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Barriers and facilitators for the adoption of telemedicine services in low-income and middle-income countries: a rapid overview of reviews
  1. Vijay Shree Dhyani1,
  2. Jisha B Krishnan1,
  3. Edlin Glane Mathias1,
  4. Mahbub M Hossain2,3,
  5. Carrie Price4,
  6. Nachiket Gudi1,
  7. Sanjay Pattanshetty5,
  8. Sanjay Zodpey6
  1. 1Public Health Evidence South Asia, Department of Health Information, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
  2. 2Department of Decision and Information Sciences, C.T. Bauer College of Business, University of Houston, Houston, Texas, USA
  3. 3Department of Health Systems and Population Health Sciences, Tilman J. Fertitta Family College of Medicine, University of Houston System, Houston, Texas, USA
  4. 4Albert S Cook Library, Towson University, Towson, Maryland, USA
  5. 5Department of Global Health Governance, Manipal Academy of Higher Education, Manipal, Karnataka, India
  6. 6Public Health Foundation of India, New Delhi, Delhi, India
  1. Correspondence to Nachiket Gudi, Public Health Evidence South Asia, Department of Health Information, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India; gudi.nachiket{at}


Objective To identify the barriers and facilitators for uptake of telemedicine services in low-income and middle-income countries (LMICs).

Design The rapid review approach to identify the barriers and facilitators for the uptake/delivery of telemedicine in health system from both the provider and the patient’s perspective. A two-stage sequential screening process was adopted. Data extraction was done using a piloted data extraction form.

Data sources A search on PubMed (NCBI), Embase (Ovid), the Cochrane Library (Wiley), Scopus (Elsevier) and the WHO Global Index Medicus was conducted.

Eligibility criteria for selecting studies Studies published between 1 January 2012 and 1 July 2022 on barriers and facilitators for uptake of telemedicine services in LMICs were included.

Results Database search identified a total of 2829 citations. After removing 1069 duplicates, 1760 were taken forward for title and abstract screening. A total of 43 articles were included at full text stage and 8 articles were included in this overview for narrative synthesis. Barriers and facilitators to telemedicine adoption and use were categorised under four subheadings, namely organisational and environmental, individual and cultural barriers, financial barriers and technological barriers. Providers, patient and health policy-makers perspectives were captured.

Conclusion Any development of telemedicine services should engage the primary users such as patients and their family caregivers to design people-centred digital health systems and services. Usability studies must be commissioned by the governments and host agencies to enhance the interaction experience pending which investments would remain futile. Future research should employ mixed methods or multi methods approaches to understand the interaction between patients and providers.

  • Public Health
  • Health services research
  • Health Care Quality, Access, and Evaluation

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  • Twitter @vsdhyani, @GudiNachiket

  • Contributors NG and EGM conceptualised the idea. NG, EGM, VSD, JBK and CP developed the search terms and CP conducted the searches on various databases. VSD, JBK, EGM, NG, MMH, SP and SZ drafted the manuscript. All the authors have proofread the manuscript and given the final approval of the version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.