Analyzing Smart Healthcare Adoption in Remote-Island Primary Care Clinics: A Hybrid MDM-AHP Study from Kinmen Island

Background: Smart healthcare is increasingly promoted to strengthen primary care services; however, adoption challenges are amplified on remote islands due to geographic isolation and resource constraints. Objectives: This study aimed to identify and prioritize key success factors (KSFs) for smart healthcare adoption in remote-island primary care clinics and to examine whether priorities differ across physician subgroups. Methods: A hybrid framework combining the Modified Delphi Method (MDM) and the Analytic Hierarchy Process (AHP) was applied. MDM (two rounds) refined a literature-based indicator pool to five dimensions and 20 criteria. AHP pairwise comparisons were collected from 21 physicians in Kinmen to derive weights and rankings. Results: System Quality (0.308) was the most critical dimension, followed by Organization (0.221), System Functionality (0.212), Environment (0.165), and Resource Investment (0.094). At the criterion level, Competitive Advantage and Security and Privacy were the two highest-ranked factors, followed by Accuracy and Data Integrity. Subgroup profiles varied across medical specialties and age groups. Conclusions: For remote-island primary care, adoption strategies should prioritize system quality and information assurance, while implementation support and resource considerations should be tailored to specialty- and cohort-specific needs.