Table 4.
Summary of qualitative findings.
| Summary of review findings | RFO expressed as % (95% CI) | GRADE-CERQual components | ||||
|---|---|---|---|---|---|---|
| Methodological Limitationsa | Coherenceb | Adequacyc | Relevanced | Overall assessmente | ||
| Top 7 identified barriers | ||||||
| 1. Healthcare professionals perceived that infrastructure and technical barriers were significantly crucial to using DHTs | 6.4 % (95% CI 2.9–14.1) | Moderate concerns | No or very minor concerns | No or very minor concerns | No or very minor concerns | High confidence |
| 2. Healthcare professionals perceived that psychological and personal issues directly affect the utilization of DHTs | 5.3% (95% CI 2.2–12.7) | Moderate concerns | No or very minor concerns | No or very minor concerns | No or very minor concerns | High confidence |
| 3. Fear of increased working hours and workload hinder the adoption and broad use of DHTs | 3.9% (95% CI 1.5–10.1) | Moderate concerns | No or very minor concerns | No or very minor concerns | No or very minor concerns | High confidence |
| 4. Healthcare professionals are aware and alert to legal and ethical features of using DHTs, factors that interfere with the success rate of any DHT | 3.6% (95% CI 1.3–9.6) | Moderate concerns | No or very minor concerns | No or very minor concerns | No or very minor concerns | High confidence |
| 5. Lack of training and educational programs causes a negative experience for healthcare professionals using DHTs, decreasing their use | 3.4% (95% CI 1.3–8.9) | Moderate concerns | No or very minor concerns | No or very minor concerns | No or very minor concerns | High confidence |
| 6. The structure of the healthcare system and lack of financial support limit the use of DHTs | 2.9% (95% CI 1.0–8.3) | Moderate concerns | No or very minor concerns | No or very minor concerns | No or very minor concerns | High confidence |
| 7. Interoperability and data incompatibility are conflicting elements in using DHTs | 2.2% (95% CI 1.0–5.0) | Moderate concerns | No or very minor concerns | No or very minor concerns | No or very minor concerns | High confidence |
| Top 7 identified facilitators | ||||||
| 1. Offering training and educational activities increase the positive experience and facilitate the adoption of DHTs by healthcare providers | 3.8% (95% CI 1.6–9.0) | Moderate concerns | No or very minor concerns | No or very minor concerns | No or very minor concerns | High confidence |
| 2. Those healthcare professionals who perceived the full usefulness of DHTs and were willing and opened to the new technology are more likely to use them in a long-term period | 3.8% (95% CI 1.8–7.9) | Moderate concerns | No or very minor concerns | No or very minor concerns | No or very minor concerns | High confidence |
| 3. Government and multisector incentives increase the use of DHTs by healthcare professionals | 3.0% (95% CI 1.4–6.6) | Moderate concerns | No or very minor concerns | No or very minor concerns | No or very minor concerns | High confidence |
| 4. Adherence promotion campaigns facilitate and increase the use of DHTs by healthcare providers | 2.2% (95% CI 1.1–4.3) | Moderate concerns | No or very minor concerns | No or very minor concerns | No or very minor concerns | High confidence |
| 5. Involvement of healthcare professionals in the process of development and implementation of DHTs facilitates their experience with the technology and increases their acceptance | 2.0% (95% CI 0.8–4.9) | Moderate concerns | No or very minor concerns | No or very minor concerns | No or very minor concerns | High confidence |
| 6. Easy-to-use and intuitive navigation systems facilitate the use of DHTs by healthcare providers | 1.9% (95% CI 0.7–5.2) | Moderate concerns | No or very minor concerns | No or very minor concerns | No or very minor concerns | High confidence |
| 7. The existence of solid leadership and local champion facilitate the creation, implementation, and long-term adoption of DHTs by healthcare professionalsFeeling of reliability in utilized equipment and technologies improve the implementation and the adoption of DHTs by healthcare providers | 1.7% (95% CI 0.7–3.8) | Moderate concerns | No or very minor concerns | No or very minor concerns | No or very minor concerns | High confidence |
CI Confidence Interval, DHTs Digital Health Technologies, RFO Relative Frequency of Occurrence.
aWe downgraded one level of confidence in the evidence based on the methodological quality of included systematic reviews and not based on the methodological limitations of primarily included studies. The rationale is that the AMSTAR-2 tool has seven strict critical domains, which, if occurred at least once, decreases overall confidence by two levels. Nevertheless, since several experts have already suggested that the reporting of many items in the PRISMA statement is suboptimal, we believe that this lack of reporting or evaluation might be associated with a “mass effect”, where researchers simply follow an inadequate pattern. Therefore, we decreased one level in the certainty of evidence instead of two levels on reviews’ methodological limitations.
bCoherence was rated as no or very minor concerns because the reviews’ findings appropriately described the data’s complexity, variation, and interconnectedness. Therefore, the available qualitative evidence provided no signs of contradictory, ambiguous, or incomplete data and competing theories or theoretical elements.
cWe found the obtained data rich enough considering the complex and vast amount of data, the number of studies included, and their associated number of participants.
dBased on the review questions expressed in each included review, we judged the body of data from these reviews to be fully integrated with each research question.
eAlthough most of our included reviews were classified as “very low methodological quality” using the AMSTAR 2 tool, we believe that the reported data is significant enough not to decrease the confidence level primarily based on the methodological quality. We analyzed a group of phenomena that could hinder or enable the use of DHTs by healthcare providers, and we did find any signs of unbalanced or one-sided. Data underlying the reviews’ findings were sufficiently rich in terms of the number of studies and number of healthcare professionals.