M, Wilkowska W, Kluge J. Telemedical versus conventional heart patient monitoring: a survey study with German physicians. Int J Technol Assess Health Care 2013 Oct;29(4):378-383. [CrossRef] [Medline]108]. Users want to be sure that it will work in every emergency even when patients are using them on their own [Moloczij N, Mosley I, Moss KM, Bagot KL, Bladin CF, Cadilhac DA. Is telemedicine helping or hindering the delivery of stroke thrombolysis in rural areas? A qualitative analysis. Intern Med J 2015 Sep;45(9):957-964. [CrossRef] [Medline]69,Sharma U, Barnett J, Clarke M. Clinical users' perspective on telemonitoring of patients with long term conditions: understood through concepts of Giddens's structuration theory & consequence of modernity. Stud Health Technol Inform 2010;160(Pt 1):545-549. [Medline]79]. Similarly, poor signal connectivity linked to speed and quality of the connection can cause major usability issues making the use of such tools almost impossible [de Souza CH, Morbeck RA, Steinman M, Hors CP, Bracco MM, Kozasa EH, et al. Barriers and benefits in telemedicine arising between a high-technology hospital service provider and remote public healthcare units: a qualitative study in Brazil. Telemed J E Health 2017 Jun;23(6):527-532. [CrossRef] [Medline]37,Giraldo L, Schachner B, Luna D, Benítez S. Exploring nurses' perceptions and expectations toward a BCMA implementation using a mobile app and workstations as a change management strategy. Stud Health Technol Inform 2018;250:134-138. [Medline]44,Hines M, Lincoln M, Ramsden R, Martinovich J, Fairweather C. Speech pathologists' perspectives on transitioning to telepractice: what factors promote acceptance? J Telemed Telecare 2015 Dec;21(8):469-473. [CrossRef] [Medline]50,Ghani MK, Jaber MM. Willingness to adopt telemedicine in major iraqi hospitals: a pilot study. Int J Telemed Appl 2015;2015:136591 [FREE Full text] [CrossRef] [Medline]95,Ehrler F, Ducloux P, Wu DT, Lovis C, Blondon K. Acceptance of a mobile application supporting nurses workflow at patient bedside: results from a pilot study. Stud Health Technol Inform 2018;247:506-510. [Medline]181], hence diminishing the usefulness of the tool [Rothstein JD, Jennings L, Moorthy A, Yang F, Gee L, Romano K, et al. Qualitative assessment of the feasibility, usability, and acceptability of a mobile client data app for community-based maternal, neonatal, and child care in rural Ghana. Int J Telemed Appl 2016;2016:2515420 [FREE Full text] [CrossRef] [Medline]74] and resulting in frustration and reluctance to use the service [O'Connor S, Andrews T. Smartphones and mobile applications (apps) in clinical nursing education: a student perspective. Nurse Educ Today 2018 Oct;69:172-178. [CrossRef] [Medline]124,Iacono T, Dissanayake C, Trembath D, Hudry K, Erickson S, Spong J. Family and practitioner perspectives on telehealth for services to young children with autism. Stud Health Technol Inform 2016;231:63-73. [Medline]153]. An offline functionality whenever possible could help overcome such issue [de Vries ST, Wong L, Sutcliffe A, Houÿez F, Ruiz CL, Mol PG, IMI Web-RADR Work Package 3b Consortium. Factors influencing the use of a mobile app for reporting adverse drug reactions and receiving safety information: a qualitative study. Drug Saf 2017 May;40(5):443-455 [FREE Full text] [CrossRef] [Medline]38], although some clinicians did not perceive slow connections as a significant barrier [Molleda L, Bahamon M, St George SM, Perrino T, Estrada Y, Herrera DC, et al. Clinic personnel, facilitator, and parent perspectives of eHealth Familias Unidas in primary care. J Pediatr Health Care 2017;31(3):350-361 [FREE Full text] [CrossRef] [Medline]68,Rogove HJ, McArthur D, Demaerschalk BM, Vespa PM. Barriers to telemedicine: survey of current users in acute care units. Telemed J E Health 2012;18(1):48-53. [CrossRef] [Medline]130]. In some cases, clinical staff developed some work-around routines to overcome connectivity issues by printing the needed patient information, resulting in additional data security and privacy issues [Walker L, Clendon J. The case for end-user involvement in design of health technologies. J Telemed Telecare 2016 Dec;22(8):443-446. [CrossRef] [Medline]172].
Many of the included studies indicated that usefulness and perceived usefulness have a direct impact on the adoption and intention to use. Clinicians are more likely to use a tool when they understand its benefits [Catan G, Espanha R, Mendes RV, Toren O, Chinitz D. Health information technology implementation - impacts and policy considerations: a comparison between Israel and Portugal. Isr J Health Policy Res 2015;4:41 [FREE Full text] [CrossRef] [Medline]34,Seto E, Leonard KJ, Cafazzo JA, Barnsley J, Masino C, Ross HJ. Perceptions and experiences of heart failure patients and clinicians on the use of mobile phone-based telemonitoring. J Med Internet Res 2012 Feb 10;14(1):e25 [FREE Full text] [CrossRef] [Medline]78,Varsi C, Ekstedt M, Gammon D, Ruland CM. Using the consolidated framework for implementation research to identify barriers and facilitators for the implementation of an internet-based patient-provider communication service in five settings: a qualitative study. J Med Internet Res 2015 Nov 18;17(11):e262 [FREE Full text] [CrossRef] [Medline]86], when they find it useful for their daily work [Varsi C, Ekstedt M, Gammon D, Børøsund E, Ruland CM. Middle managers' experiences and role in implementing an interactive tailored patient assessment eHealth intervention in clinical practice. Comput Inform Nurs 2015;33(6):249-257. [CrossRef] [Medline]85,Wilhelmsen M, Høifødt RS, Kolstrup N, Waterloo K, Eisemann M, Chenhall R, et al. Norwegian general practitioners' perspectives on implementation of a guided web-based cognitive behavioral therapy for depression: a qualitative study. J Med Internet Res 2014 Sep 10;16(9):e208 [FREE Full text] [CrossRef] [Medline]89,Putzer GJ, Park Y. Are physicians likely to adopt emerging mobile technologies? Attitudes and innovation factors affecting smartphone use in the Southeastern United States. Perspect Health Inf Manag 2012;9:1b [FREE Full text] [Medline]127,Sandholzer M, Deutsch T, Frese T, Winter A. Predictors of students' self-reported adoption of a smartphone application for medical education in general practice. BMC Med Educ 2015 May 21;15:91 [FREE Full text] [CrossRef] [Medline]134,Zhang H, Cocosila M, Archer N. Factors of adoption of mobile information technology by homecare nurses: a technology acceptance model 2 approach. Comput Inform Nurs 2010;28(1):49-56. [CrossRef] [Medline]146,Duhm J, Fleischmann R, Schmidt S, Hupperts H, Brandt SA. Mobile electronic medical records promote workflow: physicians' perspective from a survey. JMIR Mhealth Uhealth 2016 Jun 6;4(2):e70 [FREE Full text] [CrossRef] [Medline]150,Charani E, Kyratsis Y, Lawson W, Wickens H, Brannigan ET, Moore LS, et al. An analysis of the development and implementation of a smartphone application for the delivery of antimicrobial prescribing policy: lessons learnt. J Antimicrob Chemother 2013 Apr;68(4):960-967 [FREE Full text] [CrossRef] [Medline]179], and in emergencies [Han KJ, Subramanian R, Cameron GT. Listen before you leap: Sri Lankan health professionals' perspectives on m-health. Health Informatics J 2019 Sep;25(3):858-866. [CrossRef] [Medline]47,Li L, Cotton A. A systematic review of nurses' perspectives toward the telemedicine intensive care unit: a basis for supporting its future implementation in China? Telemed J E Health 2019 May;25(5):343-350. [CrossRef] [Medline]188]; they would refrain from using it if they are skeptical about the value it brings to their clinical practice [Chiang KF, Wang HH, Chien IK, Liou JK, Hung CL, Huang CM, et al. Healthcare providers' perceptions of barriers in implementing of home telecare in Taiwan: a qualitative study. Int J Med Inform 2015 Apr;84(4):277-287. [CrossRef] [Medline]35,Levine M, Richardson JE, Granieri E, Reid MC. Novel telemedicine technologies in geriatric chronic non-cancer pain: primary care providers' perspectives. Pain Med 2014 Feb;15(2):206-213 [FREE Full text] [CrossRef] [Medline]60,Moloczij N, Mosley I, Moss KM, Bagot KL, Bladin CF, Cadilhac DA. Is telemedicine helping or hindering the delivery of stroke thrombolysis in rural areas? A qualitative analysis. Intern Med J 2015 Sep;45(9):957-964. [CrossRef] [Medline]69,van Gaalen JL, van Bodegom-Vos L, Bakker MJ, Snoeck-Stroband JB, Sont JK. Internet-based self-management support for adults with asthma: a qualitative study among patients, general practitioners and practice nurses on barriers to implementation. BMJ Open 2016 Aug 26;6(8):e010809 [FREE Full text] [CrossRef] [Medline]84,Klack L, Ziefle M, Wilkowska W, Kluge J. Telemedical versus conventional heart patient monitoring: a survey study with German physicians. Int J Technol Assess Health Care 2013 Oct;29(4):378-383. [CrossRef] [Medline]108,L'Esperance ST, Perry DJ. Assessing advantages and barriers to telemedicine adoption in the practice setting: A MyCareTeam(TM) exemplar. J Am Assoc Nurse Pract 2016 Jun;28(6):311-319. [CrossRef] [Medline]115,Uscher-Pines L, Kahn JM. Barriers and facilitators to pediatric emergency telemedicine in the United States. Telemed J E Health 2014 Nov;20(11):990-996 [FREE Full text] [CrossRef] [Medline]141,Iacono T, Dissanayake C, Trembath D, Hudry K, Erickson S, Spong J. Family and practitioner perspectives on telehealth for services to young children with autism. Stud Health Technol Inform 2016;231:63-73. [Medline]153,Loh P, Flicker L, Horner B. Attitudes toward information and communication technology (ICT) in residential aged care in Western Australia. J Am Med Dir Assoc 2009 Jul;10(6):408-413. [CrossRef] [Medline]156,Lygidakis C, Wallace P, Tersar C, Marcatto F, Ferrante D, Vedova RD, et al. Download Your Doctor: implementation of a digitally mediated personal physician presence to enhance patient engagement with a health-promoting internet application. JMIR Res Protoc 2016 Mar 4;5(1):e36 [FREE Full text] [CrossRef] [Medline]158], sometimes because of their lack of awareness of studies demonstrating effectiveness [Wynn R, Bergvik S, Pettersen G, Fossum S. Clinicians' experiences with videoconferencing in psychiatry. Stud Health Technol Inform 2012;180:1218-1220. [Medline]90]. Some studies noted that the positive perception of usefulness usually increases for clinicians that use such tools more frequently [Villalba-Mora E, Casas I, Lupiañez-Villanueva F, Maghiros I. Adoption of health information technologies by physicians for clinical practice: the Andalusian case. Int J Med Inform 2015 Jul;84(7):477-485. [CrossRef] [Medline]143].
Studies also linked perceived usefulness in many cases to ease of use and effort expectancy. mHealth tools should be very user-friendly and intuitive so that every clinician can use them easily, including those not comfortable with technology [Bhatta R, Aryal K, Ellingsen G. Opportunities and challenges of a rural-telemedicine program in Nepal. J Nepal Health Res Counc 2015;13(30):149-153. [Medline]4,Morrow S, Daines L, Wiener-Ogilvie S, Steed L, McKee L, Caress A, et al. Exploring the perspectives of clinical professionals and support staff on implementing supported self-management for asthma in UK general practice: an IMPART qualitative study. NPJ Prim Care Respir Med 2017 Jul 18;27(1):45 [FREE Full text] [CrossRef] [Medline]70,Puszka S, Dingwall KM, Sweet M, Nagel T. E-Mental health innovations for aboriginal and Torres Strait Islander Australians: a qualitative study of implementation needs in health services. JMIR Ment Health 2016 Sep 19;3(3):e43 [FREE Full text] [CrossRef] [Medline]73,Possemato K, Kuhn E, Johnson EM, Hoffman JE, Brooks E. Development and refinement of a clinician intervention to facilitate primary care patient use of the PTSD Coach app. Transl Behav Med 2017 Mar;7(1):116-126 [FREE Full text] [CrossRef] [Medline]166,Penny RA, Bradford NK, Langbecker D. Registered nurse and midwife experiences of using videoconferencing in practice: a systematic review of qualitative studies. J Clin Nurs 2018 Mar;27(5-6):e739-e752. [CrossRef] [Medline]189]; otherwise, they might be considered a waste of time [Öberg U, Orre CJ, Isaksson U, Schimmer R, Larsson H, Hörnsten Å. Swedish primary healthcare nurses' perceptions of using digital eHealth services in support of patient self-management. Scand J Caring Sci 2018 Jun;32(2):961-970. [CrossRef] [Medline]72,Loh P, Flicker L, Horner B. Attitudes toward information and communication technology (ICT) in residential aged care in Western Australia. J Am Med Dir Assoc 2009 Jul;10(6):408-413. [CrossRef] [Medline]156]. Although complex and unintuitive user interfaces are considered a clear barrier [Uscher-Pines L, Kahn JM. Barriers and facilitators to pediatric emergency telemedicine in the United States. Telemed J E Health 2014 Nov;20(11):990-996 [FREE Full text] [CrossRef] [Medline]141,Jeon J, Taneva S, Kukreti V, Trbovich P, Easty AC, Rossos PG, et al. Toward successful migration to computerized physician order entry for chemotherapy. Curr Oncol 2014 Apr;21(2):e221-e228 [FREE Full text] [CrossRef] [Medline]155], it was also noted that usability alone is not enough for user acceptance [Ehrler F, Ducloux P, Wu DT, Lovis C, Blondon K. Acceptance of a mobile application supporting nurses workflow at patient bedside: results from a pilot study. Stud Health Technol Inform 2018;247:506-510. [Medline]181]. This was sometimes explained by the specific context that clinicians operate in [Ray KN, Felmet KA, Hamilton MF, Kuza CC, Saladino RA, Schultz BR, et al. Clinician attitudes toward adoption of pediatric emergency telemedicine in rural hospitals. Pediatr Emerg Care 2017 Apr;33(4):250-257. [CrossRef] [Medline]168], so ease of use could be perceived as less important in underprivileged contexts where clinicians lack resources and are grateful for any tool that would help facilitate their professional duties [Kifle M, Payton FC, Mbarika V, Meso P. Transfer and adoption of advanced information technology solutions in resource-poor environments: the case of telemedicine systems adoption in Ethiopia. Telemed J E Health 2010 Apr;16(3):327-343. [CrossRef] [Medline]105].
The tools’ technical compatibility also plays a role in its acceptance. Clinicians have a positive attitude toward tools that integrate well with the other systems that they are using on a daily basis [Putzer GJ, Park Y. Are physicians likely to adopt emerging mobile technologies? Attitudes and innovation factors affecting smartphone use in the Southeastern United States. Perspect Health Inf Manag 2012;9:1b [FREE Full text] [Medline]127,Putzer GJ, Park Y. The effects of innovation factors on smartphone adoption among nurses in community hospitals. Perspect Health Inf Manag 2010 Jan 1;7:1b [FREE Full text] [Medline]196]. Interoperability issues can raise clear concerns when mHealth tools cannot be integrated into the hospital or clinic’s current systems [Bello AK, Molzahn AE, Girard LP, Osman MA, Okpechi IG, Glassford J, et al. Patient and provider perspectives on the design and implementation of an electronic consultation system for kidney care delivery in Canada: a focus group study. BMJ Open 2017 Mar 2;7(3):e014784 [FREE Full text] [CrossRef] [Medline]87,El Amrani L, Engberink AO, Ninot G, Hayot M, Carbonnel F. Connected health devices for health care in French general medicine practice: cross-sectional study. JMIR Mhealth Uhealth 2017 Dec 21;5(12):e193 [FREE Full text] [CrossRef] [Medline]128]. Similarly, the lack of electronic medical records (EMRs) or EHR integration can cause similar issues [Gagnon MP, Ngangue P, Payne-Gagnon J, Desmartis M. m-Health adoption by healthcare professionals: a systematic review. J Am Med Inform Assoc 2016 Jan;23(1):212-220. [CrossRef] [Medline]9,Davis MM, Freeman M, Kaye J, Vuckovic N, Buckley DI. A systematic review of clinician and staff views on the acceptability of incorporating remote monitoring technology into primary care. Telemed J E Health 2014 May;20(5):428-438 [FREE Full text] [CrossRef] [Medline]183]. This can create limitations in data integration and exchange [Catan G, Espanha R, Mendes RV, Toren O, Chinitz D. Health information technology implementation - impacts and policy considerations: a comparison between Israel and Portugal. Isr J Health Policy Res 2015;4:41 [FREE Full text] [CrossRef] [Medline]34,Chung C, Cook J, Bales E, Zia J, Munson SA. More than telemonitoring: health provider use and nonuse of life-log data in irritable bowel syndrome and weight management. J Med Internet Res 2015 Aug 21;17(8):e203 [FREE Full text] [CrossRef] [Medline]36,Loh P, Flicker L, Horner B. Attitudes toward information and communication technology (ICT) in residential aged care in Western Australia. J Am Med Dir Assoc 2009 Jul;10(6):408-413. [CrossRef] [Medline]156,Bidmead E, Marshall A. A case study of stakeholder perceptions of patient held records: the Patients Know Best (PKB) solution. Digit Health 2016;2:2055207616668431 [FREE Full text] [CrossRef] [Medline]174] and therefore create duplication of effort and increase workload [Morrow S, Daines L, Wiener-Ogilvie S, Steed L, McKee L, Caress A, et al. Exploring the perspectives of clinical professionals and support staff on implementing supported self-management for asthma in UK general practice: an IMPART qualitative study. NPJ Prim Care Respir Med 2017 Jul 18;27(1):45 [FREE Full text] [CrossRef] [Medline]70,Öberg U, Orre CJ, Isaksson U, Schimmer R, Larsson H, Hörnsten Å. Swedish primary healthcare nurses' perceptions of using digital eHealth services in support of patient self-management. Scand J Caring Sci 2018 Jun;32(2):961-970. [CrossRef] [Medline]72,Sharma U, Clarke M. Nurses' and community support workers' experience of telehealth: a longitudinal case study. BMC Health Serv Res 2014 Apr 10;14:164 [FREE Full text] [CrossRef] [Medline]80]. Some clinicians also raised the reliability of self-reported data and the importance of validating it in comparison to the data in the patient’s EMR to make informed decisions [Zhang Y, Koch S. Mobile health apps in Sweden: what do physicians recommend? Stud Health Technol Inform 2015;210:793-797. [Medline]175]. Conversely, a tool that integrates well with current systems would be highly appreciated as it would ensure that patient data is always up to date and would alleviate clinicians’ workload [de Vries ST, Wong L, Sutcliffe A, Houÿez F, Ruiz CL, Mol PG, IMI Web-RADR Work Package 3b Consortium. Factors influencing the use of a mobile app for reporting adverse drug reactions and receiving safety information: a qualitative study. Drug Saf 2017 May;40(5):443-455 [FREE Full text] [CrossRef] [Medline]38,Rho MJ, Choi IY, Lee J. Predictive factors of telemedicine service acceptance and behavioral intention of physicians. Int J Med Inform 2014 Aug;83(8):559-571. [CrossRef] [Medline]129].
Layout, interface, and culturally appropriate and patient-centered design came up as important influencing factors in several studies. The choice of design and color should be well informed; for example, bright colors should be avoided as they may cause seizures in people suffering from epilepsy [de Vries ST, Wong L, Sutcliffe A, Houÿez F, Ruiz CL, Mol PG, IMI Web-RADR Work Package 3b Consortium. Factors influencing the use of a mobile app for reporting adverse drug reactions and receiving safety information: a qualitative study. Drug Saf 2017 May;40(5):443-455 [FREE Full text] [CrossRef] [Medline]38]. Cluttered and unorganized displays impact adoption negatively [Taylor J, Coates L. Caring from a distance: the role of telehealth. Nurs Times 2015;111(28-29):18-20. [Medline]83,Jeon J, Taneva S, Kukreti V, Trbovich P, Easty AC, Rossos PG, et al. Toward successful migration to computerized physician order entry for chemotherapy. Curr Oncol 2014 Apr;21(2):e221-e228 [FREE Full text] [CrossRef] [Medline]155,Taylor A, Wade V, Morris G, Pech J, Rechter S, Kidd M, et al. Technology support to a telehealth in the home service: qualitative observations. J Telemed Telecare 2016 Jul;22(5):296-303. [CrossRef] [Medline]171]. Users should also be able to adapt design elements, such as font size, according to their own preference [de Vries ST, Wong L, Sutcliffe A, Houÿez F, Ruiz CL, Mol PG, IMI Web-RADR Work Package 3b Consortium. Factors influencing the use of a mobile app for reporting adverse drug reactions and receiving safety information: a qualitative study. Drug Saf 2017 May;40(5):443-455 [FREE Full text] [CrossRef] [Medline]38]. Customization and personalization should also go beyond design elements to include the type of information displayed according to the context and the needs of the individual users [O'Connor S, Andrews T. Smartphones and mobile applications (apps) in clinical nursing education: a student perspective. Nurse Educ Today 2018 Oct;69:172-178. [CrossRef] [Medline]124,Ehrler F, Ducloux P, Wu DT, Lovis C, Blondon K. Acceptance of a mobile application supporting nurses workflow at patient bedside: results from a pilot study. Stud Health Technol Inform 2018;247:506-510. [Medline]181]. Furthermore, clinicians are keen to see tools that can be customized to each patients’ clinical condition [Morrow S, Daines L, Wiener-Ogilvie S, Steed L, McKee L, Caress A, et al. Exploring the perspectives of clinical professionals and support staff on implementing supported self-management for asthma in UK general practice: an IMPART qualitative study. NPJ Prim Care Respir Med 2017 Jul 18;27(1):45 [FREE Full text] [CrossRef] [Medline]70,van Gaalen JL, van Bodegom-Vos L, Bakker MJ, Snoeck-Stroband JB, Sont JK. Internet-based self-management support for adults with asthma: a qualitative study among patients, general practitioners and practice nurses on barriers to implementation. BMJ Open 2016 Aug 26;6(8):e010809 [FREE Full text] [CrossRef] [Medline]84]. Concerns were raised regarding the gap that sometimes exists between the tools’ designers and users, hence the desire for the tools to be adaptable to the user needs, not the other way around [Öberg U, Orre CJ, Isaksson U, Schimmer R, Larsson H, Hörnsten Å. Swedish primary healthcare nurses' perceptions of using digital eHealth services in support of patient self-management. Scand J Caring Sci 2018 Jun;32(2):961-970. [CrossRef] [Medline]72].
The convenience and mobility of tools accessed via mobile phones were mostly seen as facilitators. They also have a positive impact on perceived usefulness and ease of use [Liu CF, Cheng TJ. Exploring critical factors influencing physicians' acceptance of mobile electronic medical records based on the dual-factor model: a validation in Taiwan. BMC Med Inform Decis Mak 2015 Feb 7;15:4 [FREE Full text] [CrossRef] [Medline]116] and can increase clinicians’ ability to offer care in a timely manner [Mileski M, Kruse CS, Catalani J, Haderer T. Adopting telemedicine for the self-management of hypertension: systematic review. JMIR Med Inform 2017 Oct 24;5(4):e41 [FREE Full text] [CrossRef] [Medline]5,Seto E, Leonard KJ, Cafazzo JA, Barnsley J, Masino C, Ross HJ. Perceptions and experiences of heart failure patients and clinicians on the use of mobile phone-based telemonitoring. J Med Internet Res 2012 Feb 10;14(1):e25 [FREE Full text] [CrossRef] [Medline]78]. The portability of mHealth tools enabling clinicians to access information and achieve tasks anytime and anywhere was highly valued [Puszka S, Dingwall KM, Sweet M, Nagel T. E-Mental health innovations for aboriginal and Torres Strait Islander Australians: a qualitative study of implementation needs in health services. JMIR Ment Health 2016 Sep 19;3(3):e43 [FREE Full text] [CrossRef] [Medline]73,Sadoughi F, Erfannia L, Sancholi M, Salmani F, Sarsarshahi A. Teleradiology in Southeast Iran: Evaluating the Views of Senior Executives and Radiologists. Health Care Manag (Frederick) 2017;36(3):301-307. [CrossRef] [Medline]131,Sezgin E, Özkan-Yildirim S, Yildirim S. Understanding the perception towards using mHealth applications in practice. Inf Dev 2018;34(2):182-200. [CrossRef]136,Nerminathan A, Harrison A, Phelps M, Alexander S, Scott KM. Doctors' use of mobile devices in the clinical setting: a mixed methods study. Intern Med J 2017 Mar;47(3):291-298. [CrossRef] [Medline]161,Odnoletkova I, Buysse H, Nobels F, Goderis G, Aertgeerts B, Annemans L, et al. Patient and provider acceptance of telecoaching in type 2 diabetes: a mixed-method study embedded in a randomised clinical trial. BMC Med Inform Decis Mak 2016 Nov 9;16(1):142 [FREE Full text] [CrossRef] [Medline]162]. Conversely, it was also reported that some users perceived the small size of the mobile screen as an inconvenience that could hinder adoption [Payne KF, Weeks L, Dunning P. A mixed methods pilot study to investigate the impact of a hospital-specific iPhone application (iTreat) within a British junior doctor cohort. Health Informatics J 2014 Mar;20(1):59-73. [CrossRef] [Medline]165].
Social and Organizational Factors: Workflow Related
Workflow-related factors were the most prominent in the studied articles, with 17 subthemes. Training came up in 80 articles, showing the central role it plays in making or breaking the success of mHealth tools. Several studies identified the impact that appropriate training programs could play in increasing clinicians’ intention to use such tools [Gagnon MP, Ngangue P, Payne-Gagnon J, Desmartis M. m-Health adoption by healthcare professionals: a systematic review. J Am Med Inform Assoc 2016 Jan;23(1):212-220. [CrossRef] [Medline]9,Gagnon MP, Orruño E, Asua J, Abdeljelil AB, Emparanza J. Using a modified technology acceptance model to evaluate healthcare professionals' adoption of a new telemonitoring system. Telemed J E Health 2012;18(1):54-59 [FREE Full text] [CrossRef] [Medline]97,Asua J, Orruño E, Reviriego E, Gagnon MP. Healthcare professional acceptance of telemonitoring for chronic care patients in primary care. BMC Med Inform Decis Mak 2012 Nov 30;12:139 [FREE Full text] [CrossRef] [Medline]139,Dünnebeil S, Sunyaev A, Blohm I, Leimeister JM, Krcmar H. Determinants of physicians' technology acceptance for e-health in ambulatory care. Int J Med Inform 2012 Nov;81(11):746-760. [CrossRef] [Medline]149,Charani E, Kyratsis Y, Lawson W, Wickens H, Brannigan ET, Moore LS, et al. An analysis of the development and implementation of a smartphone application for the delivery of antimicrobial prescribing policy: lessons learnt. J Antimicrob Chemother 2013 Apr;68(4):960-967 [FREE Full text] [CrossRef] [Medline]179].
Factors such as nonexistent, inadequate or insufficient training [Bhatta R, Aryal K, Ellingsen G. Opportunities and challenges of a rural-telemedicine program in Nepal. J Nepal Health Res Counc 2015;13(30):149-153. [Medline]4,Brewster L, Mountain G, Wessels B, Kelly C, Hawley M. Factors affecting front line staff acceptance of telehealth technologies: a mixed-method systematic review. J Adv Nurs 2014 Jan;70(1):21-33. [CrossRef] [Medline]10,Farrell M. Use of iPhones by nurses in an acute care setting to improve communication and decision-making processes: qualitative analysis of nurses' perspectives on iPhone use. JMIR Mhealth Uhealth 2016 May 31;4(2):e43 [FREE Full text] [CrossRef] [Medline]42,Öberg U, Orre CJ, Isaksson U, Schimmer R, Larsson H, Hörnsten Å. Swedish primary healthcare nurses' perceptions of using digital eHealth services in support of patient self-management. Scand J Caring Sci 2018 Jun;32(2):961-970. [CrossRef] [Medline]72,Sharma U, Clarke M. Nurses' and community support workers' experience of telehealth: a longitudinal case study. BMC Health Serv Res 2014 Apr 10;14:164 [FREE Full text] [CrossRef] [Medline]80,Alajlani M, Clarke M. Effect of culture on acceptance of telemedicine in Middle Eastern countries: case study of Jordan and Syria. Telemed J E Health 2013 Apr;19(4):305-311. [CrossRef] [Medline]151], lack of time to learn how to use the new tools [Sinclair C, Holloway K, Riley G, Auret K. Online mental health resources in rural Australia: clinician perceptions of acceptability. J Med Internet Res 2013 Sep 5;15(9):e193 [FREE Full text] [CrossRef] [Medline]81,Wilhelmsen M, Høifødt RS, Kolstrup N, Waterloo K, Eisemann M, Chenhall R, et al. Norwegian general practitioners' perspectives on implementation of a guided web-based cognitive behavioral therapy for depression: a qualitative study. J Med Internet Res 2014 Sep 10;16(9):e208 [FREE Full text] [CrossRef] [Medline]89,El Amrani L, Engberink AO, Ninot G, Hayot M, Carbonnel F. Connected health devices for health care in French general medicine practice: cross-sectional study. JMIR Mhealth Uhealth 2017 Dec 21;5(12):e193 [FREE Full text] [CrossRef] [Medline]128,Davis MM, Freeman M, Kaye J, Vuckovic N, Buckley DI. A systematic review of clinician and staff views on the acceptability of incorporating remote monitoring technology into primary care. Telemed J E Health 2014 May;20(5):428-438 [FREE Full text] [CrossRef] [Medline]183], resources required to ensure the sustainability of training programs [Puszka S, Dingwall KM, Sweet M, Nagel T. E-Mental health innovations for aboriginal and Torres Strait Islander Australians: a qualitative study of implementation needs in health services. JMIR Ment Health 2016 Sep 19;3(3):e43 [FREE Full text] [CrossRef] [Medline]73,Loh P, Flicker L, Horner B. Attitudes toward information and communication technology (ICT) in residential aged care in Western Australia. J Am Med Dir Assoc 2009 Jul;10(6):408-413. [CrossRef] [Medline]156], and training programs that focus solely on the technical side without addressing the workflow changes associated with mHealth use [Giraldo L, Schachner B, Luna D, Benítez S. Exploring nurses' perceptions and expectations toward a BCMA implementation using a mobile app and workstations as a change management strategy. Stud Health Technol Inform 2018;250:134-138. [Medline]44,Taylor J, Coates L. Caring from a distance: the role of telehealth. Nurs Times 2015;111(28-29):18-20. [Medline]83,Casey M, Shaw S, Swinglehurst D. Experiences with online consultation systems in primary care: case study of one early adopter site. Br J Gen Pract 2017 Nov;67(664):e736-e743 [FREE Full text] [CrossRef] [Medline]94,Kato NP, Johansson P, Okada I, de Vries AE, Kinugawa K, Strömberg A, et al. Heart failure telemonitoring in Japan and Sweden: a cross-sectional survey. J Med Internet Res 2015 Nov 13;17(11):e258 [FREE Full text] [CrossRef] [Medline]104,Penny RA, Bradford NK, Langbecker D. Registered nurse and midwife experiences of using videoconferencing in practice: a systematic review of qualitative studies. J Clin Nurs 2018 Mar;27(5-6):e739-e752. [CrossRef] [Medline]189,Cunningham DL, Connors EH, Lever N, Stephan SH. Providers' perspectives: utilizing telepsychiatry in schools. Telemed J E Health 2013 Oct;19(10):794-799. [CrossRef] [Medline]194] were among the most important training-related barriers. The significance of training is because of clinicians’ need to develop new skills to be able to benefit from mHealth tools and embed them properly in their work practice [Bagot KL, Cadilhac DA, Bladin CF, Watkins CL, Vu M, Donnan GA, VSTASTUTE investigators. Integrating acute stroke telemedicine consultations into specialists' usual practice: a qualitative analysis comparing the experience of Australia and the United Kingdom. BMC Health Serv Res 2017 Nov 21;17(1):751 [FREE Full text] [CrossRef] [Medline]65,Morrow S, Daines L, Wiener-Ogilvie S, Steed L, McKee L, Caress A, et al. Exploring the perspectives of clinical professionals and support staff on implementing supported self-management for asthma in UK general practice: an IMPART qualitative study. NPJ Prim Care Respir Med 2017 Jul 18;27(1):45 [FREE Full text] [CrossRef] [Medline]70,Schneider T, Panzera AD, Martinasek M, McDermott R, Couluris M, Lindenberger J, et al. Physicians' perceptions of mobile technology for enhancing asthma care for youth. J Child Health Care 2016 Jun;20(2):153-163. [CrossRef] [Medline]77,Carlisle K, Warren R. A qualitative case study of telehealth for in-home monitoring to support the management of type 2 diabetes. J Telemed Telecare 2013 Oct;19(7):372-375. [CrossRef] [Medline]92,Morilla MD, Sans M, Casasa A, Giménez N. Implementing technology in healthcare: insights from physicians. BMC Med Inform Decis Mak 2017 Jun 27;17(1):92 [FREE Full text] [CrossRef] [Medline]122,Jamu JT, Lowi-Jones H, Mitchell C. Just in time? Using QR codes for multi-professional learning in clinical practice. Nurse Educ Pract 2016 Jul;19:107-112. [CrossRef] [Medline]154]. Proper training also helps achieve the highest potential of such tools, given that research shows that clinicians sometimes do not benefit from all available features simply because they were not aware of them [Duhm J, Fleischmann R, Schmidt S, Hupperts H, Brandt SA. Mobile electronic medical records promote workflow: physicians' perspective from a survey. JMIR Mhealth Uhealth 2016 Jun 6;4(2):e70 [FREE Full text] [CrossRef] [Medline]150].
Factors related to workload and resource allocation were also central. Staff and resources availability and allocation were the main hurdle identified [Gagnon MP, Ngangue P, Payne-Gagnon J, Desmartis M. m-Health adoption by healthcare professionals: a systematic review. J Am Med Inform Assoc 2016 Jan;23(1):212-220. [CrossRef] [Medline]9,Catan G, Espanha R, Mendes RV, Toren O, Chinitz D. Health information technology implementation - impacts and policy considerations: a comparison between Israel and Portugal. Isr J Health Policy Res 2015;4:41 [FREE Full text] [CrossRef] [Medline]34,James S, Perry L, Gallagher R, Lowe J. Diabetes educators: perceived experiences, supports and barriers to use of common diabetes-related technologies. J Diabetes Sci Technol 2016 Sep;10(5):1115-1121 [FREE Full text] [CrossRef] [Medline]51,Kayyali R, Hesso I, Mahdi A, Hamzat O, Adu A, Nabhani Gebara S. Telehealth: misconceptions and experiences of healthcare professionals in England. Int J Pharm Pract 2017 Jun;25(3):203-209. [CrossRef] [Medline]55,Morrow S, Daines L, Wiener-Ogilvie S, Steed L, McKee L, Caress A, et al. Exploring the perspectives of clinical professionals and support staff on implementing supported self-management for asthma in UK general practice: an IMPART qualitative study. NPJ Prim Care Respir Med 2017 Jul 18;27(1):45 [FREE Full text] [CrossRef] [Medline]70,Varsi C, Ekstedt M, Gammon D, Børøsund E, Ruland CM. Middle managers' experiences and role in implementing an interactive tailored patient assessment eHealth intervention in clinical practice. Comput Inform Nurs 2015;33(6):249-257. [CrossRef] [Medline]85,Jetty A, Moore MA, Coffman M, Petterson S, Bazemore A. Rural family physicians are twice as likely to use telehealth as urban family physicians. Telemed J E Health 2018 Apr;24(4):268-276. [CrossRef] [Medline]102,Kato NP, Johansson P, Okada I, de Vries AE, Kinugawa K, Strömberg A, et al. Heart failure telemonitoring in Japan and Sweden: a cross-sectional survey. J Med Internet Res 2015 Nov 13;17(11):e258 [FREE Full text] [CrossRef] [Medline]104,Ariens LF, Schussler-Raymakers FM, Frima C, Flinterman A, Hamminga E, Arents BW, et al. Barriers and facilitators to eHealth use in daily practice: perspectives of patients and professionals in dermatology. J Med Internet Res 2017 Sep 5;19(9):e300 [FREE Full text] [CrossRef] [Medline]152, Ehrler F, Ducloux P, Wu DT, Lovis C, Blondon K. Acceptance of a mobile application supporting nurses workflow at patient bedside: results from a pilot study. Stud Health Technol Inform 2018;247:506-510. [Medline]181,Davis MM, Freeman M, Kaye J, Vuckovic N, Buckley DI. A systematic review of clinician and staff views on the acceptability of incorporating remote monitoring technology into primary care. Telemed J E Health 2014 May;20(5):428-438 [FREE Full text] [CrossRef] [Medline]183,Ahmad F, Norman C, O'Campo P. What is needed to implement a computer-assisted health risk assessment tool? An exploratory concept mapping study. BMC Med Inform Decis Mak 2012 Dec 19;12:149 [FREE Full text] [CrossRef] [Medline]192]. Adequate staffing is considered a prerequisite for successful adoption [Avey JP, Hobbs RL. Dial in: fostering the use of telebehavioral health services in frontier Alaska. Psychol Serv 2013 Aug;10(3):289-297. [CrossRef] [Medline]2,Lord S, Moore SK, Ramsey A, Dinauer S, Johnson K. Implementation of a substance use recovery support mobile phone app in community settings: qualitative study of clinician and staff perspectives of facilitators and barriers. JMIR Ment Health 2016 Jun 28;3(2):e24 [FREE Full text] [CrossRef] [Medline]61,Schneider T, Panzera AD, Martinasek M, McDermott R, Couluris M, Lindenberger J, et al. Physicians' perceptions of mobile technology for enhancing asthma care for youth. J Child Health Care 2016 Jun;20(2):153-163. [CrossRef] [Medline]77,Seto E, Leonard KJ, Cafazzo JA, Barnsley J, Masino C, Ross HJ. Perceptions and experiences of heart failure patients and clinicians on the use of mobile phone-based telemonitoring. J Med Internet Res 2012 Feb 10;14(1):e25 [FREE Full text] [CrossRef] [Medline]78,Carlisle K, Warren R. A qualitative case study of telehealth for in-home monitoring to support the management of type 2 diabetes. J Telemed Telecare 2013 Oct;19(7):372-375. [CrossRef] [Medline]92,Koivunen M, Saranto K. Nursing professionals' experiences of the facilitators and barriers to the use of telehealth applications: a systematic review of qualitative studies. Scand J Caring Sci 2018 Mar;32(1):24-44. [CrossRef] [Medline]185,Penny RA, Bradford NK, Langbecker D. Registered nurse and midwife experiences of using videoconferencing in practice: a systematic review of qualitative studies. J Clin Nurs 2018 Mar;27(5-6):e739-e752. [CrossRef] [Medline]189]. Some studies acknowledged that mHealth caused an increase in workload [Bhatta R, Aryal K, Ellingsen G. Opportunities and challenges of a rural-telemedicine program in Nepal. J Nepal Health Res Counc 2015;13(30):149-153. [Medline]4,Fairbrother P, Ure J, Hanley J, McCloughan L, Denvir M, Sheikh A, Telescot programme team. Telemonitoring for chronic heart failure: the views of patients and healthcare professionals - a qualitative study. J Clin Nurs 2014 Jan;23(1-2):132-144. [CrossRef] [Medline]41,Bishop TF, Press MJ, Mendelsohn JL, Casalino LP. Electronic communication improves access, but barriers to its widespread adoption remain. Health Aff (Millwood) 2013 Aug;32(8):1361-1367 [FREE Full text] [CrossRef] [Medline]195] mostly because of double data entry caused by lack of integration and interoperability [Chiang KF, Wang HH, Chien IK, Liou JK, Hung CL, Huang CM, et al. Healthcare providers' perceptions of barriers in implementing of home telecare in Taiwan: a qualitative study. Int J Med Inform 2015 Apr;84(4):277-287. [CrossRef] [Medline]35,Öberg U, Orre CJ, Isaksson U, Schimmer R, Larsson H, Hörnsten Å. Swedish primary healthcare nurses' perceptions of using digital eHealth services in support of patient self-management. Scand J Caring Sci 2018 Jun;32(2):961-970. [CrossRef] [Medline]72,Walker L, Clendon J. The case for end-user involvement in design of health technologies. J Telemed Telecare 2016 Dec;22(8):443-446. [CrossRef] [Medline]172], adjustment to new responsibilities and ways of working [Hanley J, Ure J, Pagliari C, Sheikh A, McKinstry B. Experiences of patients and professionals participating in the HITS home blood pressure telemonitoring trial: a qualitative study. BMJ Open 2013 May 28;3(5):pii: e002671 [FREE Full text] [CrossRef] [Medline]48,Sharma U, Barnett J, Clarke M. Clinical users' perspective on telemonitoring of patients with long term conditions: understood through concepts of Giddens's structuration theory & consequence of modernity. Stud Health Technol Inform 2010;160(Pt 1):545-549. [Medline]79,Sharma U, Clarke M. Nurses' and community support workers' experience of telehealth: a longitudinal case study. BMC Health Serv Res 2014 Apr 10;14:164 [FREE Full text] [CrossRef] [Medline]80], and poor workflow adaptability [Radhakrishnan K, Xie B, Berkley A, Kim M. Barriers and facilitators for sustainability of tele-homecare programs: a systematic review. Health Serv Res 2016 Feb;51(1):48-75 [FREE Full text] [CrossRef] [Medline]182]. Moreover, clinicians may refrain from adopting the tools altogether if they believe that they would increase their workload [Mileski M, Kruse CS, Catalani J, Haderer T. Adopting telemedicine for the self-management of hypertension: systematic review. JMIR Med Inform 2017 Oct 24;5(4):e41 [FREE Full text] [CrossRef] [Medline]5,de Souza CH, Morbeck RA, Steinman M, Hors CP, Bracco MM, Kozasa EH, et al. Barriers and benefits in telemedicine arising between a high-technology hospital service provider and remote public healthcare units: a qualitative study in Brazil. Telemed J E Health 2017 Jun;23(6):527-532. [CrossRef] [Medline]37,Bidmead E, Marshall A. A case study of stakeholder perceptions of patient held records: the Patients Know Best (PKB) solution. Digit Health 2016;2:2055207616668431 [FREE Full text] [CrossRef] [Medline]174]. This perception is sometimes triggered by their experience with other health IT systems, which added to their workload [Grünloh C, Cajander A, Myreteg G. 'The Record is Our Work Tool!'- physicians' framing of a patient portal in Sweden. J Med Internet Res 2016 Jun 27;18(6):e167 [FREE Full text] [CrossRef] [Medline]46]. At the same time, some studies reported no change in the overall workload because of mHealth adoption [Brewster L, Mountain G, Wessels B, Kelly C, Hawley M. Factors affecting front line staff acceptance of telehealth technologies: a mixed-method systematic review. J Adv Nurs 2014 Jan;70(1):21-33. [CrossRef] [Medline]10], whereas others suggested that such technologies can alleviate workload where clinicians’ recruitment and retention are challenging by improving efficiency [Puszka S, Dingwall KM, Sweet M, Nagel T. E-Mental health innovations for aboriginal and Torres Strait Islander Australians: a qualitative study of implementation needs in health services. JMIR Ment Health 2016 Sep 19;3(3):e43 [FREE Full text] [CrossRef] [Medline]73] and providing additional support and resources [Goedken CC, Moeckli J, Cram PM, Reisinger HS. Introduction of Tele-ICU in rural hospitals: changing organisational culture to harness benefits. Intensive Crit Care Nurs 2017 Jun;40:51-56. [CrossRef] [Medline]45,Morilla MD, Sans M, Casasa A, Giménez N. Implementing technology in healthcare: insights from physicians. BMC Med Inform Decis Mak 2017 Jun 27;17(1):92 [FREE Full text] [CrossRef] [Medline]122,Mueller KJ, Potter AJ, MacKinney AC, Ward MM. Lessons from tele-emergency: improving care quality and health outcomes by expanding support for rural care systems. Health Aff (Millwood) 2014 Feb;33(2):228-234. [CrossRef] [Medline]159,Koivunen M, Saranto K. Nursing professionals' experiences of the facilitators and barriers to the use of telehealth applications: a systematic review of qualitative studies. Scand J Caring Sci 2018 Mar;32(1):24-44. [CrossRef] [Medline]185,Kumar S, Merchant S, Reynolds R. Tele-ICU: efficacy and cost-effectiveness approach of remotely managing the critical care. Open Med Inform J 2013;7:24-29 [FREE Full text] [CrossRef] [Medline]186].
