"We are so close; yet too far": perceived barriers to smartphone-based telerehabilitation among healthcare providers and patients with Chronic Obstructive Pulmonary Disease in India

Abstract

Background Telerehabilitation is imperative and impending in the management of chronic obstructive pulmonary disease patients. However, its feasibility in low- and middle-income nations such as India remained unclear. Objective To assess the feasibility of administering a smartphone-based telerehabilitation program for chronic obstructive pulmonary disease patients in India. Material and method An online cross-sectional survey was administered to stakeholders of the telerehabilitation program: chronic obstructive pulmonary disease patients, health care professionals including pulmonary care physicians, rehabilitation nurses and physiotherapists. The survey sought to ascertain the causes, barriers, and facilitators associated with the implementation of smartphone-based telerehabilitation, as well as strategies for practice improvement. Results While 71% (n = 37/52) of the 52 healthcare professionals surveyed were aware of smartphone-based telerehabilitation, implementation was found to be extremely low (n = 4/37; 10%). The majority of patients with chronic obstructive pulmonary disease (n = 21/30; 70%) agreed to accept smartphone-based telerehabilitation as one of their treatment options. In India, challenges to efficient telerehabilitation implementation included a lack of infrastructure, perceived time consumption, a lack of expertise and training, organizational support, and perceived inefficacy. Conclusion While knowledge of smartphone-based telerehabilitation is high among healthcare professionals and chronic obstructive pulmonary disease patients, implementation of this novel intervention measure has been limited due to perceived constraints associated with smartphone-based telerehabilitation. Adapting national and organizational policies to support smartphone-based telerehabilitation services is critical during this decade of social isolation.

Facilitators and Barriers for Telemedicine Systems in India from Multiple Stakeholder Perspectives and Settings

“…2. Articles with telemedicine intervention dealing with patient health in any clinical specialty in India 36,37 .…”

“…Additionally, we also identified the lack of training and awareness regarding the usage of telemedicine and the associated equipment among patients and providers as a significant barrier to the adoption of telemedicine systems in primary and secondary healthcare 26,30,31,36,44,45,49,56,58,61,65 . This may probably be due to the limited dissemination of information regarding telemedicine through workshops, conferences, seminars, and other platforms.…”

“…A study 50 reported that this lack of technical awareness of telemedicine negatively impacts the patient's willingness to adopt telemedicine. Few studies also reported that the patients expressed concern regarding the dearth of availability and expertise in telemedicine interventions 36,58 .…”

“…Patients' preconceived doubts regarding the quality and efficacy of the virtual consultations provided by telemedicine and their suitability as an alternate mode of healthcare delivery were identified as one of the most critical barriers at the socio-cultural level [29][30][31]36,47,56,58,63 . This was a significant barrier to the adoption of telemedicine in secondary care 16,22,36,45,54,59,60,63 . As reported in 22,45,54 , it appeared to be challenging for patients to accept that telemedicine can adequately replace in-person examinations.…”

“…Even some healthcare providers thought that patient consultation and therapy should involve a physical examination and in-depth observation rather than remote consultation via telemedicine 11,46,57,58 . This attitude towards telemedicine represents a potential barrier to further advancements 36,37,52,53,56,64 . Healthcare providers acknowledged the technical ease of virtual consultations but expressed doubts about the quality of virtual examinations since the patients may not be technologically competent.…”