Evidence mapPaperPMID 40920450Full record

ArticleJournal of medical Internet research2025

Using Theory-Based Frameworks to Identify Barriers and Enablers of Physicians' Telemedicine Adoption and Develop Intervention Strategies in China: Multicenter Qualitative Study.

Xinxia Wu, Yuting Yang, Yuchan Li, Yuhan Li, Huixian Li, Yanli Lyu, Ke Liu, Tracy Liu, Zheng Hou, Ke Zhang and 3 more

Abstract readMulticenter Study
In one paragraph

Article in Journal of medical Internet research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Xinxia Wu *Department of Medical Affairs, Peking University Third Hospital, Beijing, China.ORCID https://orcid.org/0009-0004-9782-0466
Yuting Yang *Institute of Hospital Management, Peking University Third Hospital, Beijing, China.ORCID https://orcid.org/0000-0001-6077-8306
Yuchan LiResearch Center for Standardization of Medical Data, Institute for Hospital Management of Tsinghua University, Beijing, China.ORCID https://orcid.org/0009-0003-6764-4038
Yuhan LiSchool of Public Health, Peking University, Beijing, China.ORCID https://orcid.org/0000-0002-1010-3842
Huixian LiDepartment of Medical Affairs, Peking University Third Hospital, Beijing, China.ORCID https://orcid.org/0009-0009-2912-078X
Yanli LyuDepartment of Medical Affairs, Peking University Third Hospital, Beijing, China.ORCID https://orcid.org/0009-0006-1642-7190
Ke LiuDepartment of Medical Affairs, Peking University Third Hospital, Beijing, China.ORCID https://orcid.org/0009-0006-0322-0051
Tracy LiuSchool of Economics and Management, Tsinghua University, Beijing, China.ORCID https://orcid.org/0000-0003-3052-5660
Zheng HouOffice of Internet Hospital, Peking University Third Hospital, Beijing, China.ORCID https://orcid.org/0000-0002-3027-6548
Ke ZhangOffice of Internet Hospital, Peking University Third Hospital, Beijing, China.ORCID https://orcid.org/0000-0002-8149-2371
Xuedong XuDepartment of Medical Affairs, Peking University Third Hospital, Beijing, China.ORCID https://orcid.org/0009-0008-5367-8989
Changxiao JinInstitute of Hospital Management, Peking University Third Hospital, Beijing, China.ORCID https://orcid.org/0009-0003-9803-3379
Yipei WangInstitute of Hospital Management, Peking University Third Hospital, Beijing, China.ORCID https://orcid.org/0009-0008-5263-8993

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundTelemedicine is developing rapidly, presenting new opportunities and challenges for physicians and patients. Limited research has examined physicians' behavior during the process of adopting telemedicine and related factors.

objectiveThis study aimed to identify perceived barriers and enablers of physicians' adoption of telemedicine and to develop intervention strategies.

methodsThree interlinked frameworks, the Theoretical Domains Framework (TDF), the Behavior Change Wheel (BCW), and behavior change techniques (BCTs), were used sequentially to identify the factors for physicians' telemedicine adoption and to develop intervention strategies. First, guided by the TDF, a questionnaire was developed and administered in interviews with 36 physicians from 29 different medical institutions in Beijing. Second, the content of the semistructured physician interviews was analyzed using the software NVivo 12.0 to extract themes under each domain. Each theme was then classified as either a barrier or an enabler based on the physicians' language and expression. Third, following the established relationships in the literature, we mapped each domain in the TDF to the corresponding intervention functions and policy categories within BCW. Fourth, for each identified intervention function, we further identified the associated BCTs using the standardized mappings reported in previous studies. The process of identifying intervention functions, policy categories, and techniques was guided by the APEASE (acceptability, practicability, effectiveness, affordability, spill-over effects, and equity) criteria. Last, potential implementation strategies were proposed via focus group discussion.

resultsWe identified 50 themes in relation to the adoption of telemedicine. These comprised 27 barriers and 23 enablers, ranging from administrative issues to specific clinical conditions. Of the 14 TDF domains, 11 domains were mentioned. The most frequently mentioned domains were environmental context and resources (10 themes), beliefs about consequences (9 themes), and emotion (7 themes). Major barriers comprised limited acceptance among senior physicians, inconsistent system performance, inadequate platform usability, and inadequate medical insurance coverage. Key enablers included sufficient communication skills and proficiency in system operations, together with the conviction that telemedicine may assist patients with resolving medical issues and prompt support from the IT department when challenges arise. Additionally, 7 of 9 intervention functions, 6 of 7 policy categories, and 26 of 93 BCTs were selected for each theme. Finally, we proposed several potential implementation strategies to enhance physician adoption of telemedicine.

conclusionsThis study identified a range of interventions and strategies that could improve telemedicine adoption in this context. Implementing these measures requires efforts from health administrative departments, medical institutions, and health care personnel.

Indexed as

PhysiciansTelemedicineAdultAttitude of Health PersonnelChinaFemaleHumansMaleQualitative ResearchSurveys and Questionnairesadoptionbehaviorbehavior change techniquesBehavior Change WheelChinaphysicianqualitative studytelemedicineTheoretical Domains Framework

Identifiers

PMID40920450
PMCPMC12455159

What Socratic holds

Textmetadata
LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.