Barriers and facilitators to the implementation of eHealth services: systematic literature analysis

Schreiweis, Björn; Pobiruchin, Monika; Strotbaum, Veronika; Suleder, Julian; Wiesner, Martin; Bergh, Björn

doi:10.2196/14197

Cited by 354Electronic Health Records SystemsTelemedicine and Telehealth ImplementationHealth Policy Implementation Science

Barriers and facilitators to the implementation of eHealth services: systematic literature analysis

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Schreiweis, Björn, Pobiruchin, Monika, Strotbaum, Veronika, Suleder, Julian, Wiesner, Martin, Bergh, Björn·2019·Journal of Medical Internet Research

DOI 10.2196/14197PMC PMC6898891

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Abstract

Background: The field of eHealth has a history of more than 20 years. During that time, many different eHealth services were developed. However, factors influencing the adoption of such services were seldom the main focus of analyses. For this reason, organizations adopting and implementing eHealth services seem not to be fully aware of the barriers and facilitators influencing the integration of eHealth services into routine care. Objective: The objective of this work is to provide (1) a comprehensive list of relevant barriers to be considered and (2) a list of facilitators or success factors to help in planning and implementing successful eHealth services. Methods: For this study, a twofold approach was applied. First, we gathered experts’ current opinions on facilitators and barriers in implementing eHealth services via expert discussions at two health informatics conferences held in Europe. Second, we conducted a systematic literature analysis concerning the barriers and facilitators for the implementation of eHealth services. Finally, we merged the results of the expert discussions with those of the systematic literature analysis. Results: Both expert discussions (23 and 10 experts, respectively) identified 15 barriers and 31 facilitators, whereas 76 barriers and 268 facilitators were found in 38 of the initial 56 articles published from 12 different countries. For the analyzed publications, the count of distinct barriers reported ranged from 0 to 40 (mean 10.24, SD 8.87, median 8). Likewise, between 0 and 48 facilitators were mentioned in the literature (mean 9.18, SD 9.33, median 6). The combination of both sources resulted in 77 barriers and 292 facilitators for the adoption and implementation of eHealth services. Conclusions: This work contributes a comprehensive list of barriers and facilitators for the implementation and adoption of eHealth services. Addressing barriers early, and leveraging facilitators during the implementation, can help create eHealth services that better meet the needs of users and provide higher benefits for patients and caregivers.

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Current evidence indicates a prevalent pattern of non-adoption and abandonment of healthcare technology innovations by their intended users, with limited success in integrating these innovations into regular practice or expanding their implementation to different contexts.
“Moreover, current evidence indicates a prevalent pattern of non-adoption and abandonment of healthcare technology innovations by their intended users, with limited success in integrating these innovations into regular practice or expanding their implementation to different contexts [6].”
From The NASSS (Non-Adoption, Abandonment, Scale-Up, Spread and Sustainability) framework use over time: A scoping review (2025) · cites this paper as [6]
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eHealth innovations purely originated from an academic context are rarely sustainably implemented into healthcare practice due to a lack of infrastructure, funding and time.
“Moreover, it has been shown that eHealth innovations purely originated from an academic context are rarely sustainably implemented into healthcare practice due to a lack of infrastructure, funding and time.24”
From Development, evaluation and implementation of a digital behavioural health treatment for chronic pain: study protocol of the multiphase DAHLIA project (2022) · cites this paper as [24]
Reviews have focused on telemedicine or eHealth in general without focusing on video consulting, with which our findings are consistent.
“Additionally, reviews have focused on telemedicine or eHealth in general without focusing on video consulting [24,77], with which our findings are consistent.”
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [77]

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Temple‐Oberle, C. F., Yakaback, S., Webb, C. E., Assadzadeh, G. E., & Nelson, G. S. (2023) · JAMA Surgery · doi:10.1001/jamasurg.2023.0616 · Cited by 61 · see citing works
Disparities in Outpatient and Telehealth Visits During the COVID-19 Pandemic in a Large Integrated Health Care Organization: Retrospective Cohort Study
Qian, L., Sy, L. S., Hong, V. X., Glenn, S. C., Ryan, D. S., Morrissette, K. L., Jacobsen, S. J., & Xu, S. (2021) · Journal of Medical Internet Research · doi:10.2196/29959 · Cited by 59 · see citing works
“Although telehealth visits increased prior to the pandemic primarily due to increased internet availability, insurance coverage, and cost savings [8], access to telehealth has inherent barriers [9,10].”
How to Implement Digital Services in a Way That They Integrate Into Routine Work: Qualitative Interview Study Among Health and Social Care Professionals
Nadav, J., Kaihlanen, A., Kujala, S., Laukka, E., Hilama, P., Koivisto, J., Keskimäki, I., & Heponiemi, T. (2021) · Journal of Medical Internet Research · doi:10.2196/31668 · Cited by 55 · see citing works
“However, these studies have mainly focused on examining implementation in certain groups of professionals [11,20] or a single digital service in a particular environment [21-25].”
Influential
eHealth literacy among hospital health care providers: a systematic review
Brørs, G., Larsen, M. H., Hølvold, L. B., & Wahl, A. K. (2023) · BMC Health Services Research · doi:10.1186/s12913-023-10103-8 · Cited by 55 · see citing works
“Among those challenges, poor eHealth literacy has been highlighted as a common barrier to the implementation of eHealth resources [18, 19].”
Background
The Digital Health Revolution and People with Disabilities: Perspective from the United States
Jones, M., DeRuyter, F., & Morris, J. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17020381 · Cited by 53 · see citing works
“[3], as well as in other regions and countries, including Europe [4] and Australia [5].”
BackgroundInfluential
Exploring perceptions toward home-care robots for older people in Finland, Ireland, and Japan: A comparative questionnaire study
Suwa, S., Tsujimura, M., Kodate, N., Donnelly, S., Kitinoja, H., Hallila, J., Toivonen, M., Ide, H., Bergman-Kärpijoki, C., Takahashi, E., et al. (2020) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2020.104178 · Cited by 53 · see citing works
“However, assistive technologies have not yet been widely implemented in society, with some exceptions, such as Denmark (Alaiad & Zhou, 2014; Granja, Janssen, & Johansen, 2018; Liddy, Dusseault, Dahrouge & Hogg 2008; Postema, Peeters & Friele, 2012; Schreiweis et al., 2019).”