Fit with the clinical practice and compatibility with workflow are also significant requirements for a successful adoption [Gagnon MP, Ngangue P, Payne-Gagnon J, Desmartis M. m-Health adoption by healthcare professionals: a systematic review. J Am Med Inform Assoc 2016 Jan;23(1):212-220. [CrossRef] [Medline]9,Tintorer DL, Domínguez JM, Pujol-Rivera E, Beneyto SF, Tuduri XM, Saigí-Rubió F. Keys to success of a community of clinical practice in primary care: a qualitative evaluation of the ECOPIH project. BMC Fam Pract 2018 May 9;19(1):56 [FREE Full text] [CrossRef] [Medline]59,van Gaalen JL, van Bodegom-Vos L, Bakker MJ, Snoeck-Stroband JB, Sont JK. Internet-based self-management support for adults with asthma: a qualitative study among patients, general practitioners and practice nurses on barriers to implementation. BMJ Open 2016 Aug 26;6(8):e010809 [FREE Full text] [CrossRef] [Medline]84,Lee SI, Park H, Kim JW, Hwang H, Cho EY, Kim Y, et al. Physicians' perceptions and use of a health information exchange: a pilot program in South Korea. Telemed J E Health 2012 Oct;18(8):604-612 [FREE Full text] [CrossRef] [Medline]114,Miller KE, Kuhn E, Owen JE, Taylor K, Yu JS, Weiss BJ, et al. Clinician perceptions related to the use of the CBT-I Coach Mobile App. Behav Sleep Med 2019;17(4):481-491. [CrossRef] [Medline]120,Sezgin E, Özkan-Yildirim S, Yildirim S. Understanding the perception towards using mHealth applications in practice. Inf Dev 2018;34(2):182-200. [CrossRef]136,Bailey JV, Tomlinson N, Hobbs LJ, Webster R. Challenges and opportunities in evaluating a digital sexual health intervention in a clinic setting: Staff and patient views. Digit Health 2017;3:2055207617704272 [FREE Full text] [CrossRef] [Medline]163,Possemato K, Kuhn E, Johnson EM, Hoffman JE, Brooks E. Development and refinement of a clinician intervention to facilitate primary care patient use of the PTSD Coach app. Transl Behav Med 2017 Mar;7(1):116-126 [FREE Full text] [CrossRef] [Medline]166,Ehrler F, Ducloux P, Wu DT, Lovis C, Blondon K. Acceptance of a mobile application supporting nurses workflow at patient bedside: results from a pilot study. Stud Health Technol Inform 2018;247:506-510. [Medline]181,Hickson R, Talbert J, Thornbury WC, Perin NR, Goodin AJ. Online medical care: the current state of 'eVisits' in acute primary care delivery. Telemed J E Health 2015 Feb;21(2):90-96. [CrossRef] [Medline]184]; accordingly, proper planning and integration [Choi WS, Park J, Choi JY, Yang J. Stakeholders' resistance to telemedicine with focus on physicians: utilizing the Delphi technique. J Telemed Telecare 2019 Jul;25(6):378-385. [CrossRef] [Medline]8,Brewster L, Mountain G, Wessels B, Kelly C, Hawley M. Factors affecting front line staff acceptance of telehealth technologies: a mixed-method systematic review. J Adv Nurs 2014 Jan;70(1):21-33. [CrossRef] [Medline]10,Lord S, Moore SK, Ramsey A, Dinauer S, Johnson K. Implementation of a substance use recovery support mobile phone app in community settings: qualitative study of clinician and staff perspectives of facilitators and barriers. JMIR Ment Health 2016 Jun 28;3(2):e24 [FREE Full text] [CrossRef] [Medline]61,Puszka S, Dingwall KM, Sweet M, Nagel T. E-Mental health innovations for aboriginal and Torres Strait Islander Australians: a qualitative study of implementation needs in health services. JMIR Ment Health 2016 Sep 19;3(3):e43 [FREE Full text] [CrossRef] [Medline]73,Radhakrishnan K, Xie B, Berkley A, Kim M. Barriers and facilitators for sustainability of tele-homecare programs: a systematic review. Health Serv Res 2016 Feb;51(1):48-75 [FREE Full text] [CrossRef] [Medline]182] and a good understanding of treatment processes [Seto E, Leonard KJ, Cafazzo JA, Barnsley J, Masino C, Ross HJ. Perceptions and experiences of heart failure patients and clinicians on the use of mobile phone-based telemonitoring. J Med Internet Res 2012 Feb 10;14(1):e25 [FREE Full text] [CrossRef] [Medline]78,Rho MJ, Choi IY, Lee J. Predictive factors of telemedicine service acceptance and behavioral intention of physicians. Int J Med Inform 2014 Aug;83(8):559-571. [CrossRef] [Medline]129,Walker L, Clendon J. The case for end-user involvement in design of health technologies. J Telemed Telecare 2016 Dec;22(8):443-446. [CrossRef] [Medline]172] are essential to avoid any disruption for clinical practice. Clinicians’ perceptions that these technologies might negatively impact their work processes can hinder adoption [Grünloh C, Cajander A, Myreteg G. 'The Record is Our Work Tool!'- physicians' framing of a patient portal in Sweden. J Med Internet Res 2016 Jun 27;18(6):e167 [FREE Full text] [CrossRef] [Medline]46,Jimbo M, Shultz CG, Nease DE, Fetters MD, Power D, Ruffin MT. Perceived barriers and facilitators of using a Web-based interactive decision aid for colorectal cancer screening in community practice settings: findings from focus groups with primary care clinicians and medical office staff. J Med Internet Res 2013 Dec 18;15(12):e286 [FREE Full text] [CrossRef] [Medline]53,Sharma U, Clarke M. Nurses' and community support workers' experience of telehealth: a longitudinal case study. BMC Health Serv Res 2014 Apr 10;14:164 [FREE Full text] [CrossRef] [Medline]80,Uscher-Pines L, Kahn JM. Barriers and facilitators to pediatric emergency telemedicine in the United States. Telemed J E Health 2014 Nov;20(11):990-996 [FREE Full text] [CrossRef] [Medline]141]. Such assessments are sometimes because of poor adaptability of the current routines to mHealth [Vest BM, Hall VM, Kahn LS, Heider AR, Maloney N, Singh R. Nurse perspectives on the implementation of routine telemonitoring for high-risk diabetes patients in a primary care setting. Prim Health Care Res Dev 2017 Jan;18(1):3-13. [CrossRef] [Medline]88,Radhakrishnan K, Xie B, Berkley A, Kim M. Barriers and facilitators for sustainability of tele-homecare programs: a systematic review. Health Serv Res 2016 Feb;51(1):48-75 [FREE Full text] [CrossRef] [Medline]182]. Nonetheless, mHealth adoption can also sometimes result in workflow modification, where an adaptation of working patterns is necessary to harness the potential of such tools [Molfenter T, Boyle M, Holloway D, Zwick J. Trends in telemedicine use in addiction treatment. Addict Sci Clin Pract 2015 May 28;10:14 [FREE Full text] [CrossRef] [Medline]67,Casey M, Shaw S, Swinglehurst D. Experiences with online consultation systems in primary care: case study of one early adopter site. Br J Gen Pract 2017 Nov;67(664):e736-e743 [FREE Full text] [CrossRef] [Medline]94,Chang F, Paramsothy T, Roche M, Gupta NS. Patient, staff, and clinician perspectives on implementing electronic communications in an interdisciplinary rural family health practice. Prim Health Care Res Dev 2017 Mar;18(2):149-160. [CrossRef] [Medline]178]. These changes are mostly aimed at complementing routine care rather than replacing it [Morrow S, Daines L, Wiener-Ogilvie S, Steed L, McKee L, Caress A, et al. Exploring the perspectives of clinical professionals and support staff on implementing supported self-management for asthma in UK general practice: an IMPART qualitative study. NPJ Prim Care Respir Med 2017 Jul 18;27(1):45 [FREE Full text] [CrossRef] [Medline]70,Cox A, Illsley M, Knibb W, Lucas C, O'Driscoll M, Potter C, et al. The acceptability of e-technology to monitor and assess patient symptoms following palliative radiotherapy for lung cancer. Palliat Med 2011 Oct;25(7):675-681. [CrossRef] [Medline]180], and reorganizing work to warrant routine practice.Egerton T, Nelligan R, Setchell J, Atkins L, Bennell KL. General practitioners' perspectives on a proposed new model of service delivery for primary care management of knee osteoarthritis: a qualitative study. BMC Fam Pract 2017 Sep 7;18(1):85 [FREE Full text] [CrossRef] [Medline]39,Esterle L, Mathieu-Fritz A. Teleconsultation in geriatrics: impact on professional practice. Int J Med Inform 2013 Aug;82(8):684-695. [CrossRef] [Medline]40,Morilla MD, Sans M, Casasa A, Giménez N. Implementing technology in healthcare: insights from physicians. BMC Med Inform Decis Mak 2017 Jun 27;17(1):92 [FREE Full text] [CrossRef] [Medline]122,Duhm J, Fleischmann R, Schmidt S, Hupperts H, Brandt SA. Mobile electronic medical records promote workflow: physicians' perspective from a survey. JMIR Mhealth Uhealth 2016 Jun 6;4(2):e70 [FREE Full text] [CrossRef] [Medline]150
mHealth could enhance competitiveness through time and cost efficiencies, optimized work patterns [Armstrong AW, Kwong MW, Chase EP, Ledo L, Nesbitt TS, Shewry SL. Teledermatology operational considerations, challenges, and benefits: the referring providers' perspective. Telemed J E Health 2012 Oct;18(8):580-584. [CrossRef] [Medline]1,Armstrong AW, Kwong MW, Ledo L, Nesbitt TS, Shewry SL. Practice models and challenges in teledermatology: a study of collective experiences from teledermatologists. PLoS One 2011;6(12):e28687 [FREE Full text] [CrossRef] [Medline]54,Tintorer DL, Domínguez JM, Pujol-Rivera E, Beneyto SF, Tuduri XM, Saigí-Rubió F. Keys to success of a community of clinical practice in primary care: a qualitative evaluation of the ECOPIH project. BMC Fam Pract 2018 May 9;19(1):56 [FREE Full text] [CrossRef] [Medline]59,Rothstein JD, Jennings L, Moorthy A, Yang F, Gee L, Romano K, et al. Qualitative assessment of the feasibility, usability, and acceptability of a mobile client data app for community-based maternal, neonatal, and child care in rural Ghana. Int J Telemed Appl 2016;2016:2515420 [FREE Full text] [CrossRef] [Medline]74,Varsi C, Ekstedt M, Gammon D, Ruland CM. Using the consolidated framework for implementation research to identify barriers and facilitators for the implementation of an internet-based patient-provider communication service in five settings: a qualitative study. J Med Internet Res 2015 Nov 18;17(11):e262 [FREE Full text] [CrossRef] [Medline]86,Kleinpell R, Barden C, Rincon T, McCarthy M, Rufo RJ. Assessing the impact of telemedicine on nursing care in intensive care units. Am J Crit Care 2016 Jan;25(1):e14-e20. [CrossRef] [Medline]109, Ariens LF, Schussler-Raymakers FM, Frima C, Flinterman A, Hamminga E, Arents BW, et al. Barriers and facilitators to eHealth use in daily practice: perspectives of patients and professionals in dermatology. J Med Internet Res 2017 Sep 5;19(9):e300 [FREE Full text] [CrossRef] [Medline]152,Nerminathan A, Harrison A, Phelps M, Alexander S, Scott KM. Doctors' use of mobile devices in the clinical setting: a mixed methods study. Intern Med J 2017 Mar;47(3):291-298. [CrossRef] [Medline]161,Li L, Cotton A. A systematic review of nurses' perspectives toward the telemedicine intensive care unit: a basis for supporting its future implementation in China? Telemed J E Health 2019 May;25(5):343-350. [CrossRef] [Medline]188,Daniel F, Jabak S, Sasso R, Chamoun Y, Tamim H. Patient-physician communication in the era of mobile phones and social media apps: cross-sectional observational study on Lebanese physicians' perceptions and attitudes. JMIR Med Inform 2018 Apr 6;6(2):e18 [FREE Full text] [CrossRef] [Medline]190,Bishop TF, Press MJ, Mendelsohn JL, Casalino LP. Electronic communication improves access, but barriers to its widespread adoption remain. Health Aff (Millwood) 2013 Aug;32(8):1361-1367 [FREE Full text] [CrossRef] [Medline]195], quicker access to care [Zilliacus E, Meiser B, Lobb E, Dudding TE, Barlow-Stewart K, Tucker K. The virtual consultation: practitioners' experiences of genetic counseling by videoconferencing in Australia. Telemed J E Health 2010 Apr;16(3):350-357. [CrossRef] [Medline]91,Sims MH, Fagnano M, Halterman JS, Halterman MW. Provider impressions of the use of a mobile crowdsourcing app in medical practice. Health Informatics J 2016 Jun;22(2):221-231. [CrossRef] [Medline]137,Mueller KJ, Potter AJ, MacKinney AC, Ward MM. Lessons from tele-emergency: improving care quality and health outcomes by expanding support for rural care systems. Health Aff (Millwood) 2014 Feb;33(2):228-234. [CrossRef] [Medline]159,Odnoletkova I, Buysse H, Nobels F, Goderis G, Aertgeerts B, Annemans L, et al. Patient and provider acceptance of telecoaching in type 2 diabetes: a mixed-method study embedded in a randomised clinical trial. BMC Med Inform Decis Mak 2016 Nov 9;16(1):142 [FREE Full text] [CrossRef] [Medline]162], and rapid triage and identification of cases that need urgent care thanks to the timely feedback that technologies such as digital patient monitoring enable [Mileski M, Kruse CS, Catalani J, Haderer T. Adopting telemedicine for the self-management of hypertension: systematic review. JMIR Med Inform 2017 Oct 24;5(4):e41 [FREE Full text] [CrossRef] [Medline]5,Han KJ, Subramanian R, Cameron GT. Listen before you leap: Sri Lankan health professionals' perspectives on m-health. Health Informatics J 2019 Sep;25(3):858-866. [CrossRef] [Medline]47,Jarvis-Selinger S, Bates J, Araki Y, Lear SA. Internet-based support for cardiovascular disease management. Int J Telemed Appl 2011;2011:342582 [FREE Full text] [CrossRef] [Medline]52,Kim JW, Tiyyagura G, Langhan M. A qualitative analysis of general emergency medicine providers' perceptions on pediatric emergency telemedicine. Pediatr Emerg Care 2019 Dec;35(12):856-861. [CrossRef] [Medline]57,Bello AK, Molzahn AE, Girard LP, Osman MA, Okpechi IG, Glassford J, et al. Patient and provider perspectives on the design and implementation of an electronic consultation system for kidney care delivery in Canada: a focus group study. BMJ Open 2017 Mar 2;7(3):e014784 [FREE Full text] [CrossRef] [Medline]87,L'Esperance ST, Perry DJ. Assessing advantages and barriers to telemedicine adoption in the practice setting: A MyCareTeam(TM) exemplar. J Am Assoc Nurse Pract 2016 Jun;28(6):311-319. [CrossRef] [Medline]115,Lapão LV, da Silva MM, Gregório J. Implementing an online pharmaceutical service using design science research. BMC Med Inform Decis Mak 2017 Mar 27;17(1):31 [FREE Full text] [CrossRef] [Medline]157]. Consequently, it can allow clinicians to prioritize by enabling them to focus more on patients that need assistance versus more stable patients [Merchant KA, Ward MM, Mueller KJ, Rural Health Research & Policy Centers, Rural Policy Research Institute‚ RUPRI Center for Rural Health Policy Analysis‚ University of Iowa College of Public Health‚ Department of Health Management and Policy. Hospital views of factors affecting telemedicine use. Rural Policy Brief 2015 Apr 1(2015 5):1-4. [Medline]64,Bidmead E, Marshall A. A case study of stakeholder perceptions of patient held records: the Patients Know Best (PKB) solution. Digit Health 2016;2:2055207616668431 [FREE Full text] [CrossRef] [Medline]174]. Large scale rollout of such technologies also necessitates standardization, resulting in higher efficiency [Brown W, Giguere R, Sheinfil A, Ibitoye M, Balan I, Ho T, et al. Challenges and solutions implementing an SMS text message-based survey CASI and adherence reminders in an international biomedical HIV PrEP study (MTN 017). J Biomed Inform 2018 Apr;80:78-86 [FREE Full text] [CrossRef] [Medline]177]. Unfortunately, there are still cases where such tools do not result in better efficiency in practice [Casey M, Shaw S, Swinglehurst D. Experiences with online consultation systems in primary care: case study of one early adopter site. Br J Gen Pract 2017 Nov;67(664):e736-e743 [FREE Full text] [CrossRef] [Medline]94], mostly because of usability issues and difficulties with technology [Klack L, Ziefle M, Wilkowska W, Kluge J. Telemedical versus conventional heart patient monitoring: a survey study with German physicians. Int J Technol Assess Health Care 2013 Oct;29(4):378-383. [CrossRef] [Medline]108,Koval PG, Kim JJ, Makhlouf T. Pharmacist perception of a mobile application audience response system for remote pharmacy continuing education participants. J Pharm Pract 2018 Aug 13:897190018792391. [CrossRef] [Medline]110] and lack of EMR integration resulting in double work and reenter of data, which eliminates the efficacy gains achieved with the tools [Giraldo L, Schachner B, Luna D, Benítez S. Exploring nurses' perceptions and expectations toward a BCMA implementation using a mobile app and workstations as a change management strategy. Stud Health Technol Inform 2018;250:134-138. [Medline]44] and adds complexities to management [Egerton T, Nelligan R, Setchell J, Atkins L, Bennell KL. General practitioners' perspectives on a proposed new model of service delivery for primary care management of knee osteoarthritis: a qualitative study. BMC Fam Pract 2017 Sep 7;18(1):85 [FREE Full text] [CrossRef] [Medline]39]. Sometimes, efficiencies such as less in-clinic visits or phone calls come at the expense of a higher overall workload when there is no appropriate reimbursement [Mairesse GH, Braunschweig F, Klersy K, Cowie MR, Leyva F. Implementation and reimbursement of remote monitoring for cardiac implantable electronic devices in Europe: a survey from the health economics committee of the European Heart Rhythm Association. Europace 2015 May;17(5):814-818. [CrossRef] [Medline]119]. Still, several studies suggested that the perceived higher efficiency can increase clinicians’ intention to use mHealth [Lord S, Moore SK, Ramsey A, Dinauer S, Johnson K. Implementation of a substance use recovery support mobile phone app in community settings: qualitative study of clinician and staff perspectives of facilitators and barriers. JMIR Ment Health 2016 Jun 28;3(2):e24 [FREE Full text] [CrossRef] [Medline]61,Seto E, Leonard KJ, Cafazzo JA, Barnsley J, Masino C, Ross HJ. Perceptions and experiences of heart failure patients and clinicians on the use of mobile phone-based telemonitoring. J Med Internet Res 2012 Feb 10;14(1):e25 [FREE Full text] [CrossRef] [Medline]78,Kim S, Lee KH, Hwang H, Yoo S. Analysis of the factors influencing healthcare professionals' adoption of mobile electronic medical record (EMR) using the unified theory of acceptance and use of technology (UTAUT) in a tertiary hospital. BMC Med Inform Decis Mak 2016 Jan 30;16:12 [FREE Full text] [CrossRef] [Medline]107,Saigi-Rubió F, Jiménez-Zarco A, Torrent-Sellens J. Determinants of the intention to use telemedicine: evidence from primary care physicians. Int J Technol Assess Health Care 2016 Jan;32(1-2):29-36. [CrossRef] [Medline]132,Steinschaden T, Petersson G, Astrand B. Physicians' attitudes towards eprescribing: a comparative web survey in Austria and Sweden. Inform Prim Care 2009;17(4):241-248 [FREE Full text] [CrossRef] [Medline]140,Duhm J, Fleischmann R, Schmidt S, Hupperts H, Brandt SA. Mobile electronic medical records promote workflow: physicians' perspective from a survey. JMIR Mhealth Uhealth 2016 Jun 6;4(2):e70 [FREE Full text] [CrossRef] [Medline]150,Ehrler F, Ducloux P, Wu DT, Lovis C, Blondon K. Acceptance of a mobile application supporting nurses workflow at patient bedside: results from a pilot study. Stud Health Technol Inform 2018;247:506-510. [Medline]181].
Improved collaboration and coordination among clinicians were among the identified facilitators [Armstrong AW, Kwong MW, Chase EP, Ledo L, Nesbitt TS, Shewry SL. Teledermatology operational considerations, challenges, and benefits: the referring providers' perspective. Telemed J E Health 2012 Oct;18(8):580-584. [CrossRef] [Medline]1,Jarvis-Selinger S, Bates J, Araki Y, Lear SA. Internet-based support for cardiovascular disease management. Int J Telemed Appl 2011;2011:342582 [FREE Full text] [CrossRef] [Medline]52,Molleda L, Bahamon M, St George SM, Perrino T, Estrada Y, Herrera DC, et al. Clinic personnel, facilitator, and parent perspectives of eHealth Familias Unidas in primary care. J Pediatr Health Care 2017;31(3):350-361 [FREE Full text] [CrossRef] [Medline]68,Kleinpell R, Barden C, Rincon T, McCarthy M, Rufo RJ. Assessing the impact of telemedicine on nursing care in intensive care units. Am J Crit Care 2016 Jan;25(1):e14-e20. [CrossRef] [Medline]109,Duhm J, Fleischmann R, Schmidt S, Hupperts H, Brandt SA. Mobile electronic medical records promote workflow: physicians' perspective from a survey. JMIR Mhealth Uhealth 2016 Jun 6;4(2):e70 [FREE Full text] [CrossRef] [Medline]150,Ariens LF, Schussler-Raymakers FM, Frima C, Flinterman A, Hamminga E, Arents BW, et al. Barriers and facilitators to eHealth use in daily practice: perspectives of patients and professionals in dermatology. J Med Internet Res 2017 Sep 5;19(9):e300 [FREE Full text] [CrossRef] [Medline]152,Kumar S, Merchant S, Reynolds R. Tele-ICU: efficacy and cost-effectiveness approach of remotely managing the critical care. Open Med Inform J 2013;7:24-29 [FREE Full text] [CrossRef] [Medline]186]. Well-planned coordination of services can increase adoption, especially when several teams or sites are involved [Avey JP, Hobbs RL. Dial in: fostering the use of telebehavioral health services in frontier Alaska. Psychol Serv 2013 Aug;10(3):289-297. [CrossRef] [Medline]2,Choi WS, Park J, Choi JY, Yang J. Stakeholders' resistance to telemedicine with focus on physicians: utilizing the Delphi technique. J Telemed Telecare 2019 Jul;25(6):378-385. [CrossRef] [Medline]8,Vest BM, Hall VM, Kahn LS, Heider AR, Maloney N, Singh R. Nurse perspectives on the implementation of routine telemonitoring for high-risk diabetes patients in a primary care setting. Prim Health Care Res Dev 2017 Jan;18(1):3-13. [CrossRef] [Medline]88,Odnoletkova I, Buysse H, Nobels F, Goderis G, Aertgeerts B, Annemans L, et al. Patient and provider acceptance of telecoaching in type 2 diabetes: a mixed-method study embedded in a randomised clinical trial. BMC Med Inform Decis Mak 2016 Nov 9;16(1):142 [FREE Full text] [CrossRef] [Medline]162,Bramley G, Mangan C, Conroy M. Using telemonitoring to support personal care planning for adults with learning disabilities. J Telemed Telecare 2019 Dec;25(10):602-610. [CrossRef] [Medline]176]. Better care coordination was also sometimes the result of the introduction of such technology [Bello AK, Molzahn AE, Girard LP, Osman MA, Okpechi IG, Glassford J, et al. Patient and provider perspectives on the design and implementation of an electronic consultation system for kidney care delivery in Canada: a focus group study. BMJ Open 2017 Mar 2;7(3):e014784 [FREE Full text] [CrossRef] [Medline]87,Cunningham DL, Connors EH, Lever N, Stephan SH. Providers' perspectives: utilizing telepsychiatry in schools. Telemed J E Health 2013 Oct;19(10):794-799. [CrossRef] [Medline]194], mainly when new multidisciplinary and integrated teams are formed [Brewster L, Mountain G, Wessels B, Kelly C, Hawley M. Factors affecting front line staff acceptance of telehealth technologies: a mixed-method systematic review. J Adv Nurs 2014 Jan;70(1):21-33. [CrossRef] [Medline]10,Egerton T, Nelligan R, Setchell J, Atkins L, Bennell KL. General practitioners' perspectives on a proposed new model of service delivery for primary care management of knee osteoarthritis: a qualitative study. BMC Fam Pract 2017 Sep 7;18(1):85 [FREE Full text] [CrossRef] [Medline]39,Hines M, Lincoln M, Ramsden R, Martinovich J, Fairweather C. Speech pathologists' perspectives on transitioning to telepractice: what factors promote acceptance? J Telemed Telecare 2015 Dec;21(8):469-473. [CrossRef] [Medline]50,Kayyali R, Hesso I, Mahdi A, Hamzat O, Adu A, Nabhani Gebara S. Telehealth: misconceptions and experiences of healthcare professionals in England. Int J Pharm Pract 2017 Jun;25(3):203-209. [CrossRef] [Medline]55,Khan NU, Rasheed S, Sharmin T, Ahmed T, Mahmood SS, Khatun F, et al. Experience of using mHealth to link village doctors with physicians: lessons from Chakaria, Bangladesh. BMC Med Inform Decis Mak 2015 Aug 5;15:62 [FREE Full text] [CrossRef] [Medline]56,Tintorer DL, Domínguez JM, Pujol-Rivera E, Beneyto SF, Tuduri XM, Saigí-Rubió F. Keys to success of a community of clinical practice in primary care: a qualitative evaluation of the ECOPIH project. BMC Fam Pract 2018 May 9;19(1):56 [FREE Full text] [CrossRef] [Medline]59,Loh P, Flicker L, Horner B. Attitudes toward information and communication technology (ICT) in residential aged care in Western Australia. J Am Med Dir Assoc 2009 Jul;10(6):408-413. [CrossRef] [Medline]156,Walker L, Clendon J. The case for end-user involvement in design of health technologies. J Telemed Telecare 2016 Dec;22(8):443-446. [CrossRef] [Medline]172,Li L, Cotton A. A systematic review of nurses' perspectives toward the telemedicine intensive care unit: a basis for supporting its future implementation in China? Telemed J E Health 2019 May;25(5):343-350. [CrossRef] [Medline]188], and peer support through second opinion and new models of shared decision making are created [Esterle L, Mathieu-Fritz A. Teleconsultation in geriatrics: impact on professional practice. Int J Med Inform 2013 Aug;82(8):684-695. [CrossRef] [Medline]40,Kim JW, Tiyyagura G, Langhan M. A qualitative analysis of general emergency medicine providers' perceptions on pediatric emergency telemedicine. Pediatr Emerg Care 2019 Dec;35(12):856-861. [CrossRef] [Medline]57,Cary MP, Spencer M, Carroll A, Hand DH, Amis K, Karan E, et al. Benefits and challenges of delivering tele-rehabilitation services to rural veterans. Home Healthc Now 2016 Sep;34(8):440-446. [CrossRef] [Medline]93,Jetty A, Moore MA, Coffman M, Petterson S, Bazemore A. Rural family physicians are twice as likely to use telehealth as urban family physicians. Telemed J E Health 2018 Apr;24(4):268-276. [CrossRef] [Medline]102,Sims MH, Fagnano M, Halterman JS, Halterman MW. Provider impressions of the use of a mobile crowdsourcing app in medical practice. Health Informatics J 2016 Jun;22(2):221-231. [CrossRef] [Medline]137,Iacono T, Dissanayake C, Trembath D, Hudry K, Erickson S, Spong J. Family and practitioner perspectives on telehealth for services to young children with autism. Stud Health Technol Inform 2016;231:63-73. [Medline]153,Mueller KJ, Potter AJ, MacKinney AC, Ward MM. Lessons from tele-emergency: improving care quality and health outcomes by expanding support for rural care systems. Health Aff (Millwood) 2014 Feb;33(2):228-234. [CrossRef] [Medline]159,Penny RA, Bradford NK, Langbecker D. Registered nurse and midwife experiences of using videoconferencing in practice: a systematic review of qualitative studies. J Clin Nurs 2018 Mar;27(5-6):e739-e752. [CrossRef] [Medline]189]. Conversely, some studies report that this can sometimes result in more pressure on clinicians, as the tools increase the possibilities to coordinate and communicate with other staff members, adding to their already high workload [Grünloh C, Cajander A, Myreteg G. 'The Record is Our Work Tool!'- physicians' framing of a patient portal in Sweden. J Med Internet Res 2016 Jun 27;18(6):e167 [FREE Full text] [CrossRef] [Medline]46], and as interprofessional collaboration can be challenging [Varsi C, Ekstedt M, Gammon D, Børøsund E, Ruland CM. Middle managers' experiences and role in implementing an interactive tailored patient assessment eHealth intervention in clinical practice. Comput Inform Nurs 2015;33(6):249-257. [CrossRef] [Medline]85], sometimes resulting in lack of trust or conflicting opinions [Moloczij N, Mosley I, Moss KM, Bagot KL, Bladin CF, Cadilhac DA. Is telemedicine helping or hindering the delivery of stroke thrombolysis in rural areas? A qualitative analysis. Intern Med J 2015 Sep;45(9):957-964. [CrossRef] [Medline]69,Li L, Cotton A. A systematic review of nurses' perspectives toward the telemedicine intensive care unit: a basis for supporting its future implementation in China? Telemed J E Health 2019 May;25(5):343-350. [CrossRef] [Medline]188]. The lack of coordination and collaboration was also seen as a barrier is some studies [Odeh B, Kayyali R, Nabhani-Gebara S, Philip N. Implementing a telehealth service: nurses' perceptions and experiences. Br J Nurs 2014;23(21):1133-1137. [CrossRef] [Medline]71,van Gaalen JL, van Bodegom-Vos L, Bakker MJ, Snoeck-Stroband JB, Sont JK. Internet-based self-management support for adults with asthma: a qualitative study among patients, general practitioners and practice nurses on barriers to implementation. BMJ Open 2016 Aug 26;6(8):e010809 [FREE Full text] [CrossRef] [Medline]84,Uscher-Pines L, Kahn JM. Barriers and facilitators to pediatric emergency telemedicine in the United States. Telemed J E Health 2014 Nov;20(11):990-996 [FREE Full text] [CrossRef] [Medline]141,Radhakrishnan K, Xie B, Berkley A, Kim M. Barriers and facilitators for sustainability of tele-homecare programs: a systematic review. Health Serv Res 2016 Feb;51(1):48-75 [FREE Full text] [CrossRef] [Medline]182,Koivunen M, Saranto K. Nursing professionals' experiences of the facilitators and barriers to the use of telehealth applications: a systematic review of qualitative studies. Scand J Caring Sci 2018 Mar;32(1):24-44. [CrossRef] [Medline]185].
