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Facilitators and Barriers to the Implementation of Digital Health Technologies in Hospital Settings in Lower- and Middle-Income Countries Since the Onset of the COVID-19 Pandemic: Scoping Review.

作者信息

Yew Sheng Qian, Trivedi Daksha, Adanan Nurul Iman Hafizah, Chew Boon How

机构信息

Department of Public Health Medicine, Faculty of Medicine, National University of Malaysia, Cheras, Malaysia.

Centre for Research in Public Health and Community Care, University of Hertfordshire, Hertforshire, United Kingdom.

出版信息

J Med Internet Res. 2025 Mar 6;27:e63482. doi: 10.2196/63482.


DOI:10.2196/63482
PMID:40053793
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11926458/
Abstract

BACKGROUND: Although the implementation process of digital health technologies (DHTs) has been extensively documented in high-income countries, the factors that facilitate and prevent their implementation in lower- and middle-income countries (LMICs) may differ for various reasons. OBJECTIVE: To address this gap in research, this scoping review aims to determine the facilitators and barriers to implementing DHTs in LMIC hospital settings following the onset of the COVID-19 pandemic. Additionally, the review outlined the types of DHTs that have been implemented in LMICs' hospitals during this pandemic and finally developed a classification framework to categorize the landscape of DHTs. METHODS: Systematic searches were conducted on PubMed, Scopus, Web of Science, and Google Scholar for studies published from March 2020 to December 2023. We extracted data on authors, publication years, study objectives, study countries, disease conditions, types of DHTs, fields of clinical medicine where the DHTs are applied, study designs, sample sizes, characteristics of the study population, study location, and data collection methods of the included studies. Both quantitative and qualitative data were utilized to conduct a thematic analysis, using a deductive method based on the Practical, Robust Implementation and Sustainability Model (PRISM), to identify facilitators and barriers to DHT implementation. Finally, all accessible DHTs were identified and organized to create a novel classification framework. RESULTS: Twelve studies were included from 292 retrieved articles. Telemedicine (n=5) was the most commonly used DHT in LMICs' hospitals, followed by hospital information systems (n=4), electronic medical records (n=2), and mobile health (n=1). These 4 DHTs, among the other existing DHTs, allowed us to develop a novel classification framework for DHTs. The included studies used qualitative methods (n=4), which included interviews and focus groups, quantitative methods (n=5), or a combination of both (n=2). Among the 64 facilitators of DHT implementation, the availability of continuous on-the-job training (n=3), the ability of DHTs to prevent cross-infection (n=2), and positive previous experiences using DHTs (n=2) were the top 3 reported facilitators. However, of the 44 barriers to DHT implementation, patients with poor digital literacy and skills in DHTs (n=3), inadequate awareness regarding DHTs among health care professionals and stakeholders (n=2), and concerns regarding the accuracy of disease diagnosis and treatment through DHTs (n=2) were commonly reported. CONCLUSIONS: In the postpandemic era, telemedicine, along with other DHTs, has seen increased implementation in hospitals within LMICs. All facilitators and barriers can be categorized into 6 themes, namely, (1) Aspects of the Health Care System; (2) Perspectives of Patients; (3) External Environment; (4) Implementation of Sustainable Infrastructure; (5) Characteristics of Health Care Organization; and (6) Characteristics of Patients.

摘要
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ea09/11926458/01cf0def2864/jmir_v27i1e63482_fig6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ea09/11926458/6e838dfe457c/jmir_v27i1e63482_fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ea09/11926458/792a06458c91/jmir_v27i1e63482_fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ea09/11926458/664538cdb3d6/jmir_v27i1e63482_fig3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ea09/11926458/842f45742497/jmir_v27i1e63482_fig4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ea09/11926458/a3b6437879f7/jmir_v27i1e63482_fig5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ea09/11926458/01cf0def2864/jmir_v27i1e63482_fig6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ea09/11926458/6e838dfe457c/jmir_v27i1e63482_fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ea09/11926458/792a06458c91/jmir_v27i1e63482_fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ea09/11926458/664538cdb3d6/jmir_v27i1e63482_fig3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ea09/11926458/842f45742497/jmir_v27i1e63482_fig4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ea09/11926458/a3b6437879f7/jmir_v27i1e63482_fig5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ea09/11926458/01cf0def2864/jmir_v27i1e63482_fig6.jpg

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本文引用的文献

[1]
Barriers and facilitators to the implementation of digital technologies in mental health systems: a qualitative systematic review to inform a policy framework.

BMC Health Serv Res. 2024-2-26

[2]
Perceptions of telemedicine among healthcare professionals in rural tertiary care hospitals of rural Sindh, Pakistan: a qualitative study.

Ann Med Surg (Lond). 2024-1-10

[3]
Facilitators and barriers of digital health technologies implementation in hospital settings in lower-income and middle-income countries since the COVID-19 pandemic: a scoping review protocol.

BMJ Open. 2024-1-31

[4]
An introduction to digital determinants of health.

PLOS Digit Health. 2024-1-4

[5]
Editorial: Evidence on low-cost technologies for neurological rehabilitation in low and middle-income countries.

Front Neurol. 2023-12-13

[6]
Development of mobile health-based interventions to promote physical activity in patients with head and neck cancer: a qualitative study.

Front Public Health. 2023

[7]
Innovation Process and Industrial System of US Food and Drug Administration-Approved Software as a Medical Device: Review and Content Analysis.

J Med Internet Res. 2023-11-24

[8]
The Large-Scale Implementation of a Health Information System in Brazilian University Hospitals: Process and Outcomes.

Int J Environ Res Public Health. 2023-10-25

[9]
Current challenges and potential solutions to the use of digital health technologies in evidence generation: a narrative review.

Front Digit Health. 2023-9-28

[10]
Routine health information system utilization and associated factors among health professionals in public health facilities in Dire Dawa, eastern Ethiopia: A cross-sectional study.

Digit Health. 2023-10-4

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