Background
Health care providers' experiences of pain management and attitudes towards digitally supported self-management interventions for chronic pain: a qualitative study
Varsi, C., Ledel Solem, I. K., Eide, H., Børøsund, E., Kristjansdottir, O. B., Heldal, K., Waxenberg, L. B., Weiss, K. E., Schreurs, K. M. G., Morrison, E. J., et al. (2021) · BMC Health Services Research · doi:10.1186/s12913-021-06278-7 · Cited by 53 · see citing works
Barriers and facilitators of health professionals in adopting digital health-related tools for medication appropriateness: A systematic review
Rodrigues, D. A., Fiol-deRoque, M. A., Mateos-Campos, R., Figueiras, A., Herdeiro, M. T., & Roque, F. (2024) · Digital Health · doi:10.1177/20552076231225133 · Cited by 59 · see citing works
“…time consuming, 28,29 security and privacy concerns, 21,23,31 limited knowledge and literacy, 21,31 weakened communication and interaction with others, 23,29 and ﬁ nancial support 21,23,31 as barriers; ease of use, 21,23,28 and equipment availability and reliability 21,28,29 as facilitators.”
BackgroundInfluential
Differences in digital health literacy and future anxiety between health care and other university students in England during the COVID-19 pandemic
Frings, D., Sykes, S., Ojo, A., Rowlands, G., Trasolini, A., Dadaczynski, K., Okan, O., & Wills, J. (2022) · BMC Public Health · doi:10.1186/s12889-022-13087-y · Cited by 49 · see citing works
Barriers to and Facilitators of Automated Patient Self-scheduling for Health Care Organizations: Scoping Review
Woodcock, E. W. (2021) · Journal of Medical Internet Research · doi:10.2196/28323 · Cited by 54 · see citing works
“Documented inner setting obstacles to technology implementation include a culture that lacks receptivity [86], an absence of trust [87], a resistance to change [88], workflow changes that were required for uptake [89,90], and upfront and ongoing costs of the solution [91].”
Background
Digital Twins in Critical Care: What, When, How, Where, Why?
Chase, J., Zhou, C., Knopp, J., Shaw, G., Näswall, K., Wong, J., Malinen, S., Moeller, K., Benyó, B., Chiew, Y., et al. (2021) · IFAC-PapersOnLine · doi:10.1016/j.ifacol.2021.10.274 · Cited by 37 · see citing works
Digital health competencies and affecting factors among healthcare professionals: additional findings from a systematic review
Longhini, J., Rossettini, G., & Palese, A. (2024) · Journal of research in nursing · doi:10.1177/17449871241226899 · Cited by 45 · see citing works
“Financial, political, institutional and organisational supports have all been identified as crucial for the success of digital health (Nadav et al., 2021; Schreiweis et al., 2019).”
Background
Comparing the Acceptance of Mobile Hypertension Apps for Disease Management Among Patients Versus Clinical Use Among Physicians: Cross-sectional Survey
Breil, B., Salewski, C., & Apolinário-Hagen, J. (2021) · JMIR Cardio · doi:10.2196/31617 · Cited by 45 · see citing works
“According to Schreiweis et al [60], potential barriers and drivers for eHealth applications can be divided into individual, organizational, and technical factors.”
Background
Delivering Virtual Cancer Rehabilitation Programming During the First 90 Days of the COVID-19 Pandemic: A Multimethod Study
Lopez, C. J., Edwards, B. Q., Langelier, D. M., Chang, E. K., Chafranskaia, A., & Jones, J. M. (2021) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2021.02.002 · Cited by 42 · see citing works
“Retired 3 (25) Working 2 (17) Prefer not to answer 1 (8)”
The barriers and facilitators of radical innovation implementation in secondary healthcare: a systematic review
Thijssen, S. V., Jacobs, M., Swart, R., Heising, L. M., Ou, C. X. J., & Roumen, C. (2021) · Journal of Health Organization and Management · doi:10.1108/jhom-12-2020-0493 · Cited by 40 · see citing works
Health apps and patient engagement: A review of effectiveness and user experience
Omaghomi, T. T., Elufioye, O. A., Akomolafe, O. O., Anyanwu, E. C., & Daraojimba, A. I. (2023) · World Journal of Advanced Research and Reviews · doi:10.30574/wjarr.2024.21.2.0476 · Cited by 40 · see citing works
“Integration with wearable devices also greatly enhances the user experience, allowing seamless synchronization with these technologies, thereby improving data accuracy and user engagement (Jacob, Sanchez-Vazquez, & Ivory, 2020; Schreiweis et al., 2019).”
Background
Experiences and Factors Affecting Usage of an eHealth Tool for Self-Management Among People With Chronic Obstructive Pulmonary Disease: Qualitative Study
Marklund, S., Tistad, M., Lundell, S., Östrand, L., Sörlin, A., Boström, C., Wadell, K., & Nyberg, A. (2021) · Journal of Medical Internet Research · doi:10.2196/25672 · Cited by 38 · see citing works
“Users (median 10 logins and 43 minutes per month) felt comfortable with information technology (IT) tools, had a positive view on triggers, and had sufficient health literacy (median [range] 5 [5-1400]).”
BackgroundMethodResultInfluential
White Paper: Open Digital Health – accelerating transparent and scalable health promotion and treatment
Kwaśnicka, D., Keller, J., Perski, O., Potthoff, S., ten Hoor, G. A., Ainsworth, B., Crutzen, R., Dohle, S., van Dongen, A., Heino, M. T. J., et al. (2022) · Health Psychology Review · doi:10.1080/17437199.2022.2046482 · Cited by 38 · see citing works
“Although some tools are e ﬀ ective, their robust evaluation and successful implementation remain limited to speci ﬁ c geographical settings and disease areas (Gordon et al., 2020; Schreiweis et al., 2019).”