Poor technical skills and experience create uncertainties about how the technology may work, thus they can be major hurdles for adoption [de Souza CH, Morbeck RA, Steinman M, Hors CP, Bracco MM, Kozasa EH, et al. Barriers and benefits in telemedicine arising between a high-technology hospital service provider and remote public healthcare units: a qualitative study in Brazil. Telemed J E Health 2017 Jun;23(6):527-532. [CrossRef] [Medline]37,Kayyali R, Hesso I, Mahdi A, Hamzat O, Adu A, Nabhani Gebara S. Telehealth: misconceptions and experiences of healthcare professionals in England. Int J Pharm Pract 2017 Jun;25(3):203-209. [CrossRef] [Medline]55,Tintorer DL, Domínguez JM, Pujol-Rivera E, Beneyto SF, Tuduri XM, Saigí-Rubió F. Keys to success of a community of clinical practice in primary care: a qualitative evaluation of the ECOPIH project. BMC Fam Pract 2018 May 9;19(1):56 [FREE Full text] [CrossRef] [Medline]59,Molfenter T, Boyle M, Holloway D, Zwick J. Trends in telemedicine use in addiction treatment. Addict Sci Clin Pract 2015 May 28;10:14 [FREE Full text] [CrossRef] [Medline]67,Sinclair C, Holloway K, Riley G, Auret K. Online mental health resources in rural Australia: clinician perceptions of acceptability. J Med Internet Res 2013 Sep 5;15(9):e193 [FREE Full text] [CrossRef] [Medline]81,Putzer GJ, Park Y. Are physicians likely to adopt emerging mobile technologies? Attitudes and innovation factors affecting smartphone use in the Southeastern United States. Perspect Health Inf Manag 2012;9:1b [FREE Full text] [Medline]127,Villalba-Mora E, Casas I, Lupiañez-Villanueva F, Maghiros I. Adoption of health information technologies by physicians for clinical practice: the Andalusian case. Int J Med Inform 2015 Jul;84(7):477-485. [CrossRef] [Medline]143,Iacono T, Dissanayake C, Trembath D, Hudry K, Erickson S, Spong J. Family and practitioner perspectives on telehealth for services to young children with autism. Stud Health Technol Inform 2016;231:63-73. [Medline]153,Charani E, Kyratsis Y, Lawson W, Wickens H, Brannigan ET, Moore LS, et al. An analysis of the development and implementation of a smartphone application for the delivery of antimicrobial prescribing policy: lessons learnt. J Antimicrob Chemother 2013 Apr;68(4):960-967 [FREE Full text] [CrossRef] [Medline]179,Hickson R, Talbert J, Thornbury WC, Perin NR, Goodin AJ. Online medical care: the current state of 'eVisits' in acute primary care delivery. Telemed J E Health 2015 Feb;21(2):90-96. [CrossRef] [Medline]184,Jungwirth D, Haluza D. Information and communication technology and the future of healthcare: results of a multi-scenario Delphi survey. Health Informatics J 2019 Mar;25(1):161-173. [CrossRef] [Medline]191], whereas users’ familiarity with the technology may create confidence that may foster adoption [Hanna L, May C, Fairhurst K. The place of information and communication technology-mediated consultations in primary care: GPs' perspectives. Fam Pract 2012 Jun;29(3):361-366. [CrossRef] [Medline]49,Saigí-Rubió F, Torrent-Sellens J, Jiménez-Zarco A. Drivers of telemedicine use: comparative evidence from samples of Spanish, Colombian and Bolivian physicians. Implement Sci 2014 Oct 8;9:128 [FREE Full text] [CrossRef] [Medline]133,Sandholzer M, Deutsch T, Frese T, Winter A. Predictors of students' self-reported adoption of a smartphone application for medical education in general practice. BMC Med Educ 2015 May 21;15:91 [FREE Full text] [CrossRef] [Medline]134,Zailani S, Gilani MS, Nikbin D, Iranmanesh M. Determinants of telemedicine acceptance in selected public hospitals in Malaysia: clinical perspective. J Med Syst 2014 Sep;38(9):111. [CrossRef] [Medline]145,Tahamtan I, Pajouhanfar S, Sedghi S, Azad M, Roudbari M. Factors affecting smartphone adoption for accessing information in medical settings. Health Info Libr J 2017 Jun;34(2):134-145. [CrossRef] [Medline]170]. The more IT-related knowledge and skills clinicians have, the lower their expected effort related to mHealth use becomes, resulting in an increase in their intention to use it [Gagnon MP, Ngangue P, Payne-Gagnon J, Desmartis M. m-Health adoption by healthcare professionals: a systematic review. J Am Med Inform Assoc 2016 Jan;23(1):212-220. [CrossRef] [Medline]9,Duplaga M. Searching for a role of nursing personnel in developing landscape of eHealth: factors determining attitudes toward key patient empowering applications. PLoS One 2016;11(4):e0153173 [FREE Full text] [CrossRef] [Medline]96,Rho MJ, Choi IY, Lee J. Predictive factors of telemedicine service acceptance and behavioral intention of physicians. Int J Med Inform 2014 Aug;83(8):559-571. [CrossRef] [Medline]129,Dünnebeil S, Sunyaev A, Blohm I, Leimeister JM, Krcmar H. Determinants of physicians' technology acceptance for e-health in ambulatory care. Int J Med Inform 2012 Nov;81(11):746-760. [CrossRef] [Medline]149]. Also, those with previous digital health experience are usually more willing to embrace mHealth than their counterparts that had not used such tools before [Lord S, Moore SK, Ramsey A, Dinauer S, Johnson K. Implementation of a substance use recovery support mobile phone app in community settings: qualitative study of clinician and staff perspectives of facilitators and barriers. JMIR Ment Health 2016 Jun 28;3(2):e24 [FREE Full text] [CrossRef] [Medline]61,Puszka S, Dingwall KM, Sweet M, Nagel T. E-Mental health innovations for aboriginal and Torres Strait Islander Australians: a qualitative study of implementation needs in health services. JMIR Ment Health 2016 Sep 19;3(3):e43 [FREE Full text] [CrossRef] [Medline]73,Taylor J, Coates L. Caring from a distance: the role of telehealth. Nurs Times 2015;111(28-29):18-20. [Medline]83,Jetty A, Moore MA, Coffman M, Petterson S, Bazemore A. Rural family physicians are twice as likely to use telehealth as urban family physicians. Telemed J E Health 2018 Apr;24(4):268-276. [CrossRef] [Medline]102,Kuhn E, Eftekhari A, Hoffman JE, Crowley JJ, Ramsey KM, Reger GM, et al. Clinician perceptions of using a smartphone app with prolonged exposure therapy. Adm Policy Ment Health 2014 Nov;41(6):800-807. [CrossRef] [Medline]112,Moore MA, Coffman M, Jetty A, Klink K, Petterson S, Bazemore A. Family physicians report considerable interest in, but limited use of, telehealth services. J Am Board Fam Med 2017;30(3):320-330 [FREE Full text] [CrossRef] [Medline]121,Ray KN, Felmet KA, Hamilton MF, Kuza CC, Saladino RA, Schultz BR, et al. Clinician attitudes toward adoption of pediatric emergency telemedicine in rural hospitals. Pediatr Emerg Care 2017 Apr;33(4):250-257. [CrossRef] [Medline]168]. However, it was also noted that in some cases, the fact that some clinicians use technology in their private life is not necessarily positively correlated with higher chances of technology adoption at the workplace [Morilla MD, Sans M, Casasa A, Giménez N. Implementing technology in healthcare: insights from physicians. BMC Med Inform Decis Mak 2017 Jun 27;17(1):92 [FREE Full text] [CrossRef] [Medline]122,Zhang H, Cocosila M, Archer N. Factors of adoption of mobile information technology by homecare nurses: a technology acceptance model 2 approach. Comput Inform Nurs 2010;28(1):49-56. [CrossRef] [Medline]146]. It is suggested that the staff’s technical skills need to improve to enable the efficient use of such new technologies [Öberg U, Orre CJ, Isaksson U, Schimmer R, Larsson H, Hörnsten Å. Swedish primary healthcare nurses' perceptions of using digital eHealth services in support of patient self-management. Scand J Caring Sci 2018 Jun;32(2):961-970. [CrossRef] [Medline]72].
Smooth integration of mHealth may necessitate changes in staff’s roles and responsibilities [Khan NU, Rasheed S, Sharmin T, Ahmed T, Mahmood SS, Khatun F, et al. Experience of using mHealth to link village doctors with physicians: lessons from Chakaria, Bangladesh. BMC Med Inform Decis Mak 2015 Aug 5;15:62 [FREE Full text] [CrossRef] [Medline]56,MacNeill V, Sanders C, Fitzpatrick R, Hendy J, Barlow J, Knapp M, et al. Experiences of front-line health professionals in the delivery of telehealth: a qualitative study. Br J Gen Pract 2014 Jul;64(624):e401-e407 [FREE Full text] [CrossRef] [Medline]62,Bagot KL, Cadilhac DA, Bladin CF, Watkins CL, Vu M, Donnan GA, VSTASTUTE investigators. Integrating acute stroke telemedicine consultations into specialists' usual practice: a qualitative analysis comparing the experience of Australia and the United Kingdom. BMC Health Serv Res 2017 Nov 21;17(1):751 [FREE Full text] [CrossRef] [Medline]65,Molfenter T, Boyle M, Holloway D, Zwick J. Trends in telemedicine use in addiction treatment. Addict Sci Clin Pract 2015 May 28;10:14 [FREE Full text] [CrossRef] [Medline]67,Öberg U, Orre CJ, Isaksson U, Schimmer R, Larsson H, Hörnsten Å. Swedish primary healthcare nurses' perceptions of using digital eHealth services in support of patient self-management. Scand J Caring Sci 2018 Jun;32(2):961-970. [CrossRef] [Medline]72], sometimes in the form of alignment of duties [Hanley J, Ure J, Pagliari C, Sheikh A, McKinstry B. Experiences of patients and professionals participating in the HITS home blood pressure telemonitoring trial: a qualitative study. BMJ Open 2013 May 28;3(5):pii: e002671 [FREE Full text] [CrossRef] [Medline]48,Varsi C, Ekstedt M, Gammon D, Ruland CM. Using the consolidated framework for implementation research to identify barriers and facilitators for the implementation of an internet-based patient-provider communication service in five settings: a qualitative study. J Med Internet Res 2015 Nov 18;17(11):e262 [FREE Full text] [CrossRef] [Medline]86,Ariens LF, Schussler-Raymakers FM, Frima C, Flinterman A, Hamminga E, Arents BW, et al. Barriers and facilitators to eHealth use in daily practice: perspectives of patients and professionals in dermatology. J Med Internet Res 2017 Sep 5;19(9):e300 [FREE Full text] [CrossRef] [Medline]152], role reassignment and redistribution [Avey JP, Hobbs RL. Dial in: fostering the use of telebehavioral health services in frontier Alaska. Psychol Serv 2013 Aug;10(3):289-297. [CrossRef] [Medline]2,Casey M, Shaw S, Swinglehurst D. Experiences with online consultation systems in primary care: case study of one early adopter site. Br J Gen Pract 2017 Nov;67(664):e736-e743 [FREE Full text] [CrossRef] [Medline]94], expanding existing staff members’ responsibilities [Varsi C, Ekstedt M, Gammon D, Børøsund E, Ruland CM. Middle managers' experiences and role in implementing an interactive tailored patient assessment eHealth intervention in clinical practice. Comput Inform Nurs 2015;33(6):249-257. [CrossRef] [Medline]85], or even the creation of additional functions or staff numbers to cover some of the new tasks related to mHealth management [Esterle L, Mathieu-Fritz A. Teleconsultation in geriatrics: impact on professional practice. Int J Med Inform 2013 Aug;82(8):684-695. [CrossRef] [Medline]40,Molleda L, Bahamon M, St George SM, Perrino T, Estrada Y, Herrera DC, et al. Clinic personnel, facilitator, and parent perspectives of eHealth Familias Unidas in primary care. J Pediatr Health Care 2017;31(3):350-361 [FREE Full text] [CrossRef] [Medline]68,Odeh B, Kayyali R, Nabhani-Gebara S, Philip N. Implementing a telehealth service: nurses' perceptions and experiences. Br J Nurs 2014;23(21):1133-1137. [CrossRef] [Medline]71,Rothstein JD, Jennings L, Moorthy A, Yang F, Gee L, Romano K, et al. Qualitative assessment of the feasibility, usability, and acceptability of a mobile client data app for community-based maternal, neonatal, and child care in rural Ghana. Int J Telemed Appl 2016;2016:2515420 [FREE Full text] [CrossRef] [Medline]74,Schneider T, Panzera AD, Martinasek M, McDermott R, Couluris M, Lindenberger J, et al. Physicians' perceptions of mobile technology for enhancing asthma care for youth. J Child Health Care 2016 Jun;20(2):153-163. [CrossRef] [Medline]77,Sharma U, Barnett J, Clarke M. Clinical users' perspective on telemonitoring of patients with long term conditions: understood through concepts of Giddens's structuration theory & consequence of modernity. Stud Health Technol Inform 2010;160(Pt 1):545-549. [Medline]79,Vest BM, Hall VM, Kahn LS, Heider AR, Maloney N, Singh R. Nurse perspectives on the implementation of routine telemonitoring for high-risk diabetes patients in a primary care setting. Prim Health Care Res Dev 2017 Jan;18(1):3-13. [CrossRef] [Medline]88,Wynn R, Bergvik S, Pettersen G, Fossum S. Clinicians' experiences with videoconferencing in psychiatry. Stud Health Technol Inform 2012;180:1218-1220. [Medline]90,Jury SC, Walker AM, Kornberg AJ. The introduction of web-based video-consultation in a paediatric acute care setting. J Telemed Telecare 2013 Oct;19(7):383-387. [CrossRef] [Medline]103]. It was noted that in some cases, the tools’ introduction resulted in a lack of clarity on roles demarcation [Egerton T, Nelligan R, Setchell J, Atkins L, Bennell KL. General practitioners' perspectives on a proposed new model of service delivery for primary care management of knee osteoarthritis: a qualitative study. BMC Fam Pract 2017 Sep 7;18(1):85 [FREE Full text] [CrossRef] [Medline]39,Morrow S, Daines L, Wiener-Ogilvie S, Steed L, McKee L, Caress A, et al. Exploring the perspectives of clinical professionals and support staff on implementing supported self-management for asthma in UK general practice: an IMPART qualitative study. NPJ Prim Care Respir Med 2017 Jul 18;27(1):45 [FREE Full text] [CrossRef] [Medline]70,Wilhelmsen M, Høifødt RS, Kolstrup N, Waterloo K, Eisemann M, Chenhall R, et al. Norwegian general practitioners' perspectives on implementation of a guided web-based cognitive behavioral therapy for depression: a qualitative study. J Med Internet Res 2014 Sep 10;16(9):e208 [FREE Full text] [CrossRef] [Medline]89,Kato NP, Johansson P, Okada I, de Vries AE, Kinugawa K, Strömberg A, et al. Heart failure telemonitoring in Japan and Sweden: a cross-sectional survey. J Med Internet Res 2015 Nov 13;17(11):e258 [FREE Full text] [CrossRef] [Medline]104,Radhakrishnan K, Xie B, Berkley A, Kim M. Barriers and facilitators for sustainability of tele-homecare programs: a systematic review. Health Serv Res 2016 Feb;51(1):48-75 [FREE Full text] [CrossRef] [Medline]182], whereas clearly defined roles [Lord S, Moore SK, Ramsey A, Dinauer S, Johnson K. Implementation of a substance use recovery support mobile phone app in community settings: qualitative study of clinician and staff perspectives of facilitators and barriers. JMIR Ment Health 2016 Jun 28;3(2):e24 [FREE Full text] [CrossRef] [Medline]61] and the presence of a local champion that can guide others on the technology use can contribute to a successful adoption [Taylor J, Coates L. Caring from a distance: the role of telehealth. Nurs Times 2015;111(28-29):18-20. [Medline]83,Orchard J, Lowres N, Freedman SB, Ladak L, Lee W, Zwar N, et al. Screening for atrial fibrillation during influenza vaccinations by primary care nurses using a smartphone electrocardiograph (iECG): A feasibility study. Eur J Prev Cardiol 2016 Oct;23(2 suppl):13-20. [CrossRef] [Medline]164]. The new tasks resulting from the use of such technologies are usually related to data analysis and interpretation [Levine M, Richardson JE, Granieri E, Reid MC. Novel telemedicine technologies in geriatric chronic non-cancer pain: primary care providers' perspectives. Pain Med 2014 Feb;15(2):206-213 [FREE Full text] [CrossRef] [Medline]60,Rothstein JD, Jennings L, Moorthy A, Yang F, Gee L, Romano K, et al. Qualitative assessment of the feasibility, usability, and acceptability of a mobile client data app for community-based maternal, neonatal, and child care in rural Ghana. Int J Telemed Appl 2016;2016:2515420 [FREE Full text] [CrossRef] [Medline]74,Bramley G, Mangan C, Conroy M. Using telemonitoring to support personal care planning for adults with learning disabilities. J Telemed Telecare 2019 Dec;25(10):602-610. [CrossRef] [Medline]176], monitoring patient data and alerting the relevant staff accordingly [Quanbeck A, Gustafson DH, Marsch LA, Chih M, Kornfield R, McTavish F, et al. Implementing a mobile health system to integrate the treatment of addiction into primary care: a hybrid implementation-effectiveness study. J Med Internet Res 2018 Jan 30;20(1):e37 [FREE Full text] [CrossRef] [Medline]167], and also some other nonclinical tasks that were deemed sometimes undermining, such as equipment installation and troubleshooting [Sharma U, Clarke M. Nurses' and community support workers' experience of telehealth: a longitudinal case study. BMC Health Serv Res 2014 Apr 10;14:164 [FREE Full text] [CrossRef] [Medline]80,Sturesson L, Groth K. Effects of the digital transformation: qualitative study on the disturbances and limitations of using video visits in outpatient care. J Med Internet Res 2018 Jun 27;20(6):e221 [FREE Full text] [CrossRef] [Medline]82,Penny RA, Bradford NK, Langbecker D. Registered nurse and midwife experiences of using videoconferencing in practice: a systematic review of qualitative studies. J Clin Nurs 2018 Mar;27(5-6):e739-e752. [CrossRef] [Medline]189]. The tools, moreover, allowed the delegation of more tasks to nursing staff in several studies, giving them more autonomy and empowering them in their role [Seto E, Leonard KJ, Cafazzo JA, Barnsley J, Masino C, Ross HJ. Perceptions and experiences of heart failure patients and clinicians on the use of mobile phone-based telemonitoring. J Med Internet Res 2012 Feb 10;14(1):e25 [FREE Full text] [CrossRef] [Medline]78,Shaw RJ, Kaufman MA, Bosworth HB, Weiner BJ, Zullig LL, Lee SD, et al. Organizational factors associated with readiness to implement and translate a primary care based telemedicine behavioral program to improve blood pressure control: the HTN-IMPROVE study. Implement Sci 2013 Sep 8;8:106 [FREE Full text] [CrossRef] [Medline]169,Davis MM, Freeman M, Kaye J, Vuckovic N, Buckley DI. A systematic review of clinician and staff views on the acceptability of incorporating remote monitoring technology into primary care. 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Leadership and institutional support were seen as a vital factor [Mileski M, Kruse CS, Catalani J, Haderer T. Adopting telemedicine for the self-management of hypertension: systematic review. JMIR Med Inform 2017 Oct 24;5(4):e41 [FREE Full text] [CrossRef] [Medline]5,Gagnon MP, Ngangue P, Payne-Gagnon J, Desmartis M. m-Health adoption by healthcare professionals: a systematic review. J Am Med Inform Assoc 2016 Jan;23(1):212-220. [CrossRef] [Medline]9,Ghani MK, Jaber MM. Willingness to adopt telemedicine in major iraqi hospitals: a pilot study. Int J Telemed Appl 2015;2015:136591 [FREE Full text] [CrossRef] [Medline]95,Putzer GJ, Park Y. Are physicians likely to adopt emerging mobile technologies? Attitudes and innovation factors affecting smartphone use in the Southeastern United States. Perspect Health Inf Manag 2012;9:1b [FREE Full text] [Medline]127,Saigi-Rubió F, Jiménez-Zarco A, Torrent-Sellens J. Determinants of the intention to use telemedicine: evidence from primary care physicians. Int J Technol Assess Health Care 2016 Jan;32(1-2):29-36. [CrossRef] [Medline]132,Sandholzer M, Deutsch T, Frese T, Winter A. Predictors of students' self-reported adoption of a smartphone application for medical education in general practice. BMC Med Educ 2015 May 21;15:91 [FREE Full text] [CrossRef] [Medline]134,Lapão LV, da Silva MM, Gregório J. Implementing an online pharmaceutical service using design science research. BMC Med Inform Decis Mak 2017 Mar 27;17(1):31 [FREE Full text] [CrossRef] [Medline]157,Radhakrishnan K, Xie B, Berkley A, Kim M. Barriers and facilitators for sustainability of tele-homecare programs: a systematic review. Health Serv Res 2016 Feb;51(1):48-75 [FREE Full text] [CrossRef] [Medline]182,Li L, Cotton A. A systematic review of nurses' perspectives toward the telemedicine intensive care unit: a basis for supporting its future implementation in China? Telemed J E Health 2019 May;25(5):343-350. [CrossRef] [Medline]188,Ahmad F, Norman C, O'Campo P. What is needed to implement a computer-assisted health risk assessment tool? An exploratory concept mapping study. BMC Med Inform Decis Mak 2012 Dec 19;12:149 [FREE Full text] [CrossRef] [Medline]192,Putzer GJ, Park Y. The effects of innovation factors on smartphone adoption among nurses in community hospitals. Perspect Health Inf Manag 2010 Jan 1;7:1b [FREE Full text] [Medline]196] and considered one of the most important facilitators of technology adoption [Lord S, Moore SK, Ramsey A, Dinauer S, Johnson K. Implementation of a substance use recovery support mobile phone app in community settings: qualitative study of clinician and staff perspectives of facilitators and barriers. JMIR Ment Health 2016 Jun 28;3(2):e24 [FREE Full text] [CrossRef] [Medline]61,Jury SC, Walker AM, Kornberg AJ. The introduction of web-based video-consultation in a paediatric acute care setting. J Telemed Telecare 2013 Oct;19(7):383-387. [CrossRef] [Medline]103,Adenuga KI, Iahad NA, Miskon S. Towards reinforcing telemedicine adoption amongst clinicians in Nigeria. Int J Med Inform 2017 Aug;104:84-96. [CrossRef] [Medline]106,Zailani S, Gilani MS, Nikbin D, Iranmanesh M. Determinants of telemedicine acceptance in selected public hospitals in Malaysia: clinical perspective. J Med Syst 2014 Sep;38(9):111. [CrossRef] [Medline]145,Possemato K, Kuhn E, Johnson EM, Hoffman JE, Brooks E. Development and refinement of a clinician intervention to facilitate primary care patient use of the PTSD Coach app. Transl Behav Med 2017 Mar;7(1):116-126 [FREE Full text] [CrossRef] [Medline]166,Bishop TF, Press MJ, Mendelsohn JL, Casalino LP. Electronic communication improves access, but barriers to its widespread adoption remain. Health Aff (Millwood) 2013 Aug;32(8):1361-1367 [FREE Full text] [CrossRef] [Medline]195]. Management support is crucial to facilitate the potential organizational changes that the new technologies entail, such as changes in roles and responsibilities [Esterle L, Mathieu-Fritz A. Teleconsultation in geriatrics: impact on professional practice. Int J Med Inform 2013 Aug;82(8):684-695. [CrossRef] [Medline]40], or changes in workflow [Farrell M. Use of iPhones by nurses in an acute care setting to improve communication and decision-making processes: qualitative analysis of nurses' perspectives on iPhone use. JMIR Mhealth Uhealth 2016 May 31;4(2):e43 [FREE Full text] [CrossRef] [Medline]42,Öberg U, Orre CJ, Isaksson U, Schimmer R, Larsson H, Hörnsten Å. Swedish primary healthcare nurses' perceptions of using digital eHealth services in support of patient self-management. Scand J Caring Sci 2018 Jun;32(2):961-970. [CrossRef] [Medline]72,Orchard J, Lowres N, Freedman SB, Ladak L, Lee W, Zwar N, et al. Screening for atrial fibrillation during influenza vaccinations by primary care nurses using a smartphone electrocardiograph (iECG): A feasibility study. Eur J Prev Cardiol 2016 Oct;23(2 suppl):13-20. [CrossRef] [Medline]164], resource allocation [Puszka S, Dingwall KM, Sweet M, Nagel T. E-Mental health innovations for aboriginal and Torres Strait Islander Australians: a qualitative study of implementation needs in health services. JMIR Ment Health 2016 Sep 19;3(3):e43 [FREE Full text] [CrossRef] [Medline]73,Sadoughi F, Erfannia L, Sancholi M, Salmani F, Sarsarshahi A. Teleradiology in Southeast Iran: Evaluating the Views of Senior Executives and Radiologists. Health Care Manag (Frederick) 2017;36(3):301-307. [CrossRef] [Medline]131,Tahamtan I, Pajouhanfar S, Sedghi S, Azad M, Roudbari M. Factors affecting smartphone adoption for accessing information in medical settings. Health Info Libr J 2017 Jun;34(2):134-145. [CrossRef] [Medline]170], and proper training [Kowitlawakul Y. The technology acceptance model: predicting nurses' intention to use telemedicine technology (eICU). Comput Inform Nurs 2011 Jul;29(7):411-418. [CrossRef] [Medline]111]. However, getting senior management support can be challenging at times [Catan G, Espanha R, Mendes RV, Toren O, Chinitz D. Health information technology implementation - impacts and policy considerations: a comparison between Israel and Portugal. Isr J Health Policy Res 2015;4:41 [FREE Full text] [CrossRef] [Medline]34,Smith PB, Buzi RS. Reproductive health professionals' adoption of emerging technologies for health promotion. Health Informatics J 2014 Dec;20(4):250-260. [CrossRef] [Medline]138,Bidmead E, Marshall A. A case study of stakeholder perceptions of patient held records: the Patients Know Best (PKB) solution. Digit Health 2016;2:2055207616668431 [FREE Full text] [CrossRef] [Medline]174], resulting in lack of recognition of clinicians’ activities taken with mHealth tools [Tintorer DL, Domínguez JM, Pujol-Rivera E, Beneyto SF, Tuduri XM, Saigí-Rubió F. Keys to success of a community of clinical practice in primary care: a qualitative evaluation of the ECOPIH project. BMC Fam Pract 2018 May 9;19(1):56 [FREE Full text] [CrossRef] [Medline]59]; this may be explained by a lack of proper understanding of mHealth from the management side [Chang F, Paramsothy T, Roche M, Gupta NS. Patient, staff, and clinician perspectives on implementing electronic communications in an interdisciplinary rural family health practice. Prim Health Care Res Dev 2017 Mar;18(2):149-160. [CrossRef] [Medline]178] or a false perception that such tools would detract staff from their real work [Loh P, Flicker L, Horner B. Attitudes toward information and communication technology (ICT) in residential aged care in Western Australia. J Am Med Dir Assoc 2009 Jul;10(6):408-413. [CrossRef] [Medline]156]. Lack of organizational support can be a barrier that slows down adoption [Odeh B, Kayyali R, Nabhani-Gebara S, Philip N. Implementing a telehealth service: nurses' perceptions and experiences. Br J Nurs 2014;23(21):1133-1137. [CrossRef] [Medline]71,Varsi C, Ekstedt M, Gammon D, Ruland CM. Using the consolidated framework for implementation research to identify barriers and facilitators for the implementation of an internet-based patient-provider communication service in five settings: a qualitative study. J Med Internet Res 2015 Nov 18;17(11):e262 [FREE Full text] [CrossRef] [Medline]86].
Organizational infrastructure is a basic prerequisite for mHealth success [Bello AK, Molzahn AE, Girard LP, Osman MA, Okpechi IG, Glassford J, et al. Patient and provider perspectives on the design and implementation of an electronic consultation system for kidney care delivery in Canada: a focus group study. BMJ Open 2017 Mar 2;7(3):e014784 [FREE Full text] [CrossRef] [Medline]87,Zilliacus E, Meiser B, Lobb E, Dudding TE, Barlow-Stewart K, Tucker K. The virtual consultation: practitioners' experiences of genetic counseling by videoconferencing in Australia. Telemed J E Health 2010 Apr;16(3):350-357. [CrossRef] [Medline]91,Liu CF, Cheng TJ. Exploring critical factors influencing physicians' acceptance of mobile electronic medical records based on the dual-factor model: a validation in Taiwan. BMC Med Inform Decis Mak 2015 Feb 7;15:4 [FREE Full text] [CrossRef] [Medline]116,Orruño E, Gagnon MP, Asua J, Abdeljelil AB. Evaluation of teledermatology adoption by health-care professionals using a modified Technology Acceptance Model. J Telemed Telecare 2011;17(6):303-307. [CrossRef] [Medline]126,Charani E, Kyratsis Y, Lawson W, Wickens H, Brannigan ET, Moore LS, et al. An analysis of the development and implementation of a smartphone application for the delivery of antimicrobial prescribing policy: lessons learnt. J Antimicrob Chemother 2013 Apr;68(4):960-967 [FREE Full text] [CrossRef] [Medline]179]. Factors such as access to the internet, equipment, and suitable space and power play a key role in whether or not clinicians would adopt such new technologies [Bhatta R, Aryal K, Ellingsen G. Opportunities and challenges of a rural-telemedicine program in Nepal. J Nepal Health Res Counc 2015;13(30):149-153. [Medline]4,Han KJ, Subramanian R, Cameron GT. Listen before you leap: Sri Lankan health professionals' perspectives on m-health. Health Informatics J 2019 Sep;25(3):858-866. [CrossRef] [Medline]47,James S, Perry L, Gallagher R, Lowe J. Diabetes educators: perceived experiences, supports and barriers to use of common diabetes-related technologies. J Diabetes Sci Technol 2016 Sep;10(5):1115-1121 [FREE Full text] [CrossRef] [Medline]51,Moloczij N, Mosley I, Moss KM, Bagot KL, Bladin CF, Cadilhac DA. Is telemedicine helping or hindering the delivery of stroke thrombolysis in rural areas? A qualitative analysis. Intern Med J 2015 Sep;45(9):957-964. [CrossRef] [Medline]69,Schneider T, Panzera AD, Martinasek M, McDermott R, Couluris M, Lindenberger J, et al. Physicians' perceptions of mobile technology for enhancing asthma care for youth. J Child Health Care 2016 Jun;20(2):153-163. [CrossRef] [Medline]77,Cary MP, Spencer M, Carroll A, Hand DH, Amis K, Karan E, et al. Benefits and challenges of delivering tele-rehabilitation services to rural veterans. Home Healthc Now 2016 Sep;34(8):440-446. [CrossRef] [Medline]93,O'Connor S, Andrews T. Smartphones and mobile applications (apps) in clinical nursing education: a student perspective. Nurse Educ Today 2018 Oct;69:172-178. [CrossRef] [Medline]124,Putzer GJ, Park Y. Are physicians likely to adopt emerging mobile technologies? Attitudes and innovation factors affecting smartphone use in the Southeastern United States. Perspect Health Inf Manag 2012;9:1b [FREE Full text] [Medline]127,Iacono T, Dissanayake C, Trembath D, Hudry K, Erickson S, Spong J. Family and practitioner perspectives on telehealth for services to young children with autism. Stud Health Technol Inform 2016;231:63-73. [Medline]153,Jamu JT, Lowi-Jones H, Mitchell C. Just in time? Using QR codes for multi-professional learning in clinical practice. Nurse Educ Pract 2016 Jul;19:107-112. [CrossRef] [Medline]154,Bailey JV, Tomlinson N, Hobbs LJ, Webster R. Challenges and opportunities in evaluating a digital sexual health intervention in a clinic setting: Staff and patient views. 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Healthcare providers' perceptions of barriers in implementing of home telecare in Taiwan: a qualitative study. Int J Med Inform 2015 Apr;84(4):277-287. [CrossRef] [Medline]35,Morrow S, Daines L, Wiener-Ogilvie S, Steed L, McKee L, Caress A, et al. Exploring the perspectives of clinical professionals and support staff on implementing supported self-management for asthma in UK general practice: an IMPART qualitative study. NPJ Prim Care Respir Med 2017 Jul 18;27(1):45 [FREE Full text] [CrossRef] [Medline]70,Sturesson L, Groth K. Effects of the digital transformation: qualitative study on the disturbances and limitations of using video visits in outpatient care. J Med Internet Res 2018 Jun 27;20(6):e221 [FREE Full text] [CrossRef] [Medline]82,Taylor J, Coates L. Caring from a distance: the role of telehealth. Nurs Times 2015;111(28-29):18-20. [Medline]83,Alajlani M, Clarke M. Effect of culture on acceptance of telemedicine in Middle Eastern countries: case study of Jordan and Syria. Telemed J E Health 2013 Apr;19(4):305-311. [CrossRef] [Medline]151,Walker L, Clendon J. The case for end-user involvement in design of health technologies. J Telemed Telecare 2016 Dec;22(8):443-446. [CrossRef] [Medline]172,Mishori R, Anastario M, Naimer K, Varanasi S, Ferdowsian H, Abel D, et al. mJustice: preliminary development of a mobile app for medical-forensic documentation of sexual violence in low-resource environments and conflict zones. Glob Health Sci Pract 2017 Mar 24;5(1):138-151 [FREE Full text] [CrossRef] [Medline]193], as clinicians who have no access to suitable equipment may refrain from using mHealth [Avey JP, Hobbs RL. Dial in: fostering the use of telebehavioral health services in frontier Alaska. Psychol Serv 2013 Aug;10(3):289-297. [CrossRef] [Medline]2].
Process standardization and planning may facilitate the tools’ uptake [Goedken CC, Moeckli J, Cram PM, Reisinger HS. Introduction of Tele-ICU in rural hospitals: changing organisational culture to harness benefits. Intensive Crit Care Nurs 2017 Jun;40:51-56. [CrossRef] [Medline]45,Puszka S, Dingwall KM, Sweet M, Nagel T. E-Mental health innovations for aboriginal and Torres Strait Islander Australians: a qualitative study of implementation needs in health services. JMIR Ment Health 2016 Sep 19;3(3):e43 [FREE Full text] [CrossRef] [Medline]73,Varsi C, Ekstedt M, Gammon D, Ruland CM. Using the consolidated framework for implementation research to identify barriers and facilitators for the implementation of an internet-based patient-provider communication service in five settings: a qualitative study. J Med Internet Res 2015 Nov 18;17(11):e262 [FREE Full text] [CrossRef] [Medline]86,Vest BM, Hall VM, Kahn LS, Heider AR, Maloney N, Singh R. Nurse perspectives on the implementation of routine telemonitoring for high-risk diabetes patients in a primary care setting. Prim Health Care Res Dev 2017 Jan;18(1):3-13. [CrossRef] [Medline]88,Dünnebeil S, Sunyaev A, Blohm I, Leimeister JM, Krcmar H. Determinants of physicians' technology acceptance for e-health in ambulatory care. Int J Med Inform 2012 Nov;81(11):746-760. [CrossRef] [Medline]149]. This can be achieved via streamlined procedures [Egerton T, Nelligan R, Setchell J, Atkins L, Bennell KL. General practitioners' perspectives on a proposed new model of service delivery for primary care management of knee osteoarthritis: a qualitative study. BMC Fam Pract 2017 Sep 7;18(1):85 [FREE Full text] [CrossRef] [Medline]39,Sharma U, Clarke M. Nurses' and community support workers' experience of telehealth: a longitudinal case study. BMC Health Serv Res 2014 Apr 10;14:164 [FREE Full text] [CrossRef] [Medline]80,Muigg D, Kastner P, Modre-Osprian R, Haluza D, Duftschmid G. Is Austria ready for telemonitoring? A readiness assessment among doctors and patients in the field of diabetes. Stud Health Technol Inform 2018;248:322-329. [Medline]160], process protocols and clear guidelines describing the practical details of integrating mHealth into clinical practice [Esterle L, Mathieu-Fritz A. Teleconsultation in geriatrics: impact on professional practice. Int J Med Inform 2013 Aug;82(8):684-695. [CrossRef] [Medline]40,Ray KN, Felmet KA, Hamilton MF, Kuza CC, Saladino RA, Schultz BR, et al. Clinician attitudes toward adoption of pediatric emergency telemedicine in rural hospitals. Pediatr Emerg Care 2017 Apr;33(4):250-257. [CrossRef] [Medline]168,Koivunen M, Saranto K. Nursing professionals' experiences of the facilitators and barriers to the use of telehealth applications: a systematic review of qualitative studies. Scand J Caring Sci 2018 Mar;32(1):24-44. [CrossRef] [Medline]185], and the presence of internal responsibility for facilitating this standardization [Lord S, Moore SK, Ramsey A, Dinauer S, Johnson K. Implementation of a substance use recovery support mobile phone app in community settings: qualitative study of clinician and staff perspectives of facilitators and barriers. JMIR Ment Health 2016 Jun 28;3(2):e24 [FREE Full text] [CrossRef] [Medline]61,Jury SC, Walker AM, Kornberg AJ. The introduction of web-based video-consultation in a paediatric acute care setting. J Telemed Telecare 2013 Oct;19(7):383-387. [CrossRef] [Medline]103,Orchard J, Lowres N, Freedman SB, Ladak L, Lee W, Zwar N, et al. Screening for atrial fibrillation during influenza vaccinations by primary care nurses using a smartphone electrocardiograph (iECG): A feasibility study. Eur J Prev Cardiol 2016 Oct;23(2 suppl):13-20. [CrossRef] [Medline]164]. Lack of planning or standardization of implementation strategies can hinder adoption as it can cause workflow challenges [Mileski M, Kruse CS, Catalani J, Haderer T. Adopting telemedicine for the self-management of hypertension: systematic review. JMIR Med Inform 2017 Oct 24;5(4):e41 [FREE Full text] [CrossRef] [Medline]5,Giraldo L, Schachner B, Luna D, Benítez S. Exploring nurses' perceptions and expectations toward a BCMA implementation using a mobile app and workstations as a change management strategy. Stud Health Technol Inform 2018;250:134-138. [Medline]44,Grünloh C, Cajander A, Myreteg G. 'The Record is Our Work Tool!'- physicians' framing of a patient portal in Sweden. J Med Internet Res 2016 Jun 27;18(6):e167 [FREE Full text] [CrossRef] [Medline]46,Molfenter T, Boyle M, Holloway D, Zwick J. Trends in telemedicine use in addiction treatment. Addict Sci Clin Pract 2015 May 28;10:14 [FREE Full text] [CrossRef] [Medline]67,Sturesson L, Groth K. Effects of the digital transformation: qualitative study on the disturbances and limitations of using video visits in outpatient care. J Med Internet Res 2018 Jun 27;20(6):e221 [FREE Full text] [CrossRef] [Medline]82-van Gaalen JL, van Bodegom-Vos L, Bakker MJ, Snoeck-Stroband JB, Sont JK. Internet-based self-management support for adults with asthma: a qualitative study among patients, general practitioners and practice nurses on barriers to implementation. BMJ Open 2016 Aug 26;6(8):e010809 [FREE Full text] [CrossRef] [Medline]84,Jeon J, Taneva S, Kukreti V, Trbovich P, Easty AC, Rossos PG, et al. Toward successful migration to computerized physician order entry for chemotherapy. Curr Oncol 2014 Apr;21(2):e221-e228 [FREE Full text] [CrossRef] [Medline]155,Quanbeck A, Gustafson DH, Marsch LA, Chih M, Kornfield R, McTavish F, et al. Implementing a mobile health system to integrate the treatment of addiction into primary care: a hybrid implementation-effectiveness study. J Med Internet Res 2018 Jan 30;20(1):e37 [FREE Full text] [CrossRef] [Medline]167,Penny RA, Bradford NK, Langbecker D. Registered nurse and midwife experiences of using videoconferencing in practice: a systematic review of qualitative studies. J Clin Nurs 2018 Mar;27(5-6):e739-e752. [CrossRef] [Medline]189].
Staff nontechnical competence and qualifications also play a role in adoption [Avey JP, Hobbs RL. Dial in: fostering the use of telebehavioral health services in frontier Alaska. Psychol Serv 2013 Aug;10(3):289-297. [CrossRef] [Medline]2,Puszka S, Dingwall KM, Sweet M, Nagel T. E-Mental health innovations for aboriginal and Torres Strait Islander Australians: a qualitative study of implementation needs in health services. JMIR Ment Health 2016 Sep 19;3(3):e43 [FREE Full text] [CrossRef] [Medline]73,van Gaalen JL, van Bodegom-Vos L, Bakker MJ, Snoeck-Stroband JB, Sont JK. Internet-based self-management support for adults with asthma: a qualitative study among patients, general practitioners and practice nurses on barriers to implementation. BMJ Open 2016 Aug 26;6(8):e010809 [FREE Full text] [CrossRef] [Medline]84,Zilliacus E, Meiser B, Lobb E, Dudding TE, Barlow-Stewart K, Tucker K. The virtual consultation: practitioners' experiences of genetic counseling by videoconferencing in Australia. Telemed J E Health 2010 Apr;16(3):350-357. [CrossRef] [Medline]91,Loh P, Flicker L, Horner B. Attitudes toward information and communication technology (ICT) in residential aged care in Western Australia. J Am Med Dir Assoc 2009 Jul;10(6):408-413. [CrossRef] [Medline]156,Orchard J, Lowres N, Freedman SB, Ladak L, Lee W, Zwar N, et al. Screening for atrial fibrillation during influenza vaccinations by primary care nurses using a smartphone electrocardiograph (iECG): A feasibility study. Eur J Prev Cardiol 2016 Oct;23(2 suppl):13-20. [CrossRef] [Medline]164,Koivunen M, Saranto K. Nursing professionals' experiences of the facilitators and barriers to the use of telehealth applications: a systematic review of qualitative studies. Scand J Caring Sci 2018 Mar;32(1):24-44. [CrossRef] [Medline]185]. Factors such as knowledge of medical terminology, a good command of the language in which the tool is offered, and the capacity to review large amounts of data and using the complex charts produced by some of these tools are paramount for successful adoption [Bhatta R, Aryal K, Ellingsen G. Opportunities and challenges of a rural-telemedicine program in Nepal. J Nepal Health Res Counc 2015;13(30):149-153. [Medline]4,Chung C, Cook J, Bales E, Zia J, Munson SA. More than telemonitoring: health provider use and nonuse of life-log data in irritable bowel syndrome and weight management. J Med Internet Res 2015 Aug 21;17(8):e203 [FREE Full text] [CrossRef] [Medline]36,Kleinpell R, Barden C, Rincon T, McCarthy M, Rufo RJ. Assessing the impact of telemedicine on nursing care in intensive care units. Am J Crit Care 2016 Jan;25(1):e14-e20. [CrossRef] [Medline]109,Bramley G, Mangan C, Conroy M. Using telemonitoring to support personal care planning for adults with learning disabilities. J Telemed Telecare 2019 Dec;25(10):602-610. [CrossRef] [Medline]176]. Given the shared decision-making models and higher collaboration enabled by mHealth, a potential hurdle may be the lack of confidence in the collaborators’ clinical competence [Egerton T, Nelligan R, Setchell J, Atkins L, Bennell KL. General practitioners' perspectives on a proposed new model of service delivery for primary care management of knee osteoarthritis: a qualitative study. BMC Fam Pract 2017 Sep 7;18(1):85 [FREE Full text] [CrossRef] [Medline]39,James S, Perry L, Gallagher R, Lowe J. Diabetes educators: perceived experiences, supports and barriers to use of common diabetes-related technologies. J Diabetes Sci Technol 2016 Sep;10(5):1115-1121 [FREE Full text] [CrossRef] [Medline]51]. Another subsequent difficulty is the fear of exposing knowledge gaps [Kifle M, Payton FC, Mbarika V, Meso P. Transfer and adoption of advanced information technology solutions in resource-poor environments: the case of telemedicine systems adoption in Ethiopia. Telemed J E Health 2010 Apr;16(3):327-343. [CrossRef] [Medline]105,Klack L, Ziefle M, Wilkowska W, Kluge J. Telemedical versus conventional heart patient monitoring: a survey study with German physicians. Int J Technol Assess Health Care 2013 Oct;29(4):378-383. [CrossRef] [Medline]108,Sims MH, Fagnano M, Halterman JS, Halterman MW. Provider impressions of the use of a mobile crowdsourcing app in medical practice. Health Informatics J 2016 Jun;22(2):221-231. [CrossRef] [Medline]137] or being marginalized and undermined [Sharma U, Clarke M. Nurses' and community support workers' experience of telehealth: a longitudinal case study. BMC Health Serv Res 2014 Apr 10;14:164 [FREE Full text] [CrossRef] [Medline]80]. Conversely, the fact that such tools enable less experienced clinicians to access clinical resources can also be a facilitator [Moloczij N, Mosley I, Moss KM, Bagot KL, Bladin CF, Cadilhac DA. Is telemedicine helping or hindering the delivery of stroke thrombolysis in rural areas? A qualitative analysis. Intern Med J 2015 Sep;45(9):957-964. [CrossRef] [Medline]69].
