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Cited by 26Telemedicine and Telehealth ImplementationElectronic Health Records SystemsHealth Policy Implementation Science

Perspectives of Policy Makers and Service Users Concerning the Implementation of eHealth in Sweden: Interview Study

Open access
Neher, Margit, Nygårdh, Annette, Broström, Anders, Lundgren, Johan, Johansson, Peter·2022·Journal of Medical Internet Research
DOI 10.2196/28870PMC PMC8838545

Published version of a preprint

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Abstract

Background: Increasing life spans of populations and a growing demand for more advanced care make effective and cost-efficient provision of health care necessary. eHealth technology is often proposed, although research on barriers to and facilitators of the implementation of eHealth technology is still scarce and fragmented. Objective: The aim of this study is to explore the perceptions concerning barriers to and facilitators of the implementation of eHealth among policy makers and service users and explore the ways in which their perceptions converge and differ. Methods: This study used interview data from policy makers at different levels of health care (n=7) and service users enrolled in eHealth interventions (n=25). The analysis included separate qualitative content analyses for the 2 groups and then a second qualitative content analysis to explore differences and commonalities. Results: Implementation barriers perceived by policy makers were that not all service users benefit from eHealth and that there is uncertainty about the impact of eHealth on the work of health care professionals. Policy makers also perceived political decision-making as complex; this included problems related to provision of technical infrastructure and lack of extra resources for health care digitalization. Facilitators were policy makers’ conviction that eHealth is what citizens want, their belief in eHealth solutions as beneficial for health care practice, and their belief in the importance of health care digitalization. Barriers for service users comprised capability limitations and varied preferences of service users and a mismatch of technology with user needs, lack of data protection, and their perception of eHealth as being more time consuming. Facilitators for service users were eHealth technology design and match with their skill set, personal feedback and staff support, a sense of privacy, a credible sender, and flexible use of time.There were several commonalities between the 2 stakeholder groups. Facilitators for both groups were the strong impetus toward technology adoption in society and expectations of time flexibility. Both groups perceived barriers in the difficulties of tailoring eHealth, and both groups expressed uncertainty about the care burden distribution. There were also differences: policy makers perceived that their decision-making was very complex and that resources for implementation were limited. Service users highlighted their need to feel that their digital data were protected and that they needed to trust the eHealth sender. Conclusions: Perceptions about barriers to and facilitators of eHealth implementation varied among stakeholders in different parts of the health care system. The study points to the need to reach an enhanced mutual understanding of priorities and overcome challenges at both the micro and macro levels of the health care system. More well-balanced decisions at the policy-maker level may lead to more effective and sustainable development and future implementation of eHealth.

AI snapshot

Written from the paper’s full text.

TL;DR

This qualitative interview study explored barriers to and facilitators of eHealth implementation among 7 Swedish policy makers and 25 service users, finding both shared and divergent perceptions. Shared views included societal momentum and time flexibility as facilitators and tailoring difficulties and care-burden uncertainty as barriers, while policy makers emphasized complex decision-making and limited resources and service users emphasized data protection and trust in the sender.

Key findings

  • Policy makers identified 5 barriers and 3 facilitators; service users identified 5 barriers and 6 facilitators.
  • Common facilitators were the strong societal impetus toward technology adoption and expectations of time flexibility; common barriers were difficulties tailoring eHealth and uncertainty about care burden distribution.
  • Differences included policy makers’ perceptions of complex political decision-making, lack of extra resources, and technical infrastructure problems, versus service users’ emphasis on data protection and trust in a credible sender.
  • Policy makers believed eHealth is what citizens want and is beneficial for health care practice; service users valued user-friendly design, skill match, privacy, personal feedback and staff support, flexible time use, and a credible sender.

Methods

  • Qualitative design in 2 steps: interviews with 7 policy makers from 4 county councils in Southeast Sweden and secondary interview data from 25 service users enrolled in eHealth interventions from 3 effectiveness studies (HeaDING, DOHART, and Heart And Insomnia Treatment Through Internet).
  • Policy maker recruitment contacted 23 people; 14 (61%) declined because of full agendas and 2 (9%) did not answer. Policy maker interviews lasted 43-63 minutes; service user interviews lasted 15-100 minutes.
  • Analysis used separate inductive qualitative content analyses for each group, followed by a supplementary comparative qualitative content analysis; NVivo 11 assisted the analysis, with consensus discussions in the wider author group.

