Barriers and facilitators of the uptake of digital health technology in cardiovascular care: a systematic scoping review

Abstract Digital health technology (DHT) has the potential to revolutionize healthcare delivery but its uptake has been low in clinical and research settings. The factors that contribute to the limited adoption of DHT, particularly in cardiovascular settings, are unclear. The objective of this review was to determine the barriers and facilitators of DHT uptake from the perspective of patients, clinicians, and researchers. We searched MEDLINE, EMBASE, and CINAHL databases for studies published from inception to May 2020 that reported barriers and/or facilitators of DHT adoption in cardiovascular care. We extracted data on study design, setting, cardiovascular condition, and type of DHT. We conducted a thematic analysis to identify barriers and facilitators of DHT uptake. The search identified 3075 unique studies, of which 29 studies met eligibility criteria. Studies employed: qualitative methods (n = 13), which included interviews and focus groups; quantitative methods (n = 5), which included surveys; or a combination of qualitative and quantitative methods (n = 11). Twenty-five studies reported patient-level barriers, most common of which were difficult-to-use technology (n = 7) and a poor internet connection (n = 7). Six studies reported clinician-level barriers, which included increased workload (n = 4) and a lack of integration with electronic medical records (n = 3).Twenty-four studies reported patient-level facilitators, which included improved communication with clinicians (n = 10) and personalized technology (n = 6). Four studies reported clinician-level facilitators, which included approval and organizational support from cardiology departments and/or hospitals (n = 3) and technologies that improved efficiency (n = 3). No studies reported researcher-level barriers or facilitators. In summary, internet access, user-friendliness, organizational support, workflow efficiency, and data integration were reported as important factors in the uptake of DHT by patients and clinicians. These factors can be considered when selecting and implementing DHTs in cardiovascular clinical settings.

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Barriers to and facilitators of the uptake of digital health technology in cardiology: a systematic review

European Heart Journal ◽

10.1093/ehjci/ehaa946.3500 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Whitelaw ◽

D Pellegrini ◽

H.G.C Van Spall

Keyword(s):

Digital Health ◽

Healthcare Delivery ◽

Health Technology ◽

Healthcare Services ◽

Structured Interviews ◽

Clinical Workflow ◽

Eligibility Criteria ◽

Health Technologies ◽

Patient Level ◽

Use Of Technology

Abstract Background Digital health technology has the potential to revolutionize the quality and efficiency of healthcare delivery. However, the uptake of digital health technology has been low in clinical practice. The factors that contribute to the limited adoption of digital health technology, particularly in cardiology, are unclear. Purpose We identified and synthesized the barriers to and facilitators of digital health technology uptake in cardiology, with a focus on provider- and patient- level barriers and facilitators. Methods We searched MEDLINE, EMBASE and CINAHL databases for studies published January 2000 - December 2019 that reported barriers to and/or facilitators of digital health technology adoption in cardiology. Two reviewers screened and extracted data independently. We conducted a thematic analysis to identify major themes pertaining to digital health technology uptake by both providers and patients. Results The search identified 3062 unique studies, of which 23 qualitative studies met eligibility criteria. Seventeen studies included semi-structured interviews and 6 included focus groups. Five (22%) studies reported provider-level facilitators, which included technology usability, integration into clinical workflow, and improved patient outcomes. Eighteen (78%) studies reported patient-level facilitators, which included ongoing technical support, improved access to healthcare services, and improved self-management. Six (26%) studies reported provider-level barriers, which included lack of integration into clinical workflow, increased healthcare costs, and lack of validation and reliability of technology. Finally, 19 (83%) studies reported patient-level barriers which included lack of knowledge about technology, limited internet access, and physical impairments making use of technology difficult. Conclusions Identifying barriers to and facilitators of digital health technology could help improve its uptake in cardiology. The findings of this study can be used to inform researchers, clinicians, and stakeholders who wish to develop and implement digital health technologies that meet the needs of providers and patients. Funding Acknowledgement Type of funding source: None

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Provider- and Patient-Related Barriers to and Facilitators of Digital Health Technology Adoption for Hypertension Management: Scoping Review (Preprint)

10.2196/preprints.11951 ◽

2018 ◽

Author(s):

Ramya Sita Palacholla ◽

Nils Fischer ◽

Amanda Coleman ◽

Stephen Agboola ◽

Katherine Kirley ◽

...

