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Cited by 32Telemedicine and Telehealth ImplementationHealthcare during COVID-19 PandemicDental Research and COVID-19

Utilization of telehealth to manage the Covid-19 pandemic in low- and middle-income countries: a scoping review

Open access
Eslami Jahromi, Maryam, Ayatollahi, Haleh·2023·Journal of the American Medical Informatics Association
DOI 10.1093/jamia/ocac250PMC PMC10018263
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Abstract

OBJECTIVE: Recently, the coronavirus disease 2019 (Covid-19) pandemic has led to an increase in the use of telehealth technology. It seems that the application of this technology in low- and middle-income countries (LMICs) has been limited, and few studies have been undertaken to review the current state of knowledge in this area. The aim of the present study was to explore the utilization of telehealth to manage the Covid-19 pandemic in LMICs. MATERIALS AND METHODS: This scoping review was conducted in 2022. PubMed, Web of Science, Scopus, the Cochrane Library, IEEE Xplore, and ProQuest were searched, and all quantitative research, qualitative studies, case reports, and case studies related to the use of telehealth to manage Covid-19 in LMICs and published since 2020 were included in the study. The findings were analyzed and reported narratively. RESULTS: In total, 18 articles were included in the research. These studies were conducted in South Asia, sub-Saharan Africa, the Middle East and North Africa, and East Asia and Oceania. Telehealth interventions included teleconsultation, telecoaching, teledermatology, televisit, mhealth applications, telerehabilitation, telepharmacy, and telepsychiatry. WhatsApp was the most common way for service delivery and in most studies, patients and health care providers were satisfied with services. CONCLUSION: Although the use of telehealth interventions was limited in LMICs during the Covid-19 pandemic, in most cases, it was an effective solution to combat the outbreak of Covid-19 and had positive outcomes. A comparison between the characteristics and clinical effectiveness of similar interventions in different countries including LMICs are worth investigation in the future studies.

Integrity signals

Registry

Crossref · 10.1093/jamia/ocac250

Cites

76 of 77 references verified0 citation errors · 1 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

21 of 38 cited sources checked · 13 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    The new strategies to combat Covid-19 necessitated the expansion of using telehealth in different countries including LMICs.

    “The new strategies to combat Covid-19 necessitated the expansion of using telehealth in different countries including low-and middleincome ones.4”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [4] 4. Kazi AM, Qazi SA, Ahsan N, et al. Current challenges of digital health interventions in Pakistan: mixed methods analysis. J Med Internet Res 2020; 22 (9): e21691. source

      The Discussion (Principal Findings; page unavailable) says COVID-19 and social distancing significantly increased demand for digital health, and describes a COVID-19 telehealth portal in Pakistan. The Conclusions (page unavailable) also note increased demand for digital health especially in LMICs. The paper does not establish that telehealth specifically expanded across multiple countries. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
  • Premisecitation

    Low-cost and widely used communication platforms such as WhatsApp or WeChat are preferred to be used in LMICs.

    “In fact, the low-cost and widely used communication platforms such as WhatsApp or WeChat are preferred to be used in LMICs.17”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [17] 17. Hoffer-Hawlik MA, Moran AE, Burka D, et al. Leveraging telemedicine for chronic disease management in low-and middle-income countries dur- ing Covid-19. Glob Heart 2020; 15 (1): 63. source

      The ‘Choosing telemedicine technology platforms’ section says WhatsApp and WeChat are low-cost, widely used ways to rapidly expand telemedicine in LMICs in the short term. It does not say they are generally preferred; it also presents dedicated telemedicine applications as an alternative. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
  • Premisecitation

    In most digital health strategies, there are plans to use telemedicine, mHealth, and eHealth tools to improve health care quality and increase health care coverage, especially for underserved populations.

    “In most strategies, there are some plans to use telemedicine, mHealth, and eHealth tools to improve health care quality and increase health care coverage, especially for underserved populations.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [64] 64. Holly L, Smith RD, Ndili N, Franz C, Stevens EAG. A review of digital health strategies in 10 countries with young populations: do they serve the health and wellbeing of children and youth in a digital age? Front Digit Health 2022; 4: 817810. source
  • Interpretationcitation

    In LMICs, the use of tools such as mobile phones and mhealth applications seems to be more appropriate than tools that require high Internet bandwidth and expensive equipment.

