Barriers and Enablers in Implementing Technology-Enabled Care for Older Adults in Rural and Remote Settings: A...

Existing reviews of technology-enabled care for older adults have primarily focused on technology usability, patient acceptance, and clinical outcomes. However, there remains limited synthesis of the organizational and system-level factors influencing the implementation of technology-enabled care in rural, regional, and remote contexts. This review addresses this gap by mapping barriers and facilitators using the Consolidated Framework for Implementation Research. Using technology to enable or enhance healthcare, rehabilitation, and self-management offers significant potential to improve access, outcomes, and equity for older adults; however, adoption and sustained use in rural, regional, and remote (RRR) settings remain limited. This scoping review aimed to identify factors influencing the implementation of technology-enabled care interventions for community-dwelling older adults in RRR contexts. Searches were conducted in PubMed, MEDLINE, CINAHL, Web of Science, and Scopus for empirical studies published from 2014 onwards. Barriers and enablers were mapped to the Consolidated Framework for Implementation Research (CFIR) and synthesized narratively. The search identified 807 records, of which 433 remained after duplicate removal and 105 proceeded to full-text assessment. Five studies met the inclusion criteria, examining telehealth, telerehabilitation, remote monitoring, and mobile health applications. Across the included studies, 71 implementation factors were identified, comprising 39 barriers and 32 enablers mapped across five CFIR domains and 20 constructs. The most frequently reported barriers related to innovation recipients' capability, innovation design, innovation complexity, and outer setting local conditions. The most frequently reported enablers related to innovation adaptability, innovation complexity, and innovation recipients' motivation. Findings suggest that implementation in RRR settings depends less on technological sophistication than on aligning design and delivery with user capability and local system capacity, reducing cognitive and technical burden, and embedding relational and contextual support.