Limitations

  • Stated: the study was conducted in prepandemic conditions, so the incentive to use eHealth was not as strong as it later became, and perceptions likely evolved.
  • Stated: service users’ scope may have been limited because interviews focused on their specific eHealth intervention (e-Mental health in cardiac care), though they were more knowledgeable than the general public.
  • Evident from the text: the policy maker sample was small (n=7) with high refusal (14/23 declined), and service users were drawn from cardiac eHealth trials, limiting generalizability beyond these groups.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.2196/28870

Cites

48 of 48 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 17 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Service users perceived flexible use of time as a facilitator.

    “Facilitators for service users were eHealth technology design and match with their skill set, personal feedback and staff support, a sense of privacy, a credible sender, and flexible use of time.”
    • Also stated in: § Results · plain
      “Flexible use of time”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The perceptions of policy makers and service users are relevant to and can inform the implementation of eHealth.
    • Rests on an assumption: The service user data from the three eHealth intervention effectiveness studies are suitable for analyzing general perceptions of factors influencing the implementation of eHealth in clinical care.
    • Rests on an assumption: Qualitative content analysis categories accurately represent participants' perceptions.
  • Findingown data

    Policy makers perceived problems related to the provision of technical infrastructure.

    “Policy makers also perceived political decision-making as complex; this included problems related to provision of technical infrastructure and lack of extra resources for health care digitalization.”
    • Also stated in: § Policy Makers · plain
      “Fear of problems with providing technical infrastructure”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The perceptions of policy makers and service users are relevant to and can inform the implementation of eHealth.
    • Rests on an assumption: Qualitative content analysis categories accurately represent participants' perceptions.
  • Findingown data

    Service users perceived capability limitations.

    “Barriers for service users comprised capability limitations and varied preferences of service users and a mismatch of technology with user needs, lack of data protection, and their perception of eHealth as being more time consuming.”
    • Also stated in: § Service Users · plain
      “Limitations in the capability of the service user”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The perceptions of policy makers and service users are relevant to and can inform the implementation of eHealth.
    • Rests on an assumption: The service user data from the three eHealth intervention effectiveness studies are suitable for analyzing general perceptions of factors influencing the implementation of eHealth in clinical care.
    • Rests on an assumption: Qualitative content analysis categories accurately represent participants' perceptions.
  • Findingown data

    Service users perceived eHealth as being more time consuming.

    “Barriers for service users comprised capability limitations and varied preferences of service users and a mismatch of technology with user needs, lack of data protection, and their perception of eHealth as being more time consuming.”
    • Also stated in: § Service Users · plain
      “eHealth is perceived as time consuming for the service user”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The perceptions of policy makers and service users are relevant to and can inform the implementation of eHealth.
    • Rests on an assumption: The service user data from the three eHealth intervention effectiveness studies are suitable for analyzing general perceptions of factors influencing the implementation of eHealth in clinical care.
    • Rests on an assumption: Qualitative content analysis categories accurately represent participants' perceptions.
  • Findingown data

    Policy makers saw cost-benefit calculations as a key factor for implementation.

    “They perceived that implementation decisions at both the clinical and political levels were influenced by the lack of economical and personal resources, as they saw cost–benefit calculations as a key factor for implementation.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The perceptions of policy makers and service users are relevant to and can inform the implementation of eHealth.
    • Rests on an assumption: Qualitative content analysis categories accurately represent participants' perceptions.
  • May combine two claims. 27
  • Classified as probably not a substantial claim. 35

  • May combine two claims.

    Findingown data

    Some policy makers discussed situations in which eHealth technology would be less beneficial: when professionals meet service users for the first time, when they prescribe psychiatric medication or assess the need for sick-leave, or when they treat the young or those service users with complex problems.

    “Although policy makers expressed very positive views about eHealth technology, some also discussed situations in which eHealth technology would be less beneficial: when professionals meet service users for the first time, when they prescribe psychiatric medication or assess the need for sick-leave, or when they treat the young or those service users with complex problems.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The perceptions of policy makers and service users are relevant to and can inform the implementation of eHealth.
    • Rests on an assumption: Qualitative content analysis categories accurately represent participants' perceptions.