    “For example, in these countries, the use of tools such as mobile phones and mhealth applications seems to be more appropriate than the tools that require high Internet bandwidth and expensive equipment.52”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [52] 52. Miller P, Owolabi E, Chu K. We asked the experts: the promises and chal- lenges of surgical telehealth in low resourced settings. World J Surg 2022; 46 (1): 45-6. source
  • Premisecitation

    South Africa rapidly changed its policies and regulations at the beginning of the Covid-19 pandemic to enable widespread adoption and use of telehealth services.

    “In Sub-Saharan Africa, South Africa was one of the countries that rapidly changed its policies and regulations at the beginning of the Covid-19 pandemic to enable widespread adoption and use of telehealth services.46”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [46] 46. Chitungo I, Mhango M, Mbunge E, Dzobo M, Musuka G, Dzinamarira T. Utility of telemedicine in sub-Saharan Africa during the COVID-19 pandemic. A rapid review. Hum Behav Emerg Technol 2021; 3 (5): 843-53. source
  • Classified as probably not a substantial claim. 24
  • May combine two claims. 26
  • The quote only partly states this claim. 1

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The PRISMA-ScR checklist was used for reporting key items of the research.

    “The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist was also used for reporting the key items of the research.25”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [25] 25. Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 2018; 169 (7): 467-73. source

  • May combine two claims.

    Premisecitation

    Benefits of telehealth during the Covid-19 pandemic included addressing key challenges in providing health care services, improving health care delivery, preventing direct physical contact, and reducing the risk of transmitting the coronavirus.

    “The benefits of this technology during the Covid-19 pandemic included addressing key challenges in providing health care services, improving health care delivery, preventing direct physical contact, and reducing the risk of transmitting the coronavirus.8”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [8] 8. Monaghesh E, Hajizadeh A. The role of telehealth during COVID-19 out- break: a systematic review based on current evidence. BMC Public Health 2020; 20 (1): 1193. source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Key components needed for successful implementation of telehealth in LMICs include setting legal and regulatory frameworks, identifying telehealth users and providers, choosing telehealth technology platforms, aligning financial incentives, designing telehealth workflows, and training and engaging health care professionals and patients.

    “Some of the key components needed for successful implementation of telehealth in LMICs include setting legal and regulatory frameworks, identifying telehealth users and providers, choosing telehealth technology platforms, aligning financial incentives, designing telehealth workflows, and training and engaging health care professionals and patients.17”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [17] 17. Hoffer-Hawlik MA, Moran AE, Burka D, et al. Leveraging telemedicine for chronic disease management in low-and middle-income countries dur- ing Covid-19. Glob Heart 2020; 15 (1): 63. source

  • May combine two claims.

    Premisecitation

    The major barriers to implementation of telehealth in LMICs are related to the high cost of development, lack of adequate technical infrastructure, and poor broadband Internet connectivity.

    “The major barriers to the implementation of telehealth in LMICs are related to the high cost of development, lack of adequate technical infrastructure, and poor broadband Internet connectivity.16”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [16] 16. Singh J. The COVID-19 pandemic: an opportunity to strengthen telemedi- cine in low and middle-income countries. Pediatr Res 2022: 1-2. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Miller et al noted that simple technologies such as WhatsApp have been successfully used for teleconsultation in LMICs.

    “Similarly, Miller et al noted that simple technologies such as WhatsApp have been successfully used for teleconsultation in LMICs.52”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [52] 52. Miller P, Owolabi E, Chu K. We asked the experts: the promises and chal- lenges of surgical telehealth in low resourced settings. World J Surg 2022; 46 (1): 45-6. source

  • May combine two claims.

    Premisecitation

    During the pandemic, these figures increased, and along with WhatsApp, Zoom (74%) was used more than other platforms such as Skype (29%) and Microsoft Teams (27%).

