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Cited by 114Health Policy Implementation ScienceElectronic Health Records SystemsTelemedicine and Telehealth Implementation

Theories Informing eHealth Implementation: Systematic Review and Typology Classification

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Heinsch, Milena, Wyllie, Jessica, Carlson, Jamie, Wells, Hannah, Tickner, Campbell, Kay-Lambkin, Frances·2021·Journal of Medical Internet Research
DOI 10.2196/18500PMC PMC8204232

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Abstract

Background: Theory-guided approaches to implementation science have informed translation efforts and the acceptance of eHealth (digital health) interventions in clinical care. However, there is scarce evidence on which theories are best suited to addressing the inherent complexity of eHealth implementation. Objective: The objectives of this systematic review are to identify theories that inform and explain eHealth implementation and to classify these theories using the typology by Sovacool and Hess for theories of sociotechnical change. Methods: An electronic search was conducted in the PsycINFO, MEDLINE, Embase, CINAHL, Scopus, Sociological Source Ultimate, Web of Science, ABI/INFORM, EBSCO, and ProQuest databases in June 2019. Studies were included if they were published between 2009 and June 2019; were written in English; reported on empirical research, regardless of study or publication type; reported on one or more theories in the context of eHealth implementation; and were published in a peer-reviewed journal. A total of 2 reviewers independently assessed the titles, abstracts, and full texts. Theories identified were classified using a typology for theories of sociotechnical change, which was considered a useful tool for ordering and analyzing the diverse theoretical approaches as a basis for future theory building. Results: Of the 13,101 potentially relevant titles, 119 studies were included. The review identified 36 theories used to explain implementation approaches in eHealth. The most commonly used approaches were the Technology Acceptance Model (TAM) (n=33) and the Unified Theory of Acceptance and Use of Technology (UTAUT) (n=32). These theories were primarily concerned with individual and interpersonal elements of eHealth acceptance. Less common were theories that reflect the various disorderly social processes and structural dimensions of implementation, such as the normalization process theory (n=17) and the structuration theory (n=6). Conclusions: Theories currently informing the implementation of eHealth interventions predominantly focus on predicting or explaining end-user acceptance. Theoretical perspectives that capture the dense and intricate relationships and structures required to enact sustainable change are less well represented in the eHealth literature. Given the growing acknowledgment of the inherent complexity of eHealth implementation, future research should develop and test models that recognize and reflect the multidimensional, dynamic, and relational nature of this process.

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Authors
Heinsch, M., Wyllie, J., Carlson, J., Wells, H., Tickner, C., & Kay-Lambkin, F.
Affiliations
University of Newcastle Australia (AU)
Corresponding author
Heinsch, Milena
ORCID
Venue
Journal of Medical Internet Research
Publisher
JMIR Publications Inc.
Published
2021-05-31
Volume
23
Issue
5
Pages
e18500
ISSN
1438-8871 (ISSN-L)
DOI
10.2196/18500
PMC
PMC8204232
OpenAlex
W3156164281
Cited by
114
References
101
Citations by year
2026: 16 · 2025: 22 · 2024: 28 · 2023: 23 · 2022: 23 · 2021: 2
FWCI
3.93
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Journal of Medical Internet Research (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • NOVA (University of Newcastle Australia) (submittedVersion)
Funders
  • Beyond Blue
  • Medical Research Council
  • National Health and Medical Research Council
Topics
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
Keywords
eHealth implementation, implementation theory, socio-technical change, technology acceptance, technology acceptance model, UTAUT, Normalization Process Theory, structuration theory, digital health interventions, end-user acceptance
MeSH terms
Humans, Telemedicine, Text Messaging

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