Barriers to telehealth uptake and use: a scoping review

We conducted a scoping review to identify barriers to telehealth use and uptake from the perspective of patient, provider, and system that were documented in the literature. In addition to identifying and categorizing the barriers, we aimed to assess how barriers differed for studies conducted during the COVID-19 pandemic, as well as how barriers differed between the United States vs internationally based studies.

Comprehensive searches of the PubMed/MEDLINE, CINAHL, and Scopus databases conducted on December 29, 2021 yielded 17 887 results, with 11 221 potentially eligible documents after duplicates were removed. The team conducted an initial title and abstract review, followed by full text review. Data from the included sources were extracted and summarized into primary themes.

We identified 395 articles specifically related to barriers of telehealth use. The top 5 barriers, in order of frequency, were: lack of skills or ability (55%), lack of interest (49%), lack of access to technology (45%), limitations of technology infrastructure (45%), and lack of quality of care (42%). Roughly one-third (39%) of studies were related to the COVID-19 pandemic and 54% were US-based studies. The rank order of barriers between COVID-19 vs non-COVID-19 studies and US vs non-US studies was the same; however, patients in the United States and those using telehealth during COVID-19 were more likely to cite barriers related to the lack of access to technology (COVID = 56% vs 38%; United States = 51% vs 38%).

Interventions to address barriers need to consider the unique needs of specific populations and the ways in which different barriers may intersect.

This review found that barriers to telehealth uptake and use are multilayered and occur at several levels (individual, structural, technological).