Background
Building health service management workforce capacity in the era of health informatics and digital health – A scoping review
Brommeyer, M., Whittaker, M. A., Mackay, M., Ng, F., & Liang, Z. (2022) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2022.104909 · Cited by 40 · see citing works
Enabling Guidelines for the Adoption of eHealth Solutions: Scoping Review
Støme, L. N., Wilhelmsen, C. R., & Kværner, K. J. (2021) · JMIR Formative Research · doi:10.2196/21357 · Cited by 36 · see citing works
“Schreiweis et al [75] studied enablers and barriers to eHealth implementation and presented similar conclusions as this study.”
Result
Best-practices for co-design processes involving people with severe mental illness for eMental health interventions: a qualitative multi-method approach.
Schouten, S. E., Kip, H., Dekkers, T., Deenik, J., Beerlage-de Jong, N., Ludden, G. D. S., & Kelders, S. M. (2022) · Design for Health · doi:10.1080/24735132.2022.2145814 · Cited by 37 · see citing works
“However, despite high levels of acceptability and evidence, the use of eMH in practice falls behind expectations with regard to uptake (Vis et al. 2018; Schreiweis et al. 2019).”
Background
Middle-aged and older adults’ acceptance of mobile nutrition and fitness apps: A systematic mixed studies review
Baer, N.-R., Vietzke, J., & Schenk, L. (2022) · PLoS ONE · doi:10.1371/journal.pone.0278879 · Cited by 35 · see citing works
Transformative synergy: SSEHCET—bridging mobile edge computing and AI for enhanced eHealth security and efficiency
Humayun, M., Alsirhani, A., Alserhani, F., Shaheen, M., & Alwakid, G. N. (2024) · Journal of Cloud Computing Advances Systems and Applications · doi:10.1186/s13677-024-00602-2 · Cited by 39 · see citing works
Access to digital health technologies: personalized framework and global perspectives
Narayan, S. M., Chung, M. K., Adedinsewo, D. A., Brant, L. C. C., Davis, L. L., Duncker, D., Hall, J. L., Han, J. K., Lam, C. S. P., Lewis, E. F., et al. (2025) · Nature Reviews Cardiology · doi:10.1038/s41569-025-01184-5 · Cited by 41 · see citing works
The NASSS (Non-Adoption, Abandonment, Scale-Up, Spread and Sustainability) framework use over time: A scoping review
Shin, H. D., Hamovitch, E., Gatov, E., MacKinnon, M., Samawi, L., Boateng, R., Thorpe, K. E., & Barwick, M. (2025) · PLOS Digital Health · doi:10.1371/journal.pdig.0000418 · Cited by 40 · see citing works
“Moreover, current evidence indicates a prevalent pattern of non-adoption and abandonment of healthcare technology innovations by their intended users, with limited success in integrating these innovations into regular practice or expanding their implementation to different contexts [6].”
Interaction Empowerment in Mobile Health: Concepts, Challenges, and Perspectives
Hamberger, M., Ikonomi, N., Schwab, J. D., Werle, S. D., Fürstberger, A., Kestler, A. M. R., Holderried, M., Kaisers, U. X., Steger, F., & Kestler, H. A. (2022) · JMIR mhealth and uhealth · doi:10.2196/32696 · Cited by 33 · see citing works
“Boxes with solid borders represent barriers mentioned by Schreiweis et al [31].”
BackgroundInfluential
Measuring the Digital Skills of Catalan Health Care Professionals as a Key Step Toward a Strategic Training Plan: Digital Competence Test Validation Study
Reixach, E., Andrés, E., Ribes, J. S., Gea‐Sánchez, M., López, A. À., Cruañas, B., Abad, A. G., Homedes, R. F., Catasús, M. G., Fontanillas, T. R., et al. (2022) · Journal of Medical Internet Research · doi:10.2196/38347 · Cited by 34 · see citing works
“…culture and developing professionals’ digital skills or competences to support digital transformation in the health care sector is fundamental to achieving this objective [6], because poor digital health competence is a common perceived barrier to the implementation of eHealth services [7-11].”
Background
Fostering Appropriate Antibiotic Use in a Complex Intervention: Mixed-Methods Process Evaluation Alongside the Cluster-Randomized Trial ARena
Poß-Doering, R., Kühn, L., Kamradt, M., Stürmlinger, A., Glassen, K., Andres, E., Kaufmann-Kolle, P., Wambach, V., Bader, L., Szécsényi, J., et al. (2020) · Antibiotics · doi:10.3390/antibiotics9120878 · Cited by 33 · see citing works
“Further determinants inhibiting a successful integration of tablet devices were also identified by recent research and comprised poor digital health literacy, added workload, lack of motivation and a miss-fit to organizational structures [37].”
Background
Health Care Providers’ Acceptance of a Personal Health Record: Cross-sectional Study
Yousef, C. C., Salgado, T. M., Farooq, A., Burnett, K., McClelland, L. E., Esba, L. C. A., Alhamdan, H. S., Khoshhal, S., Aldossary, I., Alyas, O. A., et al. (2021) · Journal of Medical Internet Research · doi:10.2196/31582 · Cited by 33 · see citing works
eHealth and mHealth in Chronic Diseases—Identification of Barriers, Existing Solutions, and Promoters Based on a Survey of EU Stakeholders Involved in Regions4PerMed (H2020)
Stefanicka-Wojtas, D., & Kurpas, D. (2022) · Journal of Personalized Medicine · doi:10.3390/jpm12030467 · Cited by 32 · see citing works
Factors Associated With Digital Intervention Engagement and Adherence in Patients With Cancer: Systematic Review
Montalescot, L., Baussard, L., & Charbonnier, É. (2024) · Journal of Medical Internet Research · doi:10.2196/52542 · Cited by 33 · see citing works
“However, several studies have reported difficulties in the implementation of digital interventions, several of them being related to patients’ engagement and adherence [15].”
