Implementation Science Perspectives on Implementing Telemedicine Interventions for Hypertension or Diabetes Management: Scoping Review

Abstract

Background Hypertension and diabetes are becoming increasingly prevalent worldwide. Telemedicine is an accessible and cost-effective means of supporting hypertension and diabetes management, especially as the COVID-19 pandemic has accelerated the adoption of technological solutions for care. However, to date, no review has examined the contextual factors that influence the implementation of telemedicine interventions for hypertension or diabetes worldwide. Objective We adopted a comprehensive implementation research perspective to synthesize the barriers to and facilitators of implementing telemedicine interventions for the management of hypertension, diabetes, or both. Methods We performed a scoping review involving searches in Ovid MEDLINE, Embase, CINAHL, Cochrane Library, Web of Science, and Google Scholar to identify studies published in English from 2017 to 2022 describing barriers and facilitators related to the implementation of telemedicine interventions for hypertension and diabetes management. The coding and synthesis of barriers and facilitators were guided by the Consolidated Framework for Implementation Research. Results Of the 17,687 records identified, 35 (0.2%) studies were included in our scoping review. We found that facilitators of and barriers to implementation were dispersed across the constructs of the Consolidated Framework for Implementation Research. Barriers related to cost, patient needs and resources (eg, lack of consideration of language needs, culture, and rural residency), and personal attributes of patients (eg, demographics and priorities) were the most common. Facilitators related to the design and packaging of the intervention (eg, user-friendliness), patient needs and resources (eg, personalized information that leveraged existing strengths), implementation climate (eg, intervention embedded into existing infrastructure), knowledge of and beliefs about the intervention (eg, convenience of telemedicine), and other personal attributes (eg, technical literacy) were the most common. Conclusions Our findings suggest that the successful implementation of telemedicine interventions for hypertension and diabetes requires comprehensive efforts at the planning, execution, engagement, and reflection and evaluation stages of intervention implementation to address challenges at the individual, interpersonal, organizational, and environmental levels.

The feasibility and usability of a personal health record for patients with multiple sclerosis: a 2-year evaluation study

“…Previous research has identified that technical difficulties and unclarities regarding PHR use can affect the adoption of a PHR, emphasizing the crucial role of usability (i.e., it should be as easy as possible to use the system) in implementing innovations ( Archer et al, 2011 ; Kruse et al, 2015 ; Hsieh et al, 2016 ; Ross et al, 2016 ). Other studies, examining the implementation of eHealth interventions, have highlighted similar barriers and facilitators ( van Gemert-Pijnen et al, 2011 ; Ross et al, 2016 ; Tossaint-Schoenmakers et al, 2021 ; Khalid et al, 2023 ). More specifically, barriers such as integration challenges of nonroutine processes, time and attention requirements for usage, minimal engagement from HCPs, limited prioritization of the intervention compared to existing initiatives, as well as facilitators, such as engagement and enthusiasm of users, sufficient knowledge about the intervention, the opportunity to provide feedback, and proper guidance concerning usage.…”

“…More specifically, barriers such as integration challenges of nonroutine processes, time and attention requirements for usage, minimal engagement from HCPs, limited prioritization of the intervention compared to existing initiatives, as well as facilitators, such as engagement and enthusiasm of users, sufficient knowledge about the intervention, the opportunity to provide feedback, and proper guidance concerning usage. Indeed, success in the implementation process is more likely when the intervention aligns with and becomes an integral part of existing organizational goals and workflows ( Khalid et al, 2023 ). Moreover, it is essential to be aware of the complexity of an implementation process ( van Gemert-Pijnen et al, 2011 ; Ross et al, 2016 ; Tossaint-Schoenmakers et al, 2021 ; Khalid et al, 2023 ), and it is necessary to explore the use of context-specific strategies that align with the implementation process phase ( Versluis et al, 2020 ).…”

“…Indeed, success in the implementation process is more likely when the intervention aligns with and becomes an integral part of existing organizational goals and workflows ( Khalid et al, 2023 ). Moreover, it is essential to be aware of the complexity of an implementation process ( van Gemert-Pijnen et al, 2011 ; Ross et al, 2016 ; Tossaint-Schoenmakers et al, 2021 ; Khalid et al, 2023 ), and it is necessary to explore the use of context-specific strategies that align with the implementation process phase ( Versluis et al, 2020 ). This study concludes, in line with previous research, that proper guidance is warranted while implementing a PHR.…”

Efficacy of telemedicine intervention in the self-management of patients with type 2 diabetes: a systematic review and meta-analysis

“…However, due to the existence of time conflicts, inconvenient transport, untimely communication and many other disadvantages in the traditional face-to-face mode, there are greater limitations in the actual operation of patients’ DSM including the lack of supervision, feedback and DM education, so patients’ DSM is generally poorer ( 4 ). Telemedicine belongs to a branch of E-health, which refers to under the condition of the distance as a key factor, health care providers offer health care support through telecommunication and computer technology ( 5 ). Telemedicine has various forms, including cell phone and SMS in the early stage.…”

Long-Term Adoption of Televisits in Nursing Homes During the COVID-19 Crisis and Following Up Into the Postpandemic Setting: Mixed Methods Study (Preprint)

“…Currently, many barriers to the implementation of telemedical tools are known, such as unstable Internet connections and other technical issues, insufficient acceptance, privacy and security concerns, poor usability of the systems, a lack of patient support from healthcare professionals (HCPs), inadequate motivation and training, a shortage of staff, poor planning and engagement, and the fear of misdiagnosis or lacking trust in the technology [31,[33][34][35][36]. However, implementation guidelines are still missing and the best practice for implementing telemedicine for ensuring longterm adoption is still unknown.…”