Background
Study aim and overview
Theoretical framework
Interactive elements and their definitions | Factors within each element and their definitions |
---|---|
Rural context
| |
Geographical area with low population density, limited resource bases, relative isolation, and cultural or ethnic homogeneity [38], and the accompanying political, economic, social, and technological developments. |
Socioeconomic variables - The social and monetary environment in which the community is located. |
Individual resources and capabilities - Factors that influence the ability of rural residents to adopt e-Health. | |
A need for e-Health - Situation where e-Health can substitute for services that have disappeared or supplement existing services in a way that rural residents perceive as useful. | |
Third party involvement - Involvement of actors or stakeholders that do not belong to the targeted user group. | |
Implementation Process
| |
“Streams of activity across time” [26:39] undertaken with the aim of implementing e-Health. |
Implementation team - Stakeholders that initiate or promote change (a single stakeholder or a coalition of stakeholders). |
Implementation strategies - Assumptions of how change needs to be executed, formulated with the aim to implement e-Health. | |
Bottom-up strategy - Implementation strategy based on shared project ownership based on horizontal relationships between stakeholders. | |
Top-down strategy - Implementation strategy based on centralized project ownership with vertical relationships between a single stakeholder and external actors. | |
Resource management - Strategic allocation of scarce resources. | |
Conflict management - Management of competing stakeholder interests as well as their ideas on the project. | |
People and organizational issues - Problems among individuals and organizations that occur when implementing e-Health, such as with technical support. | |
e-Health Content
| |
Refers to any interactive communication and information technology aimed at enhancing the quality of life and/or health outcomes in the broadest sense [39]. |
Project design - The set of shared ideas about what the project is, including its aims, costs, and conditions for success. |
e-Health design - Technical and user features of the implemented e-Health. | |
Sustainability - The enduring adoption of the e-Health content. | |
Adoption Outcomes
| |
The degree of adoption by the targeted group, leading to individual and community-level outcomes. |
Individual level adoption outcomes - The effects that the implemented e-Health has on the individual’s health. |
Community-level adoption outcomes - The effects that the implemented e-Health has on the quality of life in the rural community. |
Methods
Inclusion and exclusion criteria
Search strategy
Data analysis
Results
Included studies
Year | Paper no. |
---|---|
1995-99 | 47,74 (n=2)
|
2000-04 | 8,23,24,46,48,49,56,57,64,73,80,83 (n=12)
|
2005-09 | 11,12,13,22,25,50,51,53,54,58,59,62,65,68,69,71,77,78,79,81,82,85 (n=22)
|
2010-11 | 9,10,14,52,55,60,61,63,66,67,70,72,75,76,84 (n=15)
|
Sub-question 1:What e-Health services are implemented in rural communities and for what purposes?
Type of e-Health |
Paper numbers
| Aim related to |
---|---|---|
Internet and social media | 25,51,52,53,54,55,56,57,59,60,61,62,63,64,65,66,67,68 | Social contact (51,52,53,60,61,63,66); Economic development (55,56,57,61,63,65,68); Access to information (52,53,62,64,67); Empowerment (55,57,59,61,65,67); Health (55,59,62,67); Bridging digital divide (25,63,54,67); Quality of life (general/other) (55,61,65); Education (55,61); Reducing costs/time (63). |
Videoconferencing and telehealth | 8,9,10,13,14,22,23,58,69,70,71,72,73,74 | Health (8,9,10,13,14,22,23,58,69,70,71,72,73,74); Bridging the digital divide (13,14,58,69,70,71,72); Reducing costs/time (13,22,23,58,73,74); Education (8,10). Access to information (71); Social contact (10). |
Telecommunication (mobiles) | 11,49,50,61,64,75,76,77 | Access to information (49,50,61,64); Education (61,75); Reduction cost/time (11,50); Health (11,61); Quality of life (general/other) (61,77). Bridging digital divide (50); Social contact (61); Economic development (61). |
Community networks | 24,46,47,48,78,79,80,81 | Access to information (24,46,47,48,80,81); Bridging the digital divide (46,47,48,80); Empowerment (47,78,79,81); Reducing costs/time (24); Health (78); Economic development (78,79); Education (78); Social contact (78). |
Web portal | 12,82,83 | Access to information (12,82,83); Health (12,82); Bridging the digital divide (83). |
Computer laboratory | 78,84,85 | Education (78,84,85). |
Papers’ perspectives
Sub-question 2: Which factors promote or restrain e-Health services adoption?