Are Older Adults Special in Adopting Public eHealth Service Initiatives? The Modified Model of UTAUT
Lu, C.-C., & Tsai-Lin, T.-F. (2024) · SAGE Open · doi:10.1177/21582440241228639 · Cited by 29 · see citing works
“Schreiweis et al. (2019) conducted a systematic literature analysis on the barriers and success factors of adopting eHealth services.”
Views of Implementers and Nonimplementers of Internet-Administered Cognitive Behavioral Therapy for Depression and Anxiety: Survey of Primary Care Decision Makers in Sweden
Brantnell, A., Woodford, J., Baraldi, E., van Achterberg, T., & von Essén, L. (2020) · Journal of Medical Internet Research · doi:10.2196/18033 · Cited by 27 · see citing works
“This factor is identified as central in existing ICBT implementation research [34] and in research concerning implementation of eHealth [45,71].”
Background
Clarifying responsibility: professional digital health in the doctor-patient relationship, recommendations for physicians based on a multi-stakeholder dialogue in the Netherlands
Silven, A. V., van Peet, P. G., Boers, S. N., Tabak, M., de Groot, A., Hendriks, D., van Os, H. J. A., Bonten, T. N., Atsma, D. E., de Graaf, et al. (2022) · BMC Health Services Research · doi:10.1186/s12913-021-07316-0 · Cited by 28 · see citing works
Perceived barriers and facilitators of structural reimbursement for remote patient monitoring, an exploratory qualitative study
Rakers, M. M., van Os, H. J. A., Recourt, K., Mosis, G., Chavannes, N. H., & Struijs, J. N. (2022) · Health Policy and Technology · doi:10.1016/j.hlpt.2022.100718 · Cited by 28 · see citing works
The relationship between e-health literacy and information technology acceptance, and the willingness to share personal and health information among pregnant women
Rahdar, S., Montazeri, M., Mirzaee, M., & Ahmadian, L. (2023) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2023.105203 · Cited by 28 · see citing works
Acceptance of e-mental health services for different application purposes among psychotherapists in clinical training in Germany and Switzerland: secondary analysis of a cross-sectional survey
Braun, P., Drüge, M., Hennemann, S., Nitsch, F. J., Staeck, R., & Apolinário-Hagen, J. (2022) · Frontiers in Digital Health · doi:10.3389/fdgth.2022.840869 · Cited by 27 · see citing works
“, data security and privacy), lack of clear ethical guidelines and concerns about relational aspects (20, 37, 41, 42).”
Background
An artificial intelligence-based approach for identifying rare disease patients using retrospective electronic health records applied for Pompe disease
Lin, S. M., Nateqi, J., Weingartner-Ortner, R., Gruarin, S., Marling, H., Pilgram, V., Lagler, F. B., Aigner, E. S., & Martin, A. G. (2023) · Frontiers in Neurology · doi:10.3389/fneur.2023.1108222 · Cited by 27 · see citing works
Implementation science perspectives on implementing telemedicine interventions for hypertension or diabetes management: scoping review
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
“Very little information was reported within the outer setting, inner setting, and process domains [82-84].”
Development, evaluation and implementation of a digital behavioural health treatment for chronic pain: study protocol of the multiphase DAHLIA project
Bartels, S. L., Johnsson, S. I., Boersma, K., Flink, I., McCracken, L. M., Petersson, S., Christie, H. L., Feldman, I., Simons, L. E., Onghena, P., et al. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-059152 · Cited by 23 · see citing works
“24 To avoid research waste when creating new eHealth solutions, a strong user-centred design and focus on implementation is suggested.”
Patient and healthcare professional eHealth literacy and needs for systemic sclerosis support: a mixed methods study
Kocher, A., Simon, M., Dwyer, A. A., Blatter, C., Bogdanović, J., Künzler‐Heule, P., Villiger, P. M., Dan, D., Distler, O., Walker, U. A., et al. (2021) · RMD Open · doi:10.1136/rmdopen-2021-001783 · Cited by 26 · see citing works
Teleconsultation adoption since COVID-19: Comparison of barriers and facilitators in primary care settings in Hong Kong and the Netherlands
Coves, A. F., Yeung, K. H. T., van der Putten, I. M., & Nelson, E. A. S. (2022) · Health Policy · doi:10.1016/j.healthpol.2022.07.012 · Cited by 26 · see citing works
Information and communication technology-based interventions for suicide prevention implemented in clinical settings: a scoping review
Shin, H. D., Durocher, K., Sequeira, L., Zaheer, J., Torous, J. B., & Strudwick, G. (2023) · BMC Health Services Research · doi:10.1186/s12913-023-09254-5 · Cited by 28 · see citing works
eHealth in Geriatric Rehabilitation: An International Survey of the Experiences and Needs of Healthcare Professionals
Kraaijkamp, J. J. M., Persoon, A., Aurelian, S. M., Bachmann, S., Cameron, I. D., Choukou, M.-A., Dockery, F., Eruslanova, K. A., Gordon, A. L., Grund, S., et al. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12134504 · Cited by 26 · see citing works
“However, these studies also noted that barriers are dynamic and likely to change over time [30].”
BackgroundResultInfluential
Digital Twins and Automation of Care in the Intensive Care Unit
Chase, J. G., Zhou, C., Knopp, J. L., Möeller, K., Benyó, B. I., Desaive, T., Wong, J. H. K., Malinen, S. K., Näswall, K., Shaw, G. M., et al. (2023) · Wiley eBooks · doi:10.1002/9781119857433.ch17 · Cited by 25 · see citing works
Telehealth in rheumatology: the 2021 Arab League of Rheumatology Best Practice Guidelines
Ziadé, N., Hmamouchi, I., Kibbi, L. E., Daou, M., Abdulateef, N., Abutiban, F., Elzorkany, B. K., Dahou-Makhloufi, C., Hamdi, W., Emadi, S. A., et al. (2022) · Rheumatology International · doi:10.1007/s00296-021-05078-w · Cited by 25 · see citing works
“Adapted from the American Telemedicine Association’s definition of “telemedicine” [4, 12, 13] the definition of a teleconsultation was established specifically for these guidelines as: “A rheumatology teleconsultation is a synchronous exchange of medical information between a patient and a rheumatologist via audio or…”
Background
Barriers and Facilitators to the Implementation of Digital Health Services for People With Musculoskeletal Conditions in the Primary Health Care Setting: Systematic Review
van Tilburg, M. L., Spin, I., Pisters, M. F., Staal, J. B., Ostelo, R., van der Velde, M., Veenhof, C., & Kloek, C. J. J. (2024) · Journal of Medical Internet Research · doi:10.2196/49868 · Cited by 24 · see citing works
“The results of this study are consistent with findings in other settings or the general health care setting [70].”
