JMIR Publications

ABSTRACT

Background:

Hypertension and diabetes are increasingly prevalent around the world. Telemedicine is an accessible and cost-effective means of supporting hypertension and diabetes management, especially as the COVID-19 pandemic has accelerated the adoption of technological solutions to care. However, to date, no review has examined the contextual factors that influence the implementation of telemedicine interventions for hypertension and/or diabetes globally.

Objective:

We adopted a comprehensive implementation research perspective to synthesize the barriers and facilitators to implementing telemedicine interventions for hypertension and/or diabetes management.

Methods:

We performed a scoping review, involving searches in Ovid MEDLINE, EMBASE, CINAHL, Cochrane Library, Web of Science, and Google Scholar, to identify studies published in English from 2017 to 2022 describing barriers and facilitators related to the implementation of telemedicine interventions for hypertension and diabetes management. The coding and synthesis of barriers and facilitators were guided by the Consolidated Framework for Implementation Research (CFIR).

Results:

Of the 17685 records identified, 35 studies were included in our scoping review. We found that facilitators and barriers to implementation were dispersed across the constructs in the CFIR framework. Barriers related to cost, patient needs and resources (e.g., lack of consideration of language needs, culture, rural residency), personal attributes of patients (e.g., demographics and priorities) were most common. Facilitators related to the design and packaging of the intervention (e.g., user-friendliness), patient needs and resources (e.g., personalized information that leveraged existing strengths), implementation climate (e.g., intervention embedded into existing infrastructure), knowledge and beliefs about the intervention (e.g., convenience of telemedicine), and other personal attributes (e.g., technical literacy) were most common.

Conclusions:

Our findings suggest that successful implementation of telemedicine interventions for hypertension and diabetes requires comprehensive efforts at the planning, executing, engaging, and reflecting and evaluating stages of intervention implementation in order to address challenges at the individual, interpersonal, organizational, and environmental levels.