The ability to efficiently manage and interpret the large amounts of data generated by mHealth, such as interpreting complex charts, may also impact adoption [Bramley G, Mangan C, Conroy M. Using telemonitoring to support personal care planning for adults with learning disabilities. J Telemed Telecare 2019 Dec;25(10):602-610. [CrossRef] [Medline]176]. Data management–related challenges can hinder the use of the tools [James S, Perry L, Gallagher R, Lowe J. Diabetes educators: perceived experiences, supports and barriers to use of common diabetes-related technologies. J Diabetes Sci Technol 2016 Sep;10(5):1115-1121 [FREE Full text] [CrossRef] [Medline]51,Brown W, Giguere R, Sheinfil A, Ibitoye M, Balan I, Ho T, et al. Challenges and solutions implementing an SMS text message-based survey CASI and adherence reminders in an international biomedical HIV PrEP study (MTN 017). J Biomed Inform 2018 Apr;80:78-86 [FREE Full text] [CrossRef] [Medline]177]. Factors such as information overload [Levine M, Richardson JE, Granieri E, Reid MC. Novel telemedicine technologies in geriatric chronic non-cancer pain: primary care providers' perspectives. Pain Med 2014 Feb;15(2):206-213 [FREE Full text] [CrossRef] [Medline]60,MacNeill V, Sanders C, Fitzpatrick R, Hendy J, Barlow J, Knapp M, et al. Experiences of front-line health professionals in the delivery of telehealth: a qualitative study. Br J Gen Pract 2014 Jul;64(624):e401-e407 [FREE Full text] [CrossRef] [Medline]62,Öberg U, Orre CJ, Isaksson U, Schimmer R, Larsson H, Hörnsten Å. Swedish primary healthcare nurses' perceptions of using digital eHealth services in support of patient self-management. Scand J Caring Sci 2018 Jun;32(2):961-970. [CrossRef] [Medline]72] and the integration of the generated data in the existing workflow can be challenging [Jimbo M, Shultz CG, Nease DE, Fetters MD, Power D, Ruffin MT. Perceived barriers and facilitators of using a Web-based interactive decision aid for colorectal cancer screening in community practice settings: findings from focus groups with primary care clinicians and medical office staff. J Med Internet Res 2013 Dec 18;15(12):e286 [FREE Full text] [CrossRef] [Medline]53,Quanbeck A, Gustafson DH, Marsch LA, Chih M, Kornfield R, McTavish F, et al. Implementing a mobile health system to integrate the treatment of addiction into primary care: a hybrid implementation-effectiveness study. J Med Internet Res 2018 Jan 30;20(1):e37 [FREE Full text] [CrossRef] [Medline]167,Radhakrishnan K, Xie B, Berkley A, Kim M. Barriers and facilitators for sustainability of tele-homecare programs: a systematic review. Health Serv Res 2016 Feb;51(1):48-75 [FREE Full text] [CrossRef] [Medline]182]. Other data-related risks, such as adverse events reporting and further handling, may also hinder adoption [de Vries ST, Wong L, Sutcliffe A, Houÿez F, Ruiz CL, Mol PG, IMI Web-RADR Work Package 3b Consortium. Factors influencing the use of a mobile app for reporting adverse drug reactions and receiving safety information: a qualitative study. Drug Saf 2017 May;40(5):443-455 [FREE Full text] [CrossRef] [Medline]38]. Although such new technologies increase the potential to combine data to enhance patient monitoring and improve clinical decision making, some of the available tools do not give clinicians the flexibility to customize data reporting according to their specific needs [Chung C, Cook J, Bales E, Zia J, Munson SA. More than telemonitoring: health provider use and nonuse of life-log data in irritable bowel syndrome and weight management. J Med Internet Res 2015 Aug 21;17(8):e203 [FREE Full text] [CrossRef] [Medline]36,Miller KE, Kuhn E, Owen JE, Taylor K, Yu JS, Weiss BJ, et al. Clinician perceptions related to the use of the CBT-I Coach Mobile App. Behav Sleep Med 2019;17(4):481-491. [CrossRef] [Medline]120,Davis MM, Freeman M, Kaye J, Vuckovic N, Buckley DI. A systematic review of clinician and staff views on the acceptability of incorporating remote monitoring technology into primary care. Telemed J E Health 2014 May;20(5):428-438 [FREE Full text] [CrossRef] [Medline]183]. Facilitators include availability and access to required data [Moharra M, Almazán C, Decool M, Nilsson A, Allegretti N, Seven M. Implementation of a cross-border health service: physician and pharmacists' opinions from the epSOS project. Fam Pract 2015 Oct;32(5):564-567. [CrossRef] [Medline]66,Schneider T, Panzera AD, Martinasek M, McDermott R, Couluris M, Lindenberger J, et al. Physicians' perceptions of mobile technology for enhancing asthma care for youth. J Child Health Care 2016 Jun;20(2):153-163. [CrossRef] [Medline]77,Holderried M, Hoeper A, Holderried F, Blumenstock G, Ernst C, Tropitzsch A. Attitudes toward e-Health: the otolaryngologists' point of view. Telemed J E Health 2018 Jun;24(6):425-432. [CrossRef] [Medline]100,Duhm J, Fleischmann R, Schmidt S, Hupperts H, Brandt SA. Mobile electronic medical records promote workflow: physicians' perspective from a survey. JMIR Mhealth Uhealth 2016 Jun 6;4(2):e70 [FREE Full text] [CrossRef] [Medline]150], higher efficiency of data analysis [Rothstein JD, Jennings L, Moorthy A, Yang F, Gee L, Romano K, et al. Qualitative assessment of the feasibility, usability, and acceptability of a mobile client data app for community-based maternal, neonatal, and child care in rural Ghana. Int J Telemed Appl 2016;2016:2515420 [FREE Full text] [CrossRef] [Medline]74,Klack L, Ziefle M, Wilkowska W, Kluge J. Telemedical versus conventional heart patient monitoring: a survey study with German physicians. Int J Technol Assess Health Care 2013 Oct;29(4):378-383. [CrossRef] [Medline]108], better patient care management because of the timely availability of data [Sandberg J, Trief PM, Izquierdo R, Goland R, Morin PC, Palmas W, et al. A qualitative study of the experiences and satisfaction of direct telemedicine providers in diabetes case management. Telemed J E Health 2009 Oct;15(8):742-750. [CrossRef] [Medline]75,Seto E, Leonard KJ, Cafazzo JA, Barnsley J, Masino C, Ross HJ. Perceptions and experiences of heart failure patients and clinicians on the use of mobile phone-based telemonitoring. J Med Internet Res 2012 Feb 10;14(1):e25 [FREE Full text] [CrossRef] [Medline]78,L'Esperance ST, Perry DJ. Assessing advantages and barriers to telemedicine adoption in the practice setting: A MyCareTeam(TM) exemplar. J Am Assoc Nurse Pract 2016 Jun;28(6):311-319. [CrossRef] [Medline]115,Lapão LV, da Silva MM, Gregório J. Implementing an online pharmaceutical service using design science research. BMC Med Inform Decis Mak 2017 Mar 27;17(1):31 [FREE Full text] [CrossRef] [Medline]157], and the better ability to measure outcome [Puszka S, Dingwall KM, Sweet M, Nagel T. E-Mental health innovations for aboriginal and Torres Strait Islander Australians: a qualitative study of implementation needs in health services. JMIR Ment Health 2016 Sep 19;3(3):e43 [FREE Full text] [CrossRef] [Medline]73].
mHealth requires a change of paradigm that mostly results in changes to clinical practice [Hanley J, Ure J, Pagliari C, Sheikh A, McKinstry B. Experiences of patients and professionals participating in the HITS home blood pressure telemonitoring trial: a qualitative study. BMJ Open 2013 May 28;3(5):pii: e002671 [FREE Full text] [CrossRef] [Medline]48,Tintorer DL, Domínguez JM, Pujol-Rivera E, Beneyto SF, Tuduri XM, Saigí-Rubió F. Keys to success of a community of clinical practice in primary care: a qualitative evaluation of the ECOPIH project. BMC Fam Pract 2018 May 9;19(1):56 [FREE Full text] [CrossRef] [Medline]59,Bagot KL, Cadilhac DA, Bladin CF, Watkins CL, Vu M, Donnan GA, VSTASTUTE investigators. Integrating acute stroke telemedicine consultations into specialists' usual practice: a qualitative analysis comparing the experience of Australia and the United Kingdom. BMC Health Serv Res 2017 Nov 21;17(1):751 [FREE Full text] [CrossRef] [Medline]65,Carlisle K, Warren R. A qualitative case study of telehealth for in-home monitoring to support the management of type 2 diabetes. J Telemed Telecare 2013 Oct;19(7):372-375. [CrossRef] [Medline]92,Kumar S, Merchant S, Reynolds R. Tele-ICU: efficacy and cost-effectiveness approach of remotely managing the critical care. Open Med Inform J 2013;7:24-29 [FREE Full text] [CrossRef] [Medline]186,Penny RA, Bradford NK, Langbecker D. Registered nurse and midwife experiences of using videoconferencing in practice: a systematic review of qualitative studies. J Clin Nurs 2018 Mar;27(5-6):e739-e752. [CrossRef] [Medline]189,Ahmad F, Norman C, O'Campo P. What is needed to implement a computer-assisted health risk assessment tool? An exploratory concept mapping study. BMC Med Inform Decis Mak 2012 Dec 19;12:149 [FREE Full text] [CrossRef] [Medline]192]. This is not necessarily a barrier to adoption; on the contrary, some studies show that clinicians are aware of the change that the technology entails and have already prepared themselves for it [Asua J, Orruño E, Reviriego E, Gagnon MP. Healthcare professional acceptance of telemonitoring for chronic care patients in primary care. BMC Med Inform Decis Mak 2012 Nov 30;12:139 [FREE Full text] [CrossRef] [Medline]139]. This paradigm shift is linked to factors such as patients’ self-monitoring and self-reporting, which necessitate new ways of treatment and care [Brewster L, Mountain G, Wessels B, Kelly C, Hawley M. Factors affecting front line staff acceptance of telehealth technologies: a mixed-method systematic review. J Adv Nurs 2014 Jan;70(1):21-33. [CrossRef] [Medline]10,Öberg U, Orre CJ, Isaksson U, Schimmer R, Larsson H, Hörnsten Å. Swedish primary healthcare nurses' perceptions of using digital eHealth services in support of patient self-management. Scand J Caring Sci 2018 Jun;32(2):961-970. [CrossRef] [Medline]72,Odnoletkova I, Buysse H, Nobels F, Goderis G, Aertgeerts B, Annemans L, et al. Patient and provider acceptance of telecoaching in type 2 diabetes: a mixed-method study embedded in a randomised clinical trial. BMC Med Inform Decis Mak 2016 Nov 9;16(1):142 [FREE Full text] [CrossRef] [Medline]162,Koivunen M, Saranto K. Nursing professionals' experiences of the facilitators and barriers to the use of telehealth applications: a systematic review of qualitative studies. Scand J Caring Sci 2018 Mar;32(1):24-44. [CrossRef] [Medline]185]. However, this redistribution of roles can sometimes be challenging [de Souza CH, Morbeck RA, Steinman M, Hors CP, Bracco MM, Kozasa EH, et al. Barriers and benefits in telemedicine arising between a high-technology hospital service provider and remote public healthcare units: a qualitative study in Brazil. Telemed J E Health 2017 Jun;23(6):527-532. [CrossRef] [Medline]37,Casey M, Shaw S, Swinglehurst D. Experiences with online consultation systems in primary care: case study of one early adopter site. Br J Gen Pract 2017 Nov;67(664):e736-e743 [FREE Full text] [CrossRef] [Medline]94,Radhakrishnan K, Xie B, Berkley A, Kim M. Barriers and facilitators for sustainability of tele-homecare programs: a systematic review. Health Serv Res 2016 Feb;51(1):48-75 [FREE Full text] [CrossRef] [Medline]182]. For example, when a tool enables patients to access some of their test results before their care team, they can perceive this as an interference with established clinical practice [Grünloh C, Cajander A, Myreteg G. 'The Record is Our Work Tool!'- physicians' framing of a patient portal in Sweden. J Med Internet Res 2016 Jun 27;18(6):e167 [FREE Full text] [CrossRef] [Medline]46].
Clinicians’ perceptions of mHealth’s impact on their autonomy and job security may also influence adoption [Gagnon MP, Ngangue P, Payne-Gagnon J, Desmartis M. m-Health adoption by healthcare professionals: a systematic review. J Am Med Inform Assoc 2016 Jan;23(1):212-220. [CrossRef] [Medline]9,Brewster L, Mountain G, Wessels B, Kelly C, Hawley M. Factors affecting front line staff acceptance of telehealth technologies: a mixed-method systematic review. J Adv Nurs 2014 Jan;70(1):21-33. [CrossRef] [Medline]10,Öberg U, Orre CJ, Isaksson U, Schimmer R, Larsson H, Hörnsten Å. Swedish primary healthcare nurses' perceptions of using digital eHealth services in support of patient self-management. Scand J Caring Sci 2018 Jun;32(2):961-970. [CrossRef] [Medline]72,Bramley G, Mangan C, Conroy M. Using telemonitoring to support personal care planning for adults with learning disabilities. J Telemed Telecare 2019 Dec;25(10):602-610. [CrossRef] [Medline]176,Radhakrishnan K, Xie B, Berkley A, Kim M. Barriers and facilitators for sustainability of tele-homecare programs: a systematic review. Health Serv Res 2016 Feb;51(1):48-75 [FREE Full text] [CrossRef] [Medline]182,Koivunen M, Saranto K. Nursing professionals' experiences of the facilitators and barriers to the use of telehealth applications: a systematic review of qualitative studies. Scand J Caring Sci 2018 Mar;32(1):24-44. [CrossRef] [Medline]185,Li L, Cotton A. A systematic review of nurses' perspectives toward the telemedicine intensive care unit: a basis for supporting its future implementation in China? Telemed J E Health 2019 May;25(5):343-350. [CrossRef] [Medline]188]. Perceptions that the new tools compromise clinicians’ autonomy, for example, by making their patients’ treatment plans and outcomes more reachable to others and accordingly subject to more external control or criticism, may hinder adoption [MacNeill V, Sanders C, Fitzpatrick R, Hendy J, Barlow J, Knapp M, et al. Experiences of front-line health professionals in the delivery of telehealth: a qualitative study. Br J Gen Pract 2014 Jul;64(624):e401-e407 [FREE Full text] [CrossRef] [Medline]62,Liu CF, Cheng TJ. Exploring critical factors influencing physicians' acceptance of mobile electronic medical records based on the dual-factor model: a validation in Taiwan. BMC Med Inform Decis Mak 2015 Feb 7;15:4 [FREE Full text] [CrossRef] [Medline]116,Rogove HJ, McArthur D, Demaerschalk BM, Vespa PM. Barriers to telemedicine: survey of current users in acute care units. Telemed J E Health 2012;18(1):48-53. [CrossRef] [Medline]130,Steinschaden T, Petersson G, Astrand B. Physicians' attitudes towards eprescribing: a comparative web survey in Austria and Sweden. Inform Prim Care 2009;17(4):241-248 [FREE Full text] [CrossRef] [Medline]140,Uscher-Pines L, Kahn JM. Barriers and facilitators to pediatric emergency telemedicine in the United States. Telemed J E Health 2014 Nov;20(11):990-996 [FREE Full text] [CrossRef] [Medline]141,Kumar S, Merchant S, Reynolds R. Tele-ICU: efficacy and cost-effectiveness approach of remotely managing the critical care. Open Med Inform J 2013;7:24-29 [FREE Full text] [CrossRef] [Medline]186,Li L, Cotton A. A systematic review of nurses' perspectives toward the telemedicine intensive care unit: a basis for supporting its future implementation in China? Telemed J E Health 2019 May;25(5):343-350. [CrossRef] [Medline]188]. This can be a considerable barrier to adoption when care teams perceive the new technology as a threat to their own career and livelihood [Kayyali R, Hesso I, Mahdi A, Hamzat O, Adu A, Nabhani Gebara S. Telehealth: misconceptions and experiences of healthcare professionals in England. Int J Pharm Pract 2017 Jun;25(3):203-209. [CrossRef] [Medline]55,Öberg U, Orre CJ, Isaksson U, Schimmer R, Larsson H, Hörnsten Å. Swedish primary healthcare nurses' perceptions of using digital eHealth services in support of patient self-management. Scand J Caring Sci 2018 Jun;32(2):961-970. [CrossRef] [Medline]72,Uscher-Pines L, Kahn JM. Barriers and facilitators to pediatric emergency telemedicine in the United States. Telemed J E Health 2014 Nov;20(11):990-996 [FREE Full text] [CrossRef] [Medline]141,Alajlani M, Clarke M. Effect of culture on acceptance of telemedicine in Middle Eastern countries: case study of Jordan and Syria. Telemed J E Health 2013 Apr;19(4):305-311. [CrossRef] [Medline]151]. Equally, a tool has better chances of being adopted when perceived as a complement, not a substitute to clinicians’ role [MacNeill V, Sanders C, Fitzpatrick R, Hendy J, Barlow J, Knapp M, et al. Experiences of front-line health professionals in the delivery of telehealth: a qualitative study. Br J Gen Pract 2014 Jul;64(624):e401-e407 [FREE Full text] [CrossRef] [Medline]62]. Some studies report that clinicians feel that they need to renegotiate their professional identities in the face of the empowered and informed patient that is sometimes seen as undermining the authority and credibility of the care teams [Brewster L, Mountain G, Wessels B, Kelly C, Hawley M. Factors affecting front line staff acceptance of telehealth technologies: a mixed-method systematic review. J Adv Nurs 2014 Jan;70(1):21-33. [CrossRef] [Medline]10,MacNeill V, Sanders C, Fitzpatrick R, Hendy J, Barlow J, Knapp M, et al. Experiences of front-line health professionals in the delivery of telehealth: a qualitative study. Br J Gen Pract 2014 Jul;64(624):e401-e407 [FREE Full text] [CrossRef] [Medline]62,Öberg U, Orre CJ, Isaksson U, Schimmer R, Larsson H, Hörnsten Å. Swedish primary healthcare nurses' perceptions of using digital eHealth services in support of patient self-management. Scand J Caring Sci 2018 Jun;32(2):961-970. [CrossRef] [Medline]72,Sharma U, Clarke M. Nurses' and community support workers' experience of telehealth: a longitudinal case study. BMC Health Serv Res 2014 Apr 10;14:164 [FREE Full text] [CrossRef] [Medline]80,Radhakrishnan K, Xie B, Berkley A, Kim M. Barriers and facilitators for sustainability of tele-homecare programs: a systematic review. Health Serv Res 2016 Feb;51(1):48-75 [FREE Full text] [CrossRef] [Medline]182]. Conversely, it was also reported that mHealth can empower clinicians and help them be more autonomous, positively impacting adoption [O'Connor S, Andrews T. Smartphones and mobile applications (apps) in clinical nursing education: a student perspective. Nurse Educ Today 2018 Oct;69:172-178. [CrossRef] [Medline]124].
Clinicians’ empowerment is tightly linked to the possibility of positively impacting their professional development and expertise because of the use of these new technologies, especially among nursing staff [MacNeill V, Sanders C, Fitzpatrick R, Hendy J, Barlow J, Knapp M, et al. Experiences of front-line health professionals in the delivery of telehealth: a qualitative study. Br J Gen Pract 2014 Jul;64(624):e401-e407 [FREE Full text] [CrossRef] [Medline]62,Öberg U, Orre CJ, Isaksson U, Schimmer R, Larsson H, Hörnsten Å. Swedish primary healthcare nurses' perceptions of using digital eHealth services in support of patient self-management. Scand J Caring Sci 2018 Jun;32(2):961-970. [CrossRef] [Medline]72,O'Connor S, Andrews T. Smartphones and mobile applications (apps) in clinical nursing education: a student perspective. Nurse Educ Today 2018 Oct;69:172-178. [CrossRef] [Medline]124,Odnoletkova I, Buysse H, Nobels F, Goderis G, Aertgeerts B, Annemans L, et al. Patient and provider acceptance of telecoaching in type 2 diabetes: a mixed-method study embedded in a randomised clinical trial. BMC Med Inform Decis Mak 2016 Nov 9;16(1):142 [FREE Full text] [CrossRef] [Medline]162,Shaw RJ, Kaufman MA, Bosworth HB, Weiner BJ, Zullig LL, Lee SD, et al. Organizational factors associated with readiness to implement and translate a primary care based telemedicine behavioral program to improve blood pressure control: the HTN-IMPROVE study. Implement Sci 2013 Sep 8;8:106 [FREE Full text] [CrossRef] [Medline]169,Li L, Cotton A. A systematic review of nurses' perspectives toward the telemedicine intensive care unit: a basis for supporting its future implementation in China? Telemed J E Health 2019 May;25(5):343-350. [CrossRef] [Medline]188,Penny RA, Bradford NK, Langbecker D. Registered nurse and midwife experiences of using videoconferencing in practice: a systematic review of qualitative studies. J Clin Nurs 2018 Mar;27(5-6):e739-e752. [CrossRef] [Medline]189]. The educational benefits of mHealth for physicians can similarly encourage adoption [Sims MH, Fagnano M, Halterman JS, Halterman MW. Provider impressions of the use of a mobile crowdsourcing app in medical practice. Health Informatics J 2016 Jun;22(2):221-231. [CrossRef] [Medline]137,Nerminathan A, Harrison A, Phelps M, Alexander S, Scott KM. Doctors' use of mobile devices in the clinical setting: a mixed methods study. Intern Med J 2017 Mar;47(3):291-298. [CrossRef] [Medline]161]. The tools are perceived as enablers that prompt for best practice care, provide novel decision aids, and expand clinical knowledge [Puszka S, Dingwall KM, Sweet M, Nagel T. E-Mental health innovations for aboriginal and Torres Strait Islander Australians: a qualitative study of implementation needs in health services. JMIR Ment Health 2016 Sep 19;3(3):e43 [FREE Full text] [CrossRef] [Medline]73,Rothstein JD, Jennings L, Moorthy A, Yang F, Gee L, Romano K, et al. Qualitative assessment of the feasibility, usability, and acceptability of a mobile client data app for community-based maternal, neonatal, and child care in rural Ghana. Int J Telemed Appl 2016;2016:2515420 [FREE Full text] [CrossRef] [Medline]74,Varsi C, Ekstedt M, Gammon D, Ruland CM. Using the consolidated framework for implementation research to identify barriers and facilitators for the implementation of an internet-based patient-provider communication service in five settings: a qualitative study. J Med Internet Res 2015 Nov 18;17(11):e262 [FREE Full text] [CrossRef] [Medline]86,Sadoughi F, Erfannia L, Sancholi M, Salmani F, Sarsarshahi A. Teleradiology in Southeast Iran: Evaluating the Views of Senior Executives and Radiologists. Health Care Manag (Frederick) 2017;36(3):301-307. [CrossRef] [Medline]131].
Facilitating the adoption may be encouraged through proper incentives for clinicians [Bhatta R, Aryal K, Ellingsen G. Opportunities and challenges of a rural-telemedicine program in Nepal. J Nepal Health Res Counc 2015;13(30):149-153. [Medline]4,Vest BM, Hall VM, Kahn LS, Heider AR, Maloney N, Singh R. Nurse perspectives on the implementation of routine telemonitoring for high-risk diabetes patients in a primary care setting. Prim Health Care Res Dev 2017 Jan;18(1):3-13. [CrossRef] [Medline]88,Adenuga KI, Iahad NA, Miskon S. Towards reinforcing telemedicine adoption amongst clinicians in Nigeria. Int J Med Inform 2017 Aug;104:84-96. [CrossRef] [Medline]106,Morilla MD, Sans M, Casasa A, Giménez N. Implementing technology in healthcare: insights from physicians. BMC Med Inform Decis Mak 2017 Jun 27;17(1):92 [FREE Full text] [CrossRef] [Medline]122,Orchard J, Lowres N, Freedman SB, Ladak L, Lee W, Zwar N, et al. Screening for atrial fibrillation during influenza vaccinations by primary care nurses using a smartphone electrocardiograph (iECG): A feasibility study. Eur J Prev Cardiol 2016 Oct;23(2 suppl):13-20. [CrossRef] [Medline]164]. Incentives such as awarding continuing medical education, adding mHealth use as an objective in employee appraisals, offering financial rewards through improved reimbursement schemes, and more clarity around medico-legal topics may encourage use [Armstrong AW, Kwong MW, Ledo L, Nesbitt TS, Shewry SL. Practice models and challenges in teledermatology: a study of collective experiences from teledermatologists. PLoS One 2011;6(12):e28687 [FREE Full text] [CrossRef] [Medline]54,Tintorer DL, Domínguez JM, Pujol-Rivera E, Beneyto SF, Tuduri XM, Saigí-Rubió F. Keys to success of a community of clinical practice in primary care: a qualitative evaluation of the ECOPIH project. BMC Fam Pract 2018 May 9;19(1):56 [FREE Full text] [CrossRef] [Medline]59,Bello AK, Molzahn AE, Girard LP, Osman MA, Okpechi IG, Glassford J, et al. Patient and provider perspectives on the design and implementation of an electronic consultation system for kidney care delivery in Canada: a focus group study. BMJ Open 2017 Mar 2;7(3):e014784 [FREE Full text] [CrossRef] [Medline]87,Rho MJ, Choi IY, Lee J. Predictive factors of telemedicine service acceptance and behavioral intention of physicians. Int J Med Inform 2014 Aug;83(8):559-571. [CrossRef] [Medline]129,Uscher-Pines L, Kahn JM. Barriers and facilitators to pediatric emergency telemedicine in the United States. Telemed J E Health 2014 Nov;20(11):990-996 [FREE Full text] [CrossRef] [Medline]141,Lapão LV, da Silva MM, Gregório J. Implementing an online pharmaceutical service using design science research. BMC Med Inform Decis Mak 2017 Mar 27;17(1):31 [FREE Full text] [CrossRef] [Medline]157,Zhang Y, Koch S. Mobile health apps in Sweden: what do physicians recommend? Stud Health Technol Inform 2015;210:793-797. [Medline]175,Jungwirth D, Haluza D. Information and communication technology and the future of healthcare: results of a multi-scenario Delphi survey. Health Informatics J 2019 Mar;25(1):161-173. [CrossRef] [Medline]191].
Decision making can be a hurdle for adoption in the absence of a dedicated team or person responsible for digital health programs in the highly fragmented health care organizations [Bhatta R, Aryal K, Ellingsen G. Opportunities and challenges of a rural-telemedicine program in Nepal. J Nepal Health Res Counc 2015;13(30):149-153. [Medline]4,Jetty A, Moore MA, Coffman M, Petterson S, Bazemore A. Rural family physicians are twice as likely to use telehealth as urban family physicians. Telemed J E Health 2018 Apr;24(4):268-276. [CrossRef] [Medline]102,Muigg D, Kastner P, Modre-Osprian R, Haluza D, Duftschmid G. Is Austria ready for telemonitoring? A readiness assessment among doctors and patients in the field of diabetes. Stud Health Technol Inform 2018;248:322-329. [Medline]160,Jungwirth D, Haluza D. Information and communication technology and the future of healthcare: results of a multi-scenario Delphi survey. Health Informatics J 2019 Mar;25(1):161-173. [CrossRef] [Medline]191]. This can also be an obstacle when the official decision makers do not involve practitioners in defining the aims and objectives of the introduction of an mHealth tool [Flynn D, Gregory P, Makki H, Gabbay M. Expectations and experiences of eHealth in primary care: a qualitative practice-based investigation. Int J Med Inform 2009 Sep;78(9):588-604. [CrossRef] [Medline]43,Odeh B, Kayyali R, Nabhani-Gebara S, Philip N. Implementing a telehealth service: nurses' perceptions and experiences. Br J Nurs 2014;23(21):1133-1137. [CrossRef] [Medline]71,Öberg U, Orre CJ, Isaksson U, Schimmer R, Larsson H, Hörnsten Å. Swedish primary healthcare nurses' perceptions of using digital eHealth services in support of patient self-management. Scand J Caring Sci 2018 Jun;32(2):961-970. [CrossRef] [Medline]72].
Social and Organizational Factors: Patient Related
Improvements in the quality and efficiency of care may positively impact clinicians’ adoption of mHealth [Anderson K, Francis T, Ibanez-Carrasco F, Globerman J. Physician's perceptions of telemedicine in HIV care provision: a cross-sectional web-based survey. JMIR Public Health Surveill 2017 May 30;3(2):e31 [FREE Full text] [CrossRef] [Medline]3,Mileski M, Kruse CS, Catalani J, Haderer T. Adopting telemedicine for the self-management of hypertension: systematic review. JMIR Med Inform 2017 Oct 24;5(4):e41 [FREE Full text] [CrossRef] [Medline]5,Giraldo L, Schachner B, Luna D, Benítez S. Exploring nurses' perceptions and expectations toward a BCMA implementation using a mobile app and workstations as a change management strategy. Stud Health Technol Inform 2018;250:134-138. [Medline]44,Jarvis-Selinger S, Bates J, Araki Y, Lear SA. Internet-based support for cardiovascular disease management. Int J Telemed Appl 2011;2011:342582 [FREE Full text] [CrossRef] [Medline]52,Lord S, Moore SK, Ramsey A, Dinauer S, Johnson K. Implementation of a substance use recovery support mobile phone app in community settings: qualitative study of clinician and staff perspectives of facilitators and barriers. JMIR Ment Health 2016 Jun 28;3(2):e24 [FREE Full text] [CrossRef] [Medline]61,McNally G, Frey R, Crossan M. Nurse manager and student nurse perceptions of the use of personal smartphones or tablets and the adjunct applications, as an educational tool in clinical settings. Nurse Educ Pract 2017 Mar;23:1-7. [CrossRef] [Medline]63,Merchant KA, Ward MM, Mueller KJ, Rural Health Research & Policy Centers, Rural Policy Research Institute‚ RUPRI Center for Rural Health Policy Analysis‚ University of Iowa College of Public Health‚ Department of Health Management and Policy. Hospital views of factors affecting telemedicine use. Rural Policy Brief 2015 Apr 1(2015 5):1-4. [Medline]64,Moharra M, Almazán C, Decool M, Nilsson A, Allegretti N, Seven M. Implementation of a cross-border health service: physician and pharmacists' opinions from the epSOS project. Fam Pract 2015 Oct;32(5):564-567. [CrossRef] [Medline]66,Moloczij N, Mosley I, Moss KM, Bagot KL, Bladin CF, Cadilhac DA. Is telemedicine helping or hindering the delivery of stroke thrombolysis in rural areas? A qualitative analysis. Intern Med J 2015 Sep;45(9):957-964. [CrossRef] [Medline]69,Taylor J, Coates L. Caring from a distance: the role of telehealth. Nurs Times 2015;111(28-29):18-20. [Medline]83,Varsi C, Ekstedt M, Gammon D, Ruland CM. Using the consolidated framework for implementation research to identify barriers and facilitators for the implementation of an internet-based patient-provider communication service in five settings: a qualitative study. J Med Internet Res 2015 Nov 18;17(11):e262 [FREE Full text] [CrossRef] [Medline]86,Holderried M, Hoeper A, Holderried F, Blumenstock G, Ernst C, Tropitzsch A. Attitudes toward e-Health: the otolaryngologists' point of view. Telemed J E Health 2018 Jun;24(6):425-432. [CrossRef] [Medline]100,Kim S, Lee KH, Hwang H, Yoo S. Analysis of the factors influencing healthcare professionals' adoption of mobile electronic medical record (EMR) using the unified theory of acceptance and use of technology (UTAUT) in a tertiary hospital. BMC Med Inform Decis Mak 2016 Jan 30;16:12 [FREE Full text] [CrossRef] [Medline]107-Kleinpell R, Barden C, Rincon T, McCarthy M, Rufo RJ. Assessing the impact of telemedicine on nursing care in intensive care units. Am J Crit Care 2016 Jan;25(1):e14-e20. [CrossRef] [Medline]109,Miller KE, Kuhn E, Owen JE, Taylor K, Yu JS, Weiss BJ, et al. Clinician perceptions related to the use of the CBT-I Coach Mobile App. Behav Sleep Med 2019;17(4):481-491. [CrossRef] [Medline]120,Morilla MD, Sans M, Casasa A, Giménez N. Implementing technology in healthcare: insights from physicians. BMC Med Inform Decis Mak 2017 Jun 27;17(1):92 [FREE Full text] [CrossRef] [Medline]122, Okazaki S, Castañeda JA, Sanz S, Henseler J. Factors affecting mobile diabetes monitoring adoption among physicians: questionnaire study and path model. J Med Internet Res 2012 Dec 21;14(6):e183 [FREE Full text] [CrossRef] [Medline]125,Putzer GJ, Park Y. Are physicians likely to adopt emerging mobile technologies? Attitudes and innovation factors affecting smartphone use in the Southeastern United States. Perspect Health Inf Manag 2012;9:1b [FREE Full text] [Medline]127,Steinschaden T, Petersson G, Astrand B. Physicians' attitudes towards eprescribing: a comparative web survey in Austria and Sweden. Inform Prim Care 2009;17(4):241-248 [FREE Full text] [CrossRef] [Medline]140,Possemato K, Kuhn E, Johnson EM, Hoffman JE, Brooks E. Development and refinement of a clinician intervention to facilitate primary care patient use of the PTSD Coach app. Transl Behav Med 2017 Mar;7(1):116-126 [FREE Full text] [CrossRef] [Medline]166,Ray KN, Felmet KA, Hamilton MF, Kuza CC, Saladino RA, Schultz BR, et al. Clinician attitudes toward adoption of pediatric emergency telemedicine in rural hospitals. Pediatr Emerg Care 2017 Apr;33(4):250-257. [CrossRef] [Medline]168,Zhang Y, Koch S. Mobile health apps in Sweden: what do physicians recommend? Stud Health Technol Inform 2015;210:793-797. [Medline]175,Radhakrishnan K, Xie B, Berkley A, Kim M. Barriers and facilitators for sustainability of tele-homecare programs: a systematic review. Health Serv Res 2016 Feb;51(1):48-75 [FREE Full text] [CrossRef] [Medline]182,Kumar S, Merchant S, Reynolds R. Tele-ICU: efficacy and cost-effectiveness approach of remotely managing the critical care. Open Med Inform J 2013;7:24-29 [FREE Full text] [CrossRef] [Medline]186,Putzer GJ, Park Y. The effects of innovation factors on smartphone adoption among nurses in community hospitals. Perspect Health Inf Manag 2010 Jan 1;7:1b [FREE Full text] [Medline]196]. Such tools can improve the quality of patient care through better information access, improved disease control, personalized treatment plans, and more proactive support [Avey JP, Hobbs RL. Dial in: fostering the use of telebehavioral health services in frontier Alaska. Psychol Serv 2013 Aug;10(3):289-297. [CrossRef] [Medline]2,Chung C, Cook J, Bales E, Zia J, Munson SA. More than telemonitoring: health provider use and nonuse of life-log data in irritable bowel syndrome and weight management. J Med Internet Res 2015 Aug 21;17(8):e203 [FREE Full text] [CrossRef] [Medline]36,de Souza CH, Morbeck RA, Steinman M, Hors CP, Bracco MM, Kozasa EH, et al. Barriers and benefits in telemedicine arising between a high-technology hospital service provider and remote public healthcare units: a qualitative study in Brazil. Telemed J E Health 2017 Jun;23(6):527-532. [CrossRef] [Medline]37,Esterle L, Mathieu-Fritz A. Teleconsultation in geriatrics: impact on professional practice. Int J Med Inform 2013 Aug;82(8):684-695. [CrossRef] [Medline]40,Farrell M. Use of iPhones by nurses in an acute care setting to improve communication and decision-making processes: qualitative analysis of nurses' perspectives on iPhone use. JMIR Mhealth Uhealth 2016 May 31;4(2):e43 [FREE Full text] [CrossRef] [Medline]42,Han KJ, Subramanian R, Cameron GT. Listen before you leap: Sri Lankan health professionals' perspectives on m-health. Health Informatics J 2019 Sep;25(3):858-866. [CrossRef] [Medline]47,Hanley J, Ure J, Pagliari C, Sheikh A, McKinstry B. Experiences of patients and professionals participating in the HITS home blood pressure telemonitoring trial: a qualitative study. BMJ Open 2013 May 28;3(5):pii: e002671 [FREE Full text] [CrossRef] [Medline]48,Kayyali R, Hesso I, Mahdi A, Hamzat O, Adu A, Nabhani Gebara S. Telehealth: misconceptions and experiences of healthcare professionals in England. Int J Pharm Pract 2017 Jun;25(3):203-209. [CrossRef] [Medline]55-Kim JW, Tiyyagura G, Langhan M. A qualitative analysis of general emergency medicine providers' perceptions on pediatric emergency telemedicine. Pediatr Emerg Care 2019 Dec;35(12):856-861. [CrossRef] [Medline]57,Öberg U, Orre CJ, Isaksson U, Schimmer R, Larsson H, Hörnsten Å. Swedish primary healthcare nurses' perceptions of using digital eHealth services in support of patient self-management. Scand J Caring Sci 2018 Jun;32(2):961-970. [CrossRef] [Medline]72,Seto E, Leonard KJ, Cafazzo JA, Barnsley J, Masino C, Ross HJ. Perceptions and experiences of heart failure patients and clinicians on the use of mobile phone-based telemonitoring. J Med Internet Res 2012 Feb 10;14(1):e25 [FREE Full text] [CrossRef] [Medline]78,Sharma U, Clarke M. Nurses' and community support workers' experience of telehealth: a longitudinal case study. BMC Health Serv Res 2014 Apr 10;14:164 [FREE Full text] [CrossRef] [Medline]80, Vest BM, Hall VM, Kahn LS, Heider AR, Maloney N, Singh R. Nurse perspectives on the implementation of routine telemonitoring for high-risk diabetes patients in a primary care setting. Prim Health Care Res Dev 2017 Jan;18(1):3-13. [CrossRef] [Medline]88,Carlisle K, Warren R. A qualitative case study of telehealth for in-home monitoring to support the management of type 2 diabetes. J Telemed Telecare 2013 Oct;19(7):372-375. [CrossRef] [Medline]92,Cary MP, Spencer M, Carroll A, Hand DH, Amis K, Karan E, et al. Benefits and challenges of delivering tele-rehabilitation services to rural veterans. Home Healthc Now 2016 Sep;34(8):440-446. [CrossRef] [Medline]93,Jury SC, Walker AM, Kornberg AJ. The introduction of web-based video-consultation in a paediatric acute care setting. J Telemed Telecare 2013 Oct;19(7):383-387. [CrossRef] [Medline]103,Lee SI, Park H, Kim JW, Hwang H, Cho EY, Kim Y, et al. Physicians' perceptions and use of a health information exchange: a pilot program in South Korea. Telemed J E Health 2012 Oct;18(8):604-612 [FREE Full text] [CrossRef] [Medline]114,L'Esperance ST, Perry DJ. Assessing advantages and barriers to telemedicine adoption in the practice setting: A MyCareTeam(TM) exemplar. J Am Assoc Nurse Pract 2016 Jun;28(6):311-319. [CrossRef] [Medline]115,Mairesse GH, Braunschweig F, Klersy K, Cowie MR, Leyva F. Implementation and reimbursement of remote monitoring for cardiac implantable electronic devices in Europe: a survey from the health economics committee of the European Heart Rhythm Association. Europace 2015 May;17(5):814-818. [CrossRef] [Medline]119,Rogove HJ, McArthur D, Demaerschalk BM, Vespa PM. Barriers to telemedicine: survey of current users in acute care units. Telemed J E Health 2012;18(1):48-53. [CrossRef] [Medline]130,Lapão LV, da Silva MM, Gregório J. Implementing an online pharmaceutical service using design science research. BMC Med Inform Decis Mak 2017 Mar 27;17(1):31 [FREE Full text] [CrossRef] [Medline]157,Mueller KJ, Potter AJ, MacKinney AC, Ward MM. Lessons from tele-emergency: improving care quality and health outcomes by expanding support for rural care systems. Health Aff (Millwood) 2014 Feb;33(2):228-234. [CrossRef] [Medline]159,Muigg D, Kastner P, Modre-Osprian R, Haluza D, Duftschmid G. Is Austria ready for telemonitoring? A readiness assessment among doctors and patients in the field of diabetes. Stud Health Technol Inform 2018;248:322-329. [Medline]160,Odnoletkova I, Buysse H, Nobels F, Goderis G, Aertgeerts B, Annemans L, et al. Patient and provider acceptance of telecoaching in type 2 diabetes: a mixed-method study embedded in a randomised clinical trial. BMC Med Inform Decis Mak 2016 Nov 9;16(1):142 [FREE Full text] [CrossRef] [Medline]162,Bidmead E, Marshall A. A case study of stakeholder perceptions of patient held records: the Patients Know Best (PKB) solution. Digit Health 2016;2:2055207616668431 [FREE Full text] [CrossRef] [Medline]174,Hickson R, Talbert J, Thornbury WC, Perin NR, Goodin AJ. Online medical care: the current state of 'eVisits' in acute primary care delivery. Telemed J E Health 2015 Feb;21(2):90-96. [CrossRef] [Medline]184,Li L, Cotton A. A systematic review of nurses' perspectives toward the telemedicine intensive care unit: a basis for supporting its future implementation in China? Telemed J E Health 2019 May;25(5):343-350. [CrossRef] [Medline]188,Daniel F, Jabak S, Sasso R, Chamoun Y, Tamim H. Patient-physician communication in the era of mobile phones and social media apps: cross-sectional observational study on Lebanese physicians' perceptions and attitudes. JMIR Med Inform 2018 Apr 6;6(2):e18 [FREE Full text] [CrossRef] [Medline]190], although sometimes the perception that these new tools do not enhance patient care may hinder adoption [Anderson K, Francis T, Ibanez-Carrasco F, Globerman J. Physician's perceptions of telemedicine in HIV care provision: a cross-sectional web-based survey. JMIR Public Health Surveill 2017 May 30;3(2):e31 [FREE Full text] [CrossRef] [Medline]3,Brewster L, Mountain G, Wessels B, Kelly C, Hawley M. Factors affecting front line staff acceptance of telehealth technologies: a mixed-method systematic review. J Adv Nurs 2014 Jan;70(1):21-33. [CrossRef] [Medline]10]. Clinicians raised some concerns about the quality of patient reports, the possibility of overtreatment, or false positives being reported through the tools [de Vries ST, Wong L, Sutcliffe A, Houÿez F, Ruiz CL, Mol PG, IMI Web-RADR Work Package 3b Consortium. Factors influencing the use of a mobile app for reporting adverse drug reactions and receiving safety information: a qualitative study. Drug Saf 2017 May;40(5):443-455 [FREE Full text] [CrossRef] [Medline]38,Davis MM, Freeman M, Kaye J, Vuckovic N, Buckley DI. A systematic review of clinician and staff views on the acceptability of incorporating remote monitoring technology into primary care. Telemed J E Health 2014 May;20(5):428-438 [FREE Full text] [CrossRef] [Medline]183].