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

    Findingown data

    Building infrastructure was seen by policy makers as a crucial part of their political role, as populations in rural regions need broadband and other facilities to access eHealth programs.

    “In particular, building infrastructure was seen by policy makers as a crucial part of their political role, as populations in rural regions need broadband and other facilities to access eHealth programs.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The perceptions of policy makers and service users are relevant to and can inform the implementation of eHealth.
    • Rests on an assumption: Qualitative content analysis categories accurately represent participants' perceptions.

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

    Findingown data

    Policy makers stressed that facilitating the accessibility to care for service users was an important driver for their work.

    “Policy makers stressed that facilitating the accessibility to care for service users was an important driver for their work.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The perceptions of policy makers and service users are relevant to and can inform the implementation of eHealth.
    • Rests on an assumption: Qualitative content analysis categories accurately represent participants' perceptions.

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

    Findingown data

    Policy makers expressed very positive views about eHealth technology.

    “Although policy makers expressed very positive views about eHealth technology, some also discussed situations in which eHealth technology would be less beneficial: when professionals meet service users for the first time, when they prescribe psychiatric medication or assess the need for sick-leave, or when they treat the young or those service users with complex problems.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The perceptions of policy makers and service users are relevant to and can inform the implementation of eHealth.
    • Rests on an assumption: Qualitative content analysis categories accurately represent participants' perceptions.

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

    Findingown data

    Some policy makers expressed that they saw the necessity to take an active role in politics and fulfill their ambition to push their region to the frontline of health care digitalization and implementation of eHealth.

    “Some policy makers expressed that they saw the necessity to take an active role in politics and fulfill their ambition to push their region to the frontline of health care digitalization and implementation of eHealth.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The perceptions of policy makers and service users are relevant to and can inform the implementation of eHealth.
    • Rests on an assumption: Qualitative content analysis categories accurately represent participants' perceptions.

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

    Findingown data

    Policy makers perceived that staff could experience an uncertainty about the negative consequences of digitalization for their own employment.

    “They perceived that staff could experience an uncertainty about the negative consequences of digitalization for their own employment and thought that staff needed better support for learning about technical solutions in the workplace.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The perceptions of policy makers and service users are relevant to and can inform the implementation of eHealth.
    • Rests on an assumption: Qualitative content analysis categories accurately represent participants' perceptions.

  • May combine two claims.

    Findingown data

    Some service users preferred traditional health care with face-to-face appointments and participation in support groups and therefore perceived eHealth as the second-best alternative.

    “Some service users preferred traditional health care with face-to-face appointments and participation in support groups and therefore perceived eHealth as the second-best alternative.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The perceptions of policy makers and service users are relevant to and can inform the implementation of eHealth.
    • Rests on an assumption: The service user data from the three eHealth intervention effectiveness studies are suitable for analyzing general perceptions of factors influencing the implementation of eHealth in clinical care.
    • Rests on an assumption: Qualitative content analysis categories accurately represent participants' perceptions.

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

    Findingreasoning

    eHealth could lead to administrative effectiveness and better workflow.

    “eHealth could lead to administrative effectiveness and better workflow; as more patients and families (in theory) managed their own health administration, staff could cater to those most in need of personal service.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The perceptions of policy makers and service users are relevant to and can inform the implementation of eHealth.
    • Rests on an assumption: Qualitative content analysis categories accurately represent participants' perceptions.

  • May combine two claims.

    Findingown data

    Service users found that the log-in process was complicated and would have preferred more automated feedback from the platform.

    “They also found that the log-in process was complicated and would have preferred more automated feedback from the platform.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The perceptions of policy makers and service users are relevant to and can inform the implementation of eHealth.
    • Rests on an assumption: The service user data from the three eHealth intervention effectiveness studies are suitable for analyzing general perceptions of factors influencing the implementation of eHealth in clinical care.
    • Rests on an assumption: Qualitative content analysis categories accurately represent participants' perceptions.

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

    Findingown data

    Many policy makers perceived that citizens expect society to provide them with access to internet for professional examinations, treatment, and health monitoring, with the benefits of less traveling.

