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A consensus-based evaluation framework for telehealth in resource-constrained settings: evidence from a community
John Michael Diaz1, Ysabel Polanco2, Lara Vargas Alvarez1
1Department of Agricultural Education and Communication, University of Florida, Gainesville, FL, United States.
Frontiers in Digital Health
|July 28, 2026
Summary
Developing an equity-focused telehealth evaluation framework using community input is crucial for improving healthcare access in underserved areas. This consensus-based model addresses local barriers and enhances program sustainability.
Area of Science:
- Health Services Research
- Digital Health Equity
- Community-Based Participatory Research
Background:
- Telehealth expansion in low-resource settings faces challenges in equitable evaluation.
- Rural Colombian communities like Granizal experience significant barriers to healthcare access.
- Community-informed approaches are essential for effective and sustainable telehealth programs.
Purpose of the Study:
- To develop a consensus-based evaluation framework for a community telehealth program in Granizal, Colombia.
- To ensure the framework is responsive to local needs and promotes health equity.
- To create a replicable model for telehealth evaluation in underserved, displacement-affected areas.
Main Methods:
- A three-round Delphi methodology involving 15 diverse panelists (researchers, community health workers, decision-makers).
- Panelists were selected based on expertise in telehealth and community involvement in Granizal.
- Data collection included open-ended questionnaires, thematic analysis, Likert scale ratings, and consensus prioritization.
Main Results:
- Consensus was reached on seven evaluation domains: data, resources, barriers, engagement, and solutions.
- Key priorities included comprehensive clinical/sociodemographic data, continuity of care, patient experience, and quality of life outcomes.
- Identified barriers: limited connectivity, infrastructure, fragmented insurance, workforce instability, and lack of political will.
- Community health workers (CHWs) are vital for engagement, digital literacy, and sustainability.
Conclusions:
- Participatory, consensus-based methods are effective for designing telehealth evaluation frameworks in underserved settings.
- Embedding CHWs and local stakeholders ensures equity, relevance, and feasibility.
- The Granizal model provides a replicable approach for strengthening telehealth evaluation and decision-making globally.
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