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Cited by 137Telemedicine and Telehealth ImplementationElectronic Health Records SystemsHealth Policy Implementation Science

The DOI matches its Crossref record; 93 of the 96 references it cites were found in a registry or an index.

Implementation factors and their effect on e-Health service adoption in rural communities: a systematic literature review

Open access
Hage, Eveline, Roo, John P, van Offenbeek, Marjolein AG, Boonstra, Albert·2013·BMC Health Services Research
DOI 10.1186/1472-6963-13-19PMC PMC3575225
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Abstract

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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Figure 1 Flowchart of study selection process.
Figure 1 Flowchart of study selection process.CC BY · PubMed Central
Figure 2 Number of papers per perspective.
Figure 2 Number of papers per perspective.CC BY · PubMed Central

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Research works printed but not linked: 3

  1. Kinsella K, Velkoff VA: U.S. Census Bureau, Series P95/01-1, An Aging World. 2001, Washington DC: U.S. Government Printing Office
  2. Schalken F: Handboek online hulpverlening van de stichting e-Hulp.nl. 2010, Houten: Bohn Stafleu van Loghum
  3. Public health resource unit: NHS: Critical Appraisal Skills Programme (CAPS): 10 questions to help you make sense of qualitative research. 2006, England

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Metadata

Authors
Hage, E., Roo, J. P., van Offenbeek, M. A., & Boonstra, A.
Affiliations
University of Groningen (NL)
Corresponding author
Hage, Eveline
ORCID
Venue
BMC Health Services Research
Publisher
Springer Science and Business Media LLC
Published
2013-01-12
Volume
13
Issue
1
Pages
19-19
ISSN
1472-6963 (ISSN-L)
DOI
10.1186/1472-6963-13-19
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
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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