The impact of mHealth use on patient-clinician communication can also influence clinicians’ adoption decision [Han KJ, Subramanian R, Cameron GT. Listen before you leap: Sri Lankan health professionals' perspectives on m-health. Health Informatics J 2019 Sep;25(3):858-866. [CrossRef] [Medline]47,Vest BM, Hall VM, Kahn LS, Heider AR, Maloney N, Singh R. Nurse perspectives on the implementation of routine telemonitoring for high-risk diabetes patients in a primary care setting. Prim Health Care Res Dev 2017 Jan;18(1):3-13. [CrossRef] [Medline]88, El Amrani L, Engberink AO, Ninot G, Hayot M, Carbonnel F. Connected health devices for health care in French general medicine practice: cross-sectional study. JMIR Mhealth Uhealth 2017 Dec 21;5(12):e193 [FREE Full text] [CrossRef] [Medline]128,Bailey JV, Tomlinson N, Hobbs LJ, Webster R. Challenges and opportunities in evaluating a digital sexual health intervention in a clinic setting: Staff and patient views. 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Effects of the digital transformation: qualitative study on the disturbances and limitations of using video visits in outpatient care. J Med Internet Res 2018 Jun 27;20(6):e221 [FREE Full text] [CrossRef] [Medline]82,L'Esperance ST, Perry DJ. Assessing advantages and barriers to telemedicine adoption in the practice setting: A MyCareTeam(TM) exemplar. J Am Assoc Nurse Pract 2016 Jun;28(6):311-319. [CrossRef] [Medline]115,Duhm J, Fleischmann R, Schmidt S, Hupperts H, Brandt SA. Mobile electronic medical records promote workflow: physicians' perspective from a survey. JMIR Mhealth Uhealth 2016 Jun 6;4(2):e70 [FREE Full text] [CrossRef] [Medline]150,Walker L, Clendon J. The case for end-user involvement in design of health technologies. J Telemed Telecare 2016 Dec;22(8):443-446. [CrossRef] [Medline]172,Bidmead E, Marshall A. A case study of stakeholder perceptions of patient held records: the Patients Know Best (PKB) solution. Digit Health 2016;2:2055207616668431 [FREE Full text] [CrossRef] [Medline]174,Zhang Y, Koch S. Mobile health apps in Sweden: what do physicians recommend? Stud Health Technol Inform 2015;210:793-797. [Medline]175,Radhakrishnan K, Xie B, Berkley A, Kim M. Barriers and facilitators for sustainability of tele-homecare programs: a systematic review. Health Serv Res 2016 Feb;51(1):48-75 [FREE Full text] [CrossRef] [Medline]182,Penny RA, Bradford NK, Langbecker D. Registered nurse and midwife experiences of using videoconferencing in practice: a systematic review of qualitative studies. J Clin Nurs 2018 Mar;27(5-6):e739-e752. [CrossRef] [Medline]189], but it can also be considered a barrier when clinicians perceive the tool as an obstruction to their communications with their patients [Brewster L, Mountain G, Wessels B, Kelly C, Hawley M. Factors affecting front line staff acceptance of telehealth technologies: a mixed-method systematic review. J Adv Nurs 2014 Jan;70(1):21-33. [CrossRef] [Medline]10,Flynn D, Gregory P, Makki H, Gabbay M. Expectations and experiences of eHealth in primary care: a qualitative practice-based investigation. Int J Med Inform 2009 Sep;78(9):588-604. [CrossRef] [Medline]43,Grünloh C, Cajander A, Myreteg G. 'The Record is Our Work Tool!'- physicians' framing of a patient portal in Sweden. J Med Internet Res 2016 Jun 27;18(6):e167 [FREE Full text] [CrossRef] [Medline]46,Kayyali R, Hesso I, Mahdi A, Hamzat O, Adu A, Nabhani Gebara S. Telehealth: misconceptions and experiences of healthcare professionals in England. Int J Pharm Pract 2017 Jun;25(3):203-209. [CrossRef] [Medline]55,Wilhelmsen M, Høifødt RS, Kolstrup N, Waterloo K, Eisemann M, Chenhall R, et al. Norwegian general practitioners' perspectives on implementation of a guided web-based cognitive behavioral therapy for depression: a qualitative study. J Med Internet Res 2014 Sep 10;16(9):e208 [FREE Full text] [CrossRef] [Medline]89,Cox A, Illsley M, Knibb W, Lucas C, O'Driscoll M, Potter C, et al. The acceptability of e-technology to monitor and assess patient symptoms following palliative radiotherapy for lung cancer. Palliat Med 2011 Oct;25(7):675-681. [CrossRef] [Medline]180]. Clinicians’ concerns about digital communications are mostly about the loss of human contact, breaching patient privacy, medico-legal issues, unprofessional image, and patient’s overreliance [Fairbrother P, Ure J, Hanley J, McCloughan L, Denvir M, Sheikh A, Telescot programme team. Telemonitoring for chronic heart failure: the views of patients and healthcare professionals - a qualitative study. J Clin Nurs 2014 Jan;23(1-2):132-144. [CrossRef] [Medline]41,Öberg U, Orre CJ, Isaksson U, Schimmer R, Larsson H, Hörnsten Å. Swedish primary healthcare nurses' perceptions of using digital eHealth services in support of patient self-management. Scand J Caring Sci 2018 Jun;32(2):961-970. [CrossRef] [Medline]72,Sharma U, Barnett J, Clarke M. Clinical users' perspective on telemonitoring of patients with long term conditions: understood through concepts of Giddens's structuration theory & consequence of modernity. Stud Health Technol Inform 2010;160(Pt 1):545-549. [Medline]79,Sharma U, Clarke M. Nurses' and community support workers' experience of telehealth: a longitudinal case study. BMC Health Serv Res 2014 Apr 10;14:164 [FREE Full text] [CrossRef] [Medline]80,Wynn R, Bergvik S, Pettersen G, Fossum S. Clinicians' experiences with videoconferencing in psychiatry. Stud Health Technol Inform 2012;180:1218-1220. [Medline]90,Loh P, Flicker L, Horner B. Attitudes toward information and communication technology (ICT) in residential aged care in Western Australia. J Am Med Dir Assoc 2009 Jul;10(6):408-413. [CrossRef] [Medline]156,Muigg D, Kastner P, Modre-Osprian R, Haluza D, Duftschmid G. Is Austria ready for telemonitoring? A readiness assessment among doctors and patients in the field of diabetes. Stud Health Technol Inform 2018;248:322-329. [Medline]160,Daniel F, Jabak S, Sasso R, Chamoun Y, Tamim H. Patient-physician communication in the era of mobile phones and social media apps: cross-sectional observational study on Lebanese physicians' perceptions and attitudes. JMIR Med Inform 2018 Apr 6;6(2):e18 [FREE Full text] [CrossRef] [Medline]190]. It was also emphasized that such tools should complement rather than replace face-to-face treatment and therapy [Sinclair C, Holloway K, Riley G, Auret K. Online mental health resources in rural Australia: clinician perceptions of acceptability. J Med Internet Res 2013 Sep 5;15(9):e193 [FREE Full text] [CrossRef] [Medline]81,Varsi C, Ekstedt M, Gammon D, Ruland CM. Using the consolidated framework for implementation research to identify barriers and facilitators for the implementation of an internet-based patient-provider communication service in five settings: a qualitative study. J Med Internet Res 2015 Nov 18;17(11):e262 [FREE Full text] [CrossRef] [Medline]86,Zilliacus E, Meiser B, Lobb E, Dudding TE, Barlow-Stewart K, Tucker K. The virtual consultation: practitioners' experiences of genetic counseling by videoconferencing in Australia. Telemed J E Health 2010 Apr;16(3):350-357. [CrossRef] [Medline]91].
Improving patients’ access to care by removing time and space constraints may encourage clinicians’ adoption [Armstrong AW, Kwong MW, Chase EP, Ledo L, Nesbitt TS, Shewry SL. Teledermatology operational considerations, challenges, and benefits: the referring providers' perspective. Telemed J E Health 2012 Oct;18(8):580-584. [CrossRef] [Medline]1,Anderson K, Francis T, Ibanez-Carrasco F, Globerman J. Physician's perceptions of telemedicine in HIV care provision: a cross-sectional web-based survey. JMIR Public Health Surveill 2017 May 30;3(2):e31 [FREE Full text] [CrossRef] [Medline]3, Mileski M, Kruse CS, Catalani J, Haderer T. Adopting telemedicine for the self-management of hypertension: systematic review. JMIR Med Inform 2017 Oct 24;5(4):e41 [FREE Full text] [CrossRef] [Medline]5,Choi WS, Park J, Choi JY, Yang J. Stakeholders' resistance to telemedicine with focus on physicians: utilizing the Delphi technique. J Telemed Telecare 2019 Jul;25(6):378-385. [CrossRef] [Medline]8,Flynn D, Gregory P, Makki H, Gabbay M. Expectations and experiences of eHealth in primary care: a qualitative practice-based investigation. Int J Med Inform 2009 Sep;78(9):588-604. [CrossRef] [Medline]43,Merchant KA, Ward MM, Mueller KJ, Rural Health Research & Policy Centers, Rural Policy Research Institute‚ RUPRI Center for Rural Health Policy Analysis‚ University of Iowa College of Public Health‚ Department of Health Management and Policy. Hospital views of factors affecting telemedicine use. Rural Policy Brief 2015 Apr 1(2015 5):1-4. [Medline]64,Puszka S, Dingwall KM, Sweet M, Nagel T. E-Mental health innovations for aboriginal and Torres Strait Islander Australians: a qualitative study of implementation needs in health services. JMIR Ment Health 2016 Sep 19;3(3):e43 [FREE Full text] [CrossRef] [Medline]73,Sturesson L, Groth K. Effects of the digital transformation: qualitative study on the disturbances and limitations of using video visits in outpatient care. J Med Internet Res 2018 Jun 27;20(6):e221 [FREE Full text] [CrossRef] [Medline]82,Rho MJ, Choi IY, Lee J. Predictive factors of telemedicine service acceptance and behavioral intention of physicians. Int J Med Inform 2014 Aug;83(8):559-571. [CrossRef] [Medline]129,Rogove HJ, McArthur D, Demaerschalk BM, Vespa PM. Barriers to telemedicine: survey of current users in acute care units. Telemed J E Health 2012;18(1):48-53. [CrossRef] [Medline]130,Loh P, Flicker L, Horner B. Attitudes toward information and communication technology (ICT) in residential aged care in Western Australia. J Am Med Dir Assoc 2009 Jul;10(6):408-413. [CrossRef] [Medline]156,Odnoletkova I, Buysse H, Nobels F, Goderis G, Aertgeerts B, Annemans L, et al. Patient and provider acceptance of telecoaching in type 2 diabetes: a mixed-method study embedded in a randomised clinical trial. BMC Med Inform Decis Mak 2016 Nov 9;16(1):142 [FREE Full text] [CrossRef] [Medline]162,Bidmead E, Marshall A. A case study of stakeholder perceptions of patient held records: the Patients Know Best (PKB) solution. Digit Health 2016;2:2055207616668431 [FREE Full text] [CrossRef] [Medline]174,Radhakrishnan K, Xie B, Berkley A, Kim M. Barriers and facilitators for sustainability of tele-homecare programs: a systematic review. Health Serv Res 2016 Feb;51(1):48-75 [FREE Full text] [CrossRef] [Medline]182,Hickson R, Talbert J, Thornbury WC, Perin NR, Goodin AJ. Online medical care: the current state of 'eVisits' in acute primary care delivery. Telemed J E Health 2015 Feb;21(2):90-96. [CrossRef] [Medline]184,Daniel F, Jabak S, Sasso R, Chamoun Y, Tamim H. Patient-physician communication in the era of mobile phones and social media apps: cross-sectional observational study on Lebanese physicians' perceptions and attitudes. JMIR Med Inform 2018 Apr 6;6(2):e18 [FREE Full text] [CrossRef] [Medline]190]. This is especially true when the tools allow underserved patients, those residing in rural or remote areas, or suffering from a chronic condition, to access health care services [Bhatta R, Aryal K, Ellingsen G. Opportunities and challenges of a rural-telemedicine program in Nepal. J Nepal Health Res Counc 2015;13(30):149-153. [Medline]4,Catan G, Espanha R, Mendes RV, Toren O, Chinitz D. Health information technology implementation - impacts and policy considerations: a comparison between Israel and Portugal. Isr J Health Policy Res 2015;4:41 [FREE Full text] [CrossRef] [Medline]34, Egerton T, Nelligan R, Setchell J, Atkins L, Bennell KL. General practitioners' perspectives on a proposed new model of service delivery for primary care management of knee osteoarthritis: a qualitative study. BMC Fam Pract 2017 Sep 7;18(1):85 [FREE Full text] [CrossRef] [Medline]39,Han KJ, Subramanian R, Cameron GT. Listen before you leap: Sri Lankan health professionals' perspectives on m-health. Health Informatics J 2019 Sep;25(3):858-866. [CrossRef] [Medline]47,Armstrong AW, Kwong MW, Ledo L, Nesbitt TS, Shewry SL. Practice models and challenges in teledermatology: a study of collective experiences from teledermatologists. PLoS One 2011;6(12):e28687 [FREE Full text] [CrossRef] [Medline]54,Kayyali R, Hesso I, Mahdi A, Hamzat O, Adu A, Nabhani Gebara S. Telehealth: misconceptions and experiences of healthcare professionals in England. Int J Pharm Pract 2017 Jun;25(3):203-209. [CrossRef] [Medline]55,Molfenter T, Boyle M, Holloway D, Zwick J. Trends in telemedicine use in addiction treatment. Addict Sci Clin Pract 2015 May 28;10:14 [FREE Full text] [CrossRef] [Medline]67,Sandberg J, Trief PM, Izquierdo R, Goland R, Morin PC, Palmas W, et al. A qualitative study of the experiences and satisfaction of direct telemedicine providers in diabetes case management. Telemed J E Health 2009 Oct;15(8):742-750. [CrossRef] [Medline]75,Sinclair C, Holloway K, Riley G, Auret K. Online mental health resources in rural Australia: clinician perceptions of acceptability. J Med Internet Res 2013 Sep 5;15(9):e193 [FREE Full text] [CrossRef] [Medline]81,Cary MP, Spencer M, Carroll A, Hand DH, Amis K, Karan E, et al. Benefits and challenges of delivering tele-rehabilitation services to rural veterans. Home Healthc Now 2016 Sep;34(8):440-446. [CrossRef] [Medline]93,Jetty A, Moore MA, Coffman M, Petterson S, Bazemore A. Rural family physicians are twice as likely to use telehealth as urban family physicians. Telemed J E Health 2018 Apr;24(4):268-276. [CrossRef] [Medline]102,Moskowitz A, Chan YY, Bruns J, Levine SR. Emergency physician and stroke specialist beliefs and expectations regarding telestroke. Stroke 2010 Apr;41(4):805-809 [FREE Full text] [CrossRef] [Medline]123,Mueller KJ, Potter AJ, MacKinney AC, Ward MM. Lessons from tele-emergency: improving care quality and health outcomes by expanding support for rural care systems. Health Aff (Millwood) 2014 Feb;33(2):228-234. [CrossRef] [Medline]159,Chang F, Paramsothy T, Roche M, Gupta NS. Patient, staff, and clinician perspectives on implementing electronic communications in an interdisciplinary rural family health practice. Prim Health Care Res Dev 2017 Mar;18(2):149-160. [CrossRef] [Medline]178,Cunningham DL, Connors EH, Lever N, Stephan SH. Providers' perspectives: utilizing telepsychiatry in schools. Telemed J E Health 2013 Oct;19(10):794-799. [CrossRef] [Medline]194]. mHealth may enable better access by eliminating or reducing travel burden [Avey JP, Hobbs RL. Dial in: fostering the use of telebehavioral health services in frontier Alaska. Psychol Serv 2013 Aug;10(3):289-297. [CrossRef] [Medline]2,Bhatta R, Aryal K, Ellingsen G. Opportunities and challenges of a rural-telemedicine program in Nepal. J Nepal Health Res Counc 2015;13(30):149-153. [Medline]4,Levine M, Richardson JE, Granieri E, Reid MC. Novel telemedicine technologies in geriatric chronic non-cancer pain: primary care providers' perspectives. Pain Med 2014 Feb;15(2):206-213 [FREE Full text] [CrossRef] [Medline]60,MacNeill V, Sanders C, Fitzpatrick R, Hendy J, Barlow J, Knapp M, et al. Experiences of front-line health professionals in the delivery of telehealth: a qualitative study. Br J Gen Pract 2014 Jul;64(624):e401-e407 [FREE Full text] [CrossRef] [Medline]62,Seto E, Leonard KJ, Cafazzo JA, Barnsley J, Masino C, Ross HJ. Perceptions and experiences of heart failure patients and clinicians on the use of mobile phone-based telemonitoring. J Med Internet Res 2012 Feb 10;14(1):e25 [FREE Full text] [CrossRef] [Medline]78,Zilliacus E, Meiser B, Lobb E, Dudding TE, Barlow-Stewart K, Tucker K. The virtual consultation: practitioners' experiences of genetic counseling by videoconferencing in Australia. Telemed J E Health 2010 Apr;16(3):350-357. [CrossRef] [Medline]91,Shaw RJ, Kaufman MA, Bosworth HB, Weiner BJ, Zullig LL, Lee SD, et al. Organizational factors associated with readiness to implement and translate a primary care based telemedicine behavioral program to improve blood pressure control: the HTN-IMPROVE study. Implement Sci 2013 Sep 8;8:106 [FREE Full text] [CrossRef] [Medline]169,Lewis ER, Thomas CA, Wilson ML, Mbarika VW. Telemedicine in acute-phase injury management: a review of practice and advancements. Telemed J E Health 2012;18(6):434-445 [FREE Full text] [CrossRef] [Medline]187,Bishop TF, Press MJ, Mendelsohn JL, Casalino LP. Electronic communication improves access, but barriers to its widespread adoption remain. Health Aff (Millwood) 2013 Aug;32(8):1361-1367 [FREE Full text] [CrossRef] [Medline]195].
From the clinicians’ perspective, patient consent, comfort, and preference play an important role in adoption [Avey JP, Hobbs RL. Dial in: fostering the use of telebehavioral health services in frontier Alaska. Psychol Serv 2013 Aug;10(3):289-297. [CrossRef] [Medline]2,Gagnon MP, Ngangue P, Payne-Gagnon J, Desmartis M. m-Health adoption by healthcare professionals: a systematic review. J Am Med Inform Assoc 2016 Jan;23(1):212-220. [CrossRef] [Medline]9,Egerton T, Nelligan R, Setchell J, Atkins L, Bennell KL. General practitioners' perspectives on a proposed new model of service delivery for primary care management of knee osteoarthritis: a qualitative study. BMC Fam Pract 2017 Sep 7;18(1):85 [FREE Full text] [CrossRef] [Medline]39,Hanna L, May C, Fairhurst K. The place of information and communication technology-mediated consultations in primary care: GPs' perspectives. Fam Pract 2012 Jun;29(3):361-366. [CrossRef] [Medline]49,Wynn R, Bergvik S, Pettersen G, Fossum S. Clinicians' experiences with videoconferencing in psychiatry. Stud Health Technol Inform 2012;180:1218-1220. [Medline]90,Kato NP, Johansson P, Okada I, de Vries AE, Kinugawa K, Strömberg A, et al. Heart failure telemonitoring in Japan and Sweden: a cross-sectional survey. J Med Internet Res 2015 Nov 13;17(11):e258 [FREE Full text] [CrossRef] [Medline]104,Morilla MD, Sans M, Casasa A, Giménez N. Implementing technology in healthcare: insights from physicians. BMC Med Inform Decis Mak 2017 Jun 27;17(1):92 [FREE Full text] [CrossRef] [Medline]122,Moskowitz A, Chan YY, Bruns J, Levine SR. Emergency physician and stroke specialist beliefs and expectations regarding telestroke. Stroke 2010 Apr;41(4):805-809 [FREE Full text] [CrossRef] [Medline]123,Saigi-Rubió F, Jiménez-Zarco A, Torrent-Sellens J. Determinants of the intention to use telemedicine: evidence from primary care physicians. Int J Technol Assess Health Care 2016 Jan;32(1-2):29-36. [CrossRef] [Medline]132,Iacono T, Dissanayake C, Trembath D, Hudry K, Erickson S, Spong J. Family and practitioner perspectives on telehealth for services to young children with autism. Stud Health Technol Inform 2016;231:63-73. [Medline]153,Koivunen M, Saranto K. Nursing professionals' experiences of the facilitators and barriers to the use of telehealth applications: a systematic review of qualitative studies. Scand J Caring Sci 2018 Mar;32(1):24-44. [CrossRef] [Medline]185,Ahmad F, Norman C, O'Campo P. What is needed to implement a computer-assisted health risk assessment tool? An exploratory concept mapping study. BMC Med Inform Decis Mak 2012 Dec 19;12:149 [FREE Full text] [CrossRef] [Medline]192]. Several elements could impact patients’ preferences, such as age, the complexity of the condition, access to technology, tech-savviness, or privacy concerns [Armstrong AW, Kwong MW, Chase EP, Ledo L, Nesbitt TS, Shewry SL. Teledermatology operational considerations, challenges, and benefits: the referring providers' perspective. Telemed J E Health 2012 Oct;18(8):580-584. [CrossRef] [Medline]1,Flynn D, Gregory P, Makki H, Gabbay M. Expectations and experiences of eHealth in primary care: a qualitative practice-based investigation. Int J Med Inform 2009 Sep;78(9):588-604. [CrossRef] [Medline]43,Jarvis-Selinger S, Bates J, Araki Y, Lear SA. Internet-based support for cardiovascular disease management. Int J Telemed Appl 2011;2011:342582 [FREE Full text] [CrossRef] [Medline]52,Jimbo M, Shultz CG, Nease DE, Fetters MD, Power D, Ruffin MT. Perceived barriers and facilitators of using a Web-based interactive decision aid for colorectal cancer screening in community practice settings: findings from focus groups with primary care clinicians and medical office staff. J Med Internet Res 2013 Dec 18;15(12):e286 [FREE Full text] [CrossRef] [Medline]53,Levine M, Richardson JE, Granieri E, Reid MC. Novel telemedicine technologies in geriatric chronic non-cancer pain: primary care providers' perspectives. Pain Med 2014 Feb;15(2):206-213 [FREE Full text] [CrossRef] [Medline]60,Bidmead E, Marshall A. A case study of stakeholder perceptions of patient held records: the Patients Know Best (PKB) solution. Digit Health 2016;2:2055207616668431 [FREE Full text] [CrossRef] [Medline]174,Bramley G, Mangan C, Conroy M. Using telemonitoring to support personal care planning for adults with learning disabilities. J Telemed Telecare 2019 Dec;25(10):602-610. [CrossRef] [Medline]176,Cox A, Illsley M, Knibb W, Lucas C, O'Driscoll M, Potter C, et al. The acceptability of e-technology to monitor and assess patient symptoms following palliative radiotherapy for lung cancer. Palliat Med 2011 Oct;25(7):675-681. [CrossRef] [Medline]180,Hickson R, Talbert J, Thornbury WC, Perin NR, Goodin AJ. Online medical care: the current state of 'eVisits' in acute primary care delivery. Telemed J E Health 2015 Feb;21(2):90-96. [CrossRef] [Medline]184,Jungwirth D, Haluza D. Information and communication technology and the future of healthcare: results of a multi-scenario Delphi survey. Health Informatics J 2019 Mar;25(1):161-173. [CrossRef] [Medline]191,Bishop TF, Press MJ, Mendelsohn JL, Casalino LP. Electronic communication improves access, but barriers to its widespread adoption remain. Health Aff (Millwood) 2013 Aug;32(8):1361-1367 [FREE Full text] [CrossRef] [Medline]195]. In some cases, patients may feel more comfortable to use mHealth than face-to-face care when they are treated for sensitive conditions such as HIV or sexual health [Anderson K, Francis T, Ibanez-Carrasco F, Globerman J. Physician's perceptions of telemedicine in HIV care provision: a cross-sectional web-based survey. JMIR Public Health Surveill 2017 May 30;3(2):e31 [FREE Full text] [CrossRef] [Medline]3,Bailey JV, Tomlinson N, Hobbs LJ, Webster R. Challenges and opportunities in evaluating a digital sexual health intervention in a clinic setting: Staff and patient views. Digit Health 2017;3:2055207617704272 [FREE Full text] [CrossRef] [Medline]163].
It was reported that clinicians believe that mHealth may not be applicable or appropriate to all sorts of patients [Gagnon MP, Ngangue P, Payne-Gagnon J, Desmartis M. m-Health adoption by healthcare professionals: a systematic review. J Am Med Inform Assoc 2016 Jan;23(1):212-220. [CrossRef] [Medline]9, Lord S, Moore SK, Ramsey A, Dinauer S, Johnson K. Implementation of a substance use recovery support mobile phone app in community settings: qualitative study of clinician and staff perspectives of facilitators and barriers. JMIR Ment Health 2016 Jun 28;3(2):e24 [FREE Full text] [CrossRef] [Medline]61,Molleda L, Bahamon M, St George SM, Perrino T, Estrada Y, Herrera DC, et al. Clinic personnel, facilitator, and parent perspectives of eHealth Familias Unidas in primary care. J Pediatr Health Care 2017;31(3):350-361 [FREE Full text] [CrossRef] [Medline]68,Vest BM, Hall VM, Kahn LS, Heider AR, Maloney N, Singh R. Nurse perspectives on the implementation of routine telemonitoring for high-risk diabetes patients in a primary care setting. Prim Health Care Res Dev 2017 Jan;18(1):3-13. [CrossRef] [Medline]88,Wynn R, Bergvik S, Pettersen G, Fossum S. Clinicians' experiences with videoconferencing in psychiatry. Stud Health Technol Inform 2012;180:1218-1220. [Medline]90,Zilliacus E, Meiser B, Lobb E, Dudding TE, Barlow-Stewart K, Tucker K. The virtual consultation: practitioners' experiences of genetic counseling by videoconferencing in Australia. Telemed J E Health 2010 Apr;16(3):350-357. [CrossRef] [Medline]91,Jury SC, Walker AM, Kornberg AJ. The introduction of web-based video-consultation in a paediatric acute care setting. J Telemed Telecare 2013 Oct;19(7):383-387. [CrossRef] [Medline]103,Penny RA, Bradford NK, Langbecker D. Registered nurse and midwife experiences of using videoconferencing in practice: a systematic review of qualitative studies. J Clin Nurs 2018 Mar;27(5-6):e739-e752. [CrossRef] [Medline]189]. Consequently, it is important to have balanced selection criteria [Odeh B, Kayyali R, Nabhani-Gebara S, Philip N. Implementing a telehealth service: nurses' perceptions and experiences. Br J Nurs 2014;23(21):1133-1137. [CrossRef] [Medline]71,Sharma U, Barnett J, Clarke M. Clinical users' perspective on telemonitoring of patients with long term conditions: understood through concepts of Giddens's structuration theory & consequence of modernity. Stud Health Technol Inform 2010;160(Pt 1):545-549. [Medline]79,Wilhelmsen M, Høifødt RS, Kolstrup N, Waterloo K, Eisemann M, Chenhall R, et al. Norwegian general practitioners' perspectives on implementation of a guided web-based cognitive behavioral therapy for depression: a qualitative study. J Med Internet Res 2014 Sep 10;16(9):e208 [FREE Full text] [CrossRef] [Medline]89,Odnoletkova I, Buysse H, Nobels F, Goderis G, Aertgeerts B, Annemans L, et al. Patient and provider acceptance of telecoaching in type 2 diabetes: a mixed-method study embedded in a randomised clinical trial. BMC Med Inform Decis Mak 2016 Nov 9;16(1):142 [FREE Full text] [CrossRef] [Medline]162,Radhakrishnan K, Xie B, Berkley A, Kim M. Barriers and facilitators for sustainability of tele-homecare programs: a systematic review. Health Serv Res 2016 Feb;51(1):48-75 [FREE Full text] [CrossRef] [Medline]182]. Some perceive the tools to be more appropriate for chronic and unstable patients that need more attention to support their stabilization [Fairbrother P, Ure J, Hanley J, McCloughan L, Denvir M, Sheikh A, Telescot programme team. Telemonitoring for chronic heart failure: the views of patients and healthcare professionals - a qualitative study. J Clin Nurs 2014 Jan;23(1-2):132-144. [CrossRef] [Medline]41,Moharra M, Almazán C, Decool M, Nilsson A, Allegretti N, Seven M. Implementation of a cross-border health service: physician and pharmacists' opinions from the epSOS project. Fam Pract 2015 Oct;32(5):564-567. [CrossRef] [Medline]66], although others deemed the technology inappropriate for those with physical or psychological impairments, severely ill patients, and the ones unable to properly use technology [MacNeill V, Sanders C, Fitzpatrick R, Hendy J, Barlow J, Knapp M, et al. Experiences of front-line health professionals in the delivery of telehealth: a qualitative study. Br J Gen Pract 2014 Jul;64(624):e401-e407 [FREE Full text] [CrossRef] [Medline]62,Puszka S, Dingwall KM, Sweet M, Nagel T. E-Mental health innovations for aboriginal and Torres Strait Islander Australians: a qualitative study of implementation needs in health services. JMIR Ment Health 2016 Sep 19;3(3):e43 [FREE Full text] [CrossRef] [Medline]73,Sandberg J, Trief PM, Izquierdo R, Goland R, Morin PC, Palmas W, et al. A qualitative study of the experiences and satisfaction of direct telemedicine providers in diabetes case management. Telemed J E Health 2009 Oct;15(8):742-750. [CrossRef] [Medline]75,Sinclair C, Holloway K, Riley G, Auret K. Online mental health resources in rural Australia: clinician perceptions of acceptability. J Med Internet Res 2013 Sep 5;15(9):e193 [FREE Full text] [CrossRef] [Medline]81,Varsi C, Ekstedt M, Gammon D, Ruland CM. Using the consolidated framework for implementation research to identify barriers and facilitators for the implementation of an internet-based patient-provider communication service in five settings: a qualitative study. J Med Internet Res 2015 Nov 18;17(11):e262 [FREE Full text] [CrossRef] [Medline]86,Kato NP, Johansson P, Okada I, de Vries AE, Kinugawa K, Strömberg A, et al. Heart failure telemonitoring in Japan and Sweden: a cross-sectional survey. J Med Internet Res 2015 Nov 13;17(11):e258 [FREE Full text] [CrossRef] [Medline]104,Koivunen M, Saranto K. Nursing professionals' experiences of the facilitators and barriers to the use of telehealth applications: a systematic review of qualitative studies. Scand J Caring Sci 2018 Mar;32(1):24-44. [CrossRef] [Medline]185]. However, it is important to note that restrictive inclusion criteria might prevent some patients who need the service from accessing it [Odeh B, Kayyali R, Nabhani-Gebara S, Philip N. Implementing a telehealth service: nurses' perceptions and experiences. Br J Nurs 2014;23(21):1133-1137. [CrossRef] [Medline]71].
