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Table 2 Factors shown to account for poor uptake of telehealth in heart failure

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
  1. Compiled from various sources [5, 7, 48, 60, 61, 63, 110, 111, 113, 122, 123]