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

Abstract

BACKGROUND Hypertension and diabetes are increasingly prevalent around the world. 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 to care. However, to date, no review has examined the contextual factors that influence the implementation of telemedicine interventions for hypertension and/or diabetes globally. OBJECTIVE We adopted a comprehensive implementation research perspective to synthesize the barriers and facilitators to implementing telemedicine interventions for hypertension and/or diabetes management. 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 (CFIR). RESULTS Of the 17685 records identified, 35 studies were included in our scoping review. We found that facilitators and barriers to implementation were dispersed across the constructs in the CFIR framework. Barriers related to cost, patient needs and resources (e.g., lack of consideration of language needs, culture, rural residency), personal attributes of patients (e.g., demographics and priorities) were most common. Facilitators related to the design and packaging of the intervention (e.g., user-friendliness), patient needs and resources (e.g., personalized information that leveraged existing strengths), implementation climate (e.g., intervention embedded into existing infrastructure), knowledge and beliefs about the intervention (e.g., convenience of telemedicine), and other personal attributes (e.g., technical literacy) were most common. CONCLUSIONS Our findings suggest that successful implementation of telemedicine interventions for hypertension and diabetes requires comprehensive efforts at the planning, executing, engaging, and reflecting and evaluating stages of intervention implementation in order 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

“…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 contextspecific 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.…”

“…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 contextspecific strategies that align with the implementation process phase (Versluis et al, 2020).…”