    “Many perceived that citizens expect society to provide them with access to internet for professional examinations, treatment, and health monitoring, with the benefits of less traveling.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The perceptions of policy makers and service users are relevant to and can inform the implementation of eHealth.
    • Rests on an assumption: Qualitative content analysis categories accurately represent participants' perceptions.

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

    Findingown data

    Policy makers were convinced that eHealth is what citizens want.

    “Facilitators were policy makers’ conviction that eHealth is what citizens want, their belief in eHealth solutions as beneficial for health care practice, and their belief in the importance of health care digitalization.”
    • Also stated in: § Results · plain
      “Policy Makers’ Conviction That eHealth is What Citizens Want”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The perceptions of policy makers and service users are relevant to and can inform the implementation of eHealth.
    • Rests on an assumption: Qualitative content analysis categories accurately represent participants' perceptions.

  • May combine two claims.

    Findingown data

    As contacting health care by telephone was perceived as increasingly difficult, service users felt obligated to use digital solutions, which they described as complicated and time consuming.

    “As this was perceived as increasingly difficult, they felt obligated to use digital solutions, which they described as complicated and time consuming.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The perceptions of policy makers and service users are relevant to and can inform the implementation of eHealth.
    • Rests on an assumption: The service user data from the three eHealth intervention effectiveness studies are suitable for analyzing general perceptions of factors influencing the implementation of eHealth in clinical care.
    • Rests on an assumption: Qualitative content analysis categories accurately represent participants' perceptions.

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

    Findingreasoning

    Policy makers expressed that they would prefer not to leave the development of digital tools exclusively to commercial agents with a profit agenda or to researchers with limited resources.

    “Policy makers expressed that they would prefer not to leave the development of digital tools exclusively to commercial agents with a profit agenda or to researchers with limited resources.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The perceptions of policy makers and service users are relevant to and can inform the implementation of eHealth.
    • Rests on an assumption: Qualitative content analysis categories accurately represent participants' perceptions.

  • May combine two claims.

    Findingown data

    Although some service users described it as hard to write about health problems, some also described that the program relied on written communication and not real-time communication, as this meant that they had more time to consider how to communicate with health care staff in addressing sensitive topics.

    “Although some service users described it as hard to write about health problems, some also described that the program relied on written communication and not real-time communication, as this meant that they had more time to consider how to communicate with health care staff in addressing sensitive topics.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The perceptions of policy makers and service users are relevant to and can inform the implementation of eHealth.
    • Rests on an assumption: The service user data from the three eHealth intervention effectiveness studies are suitable for analyzing general perceptions of factors influencing the implementation of eHealth in clinical care.
    • Rests on an assumption: Qualitative content analysis categories accurately represent participants' perceptions.

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

    Findingreasoning

    Policy makers reasoned that extra resources should be allocated to implement technology in clinical everyday care.

    “They reasoned that extra resources should be allocated to implement technology in clinical everyday care and that public funds should engage more actively in supporting innovation, as resources are necessary to design and develop good digital products for health care use.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The perceptions of policy makers and service users are relevant to and can inform the implementation of eHealth.
    • Rests on an assumption: Qualitative content analysis categories accurately represent participants' perceptions.

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

    Findingown data

    Perceptions were that eHealth technology could lead to advantages for staff by providing decision support.

    “Perceptions were that eHealth technology could lead to advantages for staff by providing decision support.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The perceptions of policy makers and service users are relevant to and can inform the implementation of eHealth.
    • Rests on an assumption: Qualitative content analysis categories accurately represent participants' perceptions.

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

    Findingown data

    Some service user characteristics (such as age and condition) were described as barriers to eHealth technology.

    “Some service user characteristics (such as age and condition) were also described as barriers to eHealth technology; however, 1 policy maker thought that service users being uncomfortable with technology was the most important factor.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The perceptions of policy makers and service users are relevant to and can inform the implementation of eHealth.
    • Rests on an assumption: Qualitative content analysis categories accurately represent participants' perceptions.

  • May combine two claims.

    Findingnone given

    Neither policy makers nor service users reflected on embedding of technology in health care systems and adaptation of technology over time.

    “Neither policy makers nor service users reflected on the embedding of technology in health care systems and the adaptation of technology over time.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Policy makers perceived implementation barriers in their work role: complexity of decision-making, lack of resources for health care digitalization, and fear of technical infrastructure problems.

