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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]