JMIR Publications

ABSTRACT

Background:

Theory-guided approaches to implementation science have informed translation efforts, and the acceptance of ehealth innovations into clinical care. Yet there is scarce evidence on which theories are best suited to addressing the inherent complexity in ehealth implementation.

Objective:

The objective of this review was to identify theories that inform and explain the implementation of ehealth innovations outside of research trials, and to examine how these theories address the multiple and multi-level factors that influence the ehealth implementation process.

Methods:

An electronic search was conducted in PsycINFO, Medline, Embase, CINAHL, Scopus, Sociological Source Ultimate, Web of Science, ABI Inform, EBSCO and Proquest Databases in June 2019. Studies were included if they were published between 2009 and June 2019; were written in English; reported on empirical research; and were published in a peer-reviewed journal. Two reviewers independently assessed the titles, abstracts and full texts. Theories identified were classified using a typology for theories of sociotechnical change, which was considered a useful tool

Results:

Out of 13,101 potentially relevant titles, 119 studies were included. The review identified 36 theories used to explain implementation approaches in ehealth. Most commonly used were the Technology Acceptance Model (n =33) and the Unified Theory of Acceptance and Use of Technology (n =32). These theories were concerned primarily with individual and interpersonal elements of ehealth acceptance. Less common were theories that reflect the various disorderly social processes or systemic dimensions of implementation, such as Normalisation Process Theory (n =17) and Structuration Theory (n =6).

Conclusions:

Theories currently informing the implementation of ehealth innovations predominantly focus on predicting or explaining end-user acceptance. Theoretical perspectives that capture the dense and intricate relationships and structures required to enact sustainable change are less well-represented in the ehealth literature. Given the growing acknowledgement of the inherent complexity in ehealth implementation, future research should develop and test models that recognise and reflect the multidimensional, dynamic and relational nature of this process.