Barriers and Facilitators to Implementing Digital Health Technologies for Remote Management of NCDs in Rural Areas: Mixed Methods Systematic Review

Clinical Snapshot

Key Findings

• Effect Size: Not applicable — qualitative synthesis; no pooled quantitative effect size reported

• Primary Outcome: Barriers and facilitators to DHT implementation for NCD management in rural settings, categorised using the Consolidated Framework for Implementation Research (CFIR). Key barriers: software instability, hardware issues, poor internet connectivity, financial constraints, staff shortages, and heavy workloads. Key facilitators: user-friendly technology design, strong leadership, effective teamwork, and ongoing communication.

• Nnt Or Sensitivity: Not applicable — implementation science review; no NNT, sensitivity, specificity, or hazard ratio calculable from available data

• Confidence Interval: Not applicable — no meta-analytic estimates generated

Clinical Application

Implementation of DHTs in rural NCD management is feasible but contingent on addressing structural prerequisites: reliable broadband infrastructure, adequate workforce capacity, sustainable funding models, and organisational readiness. User-centred design and strong clinical leadership are identified as modifiable facilitators that health services can act upon. Financial fragility of rural health services remains a significant implementation barrier requiring systemic policy intervention rather than individual service-level solutions. This review has direct relevance to Australian rural and remote healthcare. Australia's rural and remote populations experience disproportionate NCD burden, with cardiovascular disease, type 2 diabetes, and hypertension among the leading causes of morbidity and mortality in these communities. The identified barriers — limited broadband access, workforce shortages, and financial constraints — mirror well-documented challenges in Australian rural health services. The Australian Digital Health Agency's National Digital Health Strategy and the My Health Record system provide a policy infrastructure for DHT integration, but implementation gaps persist, particularly in Modified Monash Model categories 4–7. The Chronic Disease Management (CDM) Medicare item numbers and the Primary Health Network (PHN) commissioning model offer potential funding levers for sustainable DHT programs. The TGA's regulatory framework for Software as a Medical Device (SaMD) is relevant for any DHT seeking clinical deployment. RACGP guidelines on telehealth and chronic disease management align with the facilitators identified in this review, particularly around continuity of care and team-based models. The University of Melbourne co-authorship (Centre for Digital Transformation of Health) strengthens Australian contextual relevance. Rural-dwelling adults with NCDs, particularly those with cardiovascular disease, hypertension, and diabetes, who are candidates for remote monitoring or telehealth-based management. Findings are most directly applicable to high-income country rural settings given the composition of included studies.

Abstract

BACKGROUND: Digital health technologies (DHTs) have the potential to improve care delivery and outcomes for patients with noncommunicable diseases. Yet their implementation in rural settings remains uneven, and the factors influencing uptake are not well understood. OBJECTIVE: This mixed methods systematic review aimed to identify barriers and facilitators influencing the implementation and use of DHTs for remote management of noncommunicable diseases in rural areas. METHODS: We searched Medline, Embase, and CINAHL from inception to February 12, 2026, using terms related to digital health, noncommunicable diseases, and rural settings. Following the Joanna Briggs Institute methodology for mixed-method systematic review, we synthesized quantitative and qualitative studies. Barriers and facilitators were categorized using the Consolidated Framework for Implementation Research, and study quality was appraised using the Mixed Methods Appraisal Tool. RESULTS: From the initial 1491 records, 14 studies met the inclusion criteria, with most conducted in high-income countries (n=11). Key barriers included technical challenges (software instability and hardware issues), poor internet connectivity, financial constraints, and workforce constraints, such as staff shortages and heavy workloads. Key facilitators included user-friendly technology design, strong leadership, effective teamwork, and ongoing communication. Evidence was predominantly qualitative, with only limited quantitative data available. CONCLUSIONS: DHTs show promise for improving access and continuity of care for cardiovascular disease, hypertension, and diabetes in rural settings; however, their impact is constrained by structural inequities, including limited broadband access, workforce shortages, and financial fragility. These findings highlight important implications for research, policy, and practice, including the need for rigorous mixed methods evaluations sensitive to rural contexts, long-term equity-oriented financing mechanisms, and strengthened organizational readiness to support effective DHT uptake.

References

1. 1.Sahakyan, S., Akseer, S., Abrahamyan, L., Metcalf, O., Allin, S., Chenhall, R., & Seto, E. (2026). Barriers and facilitators to implementing digital health technologies for remote management of NCDs in rural areas: Mixed methods systematic review. Journal of Medical Internet Research. https://doi.org/10.1101/2024.02.23.24303246