Keyword(s):

Patient Outcomes ◽

Scoping Review ◽

Full Text ◽

Digital Health ◽

Health Technology ◽

Technical Support ◽

Barriers And Facilitators ◽

Hypertension Management ◽

Inclusion Criteria ◽

Clinical Workflow

BACKGROUND The uptake of digital health technology (DHT) has been surprisingly low in clinical practice. Despite showing great promise to improve patient outcomes and disease management, there is limited information on the factors that contribute to the limited adoption of DHT, particularly for hypertension management. OBJECTIVE This scoping review provides a comprehensive summary of barriers to and facilitators of DHT adoption for hypertension management reported in the published literature with a focus on provider- and patient-related barriers and facilitators. METHODS This review followed the methodological framework developed by Arskey and O’Malley. Systematic literature searches were conducted on PubMed or Medical Literature Analysis and Retrieval System Online, Cumulative Index to Nursing and Allied Health Literature, and Excerpta Medica database. Articles that reported on barriers to and/or facilitators of digital health adoption for hypertension management published in English between 2008 and 2017 were eligible. Studies not reporting on barriers or facilitators to DHT adoption for management of hypertension were excluded. A total of 2299 articles were identified based on the above criteria after removing duplicates, and they were assessed for eligibility. Of these, 2165 references did not meet the inclusion criteria. After assessing 134 studies in full text, 98 studies were excluded (full texts were either unavailable or studies did not fulfill the inclusion criteria), resulting in a final set of 32 articles. In addition, 4 handpicked articles were also included in the review, making it a total of 36 studies. RESULTS A total of 36 studies were selected for data extraction after abstract and full-text screening by 2 independent reviewers. All conflicts were resolved by a third reviewer. Thematic analysis was conducted to identify major themes pertaining to barriers and facilitators of DHT from both provider and patient perspectives. The key facilitators of DHT adoption by physicians that were identified include ease of integration with clinical workflow, improvement in patient outcomes, and technology usability and technical support. Technology usability and timely technical support improved self-management and patient experience, and positive impact on patient-provider communication were most frequently reported facilitators for patients. Barriers to use of DHTs reported by physicians include lack of integration with clinical workflow, lack of validation of technology, and lack of technology usability and technical support. Finally, lack of technology usability and technical support, interference with patient-provider relationship, and lack of validation of technology were the most commonly reported barriers by patients. CONCLUSIONS Findings suggest the settings and context in which DHTs are implemented and individuals involved in implementation influence adoption. Finally, to fully realize the potential of digitally enabled hypertension management, there is a greater need to validate these technologies to provide patients and providers with reliable and accurate information on both clinical outcomes and cost effectiveness.

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BARRIERS AND FACILITATORS INFLUENCING ETHICAL EVALUATION IN HEALTH TECHNOLOGY ASSESSMENT

International Journal of Technology Assessment in Health Care ◽

10.1017/s026646231500032x ◽

2015 ◽

Vol 31 (3) ◽

pp. 113-123 ◽

Cited By ~ 10

Author(s):

Nazila Assasi ◽

Lisa Schwartz ◽

Jean-Eric Tarride ◽

Daria O’Reilly ◽

Ron Goeree

Keyword(s):