A systematic review of economic evaluations of web‐based or telephone‐delivered interventions for preventing overweight and obesity and/or improving obesity‐related behaviors
Brown, V., Tran, H. N. Q., Downing, K. L., Hesketh, K. D., & Moodie, M. (2021) · Obesity Reviews · doi:10.1111/obr.13227 · Cited by 23 · see citing works
Determinants of the implementation of artificial intelligence-based screening for diabetic retinopathy—a cross-sectional study with general practitioners in Germany
Wewetzer, L., Held, L. A., Goetz, K., & Steinhäuser, J. (2023) · DIGITAL HEALTH · doi:10.1177/20552076231176644 · Cited by 23 · see citing works
“Therefore, the identification of facilitating factors and barriers related to AI devices in the PC field is an important element of implementation science.(19) Exploring the needs and requirements of future users is the basis for transferring the best available evidence into everyday clinical practice.”
Background
Applying Digital Information Delivery to Convert Habits of Antibiotic Use in Primary Care in Germany: Mixed-Methods Study
Poß-Doering, R., Kühn, L., Kamradt, M., Glassen, K., & Wensing, M. (2020) · Journal of Medical Internet Research · doi:10.2196/18200 · Cited by 24 · see citing works
“Schreiweis et al [49] conducted a systematic review in which they aimed to identify barriers to and facilitators of the implementation of e-health devices.”
Background
An exploratory study comparing the quality of contraceptive counseling provided via telemedicine versus in-person visits
Shin, R. J., Yao, M., Akesson, C., Blazel, M., Mei, L., & Brant, A. R. (2022) · Contraception · doi:10.1016/j.contraception.2022.02.004 · Cited by 21 · see citing works
Telerehabilitation Delivery in Canada and the Netherlands: Results of a Survey Study
Giesbrecht, E., Major, M. E., Fricke, M., Wener, P. F., van Egmond, M. A., Aarden, J. J., Brown, C. L., Pol, M., & van der Schaaf, M. (2023) · JMIR Rehabilitation and Assistive Technologies · doi:10.2196/45448 · Cited by 21 · see citing works
“Accessibility is affected by factors at the service provider level, such as comfort or competence with eHealth delivery or the availability and systemic support of eHealth apps, or at the service recipient level, such as access to technology and internet and the applicability of eHealth apps for users with impaired he…”
Background
Development and Evaluation of eHealth Services Regarding Accessibility: Scoping Literature Review
Jonsson, M., Johansson, S., Hussain, D. A., Gulliksen, J., & Gustavsson, C. (2023) · Journal of Medical Internet Research · doi:10.2196/45118 · Cited by 27 · see citing works
“Despite standards and guidelines to improve digital accessibility and legislation to regulate the use of these guidelines, eHealth services are still perceived as inaccessible by users [15,22].”
Background
Digitalization in the Russian healthcare: barriers to digital maturity
GRIGORIEVA, N. S., Демкина, А. Е., & Николаевна, К. А. (2024) · Population and Economics · doi:10.3897/popecon.8.e111793 · Cited by 21 · see citing works
“The project used DigCompSAT questionnaire developed by the Joint Research Center (JRC) of the European Commission (EU) of the Science and Knowledge Service for self-testing, and the integrated digital literacy index was calculated on its basis (Clifford et al. 2020).”
BackgroundInfluential
Characterizing Behaviors That Influence the Implementation of Digital-Based Interventions in Health Care: Systematic Review
Patel, S. B., Iqbal, F. M., Lam, K., Acharya, A., Ashrafian, H., & Darzi, A. W. (2025) · Journal of Medical Internet Research · doi:10.2196/56711 · Cited by 26 · see citing works
“Cognitive burdens are a recognized barrier to the implementation of digital health interventions [31], specifically regarding situational awareness and decision-making impairment [32].”
A Digital Patient-Provider Communication Intervention (InvolveMe): Qualitative Study on the Implementation Preparation Based on Identified Facilitators and Barriers
Seljelid, B., Varsi, C., Nes, L. S., Øystese, K. A., & Børøsund, E. (2021) · Journal of Medical Internet Research · doi:10.2196/22399 · Cited by 18 · see citing works
“Concerns about increased workload are a well-known barrier to the implementation of eHealth interventions [28,50].”
Influential
Barriers to eHealth adoption in routine antenatal care practices: Perspectives of expectant mothers in Uganda – A qualitative study using the unified theory of acceptance and use of technology model
Namatovu, H. K., Oyana, T. J., & Sol, H. G. (2021) · Digital Health · doi:10.1177/20552076211064406 · Cited by 20 · see citing works
“This is evidence that mothers cannot use digital technologies as may be reported in other studies.(79,80,83) There is a strong correlation between digital literacy and technology use,(84) hence, for one to competently use digital technologies, they must have attained a certain level of education and ICT skills.”
BackgroundMethodResultInfluential
User satisfaction and the readiness-to-use e-health applications in the future in Polish society in the early phase of the COVID-19 pandemic: A cross-sectional study
Duplaga, M., & Turosz, N. (2022) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2022.104904 · Cited by 20 · see citing works
“, limited exposure and knowledge of e-health, including poor eHL, were most frequently mentioned in the literature as barriers to the use of e-health [34].”
