Implementation factors and their effect on e-Health service adoption in rural communities: a systematic literature review
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BACKGROUND: An ageing population is seen as a threat to the quality of life and health in rural communities, and it is often assumed that e-Health services can address this issue. As successful e-Health implementation in organizations has proven difficult, this systematic literature review considers whether this is so for rural communities. This review identifies the critical implementation factors and, following the change model of Pettigrew and Whipp, classifies them in terms of "context", "process", and "content". Through this lens, we analyze the empirical findings found in the literature to address the question: How do context, process, and content factors of e-Health implementation influence its adoption in rural communities? METHODS: We conducted a systematic literature review. This review included papers that met six inclusion and exclusion criteria and had sufficient methodological quality. Findings were categorized in a classification matrix to identify promoting and restraining implementation factors and to explore whether any interactions between context, process, and content affect adoption. RESULTS: Of the 5,896 abstracts initially identified, only 51 papers met all our criteria and were included in the review. We distinguished five different perspectives on rural e-Health implementation in these papers. Further, we list the context, process, and content implementation factors found to either promote or restrain rural e-Health adoption. Many implementation factors appear repeatedly, but there are also some contradictory results. Based on a further analysis of the papers' findings, we argue that interaction effects between context, process, and content elements of change may explain these contradictory results. More specifically, three themes that appear crucial in e-Health implementation in rural communities surfaced: the dual effects of geographical isolation, the targeting of underprivileged groups, and the changes in ownership required for sustainable e-Health adoption. CONCLUSIONS: Rural e-Health implementation is an emerging, rapidly developing, field. Too often, e-Health adoption fails due to underestimating implementation factors and their interactions. We argue that rural e-Health implementation only leads to sustainable adoption (i.e. it "sticks") when the implementation carefully considers and aligns the e-Health content (the "clicks"), the pre-existing structures in the context (the "bricks"), and the interventions in the implementation process (the "tricks").
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Barriers reported as separate entities are likely to interact with one another and cannot be considered in isolation.
“Despite many of the barriers being reported as separate entities in the identified reviews, they are likely to interact with one another and each cannot be considered in isolation [28, 32, 47, 94].”
From Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews (2015) · cites this paper as [94]
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- Authors
- Hage, E., Roo, J. P., van Offenbeek, M. A., & Boonstra, A.
- Affiliations
- University of Groningen (NL)
- Corresponding author
- Hage, Eveline
- Venue
- BMC Health Services Research
- Published
- 2013-01-12
- Volume
- 13
- Issue
- 1
- Pages
- 19-19
- ISSN
- 1472-6963 (ISSN-L)
- PMC
- PMC3575225
- OpenAlex
- W2060044403
- Cited by
- 137
- References
- 96
- Citations by year
- 2026: 2 · 2025: 8 · 2024: 9 · 2023: 9 · 2022: 14 · 2021: 17 · 2020: 14 · 2019: 14 · 2018: 14 · 2017: 8 · 2016: 10 · 2015: 11 · 2014: 7
- FWCI
- 1.33
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Health Services Research (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- digital health adoption, rural health care, implementation factors, geographic isolation, disadvantaged groups, population aging, rural communities
- MeSH terms
- Diffusion of Innovation, Female, Health Plan Implementation, Humans, Male, Rural Population, Electronic Health Records
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