    “policy makers perceived that there were implementation barriers in their work role (the complexity of decision-making, a lack of resources for health care digitalization, and fear of technical infrastructure problems)”
    Quote in the paperNot a substantial claim

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

    Findingown data

    Policy makers were convinced about the public pull toward eHealth and believed that the importance of their policy mission would facilitate implementation.

    “Policy makers were convinced about the public pull toward eHealth and believed that the importance of their policy mission would facilitate implementation.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Service users appreciated not having to set aside time for travel or parking and found eHealth easier to fit into their daily schedule than traditional treatment with physical meetings.

    “service users appreciated that they did not have to set aside time for travel or look for parking and that participating in an eHealth intervention was easier than attending a traditional treatment with physical meetings as it was easier to fit into their daily schedule.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Policy makers perceived uncertainty in their decision-making, as there was a lack of regulatory support to guide their decision-making and no extra resources for implementing technologies.

    “Policy makers perceived uncertainty in their decision-making, as there was a lack of regulatory support to guide their decision-making and no extra resources for implementing the technologies.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Findingnone given

    This study provides previously unavailable information about key informant perspectives on eHealth implementation.

    “This study provides previously unavailable information about key informant perspectives on eHealth implementation.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Policy makers believed health care practice would benefit from eHealth by freeing up staff hours and saw that as an implementation driver.

    “policy makers believed that health care practice would benefit from eHealth by freeing up staff hours and saw that as an implementation driver”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Although policy makers see eHealth as potentially freeing up staff hours, service users highlight their need for data security, feedback, and support and may sometimes even see eHealth as the lesser alternative.

    “although policy makers see eHealth as potentially freeing up staff hours, service users highlight their need for data security, feedback, and support and may sometimes even see eHealth as the lesser alternative.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Service users saw eHealth as a way of making health care fit in their daily schedule and meeting their needs.

    “Service users saw eHealth as a way of making health care fit in their daily schedule and meeting their needs.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Because eHealth was perceived as mostly managing health problems on one's own, having an option to call someone for support was very valuable.

    “As eHealth was perceived as mostly managing health problems on one’s own, being provided with an option to call someone for support was very valuable.”
    Quote in the paperSubstantial claim

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

    Findingown data

    Service users could do exercises whenever they wanted and read at their own pace.

    “they could do exercises whenever they wanted and could read at their own pace.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Policy makers perceived decision-making as complex, as technical and regulatory systems are lacking in relevance and detail, and knowledge and resources for implementation are scarce.

    “policy makers perceived decision-making as complex, as technical and regulatory systems are lacking in relevance and detail, and knowledge and resources for implementation (ie, for building the eHealth infrastructure) are scarce.”
    Quote in the paperSubstantial claim

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

    Findingown data

    Service users expressed that the design of the technology needed to be matched to their needs.

    “service users expressed that the design of the technology needed to be matched to their needs”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Service users highlighted importance of protection of digital data and trust in sender.

    “service users highlighted the importance of the protection of digital data and trust in the sender.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Service users described it was important that they knew or experienced trust for the person responsible for their treatment and needed to know they could get in touch with that person.

    “Service users also described that it was important that they knew or experienced trust for the person responsible for their treatment and needed to know that they could get in touch with that person if needed.”
    Quote in the paperSubstantial claim

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

    Study design and conductnone given

    All participants gave their informed consent.

    “All participants gave their informed consent.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    Greenhalgh et al constructed an empirically based framework describing implementation complexity in 7 domains: the condition or illness of the patient, the technology, the value proposition, the adopters, the organization, the wider system, and the embedding and adaptation of the technology over time.

    “Greenhalgh et al [8] constructed an empirically based framework that described implementation complexity in 7 domains: the condition or illness of the patient, the technology, the value proposition, the adopters, the organization, the wider system, and the embedding and adaptation of the technology over time.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [8] source

      Not checked in the free run.

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

    Study design and conductnone given

    To support trustworthiness, the results from analyses were iteratively discussed in the wider author group until consensus was reached.

    “To support trustworthiness, the results from these analyses were thereafter iteratively discussed in the wider author group until consensus was reached.”
    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

    Interviewers had clinical or research experience in cardiac nursing or clinical and research experience in implementation research and health care, and all were experienced interviewers.

