Table 2.
Factors shown to account for poor uptake of telehealth in heart failure
| 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 |