Background
Methods/design
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Review—the current systematic review of review
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Original review—the systematic review of reviews conducted by Mair et al. [7]
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Studies/papers—the systematic reviews identified and synthesised in this review of reviews
Reporting
Inclusion and exclusion criteria
Population | Healthcare settings (including but not limited to primary, intermediate, secondary, home care). |
All healthcare settings were considered. | |
Not limited by: clinical area, health concern; the type of patient receiving the e-health technology; the type of health professional delivering care or country. | |
Intervention | e-Health technologies (including management systems, such as electronic health records that allow the acquisition, transmission and storage of patient data; computerised decision support systems including diagnostic support, alerts and reminder systems; communication systems such as telecommunication that act as an intermediary between users; and information resources such as the Internet) |
Comparator | This review was not limited to comparator studies. |
Outcomes | Qualitative data on factors that inhibit or promote implementation of e-health. |
Study type | Papers were included if they were as follows: |
• Systematic reviews: where relevant literature had been identified by means of structured search of bibliographic and other databases, where transparent methodological criteria were used to exclude papers that did not meet an explicit methodological benchmark, and which presented rigorous conclusions about outcomes. | |
• Narrative reviews: where relevant literature had been purposively sampled from a field of research; where theoretical or topical criteria were used to include papers on the grounds of type, relevance and perceived significance; with the aim of summarising, discussing and critiquing conclusions. | |
• Qualitative meta-syntheses or meta-ethnographies, where relevant literature was identified by means of a structured search of bibliographic and other databases, where transparent methods had been used to draw together theoretical products, with the aim of elaborating and extending theory. | |
And were excluded if they were as follows: | |
• Secondary analyses (including qualitative meta-syntheses or meta-ethnographies) of existing data-sets for the purposes of presenting cumulative outcomes from personal research programmes. | |
• Secondary analyses (including qualitative meta-syntheses or meta-ethnographies) of existing data-sets for the purposes of presenting integrative outcomes from different research programmes. | |
• Discussions of literature included in contributions to theory building or critique. | |
• Summaries of literature for the purposes of information or commentary. | |
• Editorial discussions that argue the case for a field of research or a course of action. | |
Where an abstract stated it was a review, but there was no supporting evidence in the main paper, such as details of databases searched or criteria for selection of papers (either on methodological or theoretical grounds), the paper was excluded. |
Search strategy for identification of studies
Selection of studies
Study quality assessment
Data extraction
Data synthesis
CFIR construct | CFIR component | CFIR sub-component | Sources | e-Health domain | ||||
---|---|---|---|---|---|---|---|---|
MS | CS | CD | IS | RS | ||||
Innovation characteristics | Innovation source | x | ||||||
Evidence strength and quality | x | x | x | |||||
Relative advantage | x | x | x | x | ||||
Adaptability | x | x | x | x | x | |||
Trialability | x | x | ||||||
Complexity | x | x | x | x | ||||
Design quality and packaging | x | x | x | |||||
Cost | x | x | x | x | x | |||
Outer setting | Patient needs and resources | x | x | x | ||||
Cosmopolitanism | x | |||||||
Peer pressure | No data | |||||||
External policy and incentives | x | x | x | x | ||||
Inner setting | Structural characteristics | x | x | x | ||||
Networks and communications | x | x | x | |||||
Culture | x | x | x | x | ||||
Implementation climate | ||||||||
Tension for change | No data | |||||||
Compatibility | x | x | x | x | ||||
Relative priority | No data | |||||||
Organisational incentives and rewards | x | x | x | x | ||||
Goals and feedback | x | x | x | |||||
Learning climate | No data | |||||||
Readiness for implementation | x | x | x | |||||
Leadership engagement | x | x | x | |||||
Available resources | x | x | x | x | ||||
Access to knowledge and information | x | x | x | x | ||||
Characteristics of individuals | Knowledge and beliefs about the intervention | x | x | x | x | x | ||
Self-efficacy | [27] | x | ||||||
Individual stage of change | x | |||||||
Individual identification with organisation | x | x | ||||||
Other personal attributes | x | x | x | |||||
Process | Planning | x | x | x | x | |||
Engaging | x | x | x | |||||
Opinion leaders | x | x | x | |||||
Formally appointed internal implementation leaders | x | x | ||||||
Champions | x | x | x | |||||
External change agents | No data | |||||||
Key stakeholders (Healthcare professional) | x | x | x | x | ||||
Innovation participants (patients) | [20] | x | ||||||
Executing | No data | |||||||
Reflecting and evaluating | x | x | x | x |
Determining how studies are related
Translating the studies into one another
Synthesising translations
Expressing the synthesis
Results
Search results
Description of the included reviews
Factors that influence implementation
• Selection of an appropriate e-health system needs careful consideration taking into account: |
o Complexity |
o Adaptability |
o Compatibility with existing systems and work practices |
o Cost |
• Key stakeholders and implementation champions should be included as early as possible in the implementation process. |
• Sufficient financial and legislative support needs to be in place to support implementation. |
• Standards for technology which address inter-operability, security and privacy may improve acceptability and implementation. |
• Planning implementation is a critical step which includes ensuring that organisations are in a state of readiness. |
• The provision of training and education to all those involved with implementation is a key success factor. |
• Implementation does not stop with ‘go-live’—there is a need for ongoing monitoring, evaluation and adaptation of systems to ensure intended goals are being met, benefits realised, and ongoing identification of barriers to effective use, along with strategies to overcome these barriers. |