BMJ Innovation: Barriers and facilitators for the adoption of telemedicine services in low-income and middle-income countries: a rapid overview of reviews

3 July, 2023

Citation, abstract, key findings and a comment from me below.

CITATION: Dhyani VS, Krishnan JB, Mathias EG, et al. Barriers and facilitators for the adoption of telemedicine services in low-income and middle-income countries: a rapid overview of reviews. BMJ Innovations Published Online First: 11 May 2023. doi: 10.1136/bmjinnov-2022-001062


Objective To identify the barriers and facilitators for uptake of telemedicine services in low-income and middle-income countries (LMICs).

Design The rapid review approach to identify the barriers and facilitators for the uptake/delivery of telemedicine in health system from both the provider and the patient’s perspective. A two-stage sequential screening process was adopted. Data extraction was done using a piloted data extraction form.

Data sources A search on PubMed (NCBI), Embase (Ovid), the Cochrane Library (Wiley), Scopus (Elsevier) and the WHO Global Index Medicus was conducted.

Eligibility criteria for selecting studies Studies published between 1 January 2012 and 1 July 2022 on barriers and facilitators for uptake of telemedicine services in LMICs were included.

Results Database search identified a total of 2829 citations. After removing 1069 duplicates, 1760 were taken forward for title and abstract screening. A total of 43 articles were included at full text stage and 8 articles were included in this overview for narrative synthesis. Barriers and facilitators to telemedicine adoption and use were categorised under four subheadings, namely organisational and environmental, individual and cultural barriers, financial barriers and technological barriers. Providers, patient and health policy-makers perspectives were captured.

Conclusion Any development of telemedicine services should engage the primary users such as patients and their family caregivers to design people-centred digital health systems and services. Usability studies must be commissioned by the governments and host agencies to enhance the interaction experience pending which investments would remain futile. Future research should employ mixed methods or multi methods approaches to understand the interaction between patients and providers.


- Multilevel factors work together to influence the implementation and utilisation of telehealth technologies in different contexts with similar socioeconomic disadvantages.

- The determinants of success of telemedicine extend beyond healthcare, such as the area of IT governance, human resource, capacity building and infrastructure requirements for the delivery of telemedicine services.

- This overview mapped the barriers on the basis of a theoretical model identified by Schreiweis et al and in line with the WHO’s health system building blocks framework.

- To achieve significant coproduction in telemedicine policy output that are need based and relevant to society, an intersectoral and interactor advocacy and governance in telemedicine is needed.

- Educational and behaviour change interventions for strengthening digital health use among healthcare providers may increase their participation in digital health development in LMICs.

COMMENT (NPW): Clearly, development of telemedicine services should ideally engage the primary users, but this approach is resource-intensive. I would like to draw HIFA members' attention to the work of Geoff Royston, HIFA Steering Group member, who published a paper 'Rapid Methods to Assess the Potential Impact of Digital Health Interventions, and their Application to Low Resource Settings' The paper 'presents some "short-cut" approaches for rapid assessments that can provide useful early indications of strengths and weaknesses and can ensure that evaluative efforts are focused on key uncertainties, are not wasted on unpromising interventions, and make the most of what is already known'. This can be done before full-scale development and implementation. It would save a huge amount of time and resources if interventions could be assessed for their likely benefits and feasibility before deployment. Too often, digital health interventions fail. Partly because they did not engage end-users, but also because they were deployed without adequate early assessment.

HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: