Factors That Influence Digital Health Implementation in Rural, Regional, and Remote Australia: An Overview of Reviews and Recommended Strategies

Abstract

Introduction: Digital transformation can enhance health and healthcare delivery; however, its application in rural, regional, and remote (RRR) areas presents considerable, underexplored challenges. While the benefits of digital health for underserved areas are evident, we must understand and address the challenges to fully realise its impact.

Objective: To synthesise the evidence for factors influencing the implementation of digital health in RRR Australia and recommend implementation strategies to address barriers.

Design: An overview of existing reviews was conducted to identify relevant systematic and scoping reviews. Review quality was assessed using the AMSTAR-2 tool. Barriers and enablers to implementation were mapped using the Consolidated Framework for Implementation Research (CFIR), and strategies to address barriers were identified based on the Expert Recommendations for Implementation Change (ERIC).

Findings: Three reviews met the inclusion criteria; each was focused on telehealth and remote monitoring technologies. Influencing factors were identified across five CFIR domains, encompassing 16 barrier and 12 enabler constructs. While gaps in evidence on health outcomes were noted, the benefits of implementation, such as improved access to services, reduced travel, and enhanced patient satisfaction, were highlighted. The recommended implementation strategies involved tailoring interventions to local needs, fostering local leadership and advocacy, planning and structuring implementation, and mobilising resources.

Conclusion: This study identified key influencing factors and recommended implementation strategies to mitigate barriers. These strategies, if employed, could facilitate the successful implementation of digital health in RRR Australia.

Trial registration: PROSPERO CRD42024512742.

Keywords: CFIR; barriers and enablers; digital health innovation; implementation science; rural health services; telehealth.

FIGURE 1

Framework used in this study to analyse factors that influence digital health implementation in RRR Australia; adapted from [20].

FIGURE 2

Preferred Reporting Items for Overviews of Reviews (PRIOR) flow diagram of study selection.

FIGURE 3

Barriers and enablers to the implementation of digital health in RRR Australia, as mapped to the CFIR domains and constructs; where (−) is a barrier, (+) is an enabler, and (+/−) is both an enabler and a barrier.