Abstract
BackgroundTheory-guided approaches to implementation science have informed translation efforts and the acceptance of eHealth (digital health) interventions in clinical care. However, there is scarce evidence on which theories are best suited to addressing the inherent complexity of eHealth implementation.ObjectiveThe objectives of this systematic review are to identify theories that inform and explain eHealth implementation and to classify these theories using the typology by Sovacool and Hess for theories of sociotechnical change.MethodsAn electronic search was conducted in the PsycINFO, MEDLINE, Embase, CINAHL, Scopus, Sociological Source Ultimate, Web of Science, ABI/INFORM, EBSCO, and ProQuest databases in June 2019. Studies were included if they were published between 2009 and June 2019; were written in English; reported on empirical research, regardless of study or publication type; reported on one or more theories in the context of eHealth implementation; and were published in a peer-reviewed journal. A total of 2 reviewers independently assessed the titles, abstracts, and full texts. Theories identified were classified using a typology for theories of sociotechnical change, which was considered a useful tool for ordering and analyzing the diverse theoretical approaches as a basis for future theory building.ResultsOf the 13,101 potentially relevant titles, 119 studies were included. The review identified 36 theories used to explain implementation approaches in eHealth. The most commonly used approaches were the Technology Acceptance Model (TAM) (n=33) and the Unified Theory of Acceptance and Use of Technology (UTAUT) (n=32). These theories were primarily concerned with individual and interpersonal elements of eHealth acceptance. Less common were theories that reflect the various disorderly social processes and structural dimensions of implementation, such as the normalization process theory (n=17) and the structuration theory (n=6).ConclusionsTheories currently informing the implementation of eHealth interventions predominantly focus on predicting or explaining end-user acceptance. Theoretical perspectives that capture the dense and intricate relationships and structures required to enact sustainable change are less well represented in the eHealth literature. Given the growing acknowledgment of the inherent complexity of eHealth implementation, future research should develop and test models that recognize and reflect the multidimensional, dynamic, and relational nature of this process.
Highlights
In recent years, technological innovation in health care has developed exponentially, and eHealth is widely viewed as a significant potential contributor to improved quality of care [1,2]
36 distinct theories were identified. Classification of these theories using the typology by Sovacool and Hess [28] showed that the theories used in the literature were predominantly agency centered (19/36, 53%), followed by relational (7/36, 20%), structural (6/36, 16%), meaning (3/36, 8%), and combined theory types (1/36, 4%)
This calls into question whether theories currently being used to inform and explain the eHealth implementation adequately address the multiple and complex factors that influence the implementation process, and highlights the need for more dynamic, multilevel models of eHealth implementation [21,23,87]
Summary
Technological innovation in health care has developed exponentially, and eHealth is widely viewed as a significant potential contributor to improved quality of care [1,2]. Schreiweis et al [7] identified 77 barriers and 292 facilitators in implementing eHealth services. Studies about barriers and facilitators are important, they tend to fall short of capturing the complexity of the implementation process and the multiple interrelated factors that determine the translation and uptake of eHealth [1,9]. Theory-guided approaches to implementation science have informed translation efforts and the acceptance of eHealth (digital health) interventions in clinical care. Objective: The objectives of this systematic review are to identify theories that inform and explain eHealth implementation and to classify these theories using the typology by Sovacool and Hess for theories of sociotechnical change. The review identified 36 theories used to explain implementation approaches in eHealth. Given the growing acknowledgment of the inherent complexity of eHealth implementation, future research should develop and test models that recognize and reflect the multidimensional, dynamic, and relational nature of this process
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