Table 3 Identified barriers, successful experiences, and recommendations for implementation and adoption of telehealth during the COVID-19 pandemic based on CFIR framework.

Outer setting

• Unequal medical and technological resource distribution^27,87.

• Lack of standardized guidelines and supporting evidence^30,31.

• Provided care to patients in resource-limited areas^30,91.

• Decentralization of resources from core hospitals to resource-constrained areas²⁹.

• Expand commercial insurance to cover telehealth³².

Inner setting

• Lack of long-term evaluation methods to establish the clinical value^33,34.

• Insufficient human resources and inadequate incentives³¹.

• Reduced use of medical supplies and human resources³⁵.

• Design new workflow and reimbursement policies to accommodate telehealth services²⁸.

Intervention characteristics

• Unstable internet quality³⁶.

• Not friendly to users with low digital literacy⁵¹.

• Different health care services require different modalities (e.g., video, audio)³⁷.

• Privacy and security concerns⁴⁹.

• Low diagnostic accuracy³⁸.

• Lowered barriers (easy to use and affordable) for diverse patient populations^87,96.

• Reduced adverse events⁴⁰.

• Supported multiple functions and smooth patient-provider communication⁴⁵.

• Use off-the-shelf and already widely accepted technologies³⁷.

• Provide flexible modalities for different situations⁴⁵.

• Develop relevant infrastructure before the pandemic²⁸.

• Integrate telehealth systems with multiple functions⁴³.

• Develop inclusive and accessible technologies⁴⁹.

• Conduct dedicated outreach and provide technical support to persons with limited access or familiarity with new technologies²⁸.

Characteristics of individuals

• Low acceptance and buy-in⁴⁸.

• Preference for face-to-face interactions⁹⁵.

• Increased evidence base (especially with rigorously designed studies) to improve access or care at a reasonable cost⁹⁶.

• Support from family caregivers⁴⁹.

• Combine remote care with in-person care³¹.

Process

• Lack of public awareness⁵².

• Inadequate motivation and training³⁷.

• Additional workload for providers³⁷.

• Increased awareness of telehealth among the public⁵².

• The train the trainer model alleviated workload for providers who were in high demand³⁷.

• Partnered with third-party technology companies⁵⁵.

• Use various social media channels to promote public awareness⁵².

• Decentralize tasks to primary care⁴⁸.

• Tailoring systems based on the different patient populations or hospitals with different levels of technology infrastructures²⁹.

• Develop and use interchangeable EHRs to facilitate sharing of information among diverse providers³⁷.