Barriers and facilitators of the uptake of digital health technology in cardiovascular care: a systematic scoping review
Open accessAbstract
Abstract Digital health technology (DHT) has the potential to revolutionize healthcare delivery but its uptake has been low in clinical and research settings. The factors that contribute to the limited adoption of DHT, particularly in cardiovascular settings, are unclear. The objective of this review was to determine the barriers and facilitators of DHT uptake from the perspective of patients, clinicians, and researchers. We searched MEDLINE, EMBASE, and CINAHL databases for studies published from inception to May 2020 that reported barriers and/or facilitators of DHT adoption in cardiovascular care. We extracted data on study design, setting, cardiovascular condition, and type of DHT. We conducted a thematic analysis to identify barriers and facilitators of DHT uptake. The search identified 3075 unique studies, of which 29 studies met eligibility criteria. Studies employed: qualitative methods (n = 13), which included interviews and focus groups; quantitative methods (n = 5), which included surveys; or a combination of qualitative and quantitative methods (n = 11). Twenty-five studies reported patient-level barriers, most common of which were difficult-to-use technology (n = 7) and a poor internet connection (n = 7). Six studies reported clinician-level barriers, which included increased workload (n = 4) and a lack of integration with electronic medical records (n = 3).Twenty-four studies reported patient-level facilitators, which included improved communication with clinicians (n = 10) and personalized technology (n = 6). Four studies reported clinician-level facilitators, which included approval and organizational support from cardiology departments and/or hospitals (n = 3) and technologies that improved efficiency (n = 3). No studies reported researcher-level barriers or facilitators. In summary, internet access, user-friendliness, organizational support, workflow efficiency, and data integration were reported as important factors in the uptake of DHT by patients and clinicians. These factors can be considered when selecting and implementing DHTs in cardiovascular clinical settings.
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Telemedicine solutions have the potential to be a cost-effective way of providing improved care to patients with cardiovascular disease.
“Telemedicine solutions have the potential to be a cost-effective way of providing improved care to patients with cardiovascular disease.15,16”
From Efficacy of a web-based healthcare innovation to advance the quality of life and care of patients with an implantable cardioverter defibrillator (ACQUIRE-ICD): A randomized controlled trial (2023) · cites this paper as [16]
The Introduction says digital health technology can improve outcomes and reduce costs in cardiovascular care, and identifies remote monitoring and virtual visits as applications. The Discussion’s “Institutional support” section reports evidence of cost-effectiveness for digital health technologies overall, but does not establish it specifically for telemedicine solutions. (LLM, conf=0.82)
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Cites
Using thematic analysis in psychology
Braun, V., & Clarke, V. (2006) · Qualitative Research in Psychology · doi:10.1191/1478088706qp063oa · Cited by 194,414 · see citing works
The theory of planned behavior
Ajzen, I. (1991) · Organizational Behavior and Human Decision Processes · doi:10.1016/0749-5978(91)90020-t · Cited by 90,587 · see citing works
Perceived usefulness, perceived ease of use, and user acceptance of information technology
Davis, F. D. (1989) · MIS Quarterly · doi:10.2307/249008 · Cited by 68,483 · see citing works
User Acceptance of Information Technology: Toward A Unified View1
Venkatesh, V., Morris, M. G., Davis, G. B., & Davis, F. D. (2003) · MIS Quarterly · doi:10.2307/30036540 · Cited by 45,035 · see citing works
PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation
Tricco, A. C., Lillie, E., Zarin, W., O'Brien, K. K., Colquhoun, H., Levac, D., Moher, D., Peters, M. D. J., Horsley, T., Weeks, L., et al. (2018) · Annals of Internal Medicine · doi:10.7326/m18-0850 · Cited by 43,565 · see citing works
Rogers, E. M., Singhal, A., & Quinlan, M. M. (2019) · Routledge eBooks · doi:10.4324/9780203710753-35 · Cited by 37,557 · see citing works
Scoping studies: towards a methodological framework
Arksey, H., & O'Malley, L. (2005) · International Journal of Social Research Methodology · doi:10.1080/1364557032000119616 · Cited by 36,742 · see citing works
Kytle, J., & Bandura, A. (1978) · Contemporary Sociology · doi:10.2307/2065952 · Cited by 25,422 · see citing works
Roth, G. A., Abate, D., Abate, K. H., Abay, S. M., Abbafati, C., Abbasi, N., Abbastabar, H., Abd-Allah, F., Abdela, J., Abdelalim, A., et al. (2018) · The Lancet · doi:10.1016/s0140-6736(18)32203-7 · Cited by 8,600 · see citing works
Kyu, H. H., Abate, D., Abate, K. H., Abay, S. M., Abbafati, C., Abbasi, N., Abbastabar, H., Abd-Allah, F., Abdela, J., Abdelalim, A., et al. (2018) · The Lancet · doi:10.1016/s0140-6736(18)32335-3 · Cited by 4,112 · see citing works
A scoping review of scoping reviews: advancing the approach and enhancing the consistency
Pham, M. T., Rajić, A., Greig, J. D., Sargeant, J. M., Papadopoulos, A., & McEwen, S. A. (2014) · Research Synthesis Methods · doi:10.1002/jrsm.1123 · Cited by 3,078 · see citing works
Sullivan, L. E. (2009) · The SAGE Glossary of the Social and Behavioral Sciences · doi:10.4135/9781412972024.n747 · Cited by 2,442 · see citing works
Covid-19 and Health Care’s Digital Revolution
Keesara, S., Jonas, A., & Schulman, K. (2020) · New England Journal of Medicine · doi:10.1056/nejmp2005835 · Cited by 1,126 · see citing works
Applications of digital technology in COVID-19 pandemic planning and response
Whitelaw, S., Mamas, M. A., Topol, E., & Van Spall, H. G. C. (2020) · The Lancet Digital Health · doi:10.1016/s2589-7500(20)30142-4 · Cited by 992 · see citing works
Self-citationPhysicians’ Use Of Electronic Medical Records: Barriers And Solutions
Miller, R. H., & Sim, I. (2004) · Health Affairs · doi:10.1377/hlthaff.23.2.116 · Cited by 869 · see citing works
Gagnon, M.-P., Desmartis, M., Labrecque, M., Car, J., Pagliari, C., Pluye, P., Frémont, P., Gagnon, J., Tremblay, N., & Légaré, F. (2012) · Journal of Medical Systems · doi:10.1007/s10916-010-9473-4 · Cited by 637 · see citing works
Inan, O. T., Tenaerts, P., Prindiville, S. A., Reynolds, H. R., Dizon, D. S., Cooper-Arnold, K., Turakhia, M., Pletcher, M. J., Preston, K. L., Krumholz, H. M., et al. (2020) · npj Digital Medicine · doi:10.1038/s41746-020-0302-y · Cited by 329 · see citing works
Frederix, I., Caiani, E. G., Dendale, P., Anker, S., Bax, J., Böhm, A., Cowie, M., Crawford, J., de Groot, N., Dilaveris, P., et al. (2019) · European Journal of Preventive Cardiology · doi:10.1177/2047487319832394 · Cited by 323 · see citing works
Self-citationGuo, C., Ashrafian, H., Ghafur, S., Fontana, G., Gardner, C., & Prime, M. S. (2020) · npj Digital Medicine · doi:10.1038/s41746-020-00314-2 · Cited by 322 · see citing works
Telemedicine Training in Undergraduate Medical Education: Mixed-Methods Review
Waseh, S., & Dicker, A. P. (2019) · JMIR Medical Education · doi:10.2196/12515 · Cited by 291 · see citing works
Digital Technology and the Future of Health Systems
Mitchell, M., & Kan, L. (2019) · Health Systems & Reform · doi:10.1080/23288604.2019.1583040 · Cited by 251 · see citing works
Tieu, L., Sarkar, U., Schillinger, D., Ralston, J. D., Ratanawongsa, N., Pasick, R. J., & Lyles, C. R. (2015) · Journal of Medical Internet Research · doi:10.2196/jmir.4847 · Cited by 244 · see citing works
The wisdom of older technology (non)users
Knowles, B., & Hanson, V. L. (2018) · Communications of the ACM · doi:10.1145/3179995 · Cited by 209 · see citing works
