From: Understanding heart failure; explaining telehealth – a hermeneutic systematic review
PATIENT FACTORS | Low motivation – perhaps due to belief that the technology will have no benefit over existing approaches to care (“relative advantage”) |
Preference for a face to face encounter | |
Inability to use the technology (including limitations of health impairments) | |
Inability or unwillingness to take action in response to data or remote instructions | |
Lack of confidence in own ability to use the technology or the service (self-efficacy) | |
Fear that engaging with telehealth will lead to exclusion from a valued traditional service | |
STAFF FACTORS | Absence of champions |
Dislike of new clinical routines (including increased workload) | |
Dislike of new clinical interaction (i.e. prefers face-to-face encounters) | |
Belief that relationships and therapeutic interactions will be compromised | |
Perception that their clinical expertise is being marginalised | |
Perception that there is no value for them in the new way of working | |
Inability to use the technology (including inability to remember password) | |
TECHNICAL FACTORS | Technology unreliable (including too slow, or interrupted) |
Technology too difficult to use | |
Technology doesn’t fit / gets in the way in patient’s home | |
Technology (and/or the routines for using it) too inflexible | |
Inadequate IT infrastructure including absence of high bandwidth connectivity | |
Inter-operability problems (especially with electronic patient record) | |
Inadequate helpdesk or technician support | |
TEAM/SERVICE FACTORS | Lack of clarity about who will interpret and act on remote monitoring data |
Poor integration of the telehealth support role with wider team and service roles | |
Poor working relationships between providers | |
Insufficient staff | |
Absent, inadequate or delayed staff training | |
Lack of guidance on which patients/conditions are suitable for telehealth consultations | |
Lack of a clear and integrated referral pathway | |
Lack of (or inadequate) participation of staff in the implementation process | |
Lack of timely feedback on the success of the service | |
Programme dependent on a single individual with inadequate succession planning | |
GOVERNANCE AND REGULATORY FACTORS | Concerns about data protection and privacy |
Inadequate supporting policy and legislation | |
Opposition (or lack of active support) from professional bodies or defence societies | |
FINANCIAL/BUSINESS FACTORS | Lack of a plausible business case |
Lack of clear strategy | |
Unrealistic financial reimbursement | |
Unsupportive policy context |