Innovation of Movement Care Research Group, Research Centre for Healthy and Sustainable Living, HU University of Applied Sciences Utrecht, Utrecht, Netherlands.
Department of Rehabilitation, Physiotherapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.
J Med Internet Res. 2024 Aug 27;26:e49868. doi: 10.2196/49868.
In recent years, the effectiveness and cost-effectiveness of digital health services for people with musculoskeletal conditions have increasingly been studied and show potential. Despite the potential of digital health services, their use in primary care is lagging. A thorough implementation is needed, including the development of implementation strategies that potentially improve the use of digital health services in primary care. The first step in designing implementation strategies that fit the local context is to gain insight into determinants that influence implementation for patients and health care professionals. Until now, no systematic overview has existed of barriers and facilitators influencing the implementation of digital health services for people with musculoskeletal conditions in the primary health care setting.
This systematic literature review aims to identify barriers and facilitators to the implementation of digital health services for people with musculoskeletal conditions in the primary health care setting.
PubMed, Embase, and CINAHL were searched for eligible qualitative and mixed methods studies up to March 2024. Methodological quality of the qualitative component of the included studies was assessed with the Mixed Methods Appraisal Tool. A framework synthesis of barriers and facilitators to implementation was conducted using the Consolidated Framework for Implementation Research (CFIR). All identified CFIR constructs were given a reliability rating (high, medium, or low) to assess the consistency of reporting across each construct.
Overall, 35 studies were included in the qualitative synthesis. Methodological quality was high in 34 studies and medium in 1 study. Barriers (-) of and facilitators (+) to implementation were identified in all 5 CFIR domains: "digital health characteristics" (ie, commercial neutral [+], privacy and safety [-], specificity [+], and good usability [+]), "outer setting" (ie, acceptance by stakeholders [+], lack of health care guidelines [-], and external financial incentives [-]), "inner setting" (ie, change of treatment routines [+ and -], information incongruence (-), and support from colleagues [+]), "characteristics of the healthcare professionals" (ie, health care professionals' acceptance [+ and -] and job satisfaction [+ and -]), and the "implementation process" (involvement [+] and justification and delegation [-]). All identified constructs and subconstructs of the CFIR had a high reliability rating. Some identified determinants that influence implementation may be facilitators in certain cases, whereas in others, they may be barriers.
Barriers and facilitators were identified across all 5 CFIR domains, suggesting that the implementation process can be complex and requires implementation strategies across all CFIR domains. Stakeholders, including digital health intervention developers, health care professionals, health care organizations, health policy makers, health care funders, and researchers, can consider the identified barriers and facilitators to design tailored implementation strategies after prioritization has been carried out in their local context.
近年来，数字健康服务在肌肉骨骼疾病患者中的有效性和成本效益越来越受到研究，且显示出潜力。尽管数字健康服务具有潜力，但在初级保健中的使用仍滞后。需要全面实施，包括制定实施策略，这些策略有可能改善初级保健中数字健康服务的使用。设计适合当地情况的实施策略的第一步是深入了解影响患者和医疗保健专业人员实施的决定因素。到目前为止，还没有系统的综述来确定影响初级保健中肌肉骨骼疾病患者数字健康服务实施的障碍和促进因素。
本系统文献综述旨在确定在初级保健环境中实施肌肉骨骼疾病患者数字健康服务的障碍和促进因素。
截至 2024 年 3 月，在 PubMed、Embase 和 CINAHL 上搜索合格的定性和混合方法研究。使用混合方法评估工具评估纳入研究的定性部分的方法学质量。使用实施研究综合框架（CFIR）对实施的障碍和促进因素进行框架综合。对所有确定的 CFIR 结构进行可靠性评级（高、中或低），以评估每个结构的报告一致性。
总体而言，35 项研究被纳入定性综合分析。34 项研究的方法学质量较高，1 项研究的方法学质量中等。在所有 5 个 CFIR 领域都确定了实施的障碍（-）和促进因素（+）：“数字健康特征”（即商业中立[+]、隐私和安全[-]、特异性[+]和良好的可用性[+]）、“外部环境”（即利益相关者的接受[+]、缺乏医疗保健指南[-]和外部经济激励[-]）、“内部环境”（即治疗常规的改变[+和-]、信息不一致[-]和同事的支持[+]）、“医疗保健专业人员的特征”（即医疗保健专业人员的接受[+和-]和工作满意度[+和-]）和“实施过程”（参与[+]和证明和授权[-]）。CFIR 的所有确定的结构和子结构都具有高可靠性评级。一些确定的影响实施的决定因素在某些情况下可能是促进因素，而在其他情况下则可能是障碍。
在所有 5 个 CFIR 领域都确定了障碍和促进因素，这表明实施过程可能很复杂，需要在所有 CFIR 领域制定实施策略。利益相关者，包括数字健康干预措施的开发者、医疗保健专业人员、医疗保健组织、卫生政策制定者、卫生保健资金提供者和研究人员，可以考虑在其当地背景下进行优先排序后，确定的障碍和促进因素来设计量身定制的实施策略。
