JMIR Publications

ABSTRACT

Background:

Telemedicine is developing rapidly, presenting new opportunities and challenges for physicians and patients. Limited research has examined the behavior of physicians during the process of adopting telemedicine and related factors.

Objective:

This study aimed to identify perceived barriers to and enablers of physicians' implementation of telemedicine and develop theory-informed implementation interventions.

Methods:

Semi-structured qualitative interviews based on the theoretical domain framework (TDF) conducted with 36 physicians from 28 different medical institutions in Beijing, to identify barriers and enablers to telemedicine utilization. The data analyzed via inductive coding and TDF framework analysis. The Behavior Change Wheel (BCW) and Behavior Change Techniques (BCTs) were used to identify potential interventions to address identified barriers and enablers based on the APEASE criteria and via panel discussion.

Results:

There were 27 barriers and 23 enablers identified in the adoption of telemedicine, representing 11 of the 14 TDF domains and ranging from administrative issues to specific clinical conditions. The most frequently mentioned domains were environmental context and resources (10 subthemes), beliefs about consequences (9 subthemes), and emotion (7 subthemes). Major barriers comprise limited acceptance among senior physicians, inconsistent system performance, inadequate platform usability, and inadequate medical insurance coverage. Key enablers include sufficient communication skills and proficiency in system operations, together with the conviction that telemedicine may assist patients in resolving medical issues, and prompt support from the IT department when challenges arise. Additionally, 7 out of 9 intervention functions, 6 out of 7 policy categories, and 26 out of 93 BCTs selected for each subtheme. Finally, we proposed several potential implementation strategies.

Conclusions:

This study identified a range of interventions and strategies that could improve telemedicine use in this context. Implementing these measures requires efforts from health administrative departments, medical institutions, departments, and healthcare personnel.