Accepted for/Published in: JMIR Human Factors
Date Submitted: Jun 3, 2025
Date Accepted: Dec 28, 2025
Using the Theoretical Domains Framework to Identify Barriers and Enablers of Patient Telemedicine Services Utilization in China: A Qualitative Study
ABSTRACT
Background:
Telemedicine services are seeing swift expansion globally owing to their ease and accessibility. An increasing number of hospitals have commenced offering telemedicine services in China. However, patients' usage rate of telemedicine services remains relatively low in China, and limited research has examined patients' behaviors during the process of adopting telemedicine. Therefore, it was important to examine the factors impacting patient usage through empirical study to foster patient utilization.
Objective:
The study aimed to identify barriers and enablers for patients utilizing telemedicine services and to formulate implementation strategies.
Methods:
We conducted semi-structured qualitative interviews based on the theoretical domain framework (TDF) to identify barriers and enablers to telemedicine utilization. Twenty-one patients who had used Peking University Third Hospital's telemedicine services were included in the interviews. The data was analyzed via inductive coding under TDF framework. Moreover, a group of experts was assembled to devise potential intervention strategies.
Results:
A total of 190 determinants were identified. Of these determinants, 71 were identified as barriers and 119 as enablers, including 5 of the 14 TDF domains. The most commonly cited barriers were operational challenges, prolonged waiting periods from asynchronous communication, and skepticism regarding therapeutic efficacy. Whereas the most frequently cited enablers were the convenience of telemedicine, saving time, and support from hospitals. In light of these factors, we devised six intervention strategies.
Conclusions:
This study demonstrated that patients' utilization of telemedicine services was affected by several barriers and enablers together, including system architecture and design, patient interactions using telemedicine, and external assistance. To enhance the utilization of telemedicine services, the factors must be meticulously considered. This study also suggests strategies to enhance the utilization rate of telemedicine.
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© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.