BARRIERS AND FACILITATORS FOR EHEALTH IMPLEMENTATION IN PEOPLE WITH MUSCULOSKELETAL PROBLEMS IN THE PRIMARY HEALTHCARE SETTING: A SYSTEMATIC REVIEW

M. van Tilburg1, I. Spin1, C. Kloek1,2, M. Pisters3,4,2, B. Staal5,6, R. Ostelo7,8, C. Veenhof1,3,2
1HU University of Applied Sciences, Expertise Center Healthy Urban Living, Research Group Innovation of Human Movement Care, Utrecht, Netherlands, 2Julius Health Care Centers, Center for Physical Therapy Research and Innovation in Primary Care, Utrecht, Netherlands, 3University Medical Center Utrecht, Utrecht University, Department of Rehabilitation, Physiotherapy Science and Sports, UMC Utrecht Brain Center, Utrecht, Netherlands, 4Fontys University of Applied Sciences, Research Group Empowering Healthy Behaviour, Department of Health Innovations and Technology, Eindhoven, Netherlands, 5HAN University of Applied Sciences, Radboud University Medical Centre, Musculoskeletal Rehabilitation Research Group, Nijmegen, Netherlands, 6Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, Netherlands, 7VU University, Amsterdam Movement Sciences Research Institute, Department of Health Sciences, Faculty of Science, Amsterdam, Netherlands, 8Amsterdam University Medical Center, Amsterdam Movement Sciences Research Institute, Department of Epidemiology and Data Science, Amsterdam, Netherlands

Background: Musculoskeletal disorders are a major contributor to healthcare problems worldwide. New and important demands will be placed on primary healthcare in the coming years, because of the changing global demographics and rising healthcare costs. To stimulate patients’ ability to self-manage their musculoskeletal problems, the integration of eHealth in treatment is one of the possible solutions. However, uptake of eHealth in primary care is lagging. To support implementation of eHealth services in primary care, insight into factors that can influence the implementation of eHealth is needed.

Purpose: The aim of this systematic literature review was to identify and provide an overview of barriers and facilitating factors in the implementation of eHealth services in people with musculoskeletal problems in the primary healthcare setting.

Methods: PUBMED, EMBASE, and CINAHL were searched for eligible qualitative studies up to August 2021. The studies were examined for themes about factors that can influence implementation of eHealth services in primary care. A narrative synthesis of data from included studies was conducted using the Consolidated Framework for Implementation Research (CFIR).

Results: Sixteen qualitative studies were included in this systematic review. Barriers and facilitating factors in the implementation were identified at the level of the eHealth service characteristics, outer setting, inner setting, characteristics of the health professionals and the implementation process. Important facilitators for successful implementation are that the eHealth service is adaptable, user friendly, of high quality, and has a good price-quality ratio. Implementation is facilitated when guidelines or protocols are available, there is a positive implementation climate, there is a positive attitude, belief, and perception of stakeholders, stakeholders have enough skills and motivation and appropriate stakeholders are involved in the implementation process. Barriers are that the eHealth service is too expensive, there is no financial incentive, no suitable resources are available, the workflow is disrupted, and negative attitudes and beliefs of stakeholders.

Conclusions: This systematic review acknowledges that implementation of eHealth services in people with musculoskeletal problems in primary health care is challenging and complex and is influenced by many factors. An overview of barriers and facilitating factors for the implementation of various eHealth services is provided in people with all sorts of musculoskeletal problems in the primary health care setting.

Implications: This overview can support health professionals, policy makers and researchers when planning or evaluating an implementation process for eHealth services in people with musculoskeletal problems in the primary healthcare setting and when developing implementation strategies.

Funding acknowledgements: N/A

Keywords:
eHealth
Implementation
Musculoskeletal problems

Topics:
Musculoskeletal
Primary health care

Did this work require ethics approval? No
Reason: Ethical approval is not required, because our work is a systematic review.

All authors, affiliations and abstracts have been published as submitted.

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