Context
Category |
Factor
| Paper no. | Paper perspective |
---|---|---|---|
Socioeconomic variables | Geographical isolation | 12,13 | A,B1,E |
Demographics (low age, male, married, family composition includes children) | 11,14,24,48,49,51,53,54, 60,62,63,69,79,83 | A,B1,B2,C,E | |
High occupation status, high income | 47,48,49,53,54,62,63,64,79 | A,B1,B2,E | |
Individual resources and capabilities | Having non-local ties | 52,53 | A,B2 |
ICT experienced | 14,47,48,54,72,82 | A,B1,C | |
Highly educated, high literacy | 47,49,53,61,62,63,69,79 | A,B1,B2,C,E | |
Political and community involvement | 46,47,48,52,53,85 | A,B2,C,D | |
A need for e-Health | Lack of or barriers to services/information | 8,12,13,24,52,59,78 | A,B1,B2,C,E |
Fulfilling a specific need | 13,25,49,54,76,59 | A,B1,B2,C,D,E |
Category |
Factor
| Paper no. | Paper perspective |
---|---|---|---|
Socioeconomic variables | Demographics (high age, female, single, having no children) | 11,14,24,48,49,51,53,54,60,62,63,69,83 | A,B1,B2,C,E |
Unemployment, low occupation status, low income | 24,46,47,49,54,57,60,83 | A,B1,C,D,E | |
Geographical isolated | 9,24,62,63,64 | A,B1,B2,C | |
Gendered society, caste system | 24,49,75 | A,B1,C,D,E | |
Individual resources and capabilities | Lack of ICT skills | 12,52,59,61,63,64,75,83 | A,B1,B2,C,D,E |
Low educated, illiteracy | 49,60,75,80,83 | A,B1,B2,C,D,E | |
Having local ties | 51,52,53,66 | A,B2,E | |
Inadequate physical or mental condition | 12,14,22,23,72 | A,B1,C,E | |
Third party | Teacher/student hierarchy | 75 | B1,D,E |
Unwilling third party | 24,52,60 | A,B1,B2,C | |
Available alternatives for receiving services/information | 22,23,51 | A,B1,C,E |
Process
Category |
Factor
| Paper no. | Paper perspective |
---|---|---|---|
Implementation team | Regionally based implementation staff | 22,23,80 | B1,B2,C |
Capable, skilled, motivated implementation staff | 22,23,70,77,84,85 | A,B1,C,D | |
Implementation practices | Training | 8,10,14,24,25,48,55,63,75,78,80,83,84, 85 | A,B1,B2,C,D,E |
Implementation strategy to motivate people (both from within and without) | 47,49,79,80 | A,B1,B2,C,E | |
Best practices | 10,22,23,70,84,85 | A,B1,C,D | |
Quick wins | 65,70 | C,D | |
Evaluation and feedback loops both bottom-up and top-down | 22,23,25,84 | B1,C,D | |
Bottom-up strategy | Work with existing local community networks | 48,63 | A,C |
Partnership: local residents as partners from an early stage add value and know their needs; objectives and roles should be transparent | 65 | C,D | |
In publically financed projects, civic leaders need the support of politically active citizens | 48 | A | |
Unbiased mediator role | 25,65 | C,D | |
Use of pilot implementation projects | 65,85 | A,C,D | |
Top-down strategy | Planned diffusion strategy with a need-based product/service | 58 | B1 |
When computer resources are left to the market place, economy factors will dominate | 48 | A | |
Implementation leadership, creating collective learning through openness | 80 | B1,B2,C | |
Top-down decision-making through local politicians | 9 | B1 |
Category |
Factor
| Paper no. | Paper perspective |
---|---|---|---|
Insufficient resources | Projects that have no authority or financial means and lack the capability to improve vital parts of the implementation process | 24,58,84 | A,B1,C,D |
Conflict potential | Lack of consensus, decision power, and commitment among key stakeholders | 24,25,58 | A,B1,C,D |
People and organizational issues | Problems with technical support | 24,78 | A,B1,C |
Logistical problems | 22,23,24,58,84 | A,B1,C,D | |
Regulatory issues | 25 | C,D |
Content
Category |
Factor
| Paper no. | Paper perspective |
---|---|---|---|
Project design | Tailored to specific and agreed upon needs | 12,59,77,78,80,84 | A,B1,B2,C,D,E |
Realistic and pragmatic goals | 9,14, 64,70,71,72,77,78,83,84 | A,B1,B2,C,D | |
Funding and costs | 70 | C | |
Availability | 14,51,59,60,61,62,63,64,66,67,72,78,83 | A,B1,B2,C,E | |
Accessibility | 11,14,24,51,61,64,79,80,82,84 | A,B1,B2,C,D,E | |
Distinctions between artifacts are commonly interpreted among relevant social groups, partners, and stakeholders | 25 | C,D | |
e-Health design | Designers considered local context in their design | 22,23,24,25,48,75,79,83,84 | A,B1,C,D,E |
Technological features | 10,22,23,58 | B1,C | |
Sustainability | Stakeholders should become contractual partners | 65 | C,D |
A community electronic network needs to sell itself | 47 | A |
Category |
Factor
| Paper no. | Paper perspective |
---|---|---|---|
Project design | Funding and costs | 9,14,25,64 | A,B1,B2,C,D |
Low availability | 75 | B1,D,E | |
Low accessibility | 66 | A,E | |
e-Health design | Not fulfilling a demand | 9,52,60,61,63 | A,B1,B2,C |
Poor user friendliness | 52,59 | A,B2,E |