    “However, these figures have increased during the pandemic, and along with WhatsApp, Zoom (74%) has been used more than other platforms such as Skype (29%) and Microsoft Teams (27%).”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [54] 54. Helou S, El Helou E, Abou-Khalil V, et al. The effect of the COVID-19 pandemic on physicians' use and perception of telehealth: the case of Leb- anon. Int J Environ Res Public Health 2020; 17 (13): 4866. source

      Results §3.6 reports that more physicians increased their use of Zoom (74%) than Skype (29%) or Microsoft Teams (27%) during the pandemic; it also reports increased WhatsApp use. Those percentages measure the proportion of physicians who increased use, not the proportion who used each platform, as the citing sentence implies. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites [55] 55. Kumar M, Rani P, Joshi B, Soni RK, Kumari A, Rohilla KK. Telemedicine as an unexpected catalyst during and beyond the COVID-19 pandemic. Nepal J Epidemiol 2022; 12 (1): 1171-4. source

      The Background says telemedicine use increased exponentially during COVID-19, and “Telemedicine services in India” lists WhatsApp, Zoom and Skype as available software. Neither passage gives platform-use percentages or says Zoom was used more than Skype or Microsoft Teams; searches for those figures found no such passage in our copy. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Telephone calls and 2-way text messaging platforms such as WhatsApp and WeChat are easy-to-use, cheap, and accessible.

    “Among them, telephone calls and 2way text messaging platforms such as WhatsApp and WeChat are easy-to-use, cheap, and accessible and should be leveraged in LMICs.53”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [53] 53. Owolabi EO, Mac Quene T, Louw J, Davies JI, Chu KM. Telemedicine in surgical care in low-and middle-income countries: a scoping review. World J Surg 2022; 46 (8): 1855-69. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Fischer et al reported an increase in the use of technology in various fields including health care in South Africa during the Covid-19 quarantine.

    “Similarly, Fischer et al reported an increase in the use of technology in various fields including health care in South Africa during the Covid-19 quarantine.47”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [47] 47. Fischer AE, Van Tonder T, Gumede SB, Lalla-Edward ST. Changes in per- ceptions and use of mobile technology and health communication in South Africa during the COVID-19 lockdown: cross-sectional survey study. JMIR Form Res 2021; 5 (5): e25273. source

      The Results (Technology Use; page unavailable) report that 89.63% of surveyed South Africans said the lockdown forced them to use more technology, including for work, communication, shopping, and information. The paper also describes digital health-information services, but its reported increases do not establish a specific increase in technology use for health care. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationcitation

    Taking a greater digital ecosystem into account can help to ensure that service delivery challenges are solved in the context.

    “Taking a greater digital ecosystem into account can help to ensure that service delivery challenges are solved in the context.65”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [65] 65. Mitgang EA, Blaya JA, Chopra M. Digital health in response to COVID- 19 in low-and middle-income countries: opportunities and challenges. Glob Policy 2021; 12 (Suppl 6): 107-9. source

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

    Premisecitation

    In LMIC countries, users' readiness, accessibility of the technology and devices, and adequacy of ICT infrastructure are factors that should be taken into account.

    “The users' readiness, accessibility of the technology and devices, and adequacy of ICT infrastructure are among other factors which should be taken into account especially in LMIC countries.15”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [15] 15. Reis FJJ, Fernandes LG, Saragiotto BT. Telehealth in low-and middle- income countries: bridging the gap or exposing health disparities? Health Policy Technol 2021; 10 (4): 100577. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Wong et al found that demand for telehealth services increased in India, Bangladesh, and Pakistan.

    “Similarly, Wong et al examined global demand for telehealth services and focused on the 50 most affected countries by Covid-19.The results of their study showed that the demand for telehealth services has increased in India, Bangladesh, and Pakistan.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [45] 45. Wong MYZ, Gunasekeran DV, Nusinovici S, et al. Telehealth demand trends during the COVID-19 pandemic in the top 50 most affected coun- tries: infodemiological evaluation. JMIR Public Health Surveill 2021; 7 (2): e24445. source

  • May combine two claims.

