Table 3. CFIR Constructs^a Described as Determinants, Subanalysis (N = 15 Studies) of an Umbrella Review of Determinants of Digital Health Tool Implementation in Chronic Disease Prevention and Management in Clinical Practice Settings, 2013–2025.

CFIR construct	Barrier: no. of reviews	Barrier: quote	Facilitator: no. of reviews	Facilitator: quote
Innovation
Evidence base	8	Although there is a growing body of literature that describes the positive effects of digital care platforms, high-quality studies describing the effectiveness of these platforms integrated in oncological care are currently lacking. Hopstaken et al (29)	2	Evidence of the efficacy of e-health for improving care was seen as important for both patients as well as for HCPs: “I think that type of evidence is what’s going to change my mind as a practitioner about whether it’s worth using it or not.” Salmi et al (37)
Relative advantage	12	The use of asynchronous digital technology reduces patient engagement. Patients feel less responsible and empowered in handling their conditions because their care is discussed by the visiting nurse and the hospital staff without patients' direct involvement. . . . Both physicians and nurses reported that face-to-face consultation with the patient was important in medical consultation. Some felt that telemedicine reduced direct contact in care provision and might lead patients to complain about not seeing a physician. One doctor felt reluctant to switching to solely computer-based consultation in the future. Foong et al (27)	9	Neurologists acknowledged the significant enhancement of work-life balance through reduced travel time, effectively bridging the gap between patients’ local care needs and physicians’ need for improved equilibrium. Kissi and Annobil (35)
Adaptability	7	Lack of customizable features. Whitelaw et al (30)	4	Technology enables individualized care. Foong et al (27)
Complexity	4	Data-related problems (collecting, managing, processing), technical challenges, and overall complexity. Sung et al (4)	4	Perceived ease of use. Ramachandran et al (32)
Design	10	In terms of the AI user interface, through qualitative interviews, Hendrix et al found that 26%–33% of radiologists were deterred if the AI features did not align with their preferences, highlighting the need for increased collaboration between radiologists and technical professionals to bridge this gap. Goh et al (34)	5	Good data quality, good design, good data visualization, good content (eg, specific), and ease of use. Sung et al (4)
Cost	4	Uncertainty about costs caused scepticism and reluctance to engage in e-health. Salmi et al (37)	3	For HCPs, the use of e-health was facilitated if the intervention was perceived as cost-effective for the health care facilities they were working in. Helleman et al (26)
Implementer
Capability	6	Lack of knowledge . . . lack of digital skills. Rosenstrom et al (33)	0	NA
Opportunity	8	HCPs indicated that they have a lack of time, they did not have enough time to adjust, or the use of HIT increased consultation time and therefore depleted time resources. HCPs often had competing priorities in work and perceived the newly implemented HIT as noncore work activity. Sung et al (4)	0	NA
Motivation	6	Some nurses reported working in a constantly changing work environment, which could decrease their motivation for implementing new workflows offered by new technology. Rosenstrom et al (33)	4	HCP interest in learning new technologies. Salmi et al (37)
Need	1	Sometimes physicians preferred traditional health care message and thought that change is unneeded, especially because they did not believe patients could not efficiently manage their data. Sung et al (4)	2	Patient–technology–provider relationship: e-health significantly impacted patient–HCP relationships and communication patterns, with reduced face-to-face interaction emerging as a key sub-theme. This allowed HCPs to manage more patients, decreased the need for physical infrastructure, and, during the COVID-19 pandemic, reduced the risk of transmission. Salmi et al (37)
Inner setting
Structural characteristics	7	Lack of leadership and organizational support. Palacholla et al (25)	6	Approval and organizational support from cardiology departments and/or hospitals. Whitelaw et al (30)
Culture	0	NA	2	Innovation-oriented culture. Sung et al (4)
Compatibility	7	Two studies mentioned the integration of the platform into existing systems as a barrier. This would be especially relevant in cases in which the digital care platforms were also developed for other chronic diseases. Hopstaken et al (29)	5	Alignment of DHI usage to current practice and policy. Ramachandran et al (32)
Incentive systems	3	Reimbursement issues. Whitelaw et al (30)	1	Internal factors encompass payer mix, patient volume, and hospital profitability. Kissi and Annobil (35)
Available resources	7	Technological prerequisites such as comprehensive network coverage, stable internet connectivity, and affordable data services are critical for effective telestroke implementation. Kissi and Annobil (35)	5	Tech support. Palacholla et al (25)
Access to knowledge and information	7	The lack of clear guidelines discourages health care providers from integrating telestroke into routine clinical practice. Kissi and Annobil (35)	7	While e-health had the potential to positively impact health-seeking behavior, the benefits could be hampered by problems with training. Adequate training for both patients and HCPs emerged as a key factor to enable technology access and the implementation of e-health interventions. Salmi et al (37)
Outer setting
Critical incidents	0	NA	1	The COVID-19 pandemic proved to be an effective facilitator for the use of e-health. Some studies cited that because of the pandemic, the number of clinic visits was reduced and replaced by e-health. This was attributed to the desire to decrease contagion, as well as the belief that e-health was more accessible than in-person consults. Salmi et al (37)
Local attitudes	1	A cultural belief referred to as “Appalachian pride” could be a barrier for telehealth adoption. Appalachian pride comprises multiple cultural values (eg, privacy) that are upheld in tight-knit communities. Appalachian pride may impact tele-health adoption and preferences [US, North Carolina]. Salmi et al (37)	0	—
Local conditions	2	The availability of a reliable internet or phone connection represented an important enabler to the use of e-health. Local network issues resulting in poor audio connection, or “freezing” of the app and upload issues led to underuse and delays in patient care. Some studies noted that the greatest trigger for introducing e-health was the absence of pre-established infrastructure or services. Examples included places without access to basic health resources, and locations where specialist services were unavailable. Salmi et al (37)	3	Key external factors include market competition and critical access hospital status. Kissi and Annobil (35)
Partnerships and connections	4	A lack of coordination between vendors and the hospital, nurses, and providers challenged the implementation process. Sung et al (4)	3	A coordinated effort among governments, health care institutions, private sector stakeholders, and international organizations may be essential in creating a resilient and scalable telestroke ecosystem across the continent. Kissi and Annobil (35)
Policies and laws	5	The absence of clear regulations can create uncertainty for stakeholders about the legal boundaries associated with AI adoption. Goh et al (34)	2	Policymakers may prioritize the development of standardized regulatory frameworks that provide clear guidelines on ethical, legal, and operational aspects of telestroke, ensuring compliance with data security, patient confidentiality, and informed consent requirements. Kissi and Annobil (35)
Funding	0	NA	1	Sustainable financing mechanisms, including the integration of telestroke into national health care budgets and the promotion of public–private collaborations, may reduce dependency on external funding and ensure long-term viability. Kissi and Annobil (35)

Abbreviations: AI, artificial intelligence; CFIR, Consolidated Framework for Implementation Research; DHI, digital health information; HCPs, health care providers; HIT, health information technology; NA, not applicable.

^a Certain constructs within each domain did not show up in any reviews: innovation: source, trialability; inner setting: relational connections, communications, tension for change, relative priority, mission alignment; outer setting: external pressure.