Background
Barriers and facilitators for the adoption of telemedicine services in low-income and middle-income countries: a rapid overview of reviews
Dhyani, V. S., Krishnan, J. B., Mathias, E. G., Hossain, M. M., Price, C. L., Gudi, N., Pattanshetty, S. M., & ZODPEY, S. P. (2023) · BMJ Innovations · doi:10.1136/bmjinnov-2022-001062 · Cited by 21 · see citing works
Digital health interventions in dermatology—Mapping technology and study parameters of systematically identified publications
Reinders, P., Augustin, M., Kirsten, N., Fleyder, A., & Otten, M. (2023) · Journal of the European Academy of Dermatology and Venereology · doi:10.1111/jdv.19392 · Cited by 19 · see citing works
“41– 43 Efficiency, including cost and time efficiency, are a key promise of DHIs 4 and will affect decision-making for adoption on an individual HCP level as well as the healthcare system level.”
Background
Using an Activity Tracker in Healthcare: Experiences of Healthcare Professionals and Patients
Ummels, D., Beekman, E., Braun, S., & Beurskens, A. J. H. M. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18105147 · Cited by 18 · see citing works
“Implementation in clinical reasoning [28,36,37,39,44,46,50,63]”
Influential
“Get Used to the Fact That Some of the Care Is Really Going to Take Place in a Different Way”: General Practitioners’ Experiences with E-Health during the COVID-19 Pandemic
Meurs, M., Keuper, J., Sankatsing, V. D. V., Batenburg, R. S., & van Tuyl, L. H. D. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19095120 · Cited by 18 · see citing works
“However, the implementation of innovations such as e-health technology requires time, effort, and skills from health care professionals [15,16].”
Background
Context-specific adaptation of an eHealth-facilitated, integrated care model and tailoring its implementation strategies—A mixed-methods study as a part of the SMILe implementation science project
Valenta, S., Ribaut, J., Leppla, L., Mielke, J., Teynor, A., Koehly, K., Gerull, S., Grossmann, F. F., Witzig-Brändli, V., Geest, S. D., et al. (2023) · Frontiers in Health Services · doi:10.3389/frhs.2022.977564 · Cited by 24 · see citing works
Facilitators and Barriers to the Sustainability of eHealth Solutions in Low- and Middle-Income Countries: Descriptive Exploratory Study
Mamuye, A. L., Nigatu, A. M., Chanyalew, M. A., Amor, L. B., Loukil, S., Moyo, C., Quarshie, S., Antypas, K., & Tilahun, B. C. (2023) · JMIR Formative Research · doi:10.2196/41487 · Cited by 21 · see citing works
“The economy can also be related to the infrastructure problems that LMCIs face when trying to avail adequate infrastructure specifically for eHealth solutions sustainability and scale-up [17,27].”
Background
A Multiple Stakeholder Perspective on the Drivers and Barriers for the Implementation of Lifestyle Monitoring Using Infrared Sensors to Record Movements for Vulnerable Older Adults Living Alone at Home: A Qualitative Study
Braspenning, A. M., Cranen, K., Snaphaan, L. J. A. E., & Wouters, E. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19010570 · Cited by 18 · see citing works
“What is lacking in the literature is sufficient theory-driven knowledge to introduce assistive technologies, which aim to facilitate successful implementation [18].”
Background
Co-creation of mHealth intervention for older adults with hip fracture and family caregivers: a qualitative study
Ariza‐Vega, P., Prieto‐Moreno, R., Mora‐Traverso, M., Molina‐García, P., Ashe, M. C., & Martín‐Matillas, M. (2022) · Disability and Rehabilitation Assistive Technology · doi:10.1080/17483107.2022.2138999 · Cited by 18 · see citing works
“Including all above suggestions, is a way of supporting mHealth adoption and maintained use by stakeholders [47–49], which is one of the biggest barriers to face in this kind of intervention [50].”
Background
Efficacy of self-management mobile applications for patients with breathlessness: Systematic review and quality assessment of publicly available applications
Sunjaya, A. P., Sengupta, A., Martin, A., Tanna, G. L. D., & Jenkins, C. R. (2022) · Respiratory Medicine · doi:10.1016/j.rmed.2022.106947 · Cited by 18 · see citing works
Factors Influencing Telemedicine Adoption Among Health Care Professionals: Qualitative Interview Study
Schürmann, F., Westmattelmann, D., & Schewe, G. (2025) · JMIR Formative Research · doi:10.2196/54777 · Cited by 24 · see citing works
“Nowadays, telemedicine can provide a wide range of services, which is attributed to the continuous evolution of innovations [3].”
Opt-out rates and reasons for non-participation in a single-arm feasibility trial (ENGAGE) of a guided internet-administered CBT-based intervention for parents of children treated for cancer: a nested cross-sectional survey
Hagström, J., Woodford, J., von Essen, A., Lähteenmäki, P. M., & von Essén, L. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-056758 · Cited by 17 · see citing works
Exploring the added value of virtual reality biofeedback game DEEP in forensic psychiatric inpatient care—A qualitative study
Haneveld, L. K., Kip, H., Bouman, Y. H. A., Weerdmeester, J., Scholten, H., & Kelders, S. M. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1201485 · Cited by 14 · see citing works
Piloting an innovative concept of e–mental health and mHealth workshops with medical students using a participatory co-design approach and app prototyping: case study
Dederichs, M., Nitsch, F. J., & Apolinário-Hagen, J. (2022) · JMIR Medical Education · doi:10.2196/32017 · Cited by 16 · see citing works
“This finding fits into the international literature, where data protection concerns have been identified as a key barrier for the adoption of eHealth across various target groups [42].”
Consumer adoption of digital health services: A systematic literature review and research agenda
Goel, A., Singh, A., Taneja, U., & Jain, S. (2024) · International Journal of Consumer Studies · doi:10.1111/ijcs.13070 · Cited by 16 · see citing works
Psychological eHealth Interventions for Patients With Cardiovascular Diseases: Systematic Review and Meta-Analysis
Su, J. J., Lin, R. S. Y., Baťalík, L., Wong, A. K. C., & Grace, S. L. (2025) · Journal of Medical Internet Research · doi:10.2196/57368 · Cited by 17 · see citing works
“…to effectively track progress and prevent relapse. eHealth interventions facilitate real-time support from health care professionals, assisting in patients’active engagement [21], overcoming geographical barriers [22], and promptly identifying nonadherence and subsequently addressing it [23].”