    Premisecitation

    While most digital health strategies emphasize the need for an ethical approach to digital health, few have addressed the right to privacy and set clear policies for data security and protocols for electronic data exchange.

    “While most strategies emphasize the need for an ethical approach to digital health, it seems that a few of them have addressed the right to privacy, and set clear policies for data security and protocols for electronic data exchange.65”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [65] 65. Mitgang EA, Blaya JA, Chopra M. Digital health in response to COVID- 19 in low-and middle-income countries: opportunities and challenges. Glob Policy 2021; 12 (Suppl 6): 107-9. source

      In “Empowering the frontlines” (page not specified), the paper says that many African countries with digital health strategies do not articulate or execute clear data-security and electronic-data-exchange policies, and it identifies risks to privacy. It does not say that most strategies emphasize an ethical approach or specifically assess whether they address the right to privacy; the cited finding is also limited to countries in Africa. (LLM, conf=0.87)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The search identified 996 articles from six databases.

    “In total, 996 articles were identified following searches of the 6 databases.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The main telehealth interventions reported were teleconsultation (n=6), telecoaching (n=1), teledermatology (n=1), televisit (n=3), mhealth applications (n=3), telerehabilitation (n=2), telepharmacy (n=1), and telepsychiatry (n=1).

    “Regarding telehealth interventions, as Table 3 shows, teleconsultation (n ¼ 6), [27][28][29][30][31]43 telecoaching (n ¼ 1), 26 teledermatology (n ¼ 1), 40 televisit (n ¼ 3), 37,39,42 mhealth applications (n ¼ 3), [33][34][35] telerehabilitation (n ¼ 2), 32,36 telepharmacy (n ¼ 1), 41 and telepsychiatry (n ¼ 1) 38 were the main telehealth interventions reported in these studies.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The geographical distribution of included studies was 7 in South Asia, 6 in Sub-Saharan Africa, 4 in the Middle East and North Africa, and 1 in East Asia and Oceania.

    “In terms of the geographical distribution, the results showed that 7 studies were undertaken in South Asia (India, [26][27][28][29] Pakistan, 30,31 and Bangladesh 32 ), 6 in Sub-Saharan Africa (Nigeria, 33 Uganda, 34,35 Malawi, 36 Zambia, 37 and Kenya 38 ), 4 in the Middle East and North Africa (Egypt [39][40][41][42] ), and 1 in East Asia and Oceania.43”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Nontechnical challenges included fear of technology, limited knowledge about using technology, concerns over privacy and cybersecurity, costs, and limited online payments.

    “a number of nontechnical challenges, such as fear of the technology, limited knowledge about using the technology, concerns over privacy and cybersecurity, costs and limited online payments”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    WhatsApp was the most common platform for teleconsultation/service delivery, used in 11 studies (61.1%), followed by Zoom (6, 33.3%) and Skype (3, 16.6%).

    “WhatsApp was the most common way for service delivery”
    • Also stated in: § East Asia and Oceania · plain
      “The most common platform for teleconsultation was WhatsApp (n ¼ 11, 61.1%) followed by Zoom (n ¼ 6, 33.3%) and Skype (n ¼ 3, 16.6%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Technical challenges included poor Internet connectivity, inaccessibility of appropriate devices, and power outages.

    “technical challenges, such as the poor Internet connectivity, inaccessibility of appropriate devices, and power outages were experienced by the users.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Despite some difficulties experienced by users, most users accepted the telehealth technology and were satisfied with it in different specialties.

    “Despite some difficulties experienced by the users, the results showed that most of the users accepted the telehealth technology and were satisfied with that in different specialties.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In the current research, relevant studies were conducted in Zambia, Malawi, Uganda, and Kenya, and no paper was found reporting use of telehealth technology in South Africa.

    “However, in the current research, the relevant studies were conducted in Zambia, Malawi, Uganda, and Kenya, and we could not find a paper in which the use of the telehealth technology was reported in South Africa.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    All articles were screened on title, abstract, and full text by 2 reviewers, and disagreements were resolved through discussion.