    “Interviewers had clinical or research experience in cardiac nursing (service user interviews) or clinical and research experience in implementation research and health care (policy maker interviews), and all were experienced interviewers.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Research on the experiences of stakeholders in a policy role is scarce, as is knowledge about the overlap between policy and public (service user) perspectives.

    “Although several recent studies have identified factors that influence the perceptions of stakeholders in different populations [10-12], research on the experiences of stakeholders in a policy role is scarce, as is knowledge about the overlap between policy and public (service user) perspectives.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [10] source

      Not checked in the free run.

    • cites [11] source

      Not checked in the free run.

    • cites [12] source

      Not checked in the free run.

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

    Study design and conductnone given

    The quality of the data varied from interview to interview.

    “The quality of the data varied from interview to interview.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    At the national level in Sweden, ambitious political goals have been set to become world leaders in using the opportunities offered by eHealth by the year 2025.

    “At the national level, ambitious political goals have been set to become world leaders in using the opportunities offered by eHealth by the year 2025 [5].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] Swedish Government and Swedish Association of Local Authorities and Regions (SALAR)Vision for eHealth 2025 : follow-up 2019E-Hälsa 202520202020-06-11E-hälsomyndighetenhttps://ehalsa2025.se/wp-content/uploads/2021/02/Follow-up-2019_Vision-e-health-2025.pdf

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Many European health care systems see a proliferation in eHealth technologies, and policy decisions to implement them seem to be made despite the scarcity of convincing research data concerning both claims of cost-effectiveness and their real impact on the quality and safety of health care.

    “Many European health care systems see a proliferation in eHealth technologies, and policy decisions to implement them seem to be made despite the scarcity of convincing research data concerning both claims of cost-effectiveness and their real impact on the quality and safety of health care [3,4].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [3] source

      Not checked in the free run.

    • cites [4] source

      Not checked in the free run.

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

    Study design and conductcitation

    The analyses adhered to the procedure of inductive qualitative content analysis as described by Hsieh and Shannon.

    “The data from policy makers and the data from service users were initially analyzed separately in each group by MN and JL in a process called assorted analysis [20] and adhered to the procedure of inductive qualitative content analysis as described by Hsieh and Shannon [21].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] source

      Not checked in the free run.

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

    Premisecitation

    Implementation of eHealth technology has a multilevel complexity involving the technology, individual health care providers, inner and outer settings, and the process of implementation.

    “Implementation was found to have a multilevel complexity: the technology, individual health care providers, inner and outer settings, and process of implementation [7].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7] source

      Not checked in the free run.

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

    Study design and conductnone given

    All interviews were audio-recorded and transcribed verbatim.

    “All interviews were audio-recorded and transcribed verbatim.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationreasoning

    More well-balanced decisions at the policy-maker level may lead to more effective and sustainable development and future implementation of eHealth.

    “More well-balanced decisions at the policy-maker level may lead to more effective and sustainable development and future implementation of eHealth.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The perceptions of policy makers and service users are relevant to and can inform the implementation of eHealth.

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

    Study design and conductown data

    The regional ethics board approved the study.

    “The regional ethics board approved the study (Dnr 2016/72-31; Dnr 2015/258-31, 2017/378-32; Dnr 2011.166/31).”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    In Sweden, the implementation of eHealth technologies has been identified as an important strategy toward the future quality provision of population health care.

    “For example, in Sweden, the implementation of eHealth technologies has been identified as an important strategy toward the future quality provision of population health care.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] Swedish Government and Swedish Association of Local Authorities and Regions (SALAR)Vision for eHealth 2025 : follow-up 2019E-Hälsa 202520202020-06-11E-hälsomyndighetenhttps://ehalsa2025.se/wp-content/uploads/2021/02/Follow-up-2019_Vision-e-health-2025.pdf

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    Participants in both the policy maker and service user groups had a variety of demographic characteristics, which indicates some representativeness.

    “The participants in both the policy maker and the service user group had a variety of demographic characteristics, which indicates some representativeness.”
    Quote in the paperNot a substantial claim

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

    Interpretationreasoning

    Perceptions about using eHealth technology will likely have evolved in both stakeholder groups.