Barriers to Telemedicine: Survey of Current Users in Acute Care Units
Rogove, H. J., McArthur, D. L., Demaerschalk, B. M., & Vespa, P. M. (2011) · Telemedicine Journal and e-Health · doi:10.1089/tmj.2011.0071 · Cited by 172 · see citing works
Filkins, B. L., Kim, J. Y., Roberts, B., Armstrong, W., Miller, M. A., Hultner, M. L., Castillo, A., Ducom, J. C., Topol, E. J., & Steinhubl, S. R. (2016) · PubMed Central · Cited by 157 · see citing works
Palacholla, R. S., Fischer, N., Coleman, A., Agboola, S., Kirley, K., Felsted, J., Katz, C., Lloyd, S., & Jethwani, K. (2019) · JMIR Cardio · doi:10.2196/11951 · Cited by 127 · see citing works
Chu, A., Huber, J. T., Mastel‐Smith, B., & Cesario, S. K. (2009) · Journal of the Medical Library Association JMLA · doi:10.3163/1536-5050.97.1.003 · Cited by 113 · see citing works
Kim, Y., & Crowston, K. (2011) · Proceedings of the American Society for Information Science and Technology · doi:10.1002/meet.2011.14504801197 · Cited by 90 · see citing works
Trends and Predictors of Use of Digital Health Technology in the United States
Mahajan, S., Lu, Y., Spatz, E. S., Nasir, K., & Krumholz, H. M. (2020) · The American Journal of Medicine · doi:10.1016/j.amjmed.2020.06.033 · Cited by 87 · see citing works
Talboom-Kamp, E. P. W. A., Verdijk, N. A., Kasteleyn, M. J., Numans, M. E., & Chavannes, N. H. (2018) · Clinical eHealth · doi:10.1016/j.ceh.2018.01.001 · Cited by 86 · see citing works
Mobile health applications for the detection of atrial fibrillation: a systematic review
Lopez Perales, C. R., Van Spall, H. G. C., Maeda, S., Jimenez, A., Laţcu, D. G., Milman, A., Kirakoya-Samadoulougou, F., Mamas, M. A., Muser, D., & Casado Arroyo, R. (2021) · EP Europace · doi:10.1093/europace/euaa139 · Cited by 77 · see citing works
Self-citationBarriers and Facilitators to Workforce Changes in Integrated Care
Busetto, L., Luijkx, K. G., Calciolari, S., Ortiz, L. G. G., & Vrijhoef, H. J. (2018) · International Journal of Integrated Care · doi:10.5334/ijic.3587 · Cited by 51 · see citing works
Tsai, H.-Y. S., Rikard, R. V., Cotten, S. R., & Shillair, R. (2019) · Educational Gerontology · doi:10.1080/03601277.2019.1690802 · Cited by 45 · see citing works
Müller, F., Chandra, S., Furaijat, G., Kruse, S., Waligorski, A., Simmenroth, A., & Kleinert, E. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17041368 · Cited by 42 · see citing works
Early experiences with cardiology electronic consults: A systematic review
Oseran, A. S., & Wasfy, J. H. (2019) · American Heart Journal · doi:10.1016/j.ahj.2019.06.013 · Cited by 32 · see citing works
Using mobile technology to overcome language barriers in medicine
Chang, D., Thyer, I., Hayne, D., et al. (2014) · Annals of The Royal College of Surgeons of England · doi:10.1308/003588414x13946184903685 · Cited by 31 · see citing works
Social Media in Heart Failure: A Mixed-Methods Systematic Review
Eliya, Y., Pellegrini, D., Gevaert, A. B., Code, J., & Spall, H. G. C. V. (2019) · Current Cardiology Reviews · doi:10.2174/1573403x15666191210143657 · Cited by 14 · see citing works
Self-citationPhysician Remuneration for Remote Consults: An Overview of Approaches across Canada
Stanistreet, K., Verma, J. Y., Kirvan, K., et al. (2017) · Healthcare Quarterly · doi:10.12927/hcq.2017.25294 · Cited by 6 · see citing works
SOCIAL MEDIA IN HEART FAILURE: A MIXED METHODS SYSTEMATIC REVIEW
Pellegrini, D., Eliya, Y., Gevaert, A. B., et al. (2020) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(20)34163-2 · Cited by 5 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 6
- [16]American Medical Association. Physicians’ motivations and requirements for adopting digital health Adoption and attitudinal shifts from 2016 to 2019. https://www.ama-assn.org/system/files/2020-02/ama-digital-health-study.pdf (7 July 2020).
- [21]Fishbein M, Ajzen I. Belief, Attitude, Intention, and Behavior Reading. MA: Addison-Wesley; 1975. p 913– 927.
