Salmi Emil Matias, Basile Francesca Wanda, Khan Faiz Ahmad, Watt Larry, Song Rinn, Bijker Else Margreet
Department of Paediatrics, Maastricht University Medical Center, MosaKids Children's Hospital, Maastricht, the Netherlands.
Department of Paediatrics, Oxford Vaccine Group, University of Oxford, Oxford, UK.
BMC Health Serv Res. 2025 Jan 4;25(1):19. doi: 10.1186/s12913-024-12050-4.
Chronic respiratory diseases are important causes of disability and mortality globally. Their incidence may be higher in remote locations where healthcare is limited and risk factors, such as smoking and indoor air pollution, are more prevalent. E-health could overcome some healthcare access obstacles in remote locations, but its utilisation has been limited. An improved understanding of barriers and facilitators to the implementation of e-health in remote locations could aid enhanced application of these approaches.
We performed a qualitative evidence synthesis to explore factors affecting the successful implementation of e-health interventions in remote locations for patients with chronic respiratory diseases. We searched PubMed, CINAHL, Embase, Web of Science and PsycINFO databases for qualitative and mixed-methods studies. Studies were assessed by two researchers, and 41 studies were included in the synthesis. Quality was assessed via the CASP-tool. Findings were coded with Atlas.ti software and categorised based on an adapted Digital Health Equity Framework.
Nineteen themes were identified across five levels (individual, interpersonal, community, society and technology), with associated facilitators and barriers for implementation. An important facilitator of e-health was its role as a tool to overcome obstacles of distance and to increase access to care and patients' self-efficacy. Potential barriers included the reduction of in-person interactions and an increased burden of work for healthcare providers. Good quality, usability, adaptability and efficacy of e-health interventions were important for implementation to be successful, as were adaptation to the local setting - including culture and language -and involvement of relevant stakeholders throughout the process.
Several factors affecting the implementation of e-health in remote and rural locations for patients with chronic respiratory disease were identified. Intervention objectives, target population, geographical location, local culture, and available resources should be carefully considered when designing an e-health intervention. These findings can be used to inform the successful design and implementation of future e-health interventions.
慢性呼吸道疾病是全球致残和致死的重要原因。在医疗保健有限且吸烟和室内空气污染等风险因素更为普遍的偏远地区，其发病率可能更高。电子健康可以克服偏远地区的一些医疗保健获取障碍，但其应用一直有限。更好地理解偏远地区电子健康实施的障碍和促进因素有助于加强这些方法的应用。
我们进行了一项定性证据综合分析，以探讨影响偏远地区慢性呼吸道疾病患者电子健康干预措施成功实施的因素。我们在PubMed、CINAHL、Embase、Web of Science和PsycINFO数据库中搜索定性和混合方法研究。由两名研究人员对研究进行评估，41项研究纳入综合分析。通过CASP工具评估质量。研究结果使用Atlas.ti软件编码，并根据改编的数字健康公平框架进行分类。
在五个层面（个人、人际、社区、社会和技术）确定了19个主题，以及相关的实施促进因素和障碍。电子健康的一个重要促进因素是它作为一种工具，能够克服距离障碍，增加获得护理的机会并提高患者的自我效能感。潜在障碍包括面对面互动的减少以及医疗保健提供者工作量的增加。电子健康干预措施的高质量、可用性、适应性和有效性对于成功实施至关重要，适应当地环境（包括文化和语言）以及相关利益攸关方在整个过程中的参与也很重要。
确定了影响偏远和农村地区慢性呼吸道疾病患者电子健康实施的几个因素。在设计电子健康干预措施时，应仔细考虑干预目标、目标人群、地理位置、当地文化和可用资源。这些研究结果可用于为未来电子健康干预措施的成功设计和实施提供参考。