    “perceptions about using eHealth technology will likely have evolved in both stakeholder groups.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    The study was conducted in prepandemic conditions, so the incentive to use eHealth was not as strong as it has since become.

    “As the study was conducted in prepandemic conditions, the incentive to use eHealth was not as strong as it has since become”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Perspectives of policy makers, an underrepresented group in health care research, contribute to a broader insight into barriers to and facilitators of the implementation of eHealth.

    “The perspectives of policy makers, who are an underrepresented group in health care research, contribute to a broader insight into barriers to and facilitators of the implementation of eHealth.”
    Quote in the paperSubstantial claim

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

    Study design and conductreasoning

    As service users actively participated in eHealth interventions, they were more knowledgeable about eHealth than other members of the public, which benefited the study.

    “as the service users actively participated in eHealth interventions, they were more knowledgeable about eHealth than other members of the public, which benefited the study.”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    When necessary, the original data from the interviews with service users and policy makers were consulted to check for consistency and accuracy.

    “When necessary, the original data from the interviews with service users and policy makers were consulted to check for consistency and accuracy.”
    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

    The study was performed in accordance with the Swedish ethical law and the Declaration of Helsinki.

    “The study was performed in accordance with the Swedish ethical law and the Declaration of Helsinki.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Study design and conductnone given

    The authors' group expertise, with competencies in implementation science, extensive clinical experience, and experience of qualitative methodology, contributes to methodological trustworthiness.

    “The authors’ group expertise, with competencies in implementation science, extensive clinical experience in health care, and experience of qualitative methodology, contributes to methodological trustworthiness.”
    Quote in the paperNot a substantial claim
54 of 54

  • The paper relies on this without support.

    The perceptions of policy makers and service users are relevant to and can inform the implementation of eHealth.

    “The aim of this study is to explore the perceptions concerning the barriers to and facilitators of the implementation of eHealth as perceived by policy makers and service users, and explore the ways in which their perceptions converge and differ.”
    “Ultimately, the study may contribute new knowledge to more effectively co-design the future implementation of digital health care technology.”

  • The paper relies on this without support.

    The service user data from the three eHealth intervention effectiveness studies are suitable for analyzing general perceptions of factors influencing the implementation of eHealth in clinical care.

    “The primary focus of these interviews was on participants’ experiences with the specific eHealth intervention in which they were enrolled; the focus on their general perceptions of factors influencing the implementation of eHealth in clinical care was secondary.”

  • The paper relies on this without support.

    Qualitative content analysis categories accurately represent participants' perceptions.

    “The data from policy makers and the data from service users were initially analyzed separately in each group by MN and JL in a process called assorted analysis [20] and adhered to the procedure of inductive qualitative content analysis as described by Hsieh and Shannon [21].”
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?

Self-check

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

  • Incorrect percentage of men in HeaDING interviews

    Minor

    Eight of 13 participants is 61.54%, not 51%.

    Reported 51 · recomputed 61.538462

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. 2015, The MAPS Toolkit: mHealth Assessment and Planning for Scale, 1

Cited by

Sorted by citations

Related

Authors
Neher, M., Nygårdh, A., Broström, A., Lundgren, J., & Johansson, P.
Affiliations
  • Jönköping University (SE)
  • Linköping University Hospital (SE)
  • Linköping University (SE)
Corresponding author
Neher, Margit
ORCID
Venue
Journal of Medical Internet Research
Publisher
JMIR Publications Inc.
Published
2022-01-28
Volume
24
Issue
1
Pages
e28870
ISSN
1438-8871 (ISSN-L)
DOI
10.2196/28870
PMC
PMC8838545
OpenAlex
W3207462122
Cited by
21
References
48
Citations by year
2026: 4 · 2025: 7 · 2024: 5 · 2023: 3 · 2022: 2
FWCI
2.16
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)
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
eHealth implementation, implementation barriers, implementation facilitators, policy makers, service users, digitalization of healthcare, stakeholder perspectives, data protection, technology adoption, Sweden, health policy decision-making, staff support, temporal flexibility
MeSH terms
Administrative Personnel, Delivery of Health Care, Humans, Sweden, Telemedicine, Qualitative Research

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 2026-10-06.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.

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