    “All articles were screened on title, abstract, and full text by 2 reviewers and any disagreements were resolved through discussion between them.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Searching the reference list of selected studies, their citations, and hand-searching key journals were conducted to ensure relevant studies were included.

    “Searching the reference list of the selected studies, their citations, and hand-searching of key journals were also conducted to ensure that the relevant studies were included in the review.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    PubMed, Web of Science, Scopus, the Cochrane Library, IEEE Xplore, and ProQuest databases were searched.

    “To identify relevant studies, PubMed, Web of Science, Scopus, the Cochrane Library, IEEE Xplore, and ProQuest databases were searched and English papers published from 2020 were included in the study.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Choosing English language articles is common in conducting reviews and may have minimal effect on overall conclusions.

    “In fact, choosing English language articles is common in conducting reviews and may have minimal effect on overall conclusions.22”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [22] 22. Nussbaumer-Streit B, Klerings I, Dobrescu AI, et al. Excluding non- English publications from evidence-syntheses did not change conclusions: a meta-epidemiological study. J Clin Epidemiol 2020; 118: 42-54. source

  • May combine two claims. The quote only partly states this claim.

    Interpretationreasoning

    In most cases, telehealth was an effective solution to combat the Covid-19 outbreak and had positive outcomes.

    “in most cases, it was an effective solution to combat the outbreak of Covid-19 and had positive outcomes.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Few studies have reviewed the current state of knowledge on telehealth utilization in LMICs during the Covid-19 pandemic.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The study protocol was registered in INPLASY (Registration number: INPLASY202280004, DOI number: 10.37766/inplasy2022.8.0004).

    “The study protocol was registered in INPLASY, an international platform for registration of systematic review and meta-analysis protocols (Registration number: INPLASY202280004, DOI number: 10.37766/inplasy2022.8.0004).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    The current experience of using telehealth during the pandemic can be developed not only for use during this pandemic, but also to promote and support a more efficient healthcare system after the pandemic.

    “In fact, their current experience can be developed not only for being used during this pandemic, but also to promote and support a more efficient healthcare system after the pandemic.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The potentials of telehealth in LMICs have not been fully realized yet mainly due to technical and nontechnical challenges.

    “The results also showed that although telehealth has made several promising advances in LMICs and most of the users were satisfied with this type of services during the Covid-19 pandemic, its potentials have not been fully realized yet mainly due the technical and nontechnical challenges.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Gray literature, governmental, and organizational reports including the WHO materials were excluded.

    “Therefore, the gray literature, governmental, and organizational reports including the WHO materials were excluded.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Bali showed that inadequate ICT infrastructure and low-speed Internet connectivity are some of the barriers to the use of telehealth in developing countries.

    “Similarly, Bali showed that inadequate ICT infrastructure and low-speed Internet connectivity are some of the barriers to the use of telehealth in developing countries.62”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [62] 62. Bali S. Barriers to development of telemedicine in developing countries. In: Heston TF, ed. Telehealth. London: IntechOpen; 2018. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The global digital health strategy stresses the need for a strong legal and regulatory base to protect privacy, confidentiality, integrity, and availability of data in different platforms and information systems.

    “Therefore, it stresses the need for a strong legal and regulatory base to protect privacy, confidentiality, integrity, and availability of data in different platforms and information systems.66”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [66] 66. World Health Organization. Global strategy on digital health 2020-2025. [Internet] 2021. https://apps.who.int/iris/handle/10665/344249 Accessed- September 29, 2022.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    WhatsApp can be used to communicate effectively with health care professionals to ask questions and to avoid frequent visits to medical centers that are high-risk areas during the Covid-19 pandemic.

    “This messenger can be used to communicate effectively with health care professionals to ask questions and to avoid frequent visits to medical centers that are high-risk areas during the Covid-19 pandemic.56”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [56] 56. Delam H, Eidi A. WhatsApp messenger role in coronavirus disease 2019 (COVID 19) pandemic. J Health Sci Surveill Syst 2020; 8 (4): 183-4. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    Insufficient training in the use of technology may pose a threat to ethical issues.