Clinicians are more likely to adopt mHealth when it empowers and engages patients, giving them more autonomy and assurance about their disease or condition management [Mileski M, Kruse CS, Catalani J, Haderer T. Adopting telemedicine for the self-management of hypertension: systematic review. JMIR Med Inform 2017 Oct 24;5(4):e41 [FREE Full text] [CrossRef] [Medline]5,Catan G, Espanha R, Mendes RV, Toren O, Chinitz D. Health information technology implementation - impacts and policy considerations: a comparison between Israel and Portugal. Isr J Health Policy Res 2015;4:41 [FREE Full text] [CrossRef] [Medline]34, Giraldo L, Schachner B, Luna D, Benítez S. Exploring nurses' perceptions and expectations toward a BCMA implementation using a mobile app and workstations as a change management strategy. Stud Health Technol Inform 2018;250:134-138. [Medline]44,Hanley J, Ure J, Pagliari C, Sheikh A, McKinstry B. Experiences of patients and professionals participating in the HITS home blood pressure telemonitoring trial: a qualitative study. BMJ Open 2013 May 28;3(5):pii: e002671 [FREE Full text] [CrossRef] [Medline]48,MacNeill V, Sanders C, Fitzpatrick R, Hendy J, Barlow J, Knapp M, et al. Experiences of front-line health professionals in the delivery of telehealth: a qualitative study. Br J Gen Pract 2014 Jul;64(624):e401-e407 [FREE Full text] [CrossRef] [Medline]62,Puszka S, Dingwall KM, Sweet M, Nagel T. E-Mental health innovations for aboriginal and Torres Strait Islander Australians: a qualitative study of implementation needs in health services. JMIR Ment Health 2016 Sep 19;3(3):e43 [FREE Full text] [CrossRef] [Medline]73,Schneider T, Panzera AD, Martinasek M, McDermott R, Couluris M, Lindenberger J, et al. Physicians' perceptions of mobile technology for enhancing asthma care for youth. J Child Health Care 2016 Jun;20(2):153-163. [CrossRef] [Medline]77,Seto E, Leonard KJ, Cafazzo JA, Barnsley J, Masino C, Ross HJ. Perceptions and experiences of heart failure patients and clinicians on the use of mobile phone-based telemonitoring. J Med Internet Res 2012 Feb 10;14(1):e25 [FREE Full text] [CrossRef] [Medline]78,Vest BM, Hall VM, Kahn LS, Heider AR, Maloney N, Singh R. Nurse perspectives on the implementation of routine telemonitoring for high-risk diabetes patients in a primary care setting. Prim Health Care Res Dev 2017 Jan;18(1):3-13. [CrossRef] [Medline]88,Wilhelmsen M, Høifødt RS, Kolstrup N, Waterloo K, Eisemann M, Chenhall R, et al. Norwegian general practitioners' perspectives on implementation of a guided web-based cognitive behavioral therapy for depression: a qualitative study. J Med Internet Res 2014 Sep 10;16(9):e208 [FREE Full text] [CrossRef] [Medline]89,L'Esperance ST, Perry DJ. Assessing advantages and barriers to telemedicine adoption in the practice setting: A MyCareTeam(TM) exemplar. J Am Assoc Nurse Pract 2016 Jun;28(6):311-319. [CrossRef] [Medline]115,Lapão LV, da Silva MM, Gregório J. Implementing an online pharmaceutical service using design science research. BMC Med Inform Decis Mak 2017 Mar 27;17(1):31 [FREE Full text] [CrossRef] [Medline]157,Possemato K, Kuhn E, Johnson EM, Hoffman JE, Brooks E. Development and refinement of a clinician intervention to facilitate primary care patient use of the PTSD Coach app. Transl Behav Med 2017 Mar;7(1):116-126 [FREE Full text] [CrossRef] [Medline]166,Zhang Y, Koch S. Mobile health apps in Sweden: what do physicians recommend? Stud Health Technol Inform 2015;210:793-797. [Medline]175,Cox A, Illsley M, Knibb W, Lucas C, O'Driscoll M, Potter C, et al. The acceptability of e-technology to monitor and assess patient symptoms following palliative radiotherapy for lung cancer. Palliat Med 2011 Oct;25(7):675-681. [CrossRef] [Medline]180]. However, more evidence is needed to confirm such a positive impact on patient empowerment [El Amrani L, Engberink AO, Ninot G, Hayot M, Carbonnel F. Connected health devices for health care in French general medicine practice: cross-sectional study. JMIR Mhealth Uhealth 2017 Dec 21;5(12):e193 [FREE Full text] [CrossRef] [Medline]128]. It is also worth noting that in some contexts, patients may initially be anxious from such increased empowerment, as they are afraid of taking responsibility. However, research suggests that their confidence may develop with long-term support [Fairbrother P, Ure J, Hanley J, McCloughan L, Denvir M, Sheikh A, Telescot programme team. Telemonitoring for chronic heart failure: the views of patients and healthcare professionals - a qualitative study. J Clin Nurs 2014 Jan;23(1-2):132-144. [CrossRef] [Medline]41]. Patient engagement might also be a barrier if they perceive mHealth as a burden, or when they do not feel that they need it [Morrow S, Daines L, Wiener-Ogilvie S, Steed L, McKee L, Caress A, et al. Exploring the perspectives of clinical professionals and support staff on implementing supported self-management for asthma in UK general practice: an IMPART qualitative study. NPJ Prim Care Respir Med 2017 Jul 18;27(1):45 [FREE Full text] [CrossRef] [Medline]70,Odeh B, Kayyali R, Nabhani-Gebara S, Philip N. Implementing a telehealth service: nurses' perceptions and experiences. Br J Nurs 2014;23(21):1133-1137. [CrossRef] [Medline]71]
Safety concerns can impact intention to use [Öberg U, Orre CJ, Isaksson U, Schimmer R, Larsson H, Hörnsten Å. Swedish primary healthcare nurses' perceptions of using digital eHealth services in support of patient self-management. Scand J Caring Sci 2018 Jun;32(2):961-970. [CrossRef] [Medline]72,Jury SC, Walker AM, Kornberg AJ. The introduction of web-based video-consultation in a paediatric acute care setting. J Telemed Telecare 2013 Oct;19(7):383-387. [CrossRef] [Medline]103]. Perceived risks to patient safety can be a barrier to adoption, mainly when clinicians are concerned about factors such as device contamination, system reliability, clinical content accuracy, and self-diagnosing [Brewster L, Mountain G, Wessels B, Kelly C, Hawley M. Factors affecting front line staff acceptance of telehealth technologies: a mixed-method systematic review. J Adv Nurs 2014 Jan;70(1):21-33. [CrossRef] [Medline]10,McNally G, Frey R, Crossan M. Nurse manager and student nurse perceptions of the use of personal smartphones or tablets and the adjunct applications, as an educational tool in clinical settings. Nurse Educ Pract 2017 Mar;23:1-7. [CrossRef] [Medline]63,Sinclair C, Holloway K, Riley G, Auret K. Online mental health resources in rural Australia: clinician perceptions of acceptability. J Med Internet Res 2013 Sep 5;15(9):e193 [FREE Full text] [CrossRef] [Medline]81,Charani E, Kyratsis Y, Lawson W, Wickens H, Brannigan ET, Moore LS, et al. An analysis of the development and implementation of a smartphone application for the delivery of antimicrobial prescribing policy: lessons learnt. J Antimicrob Chemother 2013 Apr;68(4):960-967 [FREE Full text] [CrossRef] [Medline]179,Daniel F, Jabak S, Sasso R, Chamoun Y, Tamim H. Patient-physician communication in the era of mobile phones and social media apps: cross-sectional observational study on Lebanese physicians' perceptions and attitudes. JMIR Med Inform 2018 Apr 6;6(2):e18 [FREE Full text] [CrossRef] [Medline]190]. Conversely, adoption may be encouraged when mHealth increases patient safety through timeliness, early detection, or clear documentation [Giraldo L, Schachner B, Luna D, Benítez S. Exploring nurses' perceptions and expectations toward a BCMA implementation using a mobile app and workstations as a change management strategy. Stud Health Technol Inform 2018;250:134-138. [Medline]44,Moharra M, Almazán C, Decool M, Nilsson A, Allegretti N, Seven M. Implementation of a cross-border health service: physician and pharmacists' opinions from the epSOS project. Fam Pract 2015 Oct;32(5):564-567. [CrossRef] [Medline]66,Seto E, Leonard KJ, Cafazzo JA, Barnsley J, Masino C, Ross HJ. Perceptions and experiences of heart failure patients and clinicians on the use of mobile phone-based telemonitoring. J Med Internet Res 2012 Feb 10;14(1):e25 [FREE Full text] [CrossRef] [Medline]78,Varsi C, Ekstedt M, Gammon D, Ruland CM. Using the consolidated framework for implementation research to identify barriers and facilitators for the implementation of an internet-based patient-provider communication service in five settings: a qualitative study. J Med Internet Res 2015 Nov 18;17(11):e262 [FREE Full text] [CrossRef] [Medline]86,Kleinpell R, Barden C, Rincon T, McCarthy M, Rufo RJ. Assessing the impact of telemedicine on nursing care in intensive care units. Am J Crit Care 2016 Jan;25(1):e14-e20. [CrossRef] [Medline]109,Steinschaden T, Petersson G, Astrand B. Physicians' attitudes towards eprescribing: a comparative web survey in Austria and Sweden. Inform Prim Care 2009;17(4):241-248 [FREE Full text] [CrossRef] [Medline]140,Bramley G, Mangan C, Conroy M. Using telemonitoring to support personal care planning for adults with learning disabilities. J Telemed Telecare 2019 Dec;25(10):602-610. [CrossRef] [Medline]176,Li L, Cotton A. A systematic review of nurses' perspectives toward the telemedicine intensive care unit: a basis for supporting its future implementation in China? Telemed J E Health 2019 May;25(5):343-350. [CrossRef] [Medline]188,Bishop TF, Press MJ, Mendelsohn JL, Casalino LP. Electronic communication improves access, but barriers to its widespread adoption remain. Health Aff (Millwood) 2013 Aug;32(8):1361-1367 [FREE Full text] [CrossRef] [Medline]195].
The digital divide, defined in the Oxford dictionary [Murray J. Oxford Dictionary Of English. UK: Oxford University Press; 2017.198] as “the gulf between those who have ready access to computers and the Internet, and those who do not,” also plays a role in the adoption. Clinicians are concerned about patients that might be marginalized because they lack access to technology, the elderly that do not use smartphones, those who have literacy issues, or a lower living standard [Hanna L, May C, Fairhurst K. The place of information and communication technology-mediated consultations in primary care: GPs' perspectives. Fam Pract 2012 Jun;29(3):361-366. [CrossRef] [Medline]49,Jimbo M, Shultz CG, Nease DE, Fetters MD, Power D, Ruffin MT. Perceived barriers and facilitators of using a Web-based interactive decision aid for colorectal cancer screening in community practice settings: findings from focus groups with primary care clinicians and medical office staff. J Med Internet Res 2013 Dec 18;15(12):e286 [FREE Full text] [CrossRef] [Medline]53,Kayyali R, Hesso I, Mahdi A, Hamzat O, Adu A, Nabhani Gebara S. Telehealth: misconceptions and experiences of healthcare professionals in England. Int J Pharm Pract 2017 Jun;25(3):203-209. [CrossRef] [Medline]55,Levine M, Richardson JE, Granieri E, Reid MC. Novel telemedicine technologies in geriatric chronic non-cancer pain: primary care providers' perspectives. Pain Med 2014 Feb;15(2):206-213 [FREE Full text] [CrossRef] [Medline]60,Puszka S, Dingwall KM, Sweet M, Nagel T. E-Mental health innovations for aboriginal and Torres Strait Islander Australians: a qualitative study of implementation needs in health services. JMIR Ment Health 2016 Sep 19;3(3):e43 [FREE Full text] [CrossRef] [Medline]73,Sandberg J, Trief PM, Izquierdo R, Goland R, Morin PC, Palmas W, et al. A qualitative study of the experiences and satisfaction of direct telemedicine providers in diabetes case management. Telemed J E Health 2009 Oct;15(8):742-750. [CrossRef] [Medline]75,Sharma U, Barnett J, Clarke M. Clinical users' perspective on telemonitoring of patients with long term conditions: understood through concepts of Giddens's structuration theory & consequence of modernity. Stud Health Technol Inform 2010;160(Pt 1):545-549. [Medline]79,Sinclair C, Holloway K, Riley G, Auret K. Online mental health resources in rural Australia: clinician perceptions of acceptability. J Med Internet Res 2013 Sep 5;15(9):e193 [FREE Full text] [CrossRef] [Medline]81,van Gaalen JL, van Bodegom-Vos L, Bakker MJ, Snoeck-Stroband JB, Sont JK. Internet-based self-management support for adults with asthma: a qualitative study among patients, general practitioners and practice nurses on barriers to implementation. BMJ Open 2016 Aug 26;6(8):e010809 [FREE Full text] [CrossRef] [Medline]84,Miller KE, Kuhn E, Owen JE, Taylor K, Yu JS, Weiss BJ, et al. Clinician perceptions related to the use of the CBT-I Coach Mobile App. Behav Sleep Med 2019;17(4):481-491. [CrossRef] [Medline]120, Moskowitz A, Chan YY, Bruns J, Levine SR. Emergency physician and stroke specialist beliefs and expectations regarding telestroke. Stroke 2010 Apr;41(4):805-809 [FREE Full text] [CrossRef] [Medline]123,Smith PB, Buzi RS. Reproductive health professionals' adoption of emerging technologies for health promotion. Health Informatics J 2014 Dec;20(4):250-260. [CrossRef] [Medline]138,Koivunen M, Saranto K. Nursing professionals' experiences of the facilitators and barriers to the use of telehealth applications: a systematic review of qualitative studies. Scand J Caring Sci 2018 Mar;32(1):24-44. [CrossRef] [Medline]185, Jungwirth D, Haluza D. Information and communication technology and the future of healthcare: results of a multi-scenario Delphi survey. Health Informatics J 2019 Mar;25(1):161-173. [CrossRef] [Medline]191]. A study reported that nurses do not see patients’ age as a barrier [MacNeill V, Sanders C, Fitzpatrick R, Hendy J, Barlow J, Knapp M, et al. Experiences of front-line health professionals in the delivery of telehealth: a qualitative study. Br J Gen Pract 2014 Jul;64(624):e401-e407 [FREE Full text] [CrossRef] [Medline]62].
Better patient education and awareness because of the use of mHealth tools may encourage adoption [Jarvis-Selinger S, Bates J, Araki Y, Lear SA. Internet-based support for cardiovascular disease management. Int J Telemed Appl 2011;2011:342582 [FREE Full text] [CrossRef] [Medline]52,Jimbo M, Shultz CG, Nease DE, Fetters MD, Power D, Ruffin MT. Perceived barriers and facilitators of using a Web-based interactive decision aid for colorectal cancer screening in community practice settings: findings from focus groups with primary care clinicians and medical office staff. J Med Internet Res 2013 Dec 18;15(12):e286 [FREE Full text] [CrossRef] [Medline]53,Levine M, Richardson JE, Granieri E, Reid MC. Novel telemedicine technologies in geriatric chronic non-cancer pain: primary care providers' perspectives. Pain Med 2014 Feb;15(2):206-213 [FREE Full text] [CrossRef] [Medline]60,Sandberg J, Trief PM, Izquierdo R, Goland R, Morin PC, Palmas W, et al. A qualitative study of the experiences and satisfaction of direct telemedicine providers in diabetes case management. Telemed J E Health 2009 Oct;15(8):742-750. [CrossRef] [Medline]75, Varsi C, Ekstedt M, Gammon D, Ruland CM. Using the consolidated framework for implementation research to identify barriers and facilitators for the implementation of an internet-based patient-provider communication service in five settings: a qualitative study. J Med Internet Res 2015 Nov 18;17(11):e262 [FREE Full text] [CrossRef] [Medline]86,Vest BM, Hall VM, Kahn LS, Heider AR, Maloney N, Singh R. Nurse perspectives on the implementation of routine telemonitoring for high-risk diabetes patients in a primary care setting. Prim Health Care Res Dev 2017 Jan;18(1):3-13. [CrossRef] [Medline]88,Odnoletkova I, Buysse H, Nobels F, Goderis G, Aertgeerts B, Annemans L, et al. Patient and provider acceptance of telecoaching in type 2 diabetes: a mixed-method study embedded in a randomised clinical trial. BMC Med Inform Decis Mak 2016 Nov 9;16(1):142 [FREE Full text] [CrossRef] [Medline]162,Orchard J, Lowres N, Freedman SB, Ladak L, Lee W, Zwar N, et al. Screening for atrial fibrillation during influenza vaccinations by primary care nurses using a smartphone electrocardiograph (iECG): A feasibility study. Eur J Prev Cardiol 2016 Oct;23(2 suppl):13-20. [CrossRef] [Medline]164,Ray KN, Felmet KA, Hamilton MF, Kuza CC, Saladino RA, Schultz BR, et al. Clinician attitudes toward adoption of pediatric emergency telemedicine in rural hospitals. Pediatr Emerg Care 2017 Apr;33(4):250-257. [CrossRef] [Medline]168,Davis MM, Freeman M, Kaye J, Vuckovic N, Buckley DI. A systematic review of clinician and staff views on the acceptability of incorporating remote monitoring technology into primary care. Telemed J E Health 2014 May;20(5):428-438 [FREE Full text] [CrossRef] [Medline]183,Daniel F, Jabak S, Sasso R, Chamoun Y, Tamim H. Patient-physician communication in the era of mobile phones and social media apps: cross-sectional observational study on Lebanese physicians' perceptions and attitudes. JMIR Med Inform 2018 Apr 6;6(2):e18 [FREE Full text] [CrossRef] [Medline]190,Oudshoorn N, Rommes E, Stienstra M. Configuring the user as everybody: gender and design cultures in information and communication technologies. Sci Technol Hum Values 2004;29(1):30-63. [CrossRef]199]. However, clinicians were concerned that the convenience of the new tools might result in patients’ overreliance on their practitioner support [Anderson K, Francis T, Ibanez-Carrasco F, Globerman J. Physician's perceptions of telemedicine in HIV care provision: a cross-sectional web-based survey. JMIR Public Health Surveill 2017 May 30;3(2):e31 [FREE Full text] [CrossRef] [Medline]3,Fairbrother P, Ure J, Hanley J, McCloughan L, Denvir M, Sheikh A, Telescot programme team. Telemonitoring for chronic heart failure: the views of patients and healthcare professionals - a qualitative study. J Clin Nurs 2014 Jan;23(1-2):132-144. [CrossRef] [Medline]41,Seto E, Leonard KJ, Cafazzo JA, Barnsley J, Masino C, Ross HJ. Perceptions and experiences of heart failure patients and clinicians on the use of mobile phone-based telemonitoring. J Med Internet Res 2012 Feb 10;14(1):e25 [FREE Full text] [CrossRef] [Medline]78,Radhakrishnan K, Xie B, Berkley A, Kim M. Barriers and facilitators for sustainability of tele-homecare programs: a systematic review. Health Serv Res 2016 Feb;51(1):48-75 [FREE Full text] [CrossRef] [Medline]182]. Service abuse might occur when they overutilize the tool or try to access their care team after hours [Loh P, Flicker L, Horner B. Attitudes toward information and communication technology (ICT) in residential aged care in Western Australia. J Am Med Dir Assoc 2009 Jul;10(6):408-413. [CrossRef] [Medline]156,Shaw RJ, Kaufman MA, Bosworth HB, Weiner BJ, Zullig LL, Lee SD, et al. Organizational factors associated with readiness to implement and translate a primary care based telemedicine behavioral program to improve blood pressure control: the HTN-IMPROVE study. Implement Sci 2013 Sep 8;8:106 [FREE Full text] [CrossRef] [Medline]169], or if they become too dependent on technology and fail to seek medical help in case of emergency [MacNeill V, Sanders C, Fitzpatrick R, Hendy J, Barlow J, Knapp M, et al. Experiences of front-line health professionals in the delivery of telehealth: a qualitative study. Br J Gen Pract 2014 Jul;64(624):e401-e407 [FREE Full text] [CrossRef] [Medline]62,Schneider T, Panzera AD, Martinasek M, McDermott R, Couluris M, Lindenberger J, et al. Physicians' perceptions of mobile technology for enhancing asthma care for youth. J Child Health Care 2016 Jun;20(2):153-163. [CrossRef] [Medline]77].
Clinicians also pinpointed that data and surveillance-related anxiety might hinder adoption [Steinschaden T, Petersson G, Astrand B. Physicians' attitudes towards eprescribing: a comparative web survey in Austria and Sweden. Inform Prim Care 2009;17(4):241-248 [FREE Full text] [CrossRef] [Medline]140,Daniel F, Jabak S, Sasso R, Chamoun Y, Tamim H. Patient-physician communication in the era of mobile phones and social media apps: cross-sectional observational study on Lebanese physicians' perceptions and attitudes. JMIR Med Inform 2018 Apr 6;6(2):e18 [FREE Full text] [CrossRef] [Medline]190]. Patients might worry excessively because of the large amounts of data available through mHealth [Grünloh C, Cajander A, Myreteg G. 'The Record is Our Work Tool!'- physicians' framing of a patient portal in Sweden. J Med Internet Res 2016 Jun 27;18(6):e167 [FREE Full text] [CrossRef] [Medline]46,El Amrani L, Engberink AO, Ninot G, Hayot M, Carbonnel F. Connected health devices for health care in French general medicine practice: cross-sectional study. JMIR Mhealth Uhealth 2017 Dec 21;5(12):e193 [FREE Full text] [CrossRef] [Medline]128] or might feel watched because of the constant monitoring enabled by such tools [MacNeill V, Sanders C, Fitzpatrick R, Hendy J, Barlow J, Knapp M, et al. Experiences of front-line health professionals in the delivery of telehealth: a qualitative study. Br J Gen Pract 2014 Jul;64(624):e401-e407 [FREE Full text] [CrossRef] [Medline]62,Seto E, Leonard KJ, Cafazzo JA, Barnsley J, Masino C, Ross HJ. Perceptions and experiences of heart failure patients and clinicians on the use of mobile phone-based telemonitoring. J Med Internet Res 2012 Feb 10;14(1):e25 [FREE Full text] [CrossRef] [Medline]78]. Furthermore, the sustainability of mHealth services depends on several factors, such as the willingness of patients to keep using it [Mileski M, Kruse CS, Catalani J, Haderer T. Adopting telemedicine for the self-management of hypertension: systematic review. JMIR Med Inform 2017 Oct 24;5(4):e41 [FREE Full text] [CrossRef] [Medline]5], which might depend on the long-term availability of funding [Quanbeck A, Gustafson DH, Marsch LA, Chih M, Kornfield R, McTavish F, et al. Implementing a mobile health system to integrate the treatment of addiction into primary care: a hybrid implementation-effectiveness study. J Med Internet Res 2018 Jan 30;20(1):e37 [FREE Full text] [CrossRef] [Medline]167] and clinicians’ long-term commitment [Shaw RJ, Kaufman MA, Bosworth HB, Weiner BJ, Zullig LL, Lee SD, et al. Organizational factors associated with readiness to implement and translate a primary care based telemedicine behavioral program to improve blood pressure control: the HTN-IMPROVE study. Implement Sci 2013 Sep 8;8:106 [FREE Full text] [CrossRef] [Medline]169]. It is also notable that clinicians might play a gatekeeping role for mHealth directly impacting adoption [Gagnon MP, Orruño E, Asua J, Abdeljelil AB, Emparanza J. Using a modified technology acceptance model to evaluate healthcare professionals' adoption of a new telemonitoring system. Telemed J E Health 2012;18(1):54-59 [FREE Full text] [CrossRef] [Medline]97]; this may be driven by their willingness to protect their patients from any added burden [Cox A, Illsley M, Knibb W, Lucas C, O'Driscoll M, Potter C, et al. The acceptability of e-technology to monitor and assess patient symptoms following palliative radiotherapy for lung cancer. Palliat Med 2011 Oct;25(7):675-681. [CrossRef] [Medline]180].
Other Social and Organizational Factors
Concerns related to data privacy and security can be a barrier to adoption [Gagnon MP, Ngangue P, Payne-Gagnon J, Desmartis M. m-Health adoption by healthcare professionals: a systematic review. J Am Med Inform Assoc 2016 Jan;23(1):212-220. [CrossRef] [Medline]9,Egerton T, Nelligan R, Setchell J, Atkins L, Bennell KL. General practitioners' perspectives on a proposed new model of service delivery for primary care management of knee osteoarthritis: a qualitative study. BMC Fam Pract 2017 Sep 7;18(1):85 [FREE Full text] [CrossRef] [Medline]39,Molfenter T, Boyle M, Holloway D, Zwick J. Trends in telemedicine use in addiction treatment. Addict Sci Clin Pract 2015 May 28;10:14 [FREE Full text] [CrossRef] [Medline]67,van Gaalen JL, van Bodegom-Vos L, Bakker MJ, Snoeck-Stroband JB, Sont JK. Internet-based self-management support for adults with asthma: a qualitative study among patients, general practitioners and practice nurses on barriers to implementation. BMJ Open 2016 Aug 26;6(8):e010809 [FREE Full text] [CrossRef] [Medline]84,Ghani MK, Jaber MM. Willingness to adopt telemedicine in major iraqi hospitals: a pilot study. Int J Telemed Appl 2015;2015:136591 [FREE Full text] [CrossRef] [Medline]95,Klack L, Ziefle M, Wilkowska W, Kluge J. Telemedical versus conventional heart patient monitoring: a survey study with German physicians. Int J Technol Assess Health Care 2013 Oct;29(4):378-383. [CrossRef] [Medline]108,Albrecht UV, Afshar K, Illiger K, Becker S, Hartz T, Breil B, et al. Expectancy, usage and acceptance by general practitioners and patients: exploratory results from a study in the German outpatient sector. Digit Health 2017;3:2055207617695135 [FREE Full text] [CrossRef] [Medline]117,Saigi-Rubió F, Jiménez-Zarco A, Torrent-Sellens J. Determinants of the intention to use telemedicine: evidence from primary care physicians. Int J Technol Assess Health Care 2016 Jan;32(1-2):29-36. [CrossRef] [Medline]132,Villalba-Mora E, Casas I, Lupiañez-Villanueva F, Maghiros I. Adoption of health information technologies by physicians for clinical practice: the Andalusian case. Int J Med Inform 2015 Jul;84(7):477-485. [CrossRef] [Medline]143,Lygidakis C, Wallace P, Tersar C, Marcatto F, Ferrante D, Vedova RD, et al. Download Your Doctor: implementation of a digitally mediated personal physician presence to enhance patient engagement with a health-promoting internet application. JMIR Res Protoc 2016 Mar 4;5(1):e36 [FREE Full text] [CrossRef] [Medline]158,Bidmead E, Marshall A. A case study of stakeholder perceptions of patient held records: the Patients Know Best (PKB) solution. Digit Health 2016;2:2055207616668431 [FREE Full text] [CrossRef] [Medline]174,Brown W, Giguere R, Sheinfil A, Ibitoye M, Balan I, Ho T, et al. Challenges and solutions implementing an SMS text message-based survey CASI and adherence reminders in an international biomedical HIV PrEP study (MTN 017). J Biomed Inform 2018 Apr;80:78-86 [FREE Full text] [CrossRef] [Medline]177,Koivunen M, Saranto K. Nursing professionals' experiences of the facilitators and barriers to the use of telehealth applications: a systematic review of qualitative studies. Scand J Caring Sci 2018 Mar;32(1):24-44. [CrossRef] [Medline]185, Jungwirth D, Haluza D. Information and communication technology and the future of healthcare: results of a multi-scenario Delphi survey. Health Informatics J 2019 Mar;25(1):161-173. [CrossRef] [Medline]191,Ahmad F, Norman C, O'Campo P. What is needed to implement a computer-assisted health risk assessment tool? An exploratory concept mapping study. BMC Med Inform Decis Mak 2012 Dec 19;12:149 [FREE Full text] [CrossRef] [Medline]192]. Worries about confidentiality, fear of inappropriate data use, anonymity, and medico-legal risks were the main drivers of this [Avey JP, Hobbs RL. Dial in: fostering the use of telebehavioral health services in frontier Alaska. Psychol Serv 2013 Aug;10(3):289-297. [CrossRef] [Medline]2,Anderson K, Francis T, Ibanez-Carrasco F, Globerman J. Physician's perceptions of telemedicine in HIV care provision: a cross-sectional web-based survey. JMIR Public Health Surveill 2017 May 30;3(2):e31 [FREE Full text] [CrossRef] [Medline]3,Brewster L, Mountain G, Wessels B, Kelly C, Hawley M. Factors affecting front line staff acceptance of telehealth technologies: a mixed-method systematic review. J Adv Nurs 2014 Jan;70(1):21-33. [CrossRef] [Medline]10,de Souza CH, Morbeck RA, Steinman M, Hors CP, Bracco MM, Kozasa EH, et al. Barriers and benefits in telemedicine arising between a high-technology hospital service provider and remote public healthcare units: a qualitative study in Brazil. Telemed J E Health 2017 Jun;23(6):527-532. [CrossRef] [Medline]37,Han KJ, Subramanian R, Cameron GT. Listen before you leap: Sri Lankan health professionals' perspectives on m-health. Health Informatics J 2019 Sep;25(3):858-866. 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BMC Fam Pract 2018 May 9;19(1):56 [FREE Full text] [CrossRef] [Medline]59,Hackl WO, Hoerbst A, Duftschmid G, Gall W, Janzek-Hawlat S, Jung M, et al. Crucial factors for the acceptance of a computerized national medication list: insights into findings from the evaluation of the Austrian e-Medikation pilot. Appl Clin Inform 2014;5(2):527-537 [FREE Full text] [CrossRef] [Medline]98,Holderried M, Hoeper A, Holderried F, Blumenstock G, Ernst C, Tropitzsch A. Attitudes toward e-Health: the otolaryngologists' point of view. Telemed J E Health 2018 Jun;24(6):425-432. [CrossRef] [Medline]100,Jetty A, Moore MA, Coffman M, Petterson S, Bazemore A. Rural family physicians are twice as likely to use telehealth as urban family physicians. Telemed J E Health 2018 Apr;24(4):268-276. [CrossRef] [Medline]102,Koval PG, Kim JJ, Makhlouf T. Pharmacist perception of a mobile application audience response system for remote pharmacy continuing education participants. J Pharm Pract 2018 Aug 13:897190018792391. [CrossRef] [Medline]110, Moskowitz A, Chan YY, Bruns J, Levine SR. Emergency physician and stroke specialist beliefs and expectations regarding telestroke. Stroke 2010 Apr;41(4):805-809 [FREE Full text] [CrossRef] [Medline]123,El Amrani L, Engberink AO, Ninot G, Hayot M, Carbonnel F. Connected health devices for health care in French general medicine practice: cross-sectional study. JMIR Mhealth Uhealth 2017 Dec 21;5(12):e193 [FREE Full text] [CrossRef] [Medline]128,Rogove HJ, McArthur D, Demaerschalk BM, Vespa PM. Barriers to telemedicine: survey of current users in acute care units. Telemed J E Health 2012;18(1):48-53. [CrossRef] [Medline]130,Ariens LF, Schussler-Raymakers FM, Frima C, Flinterman A, Hamminga E, Arents BW, et al. Barriers and facilitators to eHealth use in daily practice: perspectives of patients and professionals in dermatology. J Med Internet Res 2017 Sep 5;19(9):e300 [FREE Full text] [CrossRef] [Medline]152,Muigg D, Kastner P, Modre-Osprian R, Haluza D, Duftschmid G. Is Austria ready for telemonitoring? A readiness assessment among doctors and patients in the field of diabetes. Stud Health Technol Inform 2018;248:322-329. [Medline]160,Bailey JV, Tomlinson N, Hobbs LJ, Webster R. Challenges and opportunities in evaluating a digital sexual health intervention in a clinic setting: Staff and patient views. Digit Health 2017;3:2055207617704272 [FREE Full text] [CrossRef] [Medline]163,Quanbeck A, Gustafson DH, Marsch LA, Chih M, Kornfield R, McTavish F, et al. Implementing a mobile health system to integrate the treatment of addiction into primary care: a hybrid implementation-effectiveness study. J Med Internet Res 2018 Jan 30;20(1):e37 [FREE Full text] [CrossRef] [Medline]167,Chang F, Paramsothy T, Roche M, Gupta NS. Patient, staff, and clinician perspectives on implementing electronic communications in an interdisciplinary rural family health practice. Prim Health Care Res Dev 2017 Mar;18(2):149-160. [CrossRef] [Medline]178,Radhakrishnan K, Xie B, Berkley A, Kim M. Barriers and facilitators for sustainability of tele-homecare programs: a systematic review. Health Serv Res 2016 Feb;51(1):48-75 [FREE Full text] [CrossRef] [Medline]182-Hickson R, Talbert J, Thornbury WC, Perin NR, Goodin AJ. Online medical care: the current state of 'eVisits' in acute primary care delivery. Telemed J E Health 2015 Feb;21(2):90-96. [CrossRef] [Medline]184,Penny RA, Bradford NK, Langbecker D. Registered nurse and midwife experiences of using videoconferencing in practice: a systematic review of qualitative studies. J Clin Nurs 2018 Mar;27(5-6):e739-e752. [CrossRef] [Medline]189,Mishori R, Anastario M, Naimer K, Varanasi S, Ferdowsian H, Abel D, et al. mJustice: preliminary development of a mobile app for medical-forensic documentation of sexual violence in low-resource environments and conflict zones. Glob Health Sci Pract 2017 Mar 24;5(1):138-151 [FREE Full text] [CrossRef] [Medline]193]. mHealth was perceived to be more prone to data security issues compared with other forms of digital health tools because of its portability and accessibility from personal devices [Puszka S, Dingwall KM, Sweet M, Nagel T. E-Mental health innovations for aboriginal and Torres Strait Islander Australians: a qualitative study of implementation needs in health services. JMIR Ment Health 2016 Sep 19;3(3):e43 [FREE Full text] [CrossRef] [Medline]73,Schneider T, Panzera AD, Martinasek M, McDermott R, Couluris M, Lindenberger J, et al. Physicians' perceptions of mobile technology for enhancing asthma care for youth. J Child Health Care 2016 Jun;20(2):153-163. [CrossRef] [Medline]77,Putzer GJ, Park Y. Are physicians likely to adopt emerging mobile technologies? Attitudes and innovation factors affecting smartphone use in the Southeastern United States. Perspect Health Inf Manag 2012;9:1b [FREE Full text] [Medline]127]. Therefore, it is deemed important to have a safe tool that protects the data provided in it [de Vries ST, Wong L, Sutcliffe A, Houÿez F, Ruiz CL, Mol PG, IMI Web-RADR Work Package 3b Consortium. Factors influencing the use of a mobile app for reporting adverse drug reactions and receiving safety information: a qualitative study. Drug Saf 2017 May;40(5):443-455 [FREE Full text] [CrossRef] [Medline]38,Lord S, Moore SK, Ramsey A, Dinauer S, Johnson K. Implementation of a substance use recovery support mobile phone app in community settings: qualitative study of clinician and staff perspectives of facilitators and barriers. JMIR Ment Health 2016 Jun 28;3(2):e24 [FREE Full text] [CrossRef] [Medline]61], work out liability issues in advance [Levine M, Richardson JE, Granieri E, Reid MC. Novel telemedicine technologies in geriatric chronic non-cancer pain: primary care providers' perspectives. Pain Med 2014 Feb;15(2):206-213 [FREE Full text] [CrossRef] [Medline]60,Sadoughi F, Erfannia L, Sancholi M, Salmani F, Sarsarshahi A. Teleradiology in Southeast Iran: Evaluating the Views of Senior Executives and Radiologists. Health Care Manag (Frederick) 2017;36(3):301-307. [CrossRef] [Medline]131], provide data privacy training to clinicians [Smith PB, Buzi RS. Reproductive health professionals' adoption of emerging technologies for health promotion. Health Informatics J 2014 Dec;20(4):250-260. [CrossRef] [Medline]138], and have clearer legal guidance [Nerminathan A, Harrison A, Phelps M, Alexander S, Scott KM. Doctors' use of mobile devices in the clinical setting: a mixed methods study. Intern Med J 2017 Mar;47(3):291-298. [CrossRef] [Medline]161,Odnoletkova I, Buysse H, Nobels F, Goderis G, Aertgeerts B, Annemans L, et al. Patient and provider acceptance of telecoaching in type 2 diabetes: a mixed-method study embedded in a randomised clinical trial. BMC Med Inform Decis Mak 2016 Nov 9;16(1):142 [FREE Full text] [CrossRef] [Medline]162]. Interestingly, some studies reported that privacy concerns are not a key barrier to adoption, given that some clinicians that have high privacy concerns might still have high usage intentions [Okazaki S, Castañeda JA, Sanz S, Henseler J. Factors affecting mobile diabetes monitoring adoption among physicians: questionnaire study and path model. J Med Internet Res 2012 Dec 21;14(6):e183 [FREE Full text] [CrossRef] [Medline]125,van Houwelingen CT, Barakat A, Best R, Boot WR, Charness N, Kort HS. Dutch nurses' willingness to use home telehealth: implications for practice and education. J Gerontol Nurs 2015 Apr;41(4):47-56. 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Policy and regulations mostly related to malpractice protection, licensing, and credentialing, in addition to costs and reimbursement issues, can certainly impact clinicians’ adoption of mHealth tools [Gagnon MP, Ngangue P, Payne-Gagnon J, Desmartis M. m-Health adoption by healthcare professionals: a systematic review. J Am Med Inform Assoc 2016 Jan;23(1):212-220. [CrossRef] [Medline]9,Brewster L, Mountain G, Wessels B, Kelly C, Hawley M. Factors affecting front line staff acceptance of telehealth technologies: a mixed-method systematic review. J Adv Nurs 2014 Jan;70(1):21-33. [CrossRef] [Medline]10,de Souza CH, Morbeck RA, Steinman M, Hors CP, Bracco MM, Kozasa EH, et al. Barriers and benefits in telemedicine arising between a high-technology hospital service provider and remote public healthcare units: a qualitative study in Brazil. Telemed J E Health 2017 Jun;23(6):527-532. [CrossRef] [Medline]37,Lord S, Moore SK, Ramsey A, Dinauer S, Johnson K. Implementation of a substance use recovery support mobile phone app in community settings: qualitative study of clinician and staff perspectives of facilitators and barriers. JMIR Ment Health 2016 Jun 28;3(2):e24 [FREE Full text] [CrossRef] [Medline]61,Puszka S, Dingwall KM, Sweet M, Nagel T. E-Mental health innovations for aboriginal and Torres Strait Islander Australians: a qualitative study of implementation needs in health services. JMIR Ment Health 2016 Sep 19;3(3):e43 [FREE Full text] [CrossRef] [Medline]73,Ghani MK, Jaber MM. Willingness to adopt telemedicine in major iraqi hospitals: a pilot study. Int J Telemed Appl 2015;2015:136591 [FREE Full text] [CrossRef] [Medline]95,Moore MA, Coffman M, Jetty A, Klink K, Petterson S, Bazemore A. Family physicians report considerable interest in, but limited use of, telehealth services. J Am Board Fam Med 2017;30(3):320-330 [FREE Full text] [CrossRef] [Medline]121,Moskowitz A, Chan YY, Bruns J, Levine SR. Emergency physician and stroke specialist beliefs and expectations regarding telestroke. Stroke 2010 Apr;41(4):805-809 [FREE Full text] [CrossRef] [Medline]123,Rogove HJ, McArthur D, Demaerschalk BM, Vespa PM. Barriers to telemedicine: survey of current users in acute care units. Telemed J E Health 2012;18(1):48-53. [CrossRef] [Medline]130,Uscher-Pines L, Kahn JM. Barriers and facilitators to pediatric emergency telemedicine in the United States. Telemed J E Health 2014 Nov;20(11):990-996 [FREE Full text] [CrossRef] [Medline]141,Alajlani M, Clarke M. Effect of culture on acceptance of telemedicine in Middle Eastern countries: case study of Jordan and Syria. Telemed J E Health 2013 Apr;19(4):305-311. [CrossRef] [Medline]151]. Unsuitable or inconsistent regulations and ambiguous policies [Mileski M, Kruse CS, Catalani J, Haderer T. Adopting telemedicine for the self-management of hypertension: systematic review. JMIR Med Inform 2017 Oct 24;5(4):e41 [FREE Full text] [CrossRef] [Medline]5,Chiang KF, Wang HH, Chien IK, Liou JK, Hung CL, Huang CM, et al. Healthcare providers' perceptions of barriers in implementing of home telecare in Taiwan: a qualitative study. Int J Med Inform 2015 Apr;84(4):277-287. [CrossRef] [Medline]35,McNally G, Frey R, Crossan M. Nurse manager and student nurse perceptions of the use of personal smartphones or tablets and the adjunct applications, as an educational tool in clinical settings. Nurse Educ Pract 2017 Mar;23:1-7. [CrossRef] [Medline]63,Jeon J, Taneva S, Kukreti V, Trbovich P, Easty AC, Rossos PG, et al. Toward successful migration to computerized physician order entry for chemotherapy. Curr Oncol 2014 Apr;21(2):e221-e228 [FREE Full text] [CrossRef] [Medline]155,Mueller KJ, Potter AJ, MacKinney AC, Ward MM. Lessons from tele-emergency: improving care quality and health outcomes by expanding support for rural care systems. Health Aff (Millwood) 2014 Feb;33(2):228-234. [CrossRef] [Medline]159,Charani E, Kyratsis Y, Lawson W, Wickens H, Brannigan ET, Moore LS, et al. An analysis of the development and implementation of a smartphone application for the delivery of antimicrobial prescribing policy: lessons learnt. J Antimicrob Chemother 2013 Apr;68(4):960-967 [FREE Full text] [CrossRef] [Medline]179], restrictive directives [Merchant KA, Ward MM, Mueller KJ, Rural Health Research & Policy Centers, Rural Policy Research Institute‚ RUPRI Center for Rural Health Policy Analysis‚ University of Iowa College of Public Health‚ Department of Health Management and Policy. Hospital views of factors affecting telemedicine use. Rural Policy Brief 2015 Apr 1(2015 5):1-4. [Medline]64,Jetty A, Moore MA, Coffman M, Petterson S, Bazemore A. Rural family physicians are twice as likely to use telehealth as urban family physicians. Telemed J E Health 2018 Apr;24(4):268-276. [CrossRef] [Medline]102], lack of policies and protocols [Catan G, Espanha R, Mendes RV, Toren O, Chinitz D. Health information technology implementation - impacts and policy considerations: a comparison between Israel and Portugal. Isr J Health Policy Res 2015;4:41 [FREE Full text] [CrossRef] [Medline]34,Han KJ, Subramanian R, Cameron GT. Listen before you leap: Sri Lankan health professionals' perspectives on m-health. Health Informatics J 2019 Sep;25(3):858-866. [CrossRef] [Medline]47,James S, Perry L, Gallagher R, Lowe J. Diabetes educators: perceived experiences, supports and barriers to use of common diabetes-related technologies. J Diabetes Sci Technol 2016 Sep;10(5):1115-1121 [FREE Full text] [CrossRef] [Medline]51,Molfenter T, Boyle M, Holloway D, Zwick J. Trends in telemedicine use in addiction treatment. Addict Sci Clin Pract 2015 May 28;10:14 [FREE Full text] [CrossRef] [Medline]67,Kato NP, Johansson P, Okada I, de Vries AE, Kinugawa K, Strömberg A, et al. Heart failure telemonitoring in Japan and Sweden: a cross-sectional survey. J Med Internet Res 2015 Nov 13;17(11):e258 [FREE Full text] [CrossRef] [Medline]104,Nerminathan A, Harrison A, Phelps M, Alexander S, Scott KM. Doctors' use of mobile devices in the clinical setting: a mixed methods study. Intern Med J 2017 Mar;47(3):291-298. [CrossRef] [Medline]161,Odnoletkova I, Buysse H, Nobels F, Goderis G, Aertgeerts B, Annemans L, et al. Patient and provider acceptance of telecoaching in type 2 diabetes: a mixed-method study embedded in a randomised clinical trial. BMC Med Inform Decis Mak 2016 Nov 9;16(1):142 [FREE Full text] [CrossRef] [Medline]162], and lack of governmental coordination [Bhatta R, Aryal K, Ellingsen G. Opportunities and challenges of a rural-telemedicine program in Nepal. J Nepal Health Res Counc 2015;13(30):149-153. [Medline]4] may hinder adoption. Clear and appropriate regulations and guidelines [Carlisle K, Warren R. A qualitative case study of telehealth for in-home monitoring to support the management of type 2 diabetes. J Telemed Telecare 2013 Oct;19(7):372-375. [CrossRef] [Medline]92,Morilla MD, Sans M, Casasa A, Giménez N. Implementing technology in healthcare: insights from physicians. BMC Med Inform Decis Mak 2017 Jun 27;17(1):92 [FREE Full text] [CrossRef] [Medline]122,O'Connor S, Andrews T. Smartphones and mobile applications (apps) in clinical nursing education: a student perspective. Nurse Educ Today 2018 Oct;69:172-178. [CrossRef] [Medline]124, Zhang H, Cocosila M, Archer N. Factors of adoption of mobile information technology by homecare nurses: a technology acceptance model 2 approach. Comput Inform Nurs 2010;28(1):49-56. [CrossRef] [Medline]146,Ray KN, Felmet KA, Hamilton MF, Kuza CC, Saladino RA, Schultz BR, et al. Clinician attitudes toward adoption of pediatric emergency telemedicine in rural hospitals. Pediatr Emerg Care 2017 Apr;33(4):250-257. [CrossRef] [Medline]168,Chang F, Paramsothy T, Roche M, Gupta NS. Patient, staff, and clinician perspectives on implementing electronic communications in an interdisciplinary rural family health practice. Prim Health Care Res Dev 2017 Mar;18(2):149-160. [CrossRef] [Medline]178,Daniel F, Jabak S, Sasso R, Chamoun Y, Tamim H. Patient-physician communication in the era of mobile phones and social media apps: cross-sectional observational study on Lebanese physicians' perceptions and attitudes. JMIR Med Inform 2018 Apr 6;6(2):e18 [FREE Full text] [CrossRef] [Medline]190,Mishori R, Anastario M, Naimer K, Varanasi S, Ferdowsian H, Abel D, et al. mJustice: preliminary development of a mobile app for medical-forensic documentation of sexual violence in low-resource environments and conflict zones. Glob Health Sci Pract 2017 Mar 24;5(1):138-151 [FREE Full text] [CrossRef] [Medline]193] and more proactive involvement of governments and medical professional associations [Villalba-Mora E, Casas I, Lupiañez-Villanueva F, Maghiros I. Adoption of health information technologies by physicians for clinical practice: the Andalusian case. Int J Med Inform 2015 Jul;84(7):477-485. [CrossRef] [Medline]143,Zailani S, Gilani MS, Nikbin D, Iranmanesh M. Determinants of telemedicine acceptance in selected public hospitals in Malaysia: clinical perspective. J Med Syst 2014 Sep;38(9):111. [CrossRef] [Medline]145,Lapão LV, da Silva MM, Gregório J. Implementing an online pharmaceutical service using design science research. BMC Med Inform Decis Mak 2017 Mar 27;17(1):31 [FREE Full text] [CrossRef] [Medline]157] are essential for efficient adoption and sustainable services.