Health Technology Assessment ◽

Practice Guidelines ◽

Technology Assessment ◽

Organizational Support ◽

Online Survey ◽

Good Practice ◽

Health Technology ◽

Educational Interventions ◽

Ethical Analysis ◽

Barriers And Facilitators

Objectives: The objective of this study was to explore barriers and facilitators influencing the integration of ethical considerations in health technology assessment (HTA).Methods: The study consisted of two complementary approaches: (a) a systematic review of the literature; and (b) an eighteen-item online survey that was distributed to fifty-six HTA agencies affiliated with the International Network of Agencies for Health Technology Assessment.Results: The review identified twenty-six relevant articles. The most often cited barriers in the literature were: scarcity, heterogeneity and complexity of ethical analysis methods; challenges in translating ethical analysis results into knowledge that is useful for decision makers; and lack of organizational support in terms of required expertise, time and financial resources. The most frequently cited facilitators included: usage of value-based appraisal methods, stakeholder and public engagement, enhancement of practice guidelines, ethical expertise, and educational interventions.Representatives of twenty-six (46.5 percent) agencies from nineteen countries completed the survey. A median of 10 percent (interquartile range, 5 percent to 50 percent) of the HTA products produced by the agencies was reported to include an assessment of ethical aspects. The most commonly perceived barriers were: limited ethical knowledge and expertise, insufficient time and resources, and difficulties in finding ethical evidence or using ethical guidelines. Educational interventions, demand by policy makers, and involvement of ethicists in HTA were the most commonly perceived facilitators.Conclusions: Our results emphasize the importance of simplification of ethics methodology and development of good practice guidelines in HTA, as well as capacity building for engaging HTA practitioners in ethical analyses.

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The Emerging Role of Digital Health Technology in Cardiovascular Care

Canadian Journal of Cardiology ◽

10.1016/j.cjca.2021.04.016 ◽

2021 ◽

Vol 37 (7) ◽

pp. 939-942

Author(s):

Yuan Qiu ◽

Chantal Y. Asselin ◽

Dania Kallas ◽

Najah Adreak ◽

Kathryn Armstrong ◽

...

Keyword(s):

Digital Health ◽

Health Technology ◽

Cardiovascular Care

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A qualitative study of chronic obstructive pulmonary disease patient perceptions of the barriers and facilitators to adopting digital health technology

Digital Health ◽

10.1177/2055207619871729 ◽

2019 ◽

Vol 5 ◽

pp. 205520761987172 ◽

Cited By ~ 5

Author(s):

Patrick Slevin ◽

Threase Kessie ◽

John Cullen ◽

Marcus W. Butler ◽

Seamas C Donnelly ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Digital Health ◽

Disease Patient ◽

Health Technology ◽

Perceived Usefulness ◽

Barriers And Facilitators ◽

Self Management ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease

Objective Non-adherence to self-management plans in chronic obstructive pulmonary disease (COPD) results in poorer outcomes for patients. Digital health technology (DHT) promises to support self-management by enhancing the sense of control patients possess over their disease. COPD digital health studies have yet to show significant evidence of improved outcomes for patients, with many user-adoption issues still present in the literature. To help better address the adoption needs of COPD patients, this paper explores their perceived barriers and facilitators to the adoption of DHT. Methods A sample of convenience was chosen and patients ( n = 30) were recruited from two Dublin university hospitals. Each patient completed a qualitative semi-structured interview. Thematic analysis of the data was performed using NVivo 12 software. Results Barrier sub-themes included lack of perceived usefulness, digital literacy, illness perception, and social context; facilitator sub-themes included existing digital self-efficacy, personalised education, and community-based support. Conclusion The findings represent a set of key considerations for researchers and clinicians to inform the design of patient-centred study protocols that aim to account for the needs and preferences of patients in the development of implementation and adoption strategies for DHT in COPD.

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Digital health and disability claims

British Actuarial Journal ◽

10.1017/s1357321719000011 ◽

2019 ◽

Vol 24 ◽

Author(s):

A. Groyer ◽

R. Campbell

Keyword(s):

Internet Of Things ◽

Return To Work ◽

Digital Technology ◽

Insurance Industry ◽

Digital Health ◽

Healthcare Delivery ◽

Working Party ◽

Health Technology ◽

Healthcare Needs ◽

Claims Management

AbstractDigital technology is starting to enable new and improved modes of healthcare delivery. The healthcare and disability claims spaces are closely intertwined. Disability claimants certainly have healthcare needs but disability claims management has the added dimension of supporting return to work.In this paper, we explain what is meant by the term “Digital Health.” We then compare the challenges in the healthcare and disability claims management spaces where digital technology may improve outcomes. We touch briefly on how the efficacy of digital technology may be evaluated. The later parts of the paper focus on Digital Health technology providers who have engaged with the insurance industry and we conclude with some learnings around the challenges of implementing these technology-based opportunities.This paper focuses on interventions once a policyholder’s health has failed to the extent that they need to claim. There are many opportunities to improve wellness and prevent claim using digital technology, as noted by the IFoA Wearables and Internet of Things Working Party,1 and we do not discuss these further this paper.

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