JMIR Publications

ABSTRACT

Background:

Because of the increasing lifespan of populations in many countries and the growing demand for more advanced care, the need for effective and cost-efficient provision of healthcare is a matter of national concern. eHealth technology is often proposed, although research about barriers and facilitators for the implementation of eHealth technology is still scarce and fragmented in groups of stakeholders, including policymakers and service users.

Objective:

The aim of this study was to explore perceptions concerning barriers and facilitators for the implementation of eHealth among policymakers and of service-users, and also to explore the ways in which their perceptions converge and differ.

Methods:

The study applied a qualitative study design. In the first step, Qualitative Content Analysis was performed separately in two groups: policymakers at different levels in healthcare (n=7) and service users (n= 25). Differences and commonalities between the two groups were explored through a second Qualitative Content Analysis.

Results:

Implementation barriers perceived by policymakers were that not all service-users benefit from eHealth, and uncertainty about the impact of eHealth on the work of healthcare professionals. Policymakers also perceived political decision-making as complex, they had a fear of problems with the provision of technical infrastructure and perceived that extra resources for healthcare digitalization were lacking. Perceived facilitators were policymakers´ conviction that e-Health is what citizens want, their belief in eHealth solutions as beneficial for healthcare practice and their belief in the importance of healthcare digitalization. Perceived implementation barriers for service-users consisted of capability limitations and/or varied preferences of service-users and a mismatch of technology with user needs, as well as lack of data protection and their perception of eHealth as more time-consuming. Perceived facilitators for service-users were user-friendly design of the eHealth technology and match to the skill-set of service-user as were personal feedback and staff support, a sense of privacy, a credible sender and the flexible use of time. There were several commonalities between the two stakeholder groups. Facilitators for both groups were the strong impetus towards technology adoption in society, and expectations of time-flexibility. Both groups perceived barriers in the difficulties of tailoring eHealth to different users’ capabilitíes and preferences, and both expressed uncertainty about the care burden distribution. There were also differences: policy-makers perceived that their decision-making was very complex and that resources for implementation were limited. Service-users highlighted their need to feel that their digital data were protected and that they needed to trust the eHealth “sender”.

Conclusions:

Perceptions about barriers and facilitators for eHealth implementation varied between stakeholders in different parts of the healthcare system. The study points to the need to exchange knowledge between the stakeholder groups in order to reach a mutual understanding of priorities, and to overcome challenges at both the micro- and macro-levels of the healthcare system. More well-balanced decisions at the policymaker level in relation to service-user needs may lead to more effective and sustainable development and future implementation of eHealth.