Clinicians’ perceptions and attitudes toward technology may impact their decision to adopt the tools [Mileski M, Kruse CS, Catalani J, Haderer T. Adopting telemedicine for the self-management of hypertension: systematic review. JMIR Med Inform 2017 Oct 24;5(4):e41 [FREE Full text] [CrossRef] [Medline]5,Chiang KF, Wang HH, Chien IK, Liou JK, Hung CL, Huang CM, et al. Healthcare providers' perceptions of barriers in implementing of home telecare in Taiwan: a qualitative study. Int J Med Inform 2015 Apr;84(4):277-287. [CrossRef] [Medline]35,Moloczij N, Mosley I, Moss KM, Bagot KL, Bladin CF, Cadilhac DA. Is telemedicine helping or hindering the delivery of stroke thrombolysis in rural areas? A qualitative analysis. Intern Med J 2015 Sep;45(9):957-964. [CrossRef] [Medline]69,Kim S, Lee KH, Hwang H, Yoo S. Analysis of the factors influencing healthcare professionals' adoption of mobile electronic medical record (EMR) using the unified theory of acceptance and use of technology (UTAUT) in a tertiary hospital. BMC Med Inform Decis Mak 2016 Jan 30;16:12 [FREE Full text] [CrossRef] [Medline]107, Ly BA, Kristjansson E, Labonté R, Bourgeault IL. Determinants of the intention of Senegal's physicians to use telemedicine in their professional activities. Telemed J E Health 2018 Nov;24(11):897-898. [CrossRef] [Medline]118,Putzer GJ, Park Y. Are physicians likely to adopt emerging mobile technologies? Attitudes and innovation factors affecting smartphone use in the Southeastern United States. Perspect Health Inf Manag 2012;9:1b [FREE Full text] [Medline]127,Sandholzer M, Deutsch T, Frese T, Winter A. Predictors of students' self-reported adoption of a smartphone application for medical education in general practice. BMC Med Educ 2015 May 21;15:91 [FREE Full text] [CrossRef] [Medline]134,Sezgin E, Özkan-Yildirim S, Yildirim S. Understanding the perception towards using mHealth applications in practice. Inf Dev 2018;34(2):182-200. [CrossRef]136,Smith PB, Buzi RS. Reproductive health professionals' adoption of emerging technologies for health promotion. Health Informatics J 2014 Dec;20(4):250-260. [CrossRef] [Medline]138,Williamson KM, Muckle J. Students' perception of technology use in nursing education. Comput Inform Nurs 2018 Feb;36(2):70-76. [CrossRef] [Medline]173]. Those who are lacking familiarity with mobile technologies, are resistant to change, or are risk averse may not use them [Catan G, Espanha R, Mendes RV, Toren O, Chinitz D. Health information technology implementation - impacts and policy considerations: a comparison between Israel and Portugal. Isr J Health Policy Res 2015;4:41 [FREE Full text] [CrossRef] [Medline]34,Levine M, Richardson JE, Granieri E, Reid MC. Novel telemedicine technologies in geriatric chronic non-cancer pain: primary care providers' perspectives. Pain Med 2014 Feb;15(2):206-213 [FREE Full text] [CrossRef] [Medline]60,Molfenter T, Boyle M, Holloway D, Zwick J. Trends in telemedicine use in addiction treatment. Addict Sci Clin Pract 2015 May 28;10:14 [FREE Full text] [CrossRef] [Medline]67, Varsi C, Ekstedt M, Gammon D, Børøsund E, Ruland CM. Middle managers' experiences and role in implementing an interactive tailored patient assessment eHealth intervention in clinical practice. Comput Inform Nurs 2015;33(6):249-257. [CrossRef] [Medline]85,Klack L, Ziefle M, Wilkowska W, Kluge J. Telemedical versus conventional heart patient monitoring: a survey study with German physicians. Int J Technol Assess Health Care 2013 Oct;29(4):378-383. [CrossRef] [Medline]108,Albrecht UV, Afshar K, Illiger K, Becker S, Hartz T, Breil B, et al. Expectancy, usage and acceptance by general practitioners and patients: exploratory results from a study in the German outpatient sector. Digit Health 2017;3:2055207617695135 [FREE Full text] [CrossRef] [Medline]117,Bidmead E, Marshall A. A case study of stakeholder perceptions of patient held records: the Patients Know Best (PKB) solution. Digit Health 2016;2:2055207616668431 [FREE Full text] [CrossRef] [Medline]174,Kumar S, Merchant S, Reynolds R. Tele-ICU: efficacy and cost-effectiveness approach of remotely managing the critical care. Open Med Inform J 2013;7:24-29 [FREE Full text] [CrossRef] [Medline]186,Bishop TF, Press MJ, Mendelsohn JL, Casalino LP. Electronic communication improves access, but barriers to its widespread adoption remain. Health Aff (Millwood) 2013 Aug;32(8):1361-1367 [FREE Full text] [CrossRef] [Medline]195]; also, there is the perception that using a mobile phone at work may seem unprofessional [McNally G, Frey R, Crossan M. Nurse manager and student nurse perceptions of the use of personal smartphones or tablets and the adjunct applications, as an educational tool in clinical settings. Nurse Educ Pract 2017 Mar;23:1-7. [CrossRef] [Medline]63,O'Connor S, Andrews T. Smartphones and mobile applications (apps) in clinical nursing education: a student perspective. Nurse Educ Today 2018 Oct;69:172-178. [CrossRef] [Medline]124,Daniel F, Jabak S, Sasso R, Chamoun Y, Tamim H. Patient-physician communication in the era of mobile phones and social media apps: cross-sectional observational study on Lebanese physicians' perceptions and attitudes. JMIR Med Inform 2018 Apr 6;6(2):e18 [FREE Full text] [CrossRef] [Medline]190]. Those with positive attitudes toward technology are more likely to adopt new tools [Gagnon MP, Orruño E, Asua J, Abdeljelil AB, Emparanza J. Using a modified technology acceptance model to evaluate healthcare professionals' adoption of a new telemonitoring system. Telemed J E Health 2012;18(1):54-59 [FREE Full text] [CrossRef] [Medline]97,Kuo KM, Talley PC, Lee C, Yen Y. The influence of telemedicine experience on physicians' perceptions regarding adoption. Telemed J E Health 2015 May;21(5):388-394. [CrossRef] [Medline]113]. In addition, their perception and attitudes toward mHealth specifically also affect their intention to use it [Brewster L, Mountain G, Wessels B, Kelly C, Hawley M. Factors affecting front line staff acceptance of telehealth technologies: a mixed-method systematic review. J Adv Nurs 2014 Jan;70(1):21-33. [CrossRef] [Medline]10,Ghani MK, Jaber MM. Willingness to adopt telemedicine in major iraqi hospitals: a pilot study. Int J Telemed Appl 2015;2015:136591 [FREE Full text] [CrossRef] [Medline]95,Kleinpell R, Barden C, Rincon T, McCarthy M, Rufo RJ. Assessing the impact of telemedicine on nursing care in intensive care units. Am J Crit Care 2016 Jan;25(1):e14-e20. [CrossRef] [Medline]109,Kowitlawakul Y. The technology acceptance model: predicting nurses' intention to use telemedicine technology (eICU). Comput Inform Nurs 2011 Jul;29(7):411-418. [CrossRef] [Medline]111,Rogove HJ, McArthur D, Demaerschalk BM, Vespa PM. Barriers to telemedicine: survey of current users in acute care units. Telemed J E Health 2012;18(1):48-53. [CrossRef] [Medline]130,Saigi-Rubió F, Jiménez-Zarco A, Torrent-Sellens J. Determinants of the intention to use telemedicine: evidence from primary care physicians. Int J Technol Assess Health Care 2016 Jan;32(1-2):29-36. [CrossRef] [Medline]132,Saigí-Rubió F, Torrent-Sellens J, Jiménez-Zarco A. Drivers of telemedicine use: comparative evidence from samples of Spanish, Colombian and Bolivian physicians. Implement Sci 2014 Oct 8;9:128 [FREE Full text] [CrossRef] [Medline]133,Ayatollahi H, Mirani N, Nazari F, Razavi N. Iranian healthcare professionals' perspectives about factors influencing the use of telemedicine in diabetes management. World J Diabetes 2018 Jun 15;9(6):92-98 [FREE Full text] [CrossRef] [Medline]147,Chang F, Paramsothy T, Roche M, Gupta NS. Patient, staff, and clinician perspectives on implementing electronic communications in an interdisciplinary rural family health practice. Prim Health Care Res Dev 2017 Mar;18(2):149-160. [CrossRef] [Medline]178,Koivunen M, Saranto K. Nursing professionals' experiences of the facilitators and barriers to the use of telehealth applications: a systematic review of qualitative studies. Scand J Caring Sci 2018 Mar;32(1):24-44. [CrossRef] [Medline]185,Li L, Cotton A. A systematic review of nurses' perspectives toward the telemedicine intensive care unit: a basis for supporting its future implementation in China? Telemed J E Health 2019 May;25(5):343-350. [CrossRef] [Medline]188]. Clinicians with negative attitudes toward mHealth are more reluctant to use it [Villalba-Mora E, Casas I, Lupiañez-Villanueva F, Maghiros I. Adoption of health information technologies by physicians for clinical practice: the Andalusian case. Int J Med Inform 2015 Jul;84(7):477-485. [CrossRef] [Medline]143,Jeon J, Taneva S, Kukreti V, Trbovich P, Easty AC, Rossos PG, et al. Toward successful migration to computerized physician order entry for chemotherapy. Curr Oncol 2014 Apr;21(2):e221-e228 [FREE Full text] [CrossRef] [Medline]155]. This is sometimes because of their perception that it will add to their workload [de Souza CH, Morbeck RA, Steinman M, Hors CP, Bracco MM, Kozasa EH, et al. Barriers and benefits in telemedicine arising between a high-technology hospital service provider and remote public healthcare units: a qualitative study in Brazil. Telemed J E Health 2017 Jun;23(6):527-532. [CrossRef] [Medline]37,Taylor J, Coates L. Caring from a distance: the role of telehealth. Nurs Times 2015;111(28-29):18-20. [Medline]83], their uncertainty to what the introduction of such new tools would mean for their workflow [Kayyali R, Hesso I, Mahdi A, Hamzat O, Adu A, Nabhani Gebara S. Telehealth: misconceptions and experiences of healthcare professionals in England. Int J Pharm Pract 2017 Jun;25(3):203-209. [CrossRef] [Medline]55,Kato NP, Johansson P, Okada I, de Vries AE, Kinugawa K, Strömberg A, et al. Heart failure telemonitoring in Japan and Sweden: a cross-sectional survey. J Med Internet Res 2015 Nov 13;17(11):e258 [FREE Full text] [CrossRef] [Medline]104,Iacono T, Dissanayake C, Trembath D, Hudry K, Erickson S, Spong J. Family and practitioner perspectives on telehealth for services to young children with autism. Stud Health Technol Inform 2016;231:63-73. [Medline]153,Possemato K, Kuhn E, Johnson EM, Hoffman JE, Brooks E. Development and refinement of a clinician intervention to facilitate primary care patient use of the PTSD Coach app. Transl Behav Med 2017 Mar;7(1):116-126 [FREE Full text] [CrossRef] [Medline]166], or their perception that it invades their privacy [Han KJ, Subramanian R, Cameron GT. Listen before you leap: Sri Lankan health professionals' perspectives on m-health. Health Informatics J 2019 Sep;25(3):858-866. [CrossRef] [Medline]47,Bagot KL, Cadilhac DA, Bladin CF, Watkins CL, Vu M, Donnan GA, VSTASTUTE investigators. Integrating acute stroke telemedicine consultations into specialists' usual practice: a qualitative analysis comparing the experience of Australia and the United Kingdom. BMC Health Serv Res 2017 Nov 21;17(1):751 [FREE Full text] [CrossRef] [Medline]65,Schneider T, Panzera AD, Martinasek M, McDermott R, Couluris M, Lindenberger J, et al. Physicians' perceptions of mobile technology for enhancing asthma care for youth. J Child Health Care 2016 Jun;20(2):153-163. [CrossRef] [Medline]77,Nerminathan A, Harrison A, Phelps M, Alexander S, Scott KM. Doctors' use of mobile devices in the clinical setting: a mixed methods study. Intern Med J 2017 Mar;47(3):291-298. [CrossRef] [Medline]161,Li L, Cotton A. A systematic review of nurses' perspectives toward the telemedicine intensive care unit: a basis for supporting its future implementation in China? Telemed J E Health 2019 May;25(5):343-350. [CrossRef] [Medline]188,Daniel F, Jabak S, Sasso R, Chamoun Y, Tamim H. Patient-physician communication in the era of mobile phones and social media apps: cross-sectional observational study on Lebanese physicians' perceptions and attitudes. JMIR Med Inform 2018 Apr 6;6(2):e18 [FREE Full text] [CrossRef] [Medline]190]. It is also important to note that personal attributes such as adaptability and the readiness to try new things may similarly impact the adoption decision [Tintorer DL, Domínguez JM, Pujol-Rivera E, Beneyto SF, Tuduri XM, Saigí-Rubió F. Keys to success of a community of clinical practice in primary care: a qualitative evaluation of the ECOPIH project. BMC Fam Pract 2018 May 9;19(1):56 [FREE Full text] [CrossRef] [Medline]59,Holderried M, Hoeper A, Holderried F, Blumenstock G, Ernst C, Tropitzsch A. Attitudes toward e-Health: the otolaryngologists' point of view. Telemed J E Health 2018 Jun;24(6):425-432. [CrossRef] [Medline]100,Lapão LV, da Silva MM, Gregório J. Implementing an online pharmaceutical service using design science research. BMC Med Inform Decis Mak 2017 Mar 27;17(1):31 [FREE Full text] [CrossRef] [Medline]157].
The organizational culture and context can also impact the clinician’s intention to use the tools [Ghani MK, Jaber MM. Willingness to adopt telemedicine in major iraqi hospitals: a pilot study. Int J Telemed Appl 2015;2015:136591 [FREE Full text] [CrossRef] [Medline]95,Alajlani M, Clarke M. Effect of culture on acceptance of telemedicine in Middle Eastern countries: case study of Jordan and Syria. Telemed J E Health 2013 Apr;19(4):305-311. [CrossRef] [Medline]151,Ray KN, Felmet KA, Hamilton MF, Kuza CC, Saladino RA, Schultz BR, et al. Clinician attitudes toward adoption of pediatric emergency telemedicine in rural hospitals. Pediatr Emerg Care 2017 Apr;33(4):250-257. [CrossRef] [Medline]168], although some studies reported that it is not a meaningful barrier [Rogove HJ, McArthur D, Demaerschalk BM, Vespa PM. Barriers to telemedicine: survey of current users in acute care units. Telemed J E Health 2012;18(1):48-53. [CrossRef] [Medline]130]. Prohibitive or unclear expectations around mobile phone use in the workplace may discourage adoption [Farrell M. Use of iPhones by nurses in an acute care setting to improve communication and decision-making processes: qualitative analysis of nurses' perspectives on iPhone use. JMIR Mhealth Uhealth 2016 May 31;4(2):e43 [FREE Full text] [CrossRef] [Medline]42,McNally G, Frey R, Crossan M. Nurse manager and student nurse perceptions of the use of personal smartphones or tablets and the adjunct applications, as an educational tool in clinical settings. Nurse Educ Pract 2017 Mar;23:1-7. [CrossRef] [Medline]63,Beauregard P, Arnaert A, Ponzoni N. Nursing students' perceptions of using smartphones in the community practicum: a qualitative study. Nurse Educ Today 2017 Jun;53:1-6. [CrossRef] [Medline]76, O'Connor S, Andrews T. Smartphones and mobile applications (apps) in clinical nursing education: a student perspective. Nurse Educ Today 2018 Oct;69:172-178. [CrossRef] [Medline]124,Nerminathan A, Harrison A, Phelps M, Alexander S, Scott KM. Doctors' use of mobile devices in the clinical setting: a mixed methods study. Intern Med J 2017 Mar;47(3):291-298. [CrossRef] [Medline]161,Payne KF, Weeks L, Dunning P. A mixed methods pilot study to investigate the impact of a hospital-specific iPhone application (iTreat) within a British junior doctor cohort. Health Informatics J 2014 Mar;20(1):59-73. [CrossRef] [Medline]165,Tahamtan I, Pajouhanfar S, Sedghi S, Azad M, Roudbari M. Factors affecting smartphone adoption for accessing information in medical settings. Health Info Libr J 2017 Jun;34(2):134-145. [CrossRef] [Medline]170,Charani E, Kyratsis Y, Lawson W, Wickens H, Brannigan ET, Moore LS, et al. An analysis of the development and implementation of a smartphone application for the delivery of antimicrobial prescribing policy: lessons learnt. J Antimicrob Chemother 2013 Apr;68(4):960-967 [FREE Full text] [CrossRef] [Medline]179]. Furthermore, an organizational culture that is resistant to change or risk averse may hinder the implementation of such new technologies [Goedken CC, Moeckli J, Cram PM, Reisinger HS. Introduction of Tele-ICU in rural hospitals: changing organisational culture to harness benefits. Intensive Crit Care Nurs 2017 Jun;40:51-56. [CrossRef] [Medline]45,Varsi C, Ekstedt M, Gammon D, Ruland CM. Using the consolidated framework for implementation research to identify barriers and facilitators for the implementation of an internet-based patient-provider communication service in five settings: a qualitative study. J Med Internet Res 2015 Nov 18;17(11):e262 [FREE Full text] [CrossRef] [Medline]86,Brieux HM, Benitez S, Otero C, Luna D, Masud JH, Marcelo A, et al. Cultural problems associated with the implementation of eHealth. Stud Health Technol Inform 2017;245:1213. [Medline]148,Bramley G, Mangan C, Conroy M. Using telemonitoring to support personal care planning for adults with learning disabilities. J Telemed Telecare 2019 Dec;25(10):602-610. [CrossRef] [Medline]176]. A cultural shift might be needed to enable and foster the acceptance of mHealth use at the workplace and transition from paper-based systems to more use of digital tools [de Souza CH, Morbeck RA, Steinman M, Hors CP, Bracco MM, Kozasa EH, et al. Barriers and benefits in telemedicine arising between a high-technology hospital service provider and remote public healthcare units: a qualitative study in Brazil. Telemed J E Health 2017 Jun;23(6):527-532. [CrossRef] [Medline]37,Zailani S, Gilani MS, Nikbin D, Iranmanesh M. Determinants of telemedicine acceptance in selected public hospitals in Malaysia: clinical perspective. J Med Syst 2014 Sep;38(9):111. [CrossRef] [Medline]145,Mishori R, Anastario M, Naimer K, Varanasi S, Ferdowsian H, Abel D, et al. mJustice: preliminary development of a mobile app for medical-forensic documentation of sexual violence in low-resource environments and conflict zones. Glob Health Sci Pract 2017 Mar 24;5(1):138-151 [FREE Full text] [CrossRef] [Medline]193].
Peer influence and endorsement are other factors that might impact clinicians’ trust in mHealth and, accordingly, their adoption decision [Avey JP, Hobbs RL. Dial in: fostering the use of telebehavioral health services in frontier Alaska. Psychol Serv 2013 Aug;10(3):289-297. [CrossRef] [Medline]2,Gagnon MP, Ngangue P, Payne-Gagnon J, Desmartis M. m-Health adoption by healthcare professionals: a systematic review. J Am Med Inform Assoc 2016 Jan;23(1):212-220. [CrossRef] [Medline]9,Okazaki S, Castañeda JA, Sanz S, Henseler J. Factors affecting mobile diabetes monitoring adoption among physicians: questionnaire study and path model. J Med Internet Res 2012 Dec 21;14(6):e183 [FREE Full text] [CrossRef] [Medline]125,van Houwelingen CT, Barakat A, Best R, Boot WR, Charness N, Kort HS. Dutch nurses' willingness to use home telehealth: implications for practice and education. J Gerontol Nurs 2015 Apr;41(4):47-56. [CrossRef] [Medline]142,Tahamtan I, Pajouhanfar S, Sedghi S, Azad M, Roudbari M. Factors affecting smartphone adoption for accessing information in medical settings. Health Info Libr J 2017 Jun;34(2):134-145. [CrossRef] [Medline]170,Zhang Y, Koch S. Mobile health apps in Sweden: what do physicians recommend? Stud Health Technol Inform 2015;210:793-797. [Medline]175,Radhakrishnan K, Xie B, Berkley A, Kim M. Barriers and facilitators for sustainability of tele-homecare programs: a systematic review. Health Serv Res 2016 Feb;51(1):48-75 [FREE Full text] [CrossRef] [Medline]182,Putzer GJ, Park Y. The effects of innovation factors on smartphone adoption among nurses in community hospitals. Perspect Health Inf Manag 2010 Jan 1;7:1b [FREE Full text] [Medline]196]. Equally, those who are change-resistant may also impact early adopters negatively [Ehrler F, Ducloux P, Wu DT, Lovis C, Blondon K. Acceptance of a mobile application supporting nurses workflow at patient bedside: results from a pilot study. Stud Health Technol Inform 2018;247:506-510. [Medline]181]. Recommendations by reliable bodies such as scientific societies, renowned health care organizations such as the National Health Service, opinion leaders, internal champions, direct managers, or senior colleagues that promote the tools may foster adoption [de Vries ST, Wong L, Sutcliffe A, Houÿez F, Ruiz CL, Mol PG, IMI Web-RADR Work Package 3b Consortium. Factors influencing the use of a mobile app for reporting adverse drug reactions and receiving safety information: a qualitative study. Drug Saf 2017 May;40(5):443-455 [FREE Full text] [CrossRef] [Medline]38,James S, Perry L, Gallagher R, Lowe J. Diabetes educators: perceived experiences, supports and barriers to use of common diabetes-related technologies. J Diabetes Sci Technol 2016 Sep;10(5):1115-1121 [FREE Full text] [CrossRef] [Medline]51,Lord S, Moore SK, Ramsey A, Dinauer S, Johnson K. Implementation of a substance use recovery support mobile phone app in community settings: qualitative study of clinician and staff perspectives of facilitators and barriers. JMIR Ment Health 2016 Jun 28;3(2):e24 [FREE Full text] [CrossRef] [Medline]61,Molfenter T, Boyle M, Holloway D, Zwick J. Trends in telemedicine use in addiction treatment. Addict Sci Clin Pract 2015 May 28;10:14 [FREE Full text] [CrossRef] [Medline]67,Hao H, Padman R. An empirical study of opinion leader effects on mobile technology implementation by physicians in an American community health system. Health Informatics J 2018 Sep;24(3):323-333. [CrossRef] [Medline]99,Kifle M, Payton FC, Mbarika V, Meso P. Transfer and adoption of advanced information technology solutions in resource-poor environments: the case of telemedicine systems adoption in Ethiopia. Telemed J E Health 2010 Apr;16(3):327-343. [CrossRef] [Medline]105,El Amrani L, Engberink AO, Ninot G, Hayot M, Carbonnel F. Connected health devices for health care in French general medicine practice: cross-sectional study. JMIR Mhealth Uhealth 2017 Dec 21;5(12):e193 [FREE Full text] [CrossRef] [Medline]128,Zhang H, Cocosila M, Archer N. Factors of adoption of mobile information technology by homecare nurses: a technology acceptance model 2 approach. Comput Inform Nurs 2010;28(1):49-56. [CrossRef] [Medline]146,Nerminathan A, Harrison A, Phelps M, Alexander S, Scott KM. Doctors' use of mobile devices in the clinical setting: a mixed methods study. Intern Med J 2017 Mar;47(3):291-298. [CrossRef] [Medline]161,Bailey JV, Tomlinson N, Hobbs LJ, Webster R. Challenges and opportunities in evaluating a digital sexual health intervention in a clinic setting: Staff and patient views. Digit Health 2017;3:2055207617704272 [FREE Full text] [CrossRef] [Medline]163].
Financial aspects are typically barriers to adoption [Morrow S, Daines L, Wiener-Ogilvie S, Steed L, McKee L, Caress A, et al. Exploring the perspectives of clinical professionals and support staff on implementing supported self-management for asthma in UK general practice: an IMPART qualitative study. NPJ Prim Care Respir Med 2017 Jul 18;27(1):45 [FREE Full text] [CrossRef] [Medline]70,Jefee-Bahloul H, Duchen D, Barkil-Oteo A. Attitudes towards implementation of Store-and-Forward telemental health in humanitarian settings: survey of Syrian healthcare providers. Telemed J E Health 2016 Jan;22(1):31-35. [CrossRef] [Medline]101,Ariens LF, Schussler-Raymakers FM, Frima C, Flinterman A, Hamminga E, Arents BW, et al. Barriers and facilitators to eHealth use in daily practice: perspectives of patients and professionals in dermatology. J Med Internet Res 2017 Sep 5;19(9):e300 [FREE Full text] [CrossRef] [Medline]152,Ray KN, Felmet KA, Hamilton MF, Kuza CC, Saladino RA, Schultz BR, et al. Clinician attitudes toward adoption of pediatric emergency telemedicine in rural hospitals. Pediatr Emerg Care 2017 Apr;33(4):250-257. [CrossRef] [Medline]168]. Lack of proper funding [Chung C, Cook J, Bales E, Zia J, Munson SA. More than telemonitoring: health provider use and nonuse of life-log data in irritable bowel syndrome and weight management. J Med Internet Res 2015 Aug 21;17(8):e203 [FREE Full text] [CrossRef] [Medline]36,Odeh B, Kayyali R, Nabhani-Gebara S, Philip N. Implementing a telehealth service: nurses' perceptions and experiences. Br J Nurs 2014;23(21):1133-1137. [CrossRef] [Medline]71,Varsi C, Ekstedt M, Gammon D, Ruland CM. Using the consolidated framework for implementation research to identify barriers and facilitators for the implementation of an internet-based patient-provider communication service in five settings: a qualitative study. J Med Internet Res 2015 Nov 18;17(11):e262 [FREE Full text] [CrossRef] [Medline]86, Villalba-Mora E, Casas I, Lupiañez-Villanueva F, Maghiros I. Adoption of health information technologies by physicians for clinical practice: the Andalusian case. Int J Med Inform 2015 Jul;84(7):477-485. [CrossRef] [Medline]143,Alajlani M, Clarke M. Effect of culture on acceptance of telemedicine in Middle Eastern countries: case study of Jordan and Syria. Telemed J E Health 2013 Apr;19(4):305-311. [CrossRef] [Medline]151,Loh P, Flicker L, Horner B. Attitudes toward information and communication technology (ICT) in residential aged care in Western Australia. J Am Med Dir Assoc 2009 Jul;10(6):408-413. [CrossRef] [Medline]156,Muigg D, Kastner P, Modre-Osprian R, Haluza D, Duftschmid G. Is Austria ready for telemonitoring? A readiness assessment among doctors and patients in the field of diabetes. Stud Health Technol Inform 2018;248:322-329. [Medline]160,Orchard J, Lowres N, Freedman SB, Ladak L, Lee W, Zwar N, et al. Screening for atrial fibrillation during influenza vaccinations by primary care nurses using a smartphone electrocardiograph (iECG): A feasibility study. Eur J Prev Cardiol 2016 Oct;23(2 suppl):13-20. [CrossRef] [Medline]164,Quanbeck A, Gustafson DH, Marsch LA, Chih M, Kornfield R, McTavish F, et al. Implementing a mobile health system to integrate the treatment of addiction into primary care: a hybrid implementation-effectiveness study. J Med Internet Res 2018 Jan 30;20(1):e37 [FREE Full text] [CrossRef] [Medline]167] and compensation or reimbursement problems [Avey JP, Hobbs RL. Dial in: fostering the use of telebehavioral health services in frontier Alaska. Psychol Serv 2013 Aug;10(3):289-297. [CrossRef] [Medline]2,Anderson K, Francis T, Ibanez-Carrasco F, Globerman J. Physician's perceptions of telemedicine in HIV care provision: a cross-sectional web-based survey. JMIR Public Health Surveill 2017 May 30;3(2):e31 [FREE Full text] [CrossRef] [Medline]3,Mileski M, Kruse CS, Catalani J, Haderer T. Adopting telemedicine for the self-management of hypertension: systematic review. JMIR Med Inform 2017 Oct 24;5(4):e41 [FREE Full text] [CrossRef] [Medline]5,Gagnon MP, Ngangue P, Payne-Gagnon J, Desmartis M. m-Health adoption by healthcare professionals: a systematic review. J Am Med Inform Assoc 2016 Jan;23(1):212-220. [CrossRef] [Medline]9,Chiang KF, Wang HH, Chien IK, Liou JK, Hung CL, Huang CM, et al. Healthcare providers' perceptions of barriers in implementing of home telecare in Taiwan: a qualitative study. Int J Med Inform 2015 Apr;84(4):277-287. [CrossRef] [Medline]35,James S, Perry L, Gallagher R, Lowe J. Diabetes educators: perceived experiences, supports and barriers to use of common diabetes-related technologies. J Diabetes Sci Technol 2016 Sep;10(5):1115-1121 [FREE Full text] [CrossRef] [Medline]51,Armstrong AW, Kwong MW, Ledo L, Nesbitt TS, Shewry SL. Practice models and challenges in teledermatology: a study of collective experiences from teledermatologists. PLoS One 2011;6(12):e28687 [FREE Full text] [CrossRef] [Medline]54,Khan NU, Rasheed S, Sharmin T, Ahmed T, Mahmood SS, Khatun F, et al. Experience of using mHealth to link village doctors with physicians: lessons from Chakaria, Bangladesh. BMC Med Inform Decis Mak 2015 Aug 5;15:62 [FREE Full text] [CrossRef] [Medline]56,Levine M, Richardson JE, Granieri E, Reid MC. Novel telemedicine technologies in geriatric chronic non-cancer pain: primary care providers' perspectives. Pain Med 2014 Feb;15(2):206-213 [FREE Full text] [CrossRef] [Medline]60,Lord S, Moore SK, Ramsey A, Dinauer S, Johnson K. Implementation of a substance use recovery support mobile phone app in community settings: qualitative study of clinician and staff perspectives of facilitators and barriers. JMIR Ment Health 2016 Jun 28;3(2):e24 [FREE Full text] [CrossRef] [Medline]61,van Gaalen JL, van Bodegom-Vos L, Bakker MJ, Snoeck-Stroband JB, Sont JK. Internet-based self-management support for adults with asthma: a qualitative study among patients, general practitioners and practice nurses on barriers to implementation. BMJ Open 2016 Aug 26;6(8):e010809 [FREE Full text] [CrossRef] [Medline]84,Holderried M, Hoeper A, Holderried F, Blumenstock G, Ernst C, Tropitzsch A. Attitudes toward e-Health: the otolaryngologists' point of view. Telemed J E Health 2018 Jun;24(6):425-432. [CrossRef] [Medline]100,Mairesse GH, Braunschweig F, Klersy K, Cowie MR, Leyva F. Implementation and reimbursement of remote monitoring for cardiac implantable electronic devices in Europe: a survey from the health economics committee of the European Heart Rhythm Association. Europace 2015 May;17(5):814-818. [CrossRef] [Medline]119,Moskowitz A, Chan YY, Bruns J, Levine SR. Emergency physician and stroke specialist beliefs and expectations regarding telestroke. Stroke 2010 Apr;41(4):805-809 [FREE Full text] [CrossRef] [Medline]123,El Amrani L, Engberink AO, Ninot G, Hayot M, Carbonnel F. Connected health devices for health care in French general medicine practice: cross-sectional study. JMIR Mhealth Uhealth 2017 Dec 21;5(12):e193 [FREE Full text] [CrossRef] [Medline]128-Rogove HJ, McArthur D, Demaerschalk BM, Vespa PM. Barriers to telemedicine: survey of current users in acute care units. Telemed J E Health 2012;18(1):48-53. [CrossRef] [Medline]130, Hickson R, Talbert J, Thornbury WC, Perin NR, Goodin AJ. Online medical care: the current state of 'eVisits' in acute primary care delivery. Telemed J E Health 2015 Feb;21(2):90-96. [CrossRef] [Medline]184,Kumar S, Merchant S, Reynolds R. Tele-ICU: efficacy and cost-effectiveness approach of remotely managing the critical care. Open Med Inform J 2013;7:24-29 [FREE Full text] [CrossRef] [Medline]186] usually hinder clinicians’ intention to use mHealth. In addition, low awareness of existing reimbursement schemes [Jetty A, Moore MA, Coffman M, Petterson S, Bazemore A. Rural family physicians are twice as likely to use telehealth as urban family physicians. Telemed J E Health 2018 Apr;24(4):268-276. [CrossRef] [Medline]102] and overcomplicated or inconsistent payment systems [Egerton T, Nelligan R, Setchell J, Atkins L, Bennell KL. General practitioners' perspectives on a proposed new model of service delivery for primary care management of knee osteoarthritis: a qualitative study. BMC Fam Pract 2017 Sep 7;18(1):85 [FREE Full text] [CrossRef] [Medline]39,Merchant KA, Ward MM, Mueller KJ, Rural Health Research & Policy Centers, Rural Policy Research Institute‚ RUPRI Center for Rural Health Policy Analysis‚ University of Iowa College of Public Health‚ Department of Health Management and Policy. Hospital views of factors affecting telemedicine use. Rural Policy Brief 2015 Apr 1(2015 5):1-4. [Medline]64,Molfenter T, Boyle M, Holloway D, Zwick J. Trends in telemedicine use in addiction treatment. Addict Sci Clin Pract 2015 May 28;10:14 [FREE Full text] [CrossRef] [Medline]67,Uscher-Pines L, Kahn JM. Barriers and facilitators to pediatric emergency telemedicine in the United States. Telemed J E Health 2014 Nov;20(11):990-996 [FREE Full text] [CrossRef] [Medline]141,Mueller KJ, Potter AJ, MacKinney AC, Ward MM. Lessons from tele-emergency: improving care quality and health outcomes by expanding support for rural care systems. Health Aff (Millwood) 2014 Feb;33(2):228-234. [CrossRef] [Medline]159,Odnoletkova I, Buysse H, Nobels F, Goderis G, Aertgeerts B, Annemans L, et al. Patient and provider acceptance of telecoaching in type 2 diabetes: a mixed-method study embedded in a randomised clinical trial. BMC Med Inform Decis Mak 2016 Nov 9;16(1):142 [FREE Full text] [CrossRef] [Medline]162] may also be a barrier. Conversely, a suitable payment model and health insurance coverage may encourage adoption [Choi WS, Park J, Choi JY, Yang J. Stakeholders' resistance to telemedicine with focus on physicians: utilizing the Delphi technique. J Telemed Telecare 2019 Jul;25(6):378-385. [CrossRef] [Medline]8,Molfenter T, Boyle M, Holloway D, Zwick J. Trends in telemedicine use in addiction treatment. Addict Sci Clin Pract 2015 May 28;10:14 [FREE Full text] [CrossRef] [Medline]67,Molleda L, Bahamon M, St George SM, Perrino T, Estrada Y, Herrera DC, et al. Clinic personnel, facilitator, and parent perspectives of eHealth Familias Unidas in primary care. J Pediatr Health Care 2017;31(3):350-361 [FREE Full text] [CrossRef] [Medline]68,Schneider T, Panzera AD, Martinasek M, McDermott R, Couluris M, Lindenberger J, et al. Physicians' perceptions of mobile technology for enhancing asthma care for youth. J Child Health Care 2016 Jun;20(2):153-163. [CrossRef] [Medline]77,Carlisle K, Warren R. A qualitative case study of telehealth for in-home monitoring to support the management of type 2 diabetes. J Telemed Telecare 2013 Oct;19(7):372-375. [CrossRef] [Medline]92,Morilla MD, Sans M, Casasa A, Giménez N. Implementing technology in healthcare: insights from physicians. BMC Med Inform Decis Mak 2017 Jun 27;17(1):92 [FREE Full text] [CrossRef] [Medline]122,Sadoughi F, Erfannia L, Sancholi M, Salmani F, Sarsarshahi A. Teleradiology in Southeast Iran: Evaluating the Views of Senior Executives and Radiologists. Health Care Manag (Frederick) 2017;36(3):301-307. [CrossRef] [Medline]131,Radhakrishnan K, Xie B, Berkley A, Kim M. Barriers and facilitators for sustainability of tele-homecare programs: a systematic review. Health Serv Res 2016 Feb;51(1):48-75 [FREE Full text] [CrossRef] [Medline]182,Bishop TF, Press MJ, Mendelsohn JL, Casalino LP. Electronic communication improves access, but barriers to its widespread adoption remain. Health Aff (Millwood) 2013 Aug;32(8):1361-1367 [FREE Full text] [CrossRef] [Medline]195]. It is noteworthy that 1 study found that the financial disadvantages because of funding and reimbursement issues were compensated by the lower travel costs and higher efficiency generated by mHealth use [Zilliacus E, Meiser B, Lobb E, Dudding TE, Barlow-Stewart K, Tucker K. The virtual consultation: practitioners' experiences of genetic counseling by videoconferencing in Australia. Telemed J E Health 2010 Apr;16(3):350-357. [CrossRef] [Medline]91].