- [31]World Health Organization. Recommendations on digital interventions for health system strengthening. https://apps.who.int/iris/bitstream/handle/10665/311941/9789241550505-eng.pdf?ua=1 (7 January 2021). 31162915
- [33]Topol E. Preparing the Healthcare Workforce to Deliver the Digital Future: The Topol Review: An Independent Report on Behalf of the Secretary of State for Health and Social Care. London, UK: NHS Health Education; 2019.
- [42]Christodoulakis C, Asgarian A, Easterbrook S. Barriers to adoption of information technology in healthcare. In: Marcellus M. (ed.) Proceedings of the 27th Annual International Conference on Computer Science and Software Engineering. New Jersy, United States. 2017; 66– 75.
- [43]American Medical Association. Digital health implementation playbook. https://www.ama-assn.org/system/files/2020-04/ama-telehealth-implementation-playbook.pdf (7 January 2021).
Cited by
Sorted by citations
Gama, F., Tyskbo, D., Nygren, J., Barlow, J., Reed, J., & Svedberg, P. (2022) · Journal of Medical Internet Research · doi:10.2196/32215 · Cited by 216 · see citing works
Tricco, A. C., Hezam, A., Parker, A., Nincic, V., Harris, C., Fennelly, O., Thomas, S. M., Ghassemi, M., McGowan, J., Paprica, P. A., et al. (2023) · BMJ Open · doi:10.1136/bmjopen-2022-065845 · Cited by 32 · see citing works
Kaihara, T., Scherrenberg, M., Intan-Goey, V., Falter, M., Kindermans, H., Frederix, I., & Dendale, P. (2022) · European Heart Journal - Digital Health · doi:10.1093/ehjdh/ztac037 · Cited by 29 · see citing works
Khalid, A., Dong, Q., Chuluunbaatar, E., Haldane, V., Durrani, H., & Wei, X. (2023) · Journal of Medical Internet Research · doi:10.2196/42134 · Cited by 27 · see citing works
Jahnel, T., Pan, C.-C., Pedros Barnils, N., Muellmann, S., Freye, M., Dassow, H.-H., Lange, O., Reinschluessel, A. V., Rogowski, W., & Gerhardus, A. (2024) · Journal of Medical Internet Research · doi:10.2196/54269 · Cited by 15 · see citing works
Abdulhussein, F. S., Pinkney, S., Görges, M., van Rooij, T., & Amed, S. (2023) · JMIR Pediatrics and Parenting · doi:10.2196/46432 · Cited by 10 · see citing works
Skov, O., Johansen, J. B., Nielsen, J. C., Larroudé, C. E., Riahi, S., Melchior, T. M., Vinther, M., Skovbakke, S. J., Rottmann, N., Wiil, U. K., et al. (2023) · Europace · doi:10.1093/europace/euad253 · Cited by 10 · see citing works
“15,16 A recent meta-analysis found that web-based health interventions in cardiac patients have beneficial effects on depression.”
Background
- Authors
- Whitelaw, S., Pellegrini, D. M., Mamas, M. A., Cowie, M., & Van Spall, H. G. C.
- Affiliations
- McMaster University (CA)
- University of Manchester (GB)
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London SW7 2AZ , UK
- Department of Health Research Methods, Evidence, and Impact, McMaster University , 1280 Main Street West, Hamilton, Ontario L8S 4L8, Canada
- Venue
- European Heart Journal - Digital Health
- Publisher
- Oxford University Press (OUP)
- Published
- 2021-02-04
- Volume
- 2
- Issue
- 1
- Pages
- 62-74
- ISSN
- 2634-3916 (ISSN-L)
- PMC
- PMC8139413
- OpenAlex
- W3127649143
- Cited by
- 241
- References
- 41
- Citations by year
- 2026: 28 · 2025: 63 · 2024: 60 · 2023: 50 · 2022: 27 · 2021: 13
- FWCI
- 7.75
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- European Heart Journal - Digital Health (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Keele Research Repository (Keele University) (submittedVersion, cc-by)
- Funders
- Canadian Institutes of Health Research
- McMaster University Department of Medicine and Women As One Escalator Award
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Keywords
- digital health technologies, technology adoption, barriers and facilitators, cardiovascular care, patient perspectives, clinician perspectives, internet access, ease of use, workload, electronic health record integration, organizational support, workflow efficiency, clinician-patient communication
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