Implications for implementation and adoption of telehealth in developing countries: a systematic review of China’s practices and experiences

Abstract

The rapid advancement of telehealth technologies has the potential to revolutionize healthcare delivery, especially in developing countries and resource-limited settings. Telehealth played a vital role during the COVID-19 pandemic, supporting numerous healthcare services. We conducted a systematic review to gain insights into the characteristics, barriers, and successful experiences in implementing telehealth during the COVID-19 pandemic in China, a representative of the developing countries. We also provide insights for other developing countries that face similar challenges to developing and using telehealth during or after the pandemic. This systematic review was conducted through searching five prominent databases including PubMed/MEDLINE, Embase, Scopus, Cochrane Library, and Web of Science. We included studies clearly defining any use of telehealth services in all aspects of health care during the COVID-19 pandemic in China. We mapped the barriers, successful experiences, and recommendations based on the Consolidated Framework for Implementation Research (CFIR). A total of 32 studies met the inclusion criteria. Successfully implementing and adopting telehealth in China during the pandemic necessitates strategic planning across aspects at society level (increasing public awareness and devising appropriate insurance policies), organizational level (training health care professionals, improving workflows, and decentralizing tasks), and technological level (strategic technological infrastructure development and designing inclusive telehealth systems). WeChat, a widely used social networking platform, was the most common platform used for telehealth services. China’s practices in addressing the barriers may provide implications and evidence for other developing countries or low-and middle- income countries (LMICs) to implement and adopt telehealth systems.

Assessing Telemedicine Competency Among Doctors in a Tertiary Care Hospital: A Questionnaire-Based Cross-Sectional Study

“…For instance, studies from China [ 11 ], Saudi Arabia [ 10 ], and India [ 12 ] show varying levels of telemedicine readiness and receptivity, owing to disparities in healthcare systems and digital infrastructure. Similar studies have been conducted with healthcare professionals and students in a variety of countries, such as Saudi Arabia [ 13 ], Indonesia [ 14 ], Pakistan [ 15 ], and the United Arab Emirates [ 16 ].…”

“…These disparities highlight the impact of diverse healthcare infrastructures, the accessibility of digital technologies, and the existence or nonexistence of training programs linked to telemedicine in diverse contexts. These variations highlight the need for region-specific telemedicine strategies that take into account the particular requirements and environments of each area [9][10][11][12][13][14][15][16][17][18].…”

“…These studies show the wide range of knowledge, perspectives, and readiness to use telemedicine services. This global viewpoint highlights how crucial it is to contextualize telemedicine adoption methods in order to maximize telemedicine's potential to improve healthcare delivery and effectively address regional disparities [9][10][11][12][13][14][15][16][17][18].…”

Breaking the Emergency Room Cycle: The Impact of Telemedicine on Emergency Department Utilization

“…Health policymakers and administrators must consider the integration of telehealth into existing healthcare frameworks, addressing regulatory, reimbursement, and infrastructure challenges [ 14 ]. The success of telemedicine in reducing non-emergent ER visits depends on a multifaceted approach that involves not only individual adoption but also systemic support and integration [ 15 ].…”

Awareness, Knowledge, Attitude, and Skills (AKAS) of Telemedicine and Its Use by Primary Healthcare Providers

“… 32 , 33 Evidence also indicated that some healthcare providers with specific specialties, such as primary care and psychiatry, have a higher knowledge and awareness of TM due to its direct relevance to their practice. 4 , 20 , 34 , 35 years of experience within the healthcare specialty is another factor that increases TM awareness among healthcare providers. 4 , 34 , 36 , 37 The healthcare providers’ geographical locations have a positive association with the level of TM awareness due to their potential to address healthcare disparities and improve access to care in remote regions.…”