Factors Associated With the Acceptance of an eHealth App for Electronic Health Record Sharing System: Population-Based Study
Huang, J., Pang, W. S., Wong, Y. Y., Mak, F. Y., Chan, F. S. W., Cheung, C. S. K., Wong, W. N., Cheung, N. T., & Wong, M. C. S. (2022) · Journal of Medical Internet Research · doi:10.2196/40370 · Cited by 16 · see citing works
“Among the eHealth app users in different studies, ease of use, user-friendliness, and availability of resources were the success factors facilitating the use of the app [20].”
Requirements for home-based upper extremity rehabilitation using wearable motion sensors for stroke patients: a user-centred approach
Langerak, A. J., Regterschot, G. R. H., Selles, R. W., Meskers, C. G. M., Evers, M., Ribbers, G. M., van Beijnum, B.-J. F., & Bussmann, J. B. J. (2023) · Disability and Rehabilitation Assistive Technology · doi:10.1080/17483107.2023.2183993 · Cited by 16 · see citing works
“Could-haves 29 Exercise delivery The system allows intervention adaptation to patient-specific needs and goals based on the patient’s previous performance during a session.”
Background
Adoption of technological innovation in healthcare delivery: a psychological perspective for healthcare decision-makers
Wong, J. H. K., Näswall, K., Pawsey, F., Chase, J. G., & Malinen, S. K. (2023) · BMJ Innovations · doi:10.1136/bmjinnov-2022-001003 · Cited by 26 · see citing works
The Effect of Innovation Capabilities of Health Care Organizations on the Quality of Health Information Technology: Model Development With Cross-sectional Data
Esdar, M., Hübner, U., Thye, J., Babitsch, B., & Liebe, J.-D. (2021) · JMIR Medical Informatics · doi:10.2196/23306 · Cited by 17 · see citing works
“Although a wide range of general facilitating factors of successful HIT adoption have been acknowledged in several theoretical frameworks [19-24] and various systematic literature reviews [3,12,25-28], little is known about the exact constituents of capabilities of health care organizations to innovate in particular a…”
Background
Barriers and Facilitators Associated With App-Based Treatment for Female Urinary Incontinence: Mixed Methods Evaluation
Wessels, N. J., Loohuis, A. M. M., van der Worp, H., Abbenhuis, L., Dekker, J. H., Berger, M. Y., van Gemert‐Pijnen, J. E. W. C., & Blanker, M. H. (2021) · JMIR mhealth and uhealth · doi:10.2196/25878 · Cited by 15 · see citing works
“Although implementation must now proceed for us to realize these benefits for patients and caregivers, successful uptake of the app requires that we identify and address the barriers and facilitators associated with this treatment modality [4].”
Background
Adoption, implementation, and sustainability of early childhood feeding, nutrition and active play interventions in real-world settings: a systematic review
Gelman, R., Whelan, J., Spiteri, S., Duric, D., Oakhill, W., Cassar, S., & Love, P. (2023) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-023-01433-1 · Cited by 17 · see citing works
From Theory to Implementation in Practice: A Qualitative Case Study of the Implementation of Virtual Reality in Mental Healthcare
Kip, H., Buitelaar-Huijsse, G. K. G., Kouijzer, M. M. T. E., & Kelders, S. M. (2023) · Global Implementation Research and Applications · doi:10.1007/s43477-023-00101-7 · Cited by 13 · see citing works
“The importance of these practical boundary conditions is in line with findings from other implementation research on technology in healthcare (Feijt et al., 2018; Kip et al., 2020a, 2020b; Schreiweis et al., 2019; Titzler et al., 2018; Vis et al., 2018).”
Acceptability and Usability of a Digital Platform Promoting Mental Health at Work: A Qualitative Evaluation
Angelis, M. D., Volpi, L., Giusino, D., Pietrantoni, L., & Fraboni, F. (2024) · International Journal of Human-Computer Interaction · doi:10.1080/10447318.2024.2313892 · Cited by 18 · see citing works
“In this sense, experts have stressed the need for designing highly effective, easy-to-use, engaging, and trust-worthy tools to fully benefit from the results of digital mental health solutions (Carolan et al., 2017; Roland et al., 2020; Schreiweis et al., 2019).”
Enhancing digital health awareness and mhealth competencies in medical education: proof-of-concept study and summative process evaluation of a quality improvement project
Sahan, F., Guthardt, L., Panitz, K., Siegel-Kianer, A., Eichhof, I., Schmitt, B. D., & Apolinario-Hagen, J. (2024) · JMIR Medical Education · doi:10.2196/59454 · Cited by 14 · see citing works
“As data security concerns are one of the main barriers to the acceptance and broad implementation of mobile health apps, addressing these issues in the process of the app’s development is essential [42].”
Background
Consumer perspectives on the national electronic health record and barriers to its adoption in Germany: does health policy require a change in communication?
Kröner, S., Schreiweis, B., Strotbaum, V., Brandl, L. C., Pobiruchin, M., & Wiesner, M. (2025) · BMC Health Services Research · doi:10.1186/s12913-024-12175-6 · Cited by 14 · see citing works
“Topics included concerns about data protection and security, as this is a crucial factor for adoption, according to the literature [14].”
Self-citation
Detecting and Treating Psychosocial and Lifestyle-Related Difficulties in Chronic Disease: Development and Treatment Protocol of the E-GOAL eHealth Care Pathway
Cardol, C. K., Tommel, J., van Middendorp, H., Ciere, Y., Sont, J. K., Evers, A. W. M., & van Dijk, S. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18063292 · Cited by 14 · see citing works
“At the same time, some vulnerable populations may be disadvantaged by eHealth: Patients do need access to digital devices as well as general skills on a computer and Internet use [45], and it has been found that, for instance, people who were unemployed or with low education benefited less from web-based interventions…”
Background
Impact of COVID-19 lockdown on patient-provider electronic communications
Hansen, M. A., Chen, R., Hirth, J. M., Langabeer, J. R., & Zoorob, R. (2023) · Journal of Telemedicine and Telecare · doi:10.1177/1357633x221146810 · Cited by 14 · see citing works
“42 Electronic messaging maintained a stable rate of occurrence during the pre-lockdown period.”
