Table 2.

Major barriers and facilitators to teledermatology across studies

CFIR domains	Barriers	Facilitators
Domain 1: intervention characteristics
Relative advantage	Teledermatology offers less clinical information than in person clinic visits (e.g., history, outcome, images) Communication challenges, including: providing diagnoses, offering emotional support and advice, having a dialog	Improved efficiency and convenience (e.g., reduced wait and travel time) Improved access to care Teledermatology improves patients’ and primary care providers’ knowledge of skin disorders
Design quality and packaging	Technological limitations of teledermatology	Easy to use and intuitive technology
Cost	Time required to learn to use the technology
Domain 2: outer setting
Patient needs and resources	Teledermatology cannot address some skin conditions Patients do not wish to be photographed due to social and religious reasons	Teledermatology meets the needs of patients
External policy and incentives	Reimbursement concerns Providers also reported increased medical liability and risk of privacy breach
Domain 3: inner setting
Compatibility	Teledermatology not compatible with existing workflow, health record system, and organizational policy	Teledermatology aligns with existing workflow and clinical needs
Available resources	Lack of time, personnel, equipment to adopt teledermatology	Availability of trainings, personnel and infrastructures
Domain 4: characteristics of individual
Self-efficacy	Lack of confidence in taking images of lesion, following recommendations from dermatologists.	Improved primary care provider and patient self-confidence in managing skin diseases
Knowledge and beliefs	Belief that teledermatology is not as accurate as in-person consultation	Beliefs in the usefulness of teledermatology
Domain 5: process
External change agents	No studies reported barriers in this domain	Involving experts with experience in teledermatology implementation