    “In addition, as insufficient training in the use of technology may pose a threat to the ethical issues, efficient management of the available resources including human and physical resources are recommended to maintain highest level of societal and ethical standards.69”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [69] 69. Dhingra D, Dabas A. Global strategy on digital health. Indian Pediatr 2020; 57 (4): 356-8. source

  • May combine two claims.

    Premisecitation

    Gudi et al found that challenges of implementing digital health interventions in India included low digital literacy, lack of specific guidelines on cross-border consultations, privacy, and affordability issues.

    “Gudi et al found that challenges of implementing digital health interventions in India included low digital literacy, lack of specific guidelines on cross-border consultations, privacy, and affordability issues.67”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [67] 67. Gudi N, Yadav UN, John O, Webster R. Challenges and opportuni- ties in employing digital health to address self-management needs of people with NCDs in India. BMJ Innov 2021: bmjinnov-2020- 000620. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The global digital health strategy emphasizes that health data are to be classified as sensitive personal data, or personally identifiable information, that require a high safety and security standard.

    “Moreover, the global digital health strategy emphasizes that health data are to be classified as sensitive personal data, or personally identifiable information, that require a high safety and security standard.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [66] 66. World Health Organization. Global strategy on digital health 2020-2025. [Internet] 2021. https://apps.who.int/iris/handle/10665/344249 Accessed- September 29, 2022.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Benefits of teleconsultation services include improving access to healthcare services, greater convenience, reduction in costs, and flexibility.

    “These benefits include improving access to healthcare services, greater convenience, reduction in costs, and flexibility in most circumstances.[49][50][51]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [49][50][51]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    WhatsApp is one of the most widely used instant messaging applications in healthcare and one of the most popular free applications in the world.

    “WhatsApp is one of the most widely used instant messaging applications in healthcare and is one of the most popular free applications in the world.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Only research articles in which the practical use of telehealth technology was reported were used.

    “Moreover, we only used research articles in which the practical use of telehealth technology was reported.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    Underestimating confidentiality issues, even for small amounts of information, may compromise patient privacy.

    “Underestimating confidentiality issues, even for small amounts of information, may compromise patient privacy.61”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [61] 61. Ayatollahi H, Bath PA, Goodacre S. Accessibility versus confidentiality of information in the emergency department. Emerg Med J 2009; 26 (12): 857-60. source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    WhatsApp has about 1.5 billion users worldwide and is compatible with all smartphone operating systems such as iPhone, Android, and Windows Phone.

    “It has about 1.5 billion users worldwide and is compatible with all smartphone operating systems such as iPhone, Android, and Windows Phone.56”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [56] 56. Delam H, Eidi A. WhatsApp messenger role in coronavirus disease 2019 (COVID 19) pandemic. J Health Sci Surveill Syst 2020; 8 (4): 183-4. source

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    The results of this study can encourage LMICs considering setting up telehealth services to learn from other countries and plan for future implementations.

    “As this pandemic is currently the biggest global health crisis, and various LMICs are considering setting up telehealth services to deal with it or with future pandemics, the results of this study can encourage them to learn from other countries and plan for future implementations.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Various LMICs are considering setting up telehealth services to deal with the Covid-19 pandemic or future pandemics.
41 of 41

  • The paper relies on this without support.

    Few studies have reviewed the current state of knowledge on telehealth utilization in LMICs during the Covid-19 pandemic.

    “As few studies have been undertaken to review the current state of knowledge in this area, the present study aimed to explore the utilization of telehealth to manage the Covid-19 pandemic in LMICs.”

  • The paper relies on this without support.

    Adequate Internet speed and bandwidth are critical for using telehealth technology and online communications between patients and health care providers.

    “Adequate Internet speed and bandwidth are critical for using the telehealth technology and online communications between patients and health care providers.”

  • The paper relies on this without support.

    Various LMICs are considering setting up telehealth services to deal with the Covid-19 pandemic or future pandemics.

    “As this pandemic is currently the biggest global health crisis, and various LMICs are considering setting up telehealth services to deal with it or with future pandemics, the results of this study can encourage them to learn from other countries and plan for future implementations.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The COVID-19 pandemic accelerated the global adoption of telemedicine and digital care models.

