Barriers and facilitators for the adoption of telemedicine services in low-income and middle-income countries: a rapid overview of reviews

Abstract

ObjectiveTo identify the barriers and facilitators for uptake of telemedicine services in low-income and middle-income countries (LMICs).DesignThe rapid review approach to identify the barriers and facilitators for the uptake/delivery of telemedicine in health system from both the provider and the patient’s perspective. A two-stage sequential screening process was adopted. Data extraction was done using a piloted data extraction form.Data sourcesA search on PubMed (NCBI), Embase (Ovid), the Cochrane Library (Wiley), Scopus (Elsevier) and the WHO Global Index Medicus was conducted.Eligibility criteria for selecting studiesStudies published between 1 January 2012 and 1 July 2022 on barriers and facilitators for uptake of telemedicine services in LMICs were included.ResultsDatabase search identified a total of 2829 citations. After removing 1069 duplicates, 1760 were taken forward for title and abstract screening. A total of 43 articles were included at full text stage and 8 articles were included in this overview for narrative synthesis. Barriers and facilitators to telemedicine adoption and use were categorised under four subheadings, namely organisational and environmental, individual and cultural barriers, financial barriers and technological barriers. Providers, patient and health policy-makers perspectives were captured.ConclusionAny development of telemedicine services should engage the primary users such as patients and their family caregivers to design people-centred digital health systems and services. Usability studies must be commissioned by the governments and host agencies to enhance the interaction experience pending which investments would remain futile. Future research should employ mixed methods or multi methods approaches to understand the interaction between patients and providers.

Physicians’ experiences with telemedicine during the COVID-19 pandemic in India

“…There have also been several calls for specific legislation In India to tackle the various medicolegal issues associated with telemedicine and virtual care [27]. Healthcare professionals and policymakers must consider these intersectional issues for the appropriateness of telemedicine implementation in the Indian context and also recognise the important disparities between India’s different states [35].…”

“…Healthcare professionals and policymakers must consider these intersectional issues for the appropriateness of telemedicine implementation in the Indian context and also recognise the important disparities between India's different states [35].…”

Telemedicine in Africa: Applications, Opportunities, and Challenges

“…This resistance to change can stem from concerns about conflict of interest, increased workload, limited information and technology infrastructure, technophobia, difficulty understanding the technology, and anxiety about using new technologies [63,64]. Limited or lack of integration of telemedicine services into daily workflow and low motivation for compliance can affect adoption by healthcare providers.…”

“…Limited or lack of integration of telemedicine services into daily workflow and low motivation for compliance can affect adoption by healthcare providers. Lack of physical examination or face-to-face contact with patients diminishes the personal touch, leading to some physician skepticism toward the effectiveness of telemedicine [63]. This can make healthcare providers fear litigation for fear of misdiagnosis.…”

“…High electricity costs and erratic power supplies often create disruptions and hinder access to telemedicine services. Unequal access to electricity across urban and rural areas exacerbates existing disparities, leaving remote and rural communities further marginalized [63]. While internet penetration is increasing, affordability and reliability continue to be major concerns.…”