JMIR Publications

ABSTRACT

Background:

In recent years, the (cost-)effectiveness of digital health services for people with musculoskeletal complaints has increasingly been studied and shows potential. Despite the potential of digital health services, its usage in primary care is lagging. Therefore, a thorough implementation is needed, including the development of implementation strategies that potentially improve the usage of digital health services in primary care. The first step in designing implementation strategies which fit the local context, is to gain insight into determinants that influence implementation for patients and healthcare professionals. Up until now, no systematic overview exists of barriers and facilitators influencing the implementation of digital health services for people with musculoskeletal complaints in the primary healthcare setting.

Objective:

The aim of this systematic literature review was to identify barriers and facilitators to the implementation of digital health services for people with musculoskeletal complaints in the primary healthcare setting.

Methods:

PUBMED, EMBASE, and CINAHL were searched for eligible qualitative and mixed-methods studies up to August 2021. Methodological quality of the qualitative component of the included studies was assessed with the Mixed Methods Appraisal Tool. Then, a framework synthesis of barriers and facilitators to implementation was conducted using the Consolidated Framework for Implementation Research (CFIR). Finally, all identified CFIR constructs were given a reliability rating (high, medium or low) to assess the consistency of reporting across each construct.

Results:

Nineteen studies were included in the synthesis. Methodological quality was high in eighteen studies and medium in one study. Barriers and facilitators to implementation were identified in all five CFIR domains: digital health characteristics, outer setting, inner setting, characteristics of the health professionals, and the implementation process. Almost all identified (sub-)constructs of the CFIR had a high reliability rating. Some identified determinants that influence implementation may be a facilitator in certain cases, while in others it can be a barrier.

Conclusions:

This systematic review provides an extensive description of barriers and facilitators to the implementation of digital health services for people with musculoskeletal complaints in the primary healthcare setting. Findings are based on the synthesis of 19 qualitative and mixed methods studies through the CFIR. Stakeholders, such as digital health intervention developers, healthcare professionals, healthcare organizations, health policy makers, healthcare funders, and researchers, can consider this generic overview of barriers and facilitators to design fitting implementation strategies. A prioritization of determinants should be carried out for the local context, as a first step in designing implementation strategies.