Facilitators and Barriers of Digital Health Technologies Implementation in Hospital Settings in Lower- and Middle-Income Countries Since the COVID-19 Pandemic – A Scoping Review

Background: Although the implementation process of digital health technologies (DHTs) has been extensively documented in developed nations, the factors that facilitate and prevent their implementation in lower- and middle-income countries (LMICs) may differ due to various reasons.

Objective: To address this gap in research, this scoping review aimed to determine the facilitators and barriers of the implementation of DHTs in LMICs hospital settings following the COVID-19 pandemic. Additionally, the review outlined the types of DHTs that have been implemented in LMICs’ hospitals during this pandemic and finally developed a classification framework to categorise the landscape of DHTs.

Methods: Systematic searches were conducted on PubMed, Scopus, Web of Science, and Google Scholar for studies published from March 2020 to December 2023. We extracted data on authors, publication years, study objectives, study countries, disease conditions, types of DHTs, fields of clinical medicine where the DHTs are applied, study designs, sample sizes, characteristics of the study population, study location, and data collection methods of the included studies. Both quantitative and qualitative data were utilised to conduct a thematic analysis, employing a deductive method based on the Practical, Robust Implementation and Sustainability Model (PRISM), to identify facilitators and barriers of DHT’s implementation. Finally, all accessible DHTs were identified and organised to create a novel classification framework.

Results: Twelve studies were included from 292 retrieved articles. Telemedicine (n = 5) was found to be the most commonly used DHTs in LMICs’ hospitals, followed by hospital information systems (n = 4), electronic medical records (n = 2), and mobile health (n = 1). These four DHTs, among the other existing DHTs allowed us to develop a novel classification framework for DHTs. The included studies employed qualitative methods (n = 4) which included interviews and focus groups, quantitative methods (n = 5) or a combination of both (n = 2). Among the 64 facilitators of DHTs implementation, the availability of continuous on-the-job training (n = 3), ability of DHTs to prevent cross-infection (n = 2), and positive previous experiences using DHTs (n = 2) were the top three reported facilitators. However, out of the 44 barriers of DHTs implementation, patients with poor digital literacy and skills in DHTs (n = 3), inadequate awareness regarding DHTs among healthcare professionals and stakeholders (n = 2), and concerns regarding the accuracy of disease diagnosis and treatment through DHTs (n = 2) were commonly reported.

Conclusions: In the post pandemic era, telemedicine, along with other DHTs, has seen extensive implementation in hospitals within LMICs. All facilitators and barriers can be categorised into six themes, namely the aspects of healthcare system, perspectives of patients, external environment, implementation of sustainable infrastructure, characteristics of healthcare organisations, and characteristics of patients.

Registration: The protocol for this review has been registered at the Open Science Framework (OSF) Registry (https://osf.io/bqjuw)