JMIR Publications

ABSTRACT

Background:

Digital health technologies (DHTs) have the potential to improve care delivery and outcomes for patients with non-communicable diseases (NCDs). Yet their implementation in rural settings remains uneven, and the factors influencing uptake are not well understood.

Objective:

This mixed-methods systematic review aimed to identify barriers and facilitators affecting the implementation and use of DHTs for remote monitoring and self-management of NCDs in rural areas.

Methods:

We searched Medline, Embase, and CINAHL from inception to February 15, 2024, using terms related to digital health, NCDs, and rural settings. Following the Joanna Briggs Institute methodology for MMSR, we synthesized quantitative and qualitative studies. Barriers and facilitators were categorized using the Consolidated Framework for Implementation Research (CFIR), and study quality was appraised using the Mixed Methods Appraisal Tool (MMAT).

Results:

From the initial 1491 records, 14 studies met the inclusion criteria. Barriers were clustered within three CFIR domains: (1) Intervention characteristics, including software instability and hardware issues; (2) Outer setting, such as poor internet connectivity and financial constraints, and (3) Inner setting, particularly staff shortages and heavy workloads. Facilitators related to Intervention characteristics, reflected in a user-friendly design, and to the Inner setting, where strong leadership, teamwork, and ongoing communication supported implementation and uptake. Evidence was predominantly qualitative, with limited quantitative data available.

Conclusions:

DHTs show promise for improving access and continuity of care for cardiovascular disease, hypertension, and diabetes in rural settings; however, their impact is constrained by structural inequities, including limited broadband access, workforce shortages, and financial fragility. These findings highlight important implications for research, policy, and practice, including the need for rigorous mixed‑methods evaluations sensitive to rural contexts, long‑term equity‑oriented financing mechanisms, and strengthened organizational readiness to support effective DHT uptake.