Reducing organizational costs may positively impact clinicians’ adoption as it helps them achieve budget efficiency [Armstrong AW, Kwong MW, Chase EP, Ledo L, Nesbitt TS, Shewry SL. Teledermatology operational considerations, challenges, and benefits: the referring providers' perspective. Telemed J E Health 2012 Oct;18(8):580-584. [CrossRef] [Medline]1,Avey JP, Hobbs RL. Dial in: fostering the use of telebehavioral health services in frontier Alaska. Psychol Serv 2013 Aug;10(3):289-297. [CrossRef] [Medline]2,Mileski M, Kruse CS, Catalani J, Haderer T. Adopting telemedicine for the self-management of hypertension: systematic review. JMIR Med Inform 2017 Oct 24;5(4):e41 [FREE Full text] [CrossRef] [Medline]5,Zilliacus E, Meiser B, Lobb E, Dudding TE, Barlow-Stewart K, Tucker K. The virtual consultation: practitioners' experiences of genetic counseling by videoconferencing in Australia. Telemed J E Health 2010 Apr;16(3):350-357. [CrossRef] [Medline]91,Saigi-Rubió F, Jiménez-Zarco A, Torrent-Sellens J. Determinants of the intention to use telemedicine: evidence from primary care physicians. Int J Technol Assess Health Care 2016 Jan;32(1-2):29-36. [CrossRef] [Medline]132,Ayatollahi H, Mirani N, Nazari F, Razavi N. Iranian healthcare professionals' perspectives about factors influencing the use of telemedicine in diabetes management. World J Diabetes 2018 Jun 15;9(6):92-98 [FREE Full text] [CrossRef] [Medline]147,Mueller KJ, Potter AJ, MacKinney AC, Ward MM. Lessons from tele-emergency: improving care quality and health outcomes by expanding support for rural care systems. Health Aff (Millwood) 2014 Feb;33(2):228-234. [CrossRef] [Medline]159,Radhakrishnan K, Xie B, Berkley A, Kim M. Barriers and facilitators for sustainability of tele-homecare programs: a systematic review. Health Serv Res 2016 Feb;51(1):48-75 [FREE Full text] [CrossRef] [Medline]182]. However, uncertainties around cost-effectiveness [Catan G, Espanha R, Mendes RV, Toren O, Chinitz D. Health information technology implementation - impacts and policy considerations: a comparison between Israel and Portugal. Isr J Health Policy Res 2015;4:41 [FREE Full text] [CrossRef] [Medline]34,Fairbrother P, Ure J, Hanley J, McCloughan L, Denvir M, Sheikh A, Telescot programme team. Telemonitoring for chronic heart failure: the views of patients and healthcare professionals - a qualitative study. J Clin Nurs 2014 Jan;23(1-2):132-144. [CrossRef] [Medline]41,Puszka S, Dingwall KM, Sweet M, Nagel T. E-Mental health innovations for aboriginal and Torres Strait Islander Australians: a qualitative study of implementation needs in health services. JMIR Ment Health 2016 Sep 19;3(3):e43 [FREE Full text] [CrossRef] [Medline]73,Seto E, Leonard KJ, Cafazzo JA, Barnsley J, Masino C, Ross HJ. Perceptions and experiences of heart failure patients and clinicians on the use of mobile phone-based telemonitoring. J Med Internet Res 2012 Feb 10;14(1):e25 [FREE Full text] [CrossRef] [Medline]78,Lee SI, Park H, Kim JW, Hwang H, Cho EY, Kim Y, et al. Physicians' perceptions and use of a health information exchange: a pilot program in South Korea. Telemed J E Health 2012 Oct;18(8):604-612 [FREE Full text] [CrossRef] [Medline]114] and the actual tool’s or service’s charge and affordability [Gagnon MP, Ngangue P, Payne-Gagnon J, Desmartis M. m-Health adoption by healthcare professionals: a systematic review. J Am Med Inform Assoc 2016 Jan;23(1):212-220. [CrossRef] [Medline]9,de Vries ST, Wong L, Sutcliffe A, Houÿez F, Ruiz CL, Mol PG, IMI Web-RADR Work Package 3b Consortium. Factors influencing the use of a mobile app for reporting adverse drug reactions and receiving safety information: a qualitative study. Drug Saf 2017 May;40(5):443-455 [FREE Full text] [CrossRef] [Medline]38,Egerton T, Nelligan R, Setchell J, Atkins L, Bennell KL. General practitioners' perspectives on a proposed new model of service delivery for primary care management of knee osteoarthritis: a qualitative study. BMC Fam Pract 2017 Sep 7;18(1):85 [FREE Full text] [CrossRef] [Medline]39,James S, Perry L, Gallagher R, Lowe J. Diabetes educators: perceived experiences, supports and barriers to use of common diabetes-related technologies. J Diabetes Sci Technol 2016 Sep;10(5):1115-1121 [FREE Full text] [CrossRef] [Medline]51,Jimbo M, Shultz CG, Nease DE, Fetters MD, Power D, Ruffin MT. Perceived barriers and facilitators of using a Web-based interactive decision aid for colorectal cancer screening in community practice settings: findings from focus groups with primary care clinicians and medical office staff. J Med Internet Res 2013 Dec 18;15(12):e286 [FREE Full text] [CrossRef] [Medline]53,Kayyali R, Hesso I, Mahdi A, Hamzat O, Adu A, Nabhani Gebara S. Telehealth: misconceptions and experiences of healthcare professionals in England. Int J Pharm Pract 2017 Jun;25(3):203-209. [CrossRef] [Medline]55, Levine M, Richardson JE, Granieri E, Reid MC. Novel telemedicine technologies in geriatric chronic non-cancer pain: primary care providers' perspectives. Pain Med 2014 Feb;15(2):206-213 [FREE Full text] [CrossRef] [Medline]60,Lord S, Moore SK, Ramsey A, Dinauer S, Johnson K. Implementation of a substance use recovery support mobile phone app in community settings: qualitative study of clinician and staff perspectives of facilitators and barriers. JMIR Ment Health 2016 Jun 28;3(2):e24 [FREE Full text] [CrossRef] [Medline]61,McNally G, Frey R, Crossan M. Nurse manager and student nurse perceptions of the use of personal smartphones or tablets and the adjunct applications, as an educational tool in clinical settings. Nurse Educ Pract 2017 Mar;23:1-7. [CrossRef] [Medline]63,Merchant KA, Ward MM, Mueller KJ, Rural Health Research & Policy Centers, Rural Policy Research Institute‚ RUPRI Center for Rural Health Policy Analysis‚ University of Iowa College of Public Health‚ Department of Health Management and Policy. Hospital views of factors affecting telemedicine use. Rural Policy Brief 2015 Apr 1(2015 5):1-4. [Medline]64,Molfenter T, Boyle M, Holloway D, Zwick J. Trends in telemedicine use in addiction treatment. Addict Sci Clin Pract 2015 May 28;10:14 [FREE Full text] [CrossRef] [Medline]67,van Gaalen JL, van Bodegom-Vos L, Bakker MJ, Snoeck-Stroband JB, Sont JK. Internet-based self-management support for adults with asthma: a qualitative study among patients, general practitioners and practice nurses on barriers to implementation. BMJ Open 2016 Aug 26;6(8):e010809 [FREE Full text] [CrossRef] [Medline]84,Koval PG, Kim JJ, Makhlouf T. Pharmacist perception of a mobile application audience response system for remote pharmacy continuing education participants. J Pharm Pract 2018 Aug 13:897190018792391. [CrossRef] [Medline]110,Moskowitz A, Chan YY, Bruns J, Levine SR. Emergency physician and stroke specialist beliefs and expectations regarding telestroke. Stroke 2010 Apr;41(4):805-809 [FREE Full text] [CrossRef] [Medline]123,van Houwelingen CT, Barakat A, Best R, Boot WR, Charness N, Kort HS. Dutch nurses' willingness to use home telehealth: implications for practice and education. J Gerontol Nurs 2015 Apr;41(4):47-56. [CrossRef] [Medline]142,Ayatollahi H, Mirani N, Nazari F, Razavi N. Iranian healthcare professionals' perspectives about factors influencing the use of telemedicine in diabetes management. World J Diabetes 2018 Jun 15;9(6):92-98 [FREE Full text] [CrossRef] [Medline]147,Loh P, Flicker L, Horner B. Attitudes toward information and communication technology (ICT) in residential aged care in Western Australia. J Am Med Dir Assoc 2009 Jul;10(6):408-413. [CrossRef] [Medline]156,Jungwirth D, Haluza D. Information and communication technology and the future of healthcare: results of a multi-scenario Delphi survey. Health Informatics J 2019 Mar;25(1):161-173. [CrossRef] [Medline]191] may hinder adoption.
Clinicians’ perception that the timeliness and amount of the data generated by mHealth can enhance the evidence for benefit is a facilitator [Varsi C, Ekstedt M, Gammon D, Børøsund E, Ruland CM. Middle managers' experiences and role in implementing an interactive tailored patient assessment eHealth intervention in clinical practice. Comput Inform Nurs 2015;33(6):249-257. [CrossRef] [Medline]85,Wilhelmsen M, Høifødt RS, Kolstrup N, Waterloo K, Eisemann M, Chenhall R, et al. Norwegian general practitioners' perspectives on implementation of a guided web-based cognitive behavioral therapy for depression: a qualitative study. J Med Internet Res 2014 Sep 10;16(9):e208 [FREE Full text] [CrossRef] [Medline]89,Klack L, Ziefle M, Wilkowska W, Kluge J. Telemedical versus conventional heart patient monitoring: a survey study with German physicians. Int J Technol Assess Health Care 2013 Oct;29(4):378-383. [CrossRef] [Medline]108,Kleinpell R, Barden C, Rincon T, McCarthy M, Rufo RJ. Assessing the impact of telemedicine on nursing care in intensive care units. Am J Crit Care 2016 Jan;25(1):e14-e20. [CrossRef] [Medline]109,L'Esperance ST, Perry DJ. Assessing advantages and barriers to telemedicine adoption in the practice setting: A MyCareTeam(TM) exemplar. J Am Assoc Nurse Pract 2016 Jun;28(6):311-319. [CrossRef] [Medline]115,Mueller KJ, Potter AJ, MacKinney AC, Ward MM. Lessons from tele-emergency: improving care quality and health outcomes by expanding support for rural care systems. Health Aff (Millwood) 2014 Feb;33(2):228-234. [CrossRef] [Medline]159,Shaw RJ, Kaufman MA, Bosworth HB, Weiner BJ, Zullig LL, Lee SD, et al. Organizational factors associated with readiness to implement and translate a primary care based telemedicine behavioral program to improve blood pressure control: the HTN-IMPROVE study. Implement Sci 2013 Sep 8;8:106 [FREE Full text] [CrossRef] [Medline]169]. However, the perceived lack of a solid evidence base and proof of concept for clinical benefit resulting from mHealth use is considered a barrier to adoption [Mileski M, Kruse CS, Catalani J, Haderer T. Adopting telemedicine for the self-management of hypertension: systematic review. JMIR Med Inform 2017 Oct 24;5(4):e41 [FREE Full text] [CrossRef] [Medline]5,Flynn D, Gregory P, Makki H, Gabbay M. Expectations and experiences of eHealth in primary care: a qualitative practice-based investigation. Int J Med Inform 2009 Sep;78(9):588-604. [CrossRef] [Medline]43,Levine M, Richardson JE, Granieri E, Reid MC. Novel telemedicine technologies in geriatric chronic non-cancer pain: primary care providers' perspectives. Pain Med 2014 Feb;15(2):206-213 [FREE Full text] [CrossRef] [Medline]60,Moloczij N, Mosley I, Moss KM, Bagot KL, Bladin CF, Cadilhac DA. Is telemedicine helping or hindering the delivery of stroke thrombolysis in rural areas? A qualitative analysis. Intern Med J 2015 Sep;45(9):957-964. [CrossRef] [Medline]69,Puszka S, Dingwall KM, Sweet M, Nagel T. E-Mental health innovations for aboriginal and Torres Strait Islander Australians: a qualitative study of implementation needs in health services. JMIR Ment Health 2016 Sep 19;3(3):e43 [FREE Full text] [CrossRef] [Medline]73,van Gaalen JL, van Bodegom-Vos L, Bakker MJ, Snoeck-Stroband JB, Sont JK. Internet-based self-management support for adults with asthma: a qualitative study among patients, general practitioners and practice nurses on barriers to implementation. BMJ Open 2016 Aug 26;6(8):e010809 [FREE Full text] [CrossRef] [Medline]84,Muigg D, Kastner P, Modre-Osprian R, Haluza D, Duftschmid G. Is Austria ready for telemonitoring? A readiness assessment among doctors and patients in the field of diabetes. Stud Health Technol Inform 2018;248:322-329. [Medline]160,Odnoletkova I, Buysse H, Nobels F, Goderis G, Aertgeerts B, Annemans L, et al. Patient and provider acceptance of telecoaching in type 2 diabetes: a mixed-method study embedded in a randomised clinical trial. BMC Med Inform Decis Mak 2016 Nov 9;16(1):142 [FREE Full text] [CrossRef] [Medline]162,Zhang Y, Koch S. Mobile health apps in Sweden: what do physicians recommend? Stud Health Technol Inform 2015;210:793-797. [Medline]175,Li L, Cotton A. A systematic review of nurses' perspectives toward the telemedicine intensive care unit: a basis for supporting its future implementation in China? Telemed J E Health 2019 May;25(5):343-350. [CrossRef] [Medline]188]. There is a need for more research about the outcomes of such technologies use in clinical practice to help foster adoption [Kayyali R, Hesso I, Mahdi A, Hamzat O, Adu A, Nabhani Gebara S. Telehealth: misconceptions and experiences of healthcare professionals in England. Int J Pharm Pract 2017 Jun;25(3):203-209. [CrossRef] [Medline]55,Jeon J, Taneva S, Kukreti V, Trbovich P, Easty AC, Rossos PG, et al. Toward successful migration to computerized physician order entry for chemotherapy. Curr Oncol 2014 Apr;21(2):e221-e228 [FREE Full text] [CrossRef] [Medline]155,Kumar S, Merchant S, Reynolds R. Tele-ICU: efficacy and cost-effectiveness approach of remotely managing the critical care. Open Med Inform J 2013;7:24-29 [FREE Full text] [CrossRef] [Medline]186].
The lack of awareness of mHealth tools may hinder adoption [Puszka S, Dingwall KM, Sweet M, Nagel T. E-Mental health innovations for aboriginal and Torres Strait Islander Australians: a qualitative study of implementation needs in health services. JMIR Ment Health 2016 Sep 19;3(3):e43 [FREE Full text] [CrossRef] [Medline]73,Miller KE, Kuhn E, Owen JE, Taylor K, Yu JS, Weiss BJ, et al. Clinician perceptions related to the use of the CBT-I Coach Mobile App. Behav Sleep Med 2019;17(4):481-491. [CrossRef] [Medline]120,Alajlani M, Clarke M. Effect of culture on acceptance of telemedicine in Middle Eastern countries: case study of Jordan and Syria. Telemed J E Health 2013 Apr;19(4):305-311. [CrossRef] [Medline]151,Zhang Y, Koch S. Mobile health apps in Sweden: what do physicians recommend? Stud Health Technol Inform 2015;210:793-797. [Medline]175]. Active promotion of the tools’ existence and objectives [Gagnon MP, Ngangue P, Payne-Gagnon J, Desmartis M. m-Health adoption by healthcare professionals: a systematic review. J Am Med Inform Assoc 2016 Jan;23(1):212-220. [CrossRef] [Medline]9,Kayyali R, Hesso I, Mahdi A, Hamzat O, Adu A, Nabhani Gebara S. Telehealth: misconceptions and experiences of healthcare professionals in England. Int J Pharm Pract 2017 Jun;25(3):203-209. [CrossRef] [Medline]55,Khan NU, Rasheed S, Sharmin T, Ahmed T, Mahmood SS, Khatun F, et al. Experience of using mHealth to link village doctors with physicians: lessons from Chakaria, Bangladesh. BMC Med Inform Decis Mak 2015 Aug 5;15:62 [FREE Full text] [CrossRef] [Medline]56,Duhm J, Fleischmann R, Schmidt S, Hupperts H, Brandt SA. Mobile electronic medical records promote workflow: physicians' perspective from a survey. JMIR Mhealth Uhealth 2016 Jun 6;4(2):e70 [FREE Full text] [CrossRef] [Medline]150,Loh P, Flicker L, Horner B. Attitudes toward information and communication technology (ICT) in residential aged care in Western Australia. J Am Med Dir Assoc 2009 Jul;10(6):408-413. [CrossRef] [Medline]156], and their benefits and impact on patient outcome may encourage their use [Avey JP, Hobbs RL. Dial in: fostering the use of telebehavioral health services in frontier Alaska. Psychol Serv 2013 Aug;10(3):289-297. [CrossRef] [Medline]2,de Vries ST, Wong L, Sutcliffe A, Houÿez F, Ruiz CL, Mol PG, IMI Web-RADR Work Package 3b Consortium. Factors influencing the use of a mobile app for reporting adverse drug reactions and receiving safety information: a qualitative study. Drug Saf 2017 May;40(5):443-455 [FREE Full text] [CrossRef] [Medline]38,Flynn D, Gregory P, Makki H, Gabbay M. Expectations and experiences of eHealth in primary care: a qualitative practice-based investigation. Int J Med Inform 2009 Sep;78(9):588-604. [CrossRef] [Medline]43,Lord S, Moore SK, Ramsey A, Dinauer S, Johnson K. Implementation of a substance use recovery support mobile phone app in community settings: qualitative study of clinician and staff perspectives of facilitators and barriers. JMIR Ment Health 2016 Jun 28;3(2):e24 [FREE Full text] [CrossRef] [Medline]61,Wilhelmsen M, Høifødt RS, Kolstrup N, Waterloo K, Eisemann M, Chenhall R, et al. Norwegian general practitioners' perspectives on implementation of a guided web-based cognitive behavioral therapy for depression: a qualitative study. J Med Internet Res 2014 Sep 10;16(9):e208 [FREE Full text] [CrossRef] [Medline]89,Sadoughi F, Erfannia L, Sancholi M, Salmani F, Sarsarshahi A. Teleradiology in Southeast Iran: Evaluating the Views of Senior Executives and Radiologists. Health Care Manag (Frederick) 2017;36(3):301-307. [CrossRef] [Medline]131,Dünnebeil S, Sunyaev A, Blohm I, Leimeister JM, Krcmar H. Determinants of physicians' technology acceptance for e-health in ambulatory care. Int J Med Inform 2012 Nov;81(11):746-760. [CrossRef] [Medline]149,Ray KN, Felmet KA, Hamilton MF, Kuza CC, Saladino RA, Schultz BR, et al. Clinician attitudes toward adoption of pediatric emergency telemedicine in rural hospitals. Pediatr Emerg Care 2017 Apr;33(4):250-257. [CrossRef] [Medline]168,Cox A, Illsley M, Knibb W, Lucas C, O'Driscoll M, Potter C, et al. The acceptability of e-technology to monitor and assess patient symptoms following palliative radiotherapy for lung cancer. Palliat Med 2011 Oct;25(7):675-681. [CrossRef] [Medline]180,Radhakrishnan K, Xie B, Berkley A, Kim M. Barriers and facilitators for sustainability of tele-homecare programs: a systematic review. Health Serv Res 2016 Feb;51(1):48-75 [FREE Full text] [CrossRef] [Medline]182].
Engaging users in the development, planning, and implementation phases may positively impact their adoption decision [Molleda L, Bahamon M, St George SM, Perrino T, Estrada Y, Herrera DC, et al. Clinic personnel, facilitator, and parent perspectives of eHealth Familias Unidas in primary care. J Pediatr Health Care 2017;31(3):350-361 [FREE Full text] [CrossRef] [Medline]68,Varsi C, Ekstedt M, Gammon D, Ruland CM. Using the consolidated framework for implementation research to identify barriers and facilitators for the implementation of an internet-based patient-provider communication service in five settings: a qualitative study. J Med Internet Res 2015 Nov 18;17(11):e262 [FREE Full text] [CrossRef] [Medline]86,Schmeer R, Behrends M, Kupka T, Meyenburg-Altwarg I, Marschollek M. Use and acceptance of mobile technology by hospital nurses in Germany. Stud Health Technol Inform 2016;225:944-945. [Medline]135,Shaw RJ, Kaufman MA, Bosworth HB, Weiner BJ, Zullig LL, Lee SD, et al. Organizational factors associated with readiness to implement and translate a primary care based telemedicine behavioral program to improve blood pressure control: the HTN-IMPROVE study. Implement Sci 2013 Sep 8;8:106 [FREE Full text] [CrossRef] [Medline]169,Walker L, Clendon J. The case for end-user involvement in design of health technologies. J Telemed Telecare 2016 Dec;22(8):443-446. [CrossRef] [Medline]172,Davis MM, Freeman M, Kaye J, Vuckovic N, Buckley DI. A systematic review of clinician and staff views on the acceptability of incorporating remote monitoring technology into primary care. Telemed J E Health 2014 May;20(5):428-438 [FREE Full text] [CrossRef] [Medline]183]. Enabling user feedback [de Vries ST, Wong L, Sutcliffe A, Houÿez F, Ruiz CL, Mol PG, IMI Web-RADR Work Package 3b Consortium. Factors influencing the use of a mobile app for reporting adverse drug reactions and receiving safety information: a qualitative study. Drug Saf 2017 May;40(5):443-455 [FREE Full text] [CrossRef] [Medline]38,Jarvis-Selinger S, Bates J, Araki Y, Lear SA. Internet-based support for cardiovascular disease management. Int J Telemed Appl 2011;2011:342582 [FREE Full text] [CrossRef] [Medline]52], collaborative involvement, and codesign [Brewster L, Mountain G, Wessels B, Kelly C, Hawley M. Factors affecting front line staff acceptance of telehealth technologies: a mixed-method systematic review. J Adv Nurs 2014 Jan;70(1):21-33. [CrossRef] [Medline]10,Lord S, Moore SK, Ramsey A, Dinauer S, Johnson K. Implementation of a substance use recovery support mobile phone app in community settings: qualitative study of clinician and staff perspectives of facilitators and barriers. JMIR Ment Health 2016 Jun 28;3(2):e24 [FREE Full text] [CrossRef] [Medline]61] have shown to encourage adoption. Unfortunately, in some cases, clinicians are hardly asked for their input or involvement even though mHealth is one of their work tools [Öberg U, Orre CJ, Isaksson U, Schimmer R, Larsson H, Hörnsten Å. Swedish primary healthcare nurses' perceptions of using digital eHealth services in support of patient self-management. Scand J Caring Sci 2018 Jun;32(2):961-970. [CrossRef] [Medline]72,Radhakrishnan K, Xie B, Berkley A, Kim M. Barriers and facilitators for sustainability of tele-homecare programs: a systematic review. Health Serv Res 2016 Feb;51(1):48-75 [FREE Full text] [CrossRef] [Medline]182].
Moderating Factors
Some of the included studies reported that moderating factors, such as age, gender, specialty, and years of professional experience, may have an impact on clinicians’ adoption intentions [de Vries ST, Wong L, Sutcliffe A, Houÿez F, Ruiz CL, Mol PG, IMI Web-RADR Work Package 3b Consortium. Factors influencing the use of a mobile app for reporting adverse drug reactions and receiving safety information: a qualitative study. Drug Saf 2017 May;40(5):443-455 [FREE Full text] [CrossRef] [Medline]38,Adenuga KI, Iahad NA, Miskon S. Towards reinforcing telemedicine adoption amongst clinicians in Nigeria. Int J Med Inform 2017 Aug;104:84-96. [CrossRef] [Medline]106]. However, other studies concluded that such moderating factors do not necessarily influence mHealth usage [Albrecht UV, Afshar K, Illiger K, Becker S, Hartz T, Breil B, et al. Expectancy, usage and acceptance by general practitioners and patients: exploratory results from a study in the German outpatient sector. Digit Health 2017;3:2055207617695135 [FREE Full text] [CrossRef] [Medline]117,Putzer GJ, Park Y. Are physicians likely to adopt emerging mobile technologies? Attitudes and innovation factors affecting smartphone use in the Southeastern United States. Perspect Health Inf Manag 2012;9:1b [FREE Full text] [Medline]127,Putzer GJ, Park Y. The effects of innovation factors on smartphone adoption among nurses in community hospitals. Perspect Health Inf Manag 2010 Jan 1;7:1b [FREE Full text] [Medline]196].
Younger clinicians typically have a more positive attitude toward such new technologies compared with their older counterparts [Tintorer DL, Domínguez JM, Pujol-Rivera E, Beneyto SF, Tuduri XM, Saigí-Rubió F. Keys to success of a community of clinical practice in primary care: a qualitative evaluation of the ECOPIH project. BMC Fam Pract 2018 May 9;19(1):56 [FREE Full text] [CrossRef] [Medline]59,Puszka S, Dingwall KM, Sweet M, Nagel T. E-Mental health innovations for aboriginal and Torres Strait Islander Australians: a qualitative study of implementation needs in health services. JMIR Ment Health 2016 Sep 19;3(3):e43 [FREE Full text] [CrossRef] [Medline]73,Beauregard P, Arnaert A, Ponzoni N. Nursing students' perceptions of using smartphones in the community practicum: a qualitative study. Nurse Educ Today 2017 Jun;53:1-6. [CrossRef] [Medline]76,Sinclair C, Holloway K, Riley G, Auret K. Online mental health resources in rural Australia: clinician perceptions of acceptability. J Med Internet Res 2013 Sep 5;15(9):e193 [FREE Full text] [CrossRef] [Medline]81,Holderried M, Hoeper A, Holderried F, Blumenstock G, Ernst C, Tropitzsch A. Attitudes toward e-Health: the otolaryngologists' point of view. Telemed J E Health 2018 Jun;24(6):425-432. [CrossRef] [Medline]100,Ly BA, Kristjansson E, Labonté R, Bourgeault IL. Determinants of the intention of Senegal's physicians to use telemedicine in their professional activities. Telemed J E Health 2018 Nov;24(11):897-898. [CrossRef] [Medline]118,Morilla MD, Sans M, Casasa A, Giménez N. Implementing technology in healthcare: insights from physicians. BMC Med Inform Decis Mak 2017 Jun 27;17(1):92 [FREE Full text] [CrossRef] [Medline]122,Okazaki S, Castañeda JA, Sanz S, Henseler J. Factors affecting mobile diabetes monitoring adoption among physicians: questionnaire study and path model. J Med Internet Res 2012 Dec 21;14(6):e183 [FREE Full text] [CrossRef] [Medline]125,Schmeer R, Behrends M, Kupka T, Meyenburg-Altwarg I, Marschollek M. Use and acceptance of mobile technology by hospital nurses in Germany. Stud Health Technol Inform 2016;225:944-945. [Medline]135,Smith PB, Buzi RS. Reproductive health professionals' adoption of emerging technologies for health promotion. Health Informatics J 2014 Dec;20(4):250-260. [CrossRef] [Medline]138], although some studies established that the age-gap does not play a role in adoption [van Houwelingen CT, Barakat A, Best R, Boot WR, Charness N, Kort HS. Dutch nurses' willingness to use home telehealth: implications for practice and education. J Gerontol Nurs 2015 Apr;41(4):47-56. [CrossRef] [Medline]142,Villalba-Mora E, Casas I, Lupiañez-Villanueva F, Maghiros I. Adoption of health information technologies by physicians for clinical practice: the Andalusian case. Int J Med Inform 2015 Jul;84(7):477-485. [CrossRef] [Medline]143]. Also, clinicians with previous digital health experience seem to have more favorable attitudes toward mHealth adoption compared with their counterparts that have no previous experience [Miller KE, Kuhn E, Owen JE, Taylor K, Yu JS, Weiss BJ, et al. Clinician perceptions related to the use of the CBT-I Coach Mobile App. Behav Sleep Med 2019;17(4):481-491. [CrossRef] [Medline]120,Morilla MD, Sans M, Casasa A, Giménez N. Implementing technology in healthcare: insights from physicians. BMC Med Inform Decis Mak 2017 Jun 27;17(1):92 [FREE Full text] [CrossRef] [Medline]122,van Houwelingen CT, Barakat A, Best R, Boot WR, Charness N, Kort HS. Dutch nurses' willingness to use home telehealth: implications for practice and education. J Gerontol Nurs 2015 Apr;41(4):47-56. [CrossRef] [Medline]142].
Gender does not seem to be consistently reported as a moderating factor; 2 studies reported that female clinicians are more likely to accept the tools than their male counterparts [Sandholzer M, Deutsch T, Frese T, Winter A. Predictors of students' self-reported adoption of a smartphone application for medical education in general practice. BMC Med Educ 2015 May 21;15:91 [FREE Full text] [CrossRef] [Medline]134,Villalba-Mora E, Casas I, Lupiañez-Villanueva F, Maghiros I. Adoption of health information technologies by physicians for clinical practice: the Andalusian case. Int J Med Inform 2015 Jul;84(7):477-485. [CrossRef] [Medline]143], whereas 1 study reported the reverse [Saigí-Rubió F, Torrent-Sellens J, Jiménez-Zarco A. Drivers of telemedicine use: comparative evidence from samples of Spanish, Colombian and Bolivian physicians. Implement Sci 2014 Oct 8;9:128 [FREE Full text] [CrossRef] [Medline]133]. The years of professional experience seem to negatively impact adoption [Kowitlawakul Y. The technology acceptance model: predicting nurses' intention to use telemedicine technology (eICU). Comput Inform Nurs 2011 Jul;29(7):411-418. [CrossRef] [Medline]111,Ly BA, Kristjansson E, Labonté R, Bourgeault IL. Determinants of the intention of Senegal's physicians to use telemedicine in their professional activities. Telemed J E Health 2018 Nov;24(11):897-898. [CrossRef] [Medline]118].
Conclusions and Implications
The systematic review findings indicate important guidelines and areas that must be targeted regarding social and organizational practices to promote and foster clinicians’ adoption of mHealth tools successfully. As shown in 
Figure 5, these implications can be split into 3 categories to address the actions needed from 3 key stakeholders: policymakers, mHealth providers, and clinical decision makers.
Policymakers can play a crucial role in unleashing the potential of mHealth in clinical practice. This can be achieved through regulations that simplify and facilitate reimbursement and address data privacy and management issues. Incorporating mHealth in health insurance schemes can help solve the cost and payment barriers and encourage not only clinicians’ adoption but also patients’ use. Developing new remote care protocols may help practitioners standardize these new services and better integrate them into their clinical practice. It is also important to support the inclusion of mHealth-related skills in official medical education to ensure that new graduates will be equipped with all the necessary capabilities to successfully run such new technologies. Funding more research that contributes to a solid evidence base about the clinical and efficiency benefits and the added value of the new tools can foster their acceptance. Coordinating the different stakeholders to streamline and harmonize technology in a way that helps reach interoperability would also ensure the successful implementation of such tools and solve the issue of additional workload that sometimes results from a double entry in the different systems.
Such policy implications echo the findings of other researchers. For example, Davis et al [Davis MM, Freeman M, Kaye J, Vuckovic N, Buckley DI. A systematic review of clinician and staff views on the acceptability of incorporating remote monitoring technology into primary care. Telemed J E Health 2014 May;20(5):428-438 [FREE Full text] [CrossRef] [Medline]183] addressed the barriers related to unclear legal liability and system interoperability. Gagnon et al [Gagnon MP, Ngangue P, Payne-Gagnon J, Desmartis M. m-Health adoption by healthcare professionals: a systematic review. J Am Med Inform Assoc 2016 Jan;23(1):212-220. [CrossRef] [Medline]9] also discussed the importance of cost-related barriers and the need to address them.
Providers and developers of mHealth tools should always proactively involve clinicians in the design, planning, and implementation of their services to ensure that it fits well into clinical practice. Facilitating user feedback is key to warrant the relevance and sustainability of the tool. Providing reliable training material about the tools’ features, benefits, and workflow integration scenarios may help clinicians better integrate the new tools into their daily practice. Delivering tools that are useful and ease of use, and ensuring continuous technical support, is crucial for smooth day-to-day usage and to overcome any technical issues that might push users to abandon the tool. Working on solving interoperability and EMR integration issues would help them emphasize the efficiency gains resulting from their services that are sometimes compromised because of the burden of double data entry when systems are not integrated properly. Furthermore, engaging with reliable clinical associations and opinion leaders to endorse the tool can help create trust and accelerate the adoption.
Recommendations for providers and developers of mHealth tools are aligned with Brewster et al [Brewster L, Mountain G, Wessels B, Kelly C, Hawley M. Factors affecting front line staff acceptance of telehealth technologies: a mixed-method systematic review. J Adv Nurs 2014 Jan;70(1):21-33. [CrossRef] [Medline]10], Davis et al [Davis MM, Freeman M, Kaye J, Vuckovic N, Buckley DI. A systematic review of clinician and staff views on the acceptability of incorporating remote monitoring technology into primary care. Telemed J E Health 2014 May;20(5):428-438 [FREE Full text] [CrossRef] [Medline]183], and Radhakrishnan et al [Radhakrishnan K, Xie B, Berkley A, Kim M. Barriers and facilitators for sustainability of tele-homecare programs: a systematic review. Health Serv Res 2016 Feb;51(1):48-75 [FREE Full text] [CrossRef] [Medline]182] conclusions on the importance of the inclusion of clinicians in the development process to improve acceptance. Davis et al [Davis MM, Freeman M, Kaye J, Vuckovic N, Buckley DI. A systematic review of clinician and staff views on the acceptability of incorporating remote monitoring technology into primary care. Telemed J E Health 2014 May;20(5):428-438 [FREE Full text] [CrossRef] [Medline]183] also shed light on the importance of system interoperability and EHR integration to facilitate adoption.
Clinical decision makers in hospitals and clinics need to support a cultural shift that promotes the benefits of technology and innovation to encourage their staff to change their traditional ways of working and embrace the new modalities. Facilitating mHealth training programs may help clinical staff acquire the new skills needed to successfully adopt the new tools. In addition, integrating mHealth in the clinical workflow is key to avoid that the tools become more of a hurdle to the staff. Encouraging the creation of multidisciplinary teams combining digital and clinical expertise and redefining the current roles to reflect the new skills needed to run the new technologies may contribute to a successful implementation. In some cases, the creation of new roles that support the implementation might be necessary.
In terms of implications for clinical decision makers, our findings are congruent with those of Duennebeil et al [Dünnebeil S, Sunyaev A, Blohm I, Leimeister JM, Krcmar H. Determinants of physicians' technology acceptance for e-health in ambulatory care. Int J Med Inform 2012 Nov;81(11):746-760. [CrossRef] [Medline]149], who emphasized the importance of establishing standards and treatment processes and training programs that would enable the adoption of such new tools. Training, promotion, and redefinition of roles were also highlighted by Brewster et al [Brewster L, Mountain G, Wessels B, Kelly C, Hawley M. Factors affecting front line staff acceptance of telehealth technologies: a mixed-method systematic review. J Adv Nurs 2014 Jan;70(1):21-33. [CrossRef] [Medline]10] and Radhakrishnan et al [Radhakrishnan K, Xie B, Berkley A, Kim M. Barriers and facilitators for sustainability of tele-homecare programs: a systematic review. Health Serv Res 2016 Feb;51(1):48-75 [FREE Full text] [CrossRef] [Medline]182].
Limitations and Recommendations for Future Research
Although this study contributes to the understanding of the factors impacting clinicians’ adoption of mHealth, some limitations must be acknowledged. This review may not have included relevant studies that were not indexed in the searched databases, written in a language other than English, and grey literature searches that could have also allowed the identification of additional relevant insights. However, this study meant to concentrate on peer-reviewed scientific papers.
Moreover, this analysis only considered published studies, and no further contacts were made with the papers’ authors to obtain extra information or to validate our thematic analysis. Consequently, it is possible that other mHealth adoption factors might have been missed. Future reviews could include studies in other languages to have a better grasp of any interregional or intercultural differences, and to have more studies in developed countries.
Conflicts of Interest
None declared.
Multimedia Appendix 1
Screenshot of Rayyan QCRI (Qatar Computing Research Institute).
PNG File , 360 KB
Multimedia Appendix 3
Critical appraisal of the included studies.
XLSX File (Microsoft Excel File), 141 KB
Multimedia Appendix 4
Phases of thematic analysis after Braun and Clarke.
PDF File (Adobe PDF File), 48 KBReferences
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Abbreviations
| eHealth: electronic health |
| EHR: electronic health record |
| EMR: electronic medical record |
| IT: information technology |
| mHealth: mobile health |
| PICO: participants, intervention, comparators, and outcome framework |
| PRISMA: Preferred Reporting Items for Systematic Review and Meta-Analysis |
| TAM: Technology Acceptance Model |
| UTAUT: unified theory of acceptance and use of technology |
Edited by G Eysenbach; submitted 22.08.19; peer-reviewed by C Varsi, E Sezgin, C May; comments to author 02.11.19; revised version received 03.12.19; accepted 31.12.19; published 20.02.20
Copyright©Christine K Jacob, Antonio Sanchez-Vazquez, Chris Ivory. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 20.02.2020.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mHealth and uHealth, is properly cited. The complete bibliographic information, a link to the original publication on http://mhealth.jmir.org/, as well as this copyright and license information must be included.