    “The COVID-19 pandemic accelerated the global adoption of telemedicine and digital care models, making it imperative to learn from large-scale implementations like Babyl to inform future digital health initiatives [18].”

    From Digital Primary Health in Rwanda: Qualitative Study of User Experiences and Implementation Lessons From Babyl's Telemedicine Platform (2026) · cites this paper as [18]

  • The use of established qualitative methods with rigorous analysis procedures, including independent coding, regular team discussions, member checking, and audit trails, enhanced analytical validity.

    “The use of established qualitative methods with rigorous analysis procedures, including independent coding, regular team discussions, member checking, and audit trails, enhanced analytical validity [18].”

    From Digital Primary Health in Rwanda: Qualitative Study of User Experiences and Implementation Lessons From Babyl's Telemedicine Platform (2026) · cites this paper as [18]

    The Stage 3–4 methods passage describes screening by two reviewers and resolving disagreements through discussion; Stage 5 describes a narrative synthesis. Neither passage establishes independent coding, regular team discussions, member checking, audit trails, or an improvement in analytical validity. Searches for those procedures and for analytical validity found no supporting passage in our copy. (LLM, conf=0.73)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Nigeria is omitted from the later account of included African studies

    Minor

    The results identify an included study from Nigeria, whereas the discussion describes the relevant Sub-Saharan African studies as coming from four other countries.

  • WhatsApp study count conflicts with the cited studies

    Minor

    The paper reports WhatsApp use in 11 studies, but its earlier list of studies using WhatsApp contains 16 distinct references.

  • The publication year for Mostafa and Hegazy differs

    Minor

    Table 2 dates this included study to 2020, but its corresponding reference lists publication in 2022.

3 of 3

Cited works that were retracted

Works this paper cites that were later retracted, from the retraction notices publishers deposit. Major when the notice came out before this paper was published.

  • Cites a retracted work: 10.1111/ijcp.14310

    Major

    The cited work was retracted on 2021-10-12 (notice 10.1111/ijcp.14925), before this paper was published (2022-12-24). Its authors could have known.

    Cited work 10.1111/ijcp.14310 · retracted 2021-10-12 · notice 10.1111/ijcp.14925 · this paper published 2022-12-24

1 of 1

Cites

1 retracted

Flagged first, then by citations

Research works printed but not linked: 1

  1. Ahmed, 2021, Proceedings of the international conference on health information science; Oct 25–28, 2021, 24

Cited by

Sorted by citations

Related

Authors
Eslami Jahromi, M., & Ayatollahi, H.
Affiliations
  • Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences , Tehran, Iran
  • Iran University of Medical Sciences (IR)
Corresponding author
Ayatollahi, Haleh
ORCID
Ayatollahi, Haleh
Venue
Journal of the American Medical Informatics Association
Publisher
Oxford University Press (OUP)
Published
2022-12-24
Volume
30
Issue
4
Pages
738-751
ISSN
  • 1067-5027 (ISSN-L)
  • 1527-974X
DOI
10.1093/jamia/ocac250
PMC
PMC10018263
OpenAlex
W4312129813
Cited by
30
References
71
Citations by year
2026: 5 · 2025: 10 · 2024: 10 · 2023: 5
FWCI
1.24
Type
journal article
Language
en
Open access
Licence
academic.oup.com/pages/standard-publication-reuse-rights (vor)
Locations
  • Journal of the American Medical Informatics Association (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
  • Physical Sciences › Computer Science › Information Systems › Healthcare during COVID-19 Pandemic
  • Health Sciences › Dentistry › General Dentistry › Dental Research and COVID-19
Keywords
telemedicine, COVID-19 pandemic, low- and middle-income countries, teleconsultation, teledermatology, mobile health, telerehabilitation, telepharmacy, telepsychiatry, WhatsApp, patient satisfaction, health care delivery
MeSH terms
COVID-19, Developing Countries, Humans, Psychiatry, Telemedicine, Pandemics

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-11.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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