A Practice-Proven Adaptive Case Management Approach for Innovative Health Care Services (Health Circuit): Cluster Randomized Clinical Pilot and Descriptive Observational Study
Herranz, C., Banegas, L. M.-M., Muzzio, F. D., Sisó‐Almirall, A., Roca, J., & Cano, I. (2023) · Journal of Medical Internet Research · doi:10.2196/47672 · Cited by 14 · see citing works
“Because knowledge-based work is data-intensive, the ACM approach can foster more informed decisions and customize business processes as necessary [3,4].”
Investigating information needs and preferences regarding digital mental health services among medical and psychology students in Germany: A qualitative study
Braun, P., Schwientek, A.-K., Angerer, P., Guthardt, L., Icks, A., Loerbroks, A., & Apolinário-Hagen, J. (2023) · Digital Health · doi:10.1177/20552076231173568 · Cited by 13 · see citing works
“Through AFIs in the form of recipient-targeted information strategies on dMHSs, barriers such as low digital health literacy, information overload or concerns about the efficacy and safety of dMHSs could be overcome.(37) Our results are specifically helpful for, for example, student services centers as they give recom…”
Background
Developing a model to explain users' ethical perceptions regarding the use of care robots in home care: A cross-sectional study in Ireland, Finland, and Japan
Ide, H., Suwa, S., Akuta, Y., Kodate, N., Tsujimura, M., Ishimaru, M., Shimamura, A., Kitinoja, H., Donnelly, S., Hallila, J., et al. (2023) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2023.105137 · Cited by 13 · see citing works
Preparing for the future of healthcare: Digital health literacy among medical students in Lahore, Pakistan
Imran, N., Farooq, Z., & Imran, A. (2023) · Pakistan Journal of Medical Sciences · doi:10.12669/pjms.40.1.8711 · Cited by 13 · see citing works
Feasibility of a Digital Patient–Provider Communication Intervention to Support Shared Decision-Making in Chronic Health Care, InvolveMe: Pilot Study
Seljelid, B., Varsi, C., Nes, L. S., Øystese, K. A., & Børøsund, E. (2022) · JMIR Formative Research · doi:10.2196/34738 · Cited by 13 · see citing works
“Use of standards for provision of eHealth systems has been recognized as a key factor for successful implementation [31,32], and the importance of developing new software features and systems according to established standards are clearly emphasized through this feasibility pilot study.”
BackgroundMethodInfluential
Barriers and facilitators to the integration of digital technologies in mental health systems: A protocol for a qualitative systematic review
Berardi, C., Hinwood, M., Smith, A., Melia, A., & Paolucci, F. (2021) · PLoS ONE · doi:10.1371/journal.pone.0259995 · Cited by 11 · see citing works
Advancing Telemedicine Within Family Medicine's Core Values
Cheng, A., Guzmán, C. E. V., Duffield, T. C., & Hofkamp, H. (2020) · Telemedicine Journal and e-Health · doi:10.1089/tmj.2020.0282 · Cited by 12 · see citing works

Understanding the implementation and integration of e-health services
Mair, F., May, C., Finch, T., Murray, E., Anderson, G. K., Sullivan, F., O'Donnell, C., Wallace, P., & Epstein, O. (2007) · Journal of Telemedicine and Telecare · doi:10.1258/135763307781645112 · Cited by 105 · see citing works
Factors Influencing the Successful Implementation of eHealth in Healthcare Facilities in Developing Countries: A Scoping Review
Adong, G., Odoyo, C. O., & Ondulo, J. M. (2024) · Journal of Science Innovation and Creativity · doi:10.58721/jsic.v3i2.731 · Cited by 1 · see citing works
Enablers and Challenges for E-Health Services
Kumari, R., Singh, A. K., Verma, R., & Fetais, A. H. M. A. (2022) · International Journal of Electronic Government Research · doi:10.4018/ijegr.298626 · Cited by 6 · see citing works
Exploring the challenges of implementing e-health: a protocol for an update of a systematic review of reviews
Ross, J., Stevenson, F., Lau, R., & Murray, E. (2015) · BMJ Open · doi:10.1136/bmjopen-2014-006773 · Cited by 64 · see citing works
Barriers and facilitators of developing and implementing eHealth applications: a questionnaire study with eHealth professionals
Metting, E., Verhallen, L., & de Jong, C. (2019) · doi:10.1183/13993003.congress-2019.pa2239

Authors: Schreiweis, B., Pobiruchin, M., Strotbaum, V., Suleder, J., Wiesner, M., & Bergh, B.
Affiliations: Christian-Albrechts-Universität zu Kiel (DE)
Heilbronn University (DE)
Corresponding author: Schreiweis, Björn
ORCID: Schreiweis, Björn
Pobiruchin, Monika
Strotbaum, Veronika
Suleder, Julian
Wiesner, Martin
Bergh, Björn
Venue: Journal of Medical Internet Research
Publisher: JMIR Publications Inc.
Published: 2019-11-22
Volume: 21
Issue: 11
Pages: e14197
ISSN: 1438-8871 (ISSN-L)
DOI: 10.2196/14197
PMC: PMC6898891
OpenAlex: W2970062122
Cited by: 354
References: 54
Citations by year: 2026: 31 · 2025: 56 · 2024: 66 · 2023: 76 · 2022: 51 · 2021: 49 · 2020: 25
FWCI: 5.88
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
Locations: Journal of Medical Internet Research (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
Topics: Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Keywords: e-health services, implementation barriers, implementation facilitators, technology adoption, health informatics, expert consensus, implementation planning
MeSH terms: Data Collection, Humans, Telemedicine

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Barriers and facilitators to the implementation of eHealth services: systematic literature analysis

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