Document Type : Original Article
Authors
1 Undergraduate student, Department of Management, Faculty of Administrative Sciences and Economics, Vali-E- Asr University of Rafsanjan, Rafsanjan, Iran
2 Department of Management, Faculty of Administrative Sciences and Economics, Vali-e- Asr University of Rafsanjan, Rafsanjan, Iran
3 Department of Management, Faculty of Administrative Sciences and Economics, Vali-E- Asr University of Rafsanjan, Rafsanjan, Iran
Abstract
Introduction: Telehealth can be a valuable tool for improving access to healthcare, especially during a pandemic. However, certain barriers have limited its widespread adoption. Therefore, this study aims to prioritize the barriers to telehealth services and identify the relationships between them.
Methods: This study is applied in terms of its objective and employs a qualitative-analytical approach for data analysis. First, key barriers were identified through a systematic review of scientific resources and expert opinions. The validity of the barriers was assessed using the Content Validity Ratio (CVR). After validating the barriers, causal relationships between them were extracted and prioritized using the Interpretive Structural Modeling (ISM) method. The research population included university professors, physicians, hospital managers, and health and medical experts, of whom 22 participants were selected through purposive (snowball) sampling. Data collection was conducted using a questionnaire.
Results: A review of the literature identified 16 initial barriers related to telehealth. Experts validated and finalized 14 of these barriers. The finalized barriers were classified into a six-level model. The findings indicate that the lack of an appropriate institutional framework to support telehealth and insufficient financial resources are the most fundamental and influential barriers. Addressing these barriers could help mitigate other challenges, such as technological issues and resistance to change. Additionally, barriers such as inconsistencies in insurance reimbursement and increased workload were identified as dependent barriers with less impact.
Conclusion: Based on the study results, it is recommended that policymakers, including the Ministry of Health and Medical Education, health insurance organizations, and other relevant institutions, take steps to establish robust legal and institutional frameworks and ensure sufficient financial resources. Furthermore, providing specialized training, developing operational guidelines, and simplifying regulations are key strategies for enhancing the acceptance and efficiency of telehealth services.
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- Eiland L, Drincic A. Far Apart, but Close at Heart: The Importance of Understanding Patient Barriers to Telehealth and Potential Solutions. Circulation. 2022; 146(3): 147-9. https://doi.org/10.1161/CIRCULATIONAHA.121.057576
- Chen J, Amaize A, Barath D. Evaluating Telehealth Adoption and Related Barriers Among Hospitals Located in Rural and Urban Areas. J Rural Health. 2021; 37(4): 801-11. https://doi.org/10.1111/jrh.12534
- Gajarawala SN, Pelkowski JN. Telehealth Benefits and Barriers. J Nurse Pract. 2021; 17(2): 218-21. https://doi.org/10.1016/j.nurpra.2020.09.013
- Arora S, Huda RK, Verma S, Khetan M, Sangwan RK. Challenges, Barriers, and Facilitators in Telemedicine Implementation in India: A Scoping Review. Cureus. 2024; 16(8): e67388. https://doi.org/10.7759/cureus.67388
- Kuziemsky C, Maeder AJ, John O, Gogia SB, Basu A, Meher S, et al. Role of Artificial Intelligence within the Telehealth Domain. Yearb Med Inform. 2019; 28(1): 35-40. https://doi.org/10.1055/s-0039-1677897
- Kalicki AV, Moody KA, Franzosa E, Gliatto PM, Ornstein KA. Barriers to telehealth access among homebound older adults. J Am Geriatr Soc. 2021; 69(9): 2404-11. https://doi.org/10.1111/jgs.17163
- Kemp MT, Williams AM, Brown CS, Liesman DR, Sharma SB, Wakam GK, et al. Practical Guidance for Early Identification of Barriers in Surgical Telehealth Clinics. Ann Surg. 2021; 273(6): e268-e70. https://doi.org/10.1097/SLA.0000000000004633
- Scott Kruse C, Karem P, Shifflett K, Vegi L, Ravi K, Brooks M. Evaluating barriers to adopting telemedicine worldwide: A systematic review. J Telemed Telecare. 2016; 24(1): 4-12. https://doi.org/10.1177/1357633X16674087
- Zhai Y. A Call for Addressing Barriers to Telemedicine: Health Disparities during the COVID-19 Pandemic. Psychother Psychosom. 2021; 90(1): 64-6. https://doi.org/10.1159/000509000
- Triana AJ, Gusdorf RE, Shah KP, Horst SN. Technology Literacy as a Barrier to Telehealth During COVID-19. Telemed J E Health. 2020; 26(9): 1118-9. https://doi.org/10.1089/tmj.2020.0155
- Wubante SM, Nigatu AM, Jemere AT. Health professionals' readiness and its associated factors to implement Telemedicine system at private hospitals in Amhara region, Ethiopia 2021. PLoS One. 2022; 17(9): e0275133. https://doi.org/10.1371/journal.pone.0275133
- Ftouni R, AlJardali B, Hamdanieh M, Ftouni L, Salem N. Challenges of Telemedicine during the COVID-19 pandemic: a systematic review. BMC Med Inform Decis Mak. 2022; 22(1): 207. https://doi.org/10.1186/s12911-022-01952-0
- Ellimoottil C, An L, Moyer M, Sossong S, Hollander JE. Challenges And Opportunities Faced By Large Health Systems Implementing Telehealth. Health Aff (Millwood). 2018; 37(12): 1955-9. https://doi.org/10.1377/hlthaff.2018.05099
- Houser SH, Flite CA, Foster SL. Privacy and security risk factors related to telehealth services–a systematic review. Perspectives in health information management. 2023 Jan 10; 20(1): 1f.
- Alsaleh MM, Watzlaf VJ, DeAlmeida DR, Saptono A. Evaluation of a telehealth application (Sehha) used during the COVID-19 pandemic in Saudi Arabia: provider experience and satisfaction. Perspectives in health information management. 2021 Oct 1; 18(4): 1b.
- Ollio J, Gyan A, Gyan E. Using telehealth to provide behavioral healthcare to young adults and college students. Perspectives in health information management. 2022 Jan 1; 19(1): 1b.
- Greenwood H, Krzyzaniak N, Peiris R, Clark J, Scott AM, Cardona M, et al. Telehealth Versus Face-to-face Psychotherapy for Less Common Mental Health Conditions: Systematic Review and Meta-analysis of Randomized Controlled Trials. JMIR Ment Health. 2022; 9(3): e31780. https://doi.org/10.2196/31780
- Ko JS, El-Toukhy S, Quintero SM, Wilkerson MJ, Napoles AM, Stewart AL, et al. Disparities in telehealth access, not willingness to use services, likely explain rural telehealth disparities. J Rural Health. 2023; 39(3): 617-24. https://doi.org/10.1111/jrh.12759
- Bernabe M, Ebardo R. Barriers Leading to the Discontinuance of Telemedicine among Healthcare Providers: A Systematic Review. Data and Metadata. 2025. https://doi.org/10.56294/dm2025440
- Dinesen B, Nonnecke B, Lindeman D, Toft E, Kidholm K, Jethwani K, et al. Personalized Telehealth in the Future: A Global Research Agenda. J Med Internet Res. 2016; 18(3): e53. https://doi.org/10.2196/jmir.5257
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