# Using the Theoretical Domains Framework to Identify Barriers to and Enablers of Patient Telemedicine Services Use in China: Qualitative Study

## TL;DR

This study explores why patients in China use or avoid telemedicine services and suggests ways to improve their use.

## Contribution

The study uses the Theoretical Domains Framework to identify barriers and enablers of telemedicine adoption in China and proposes targeted strategies.

## Key findings

- 28 themes were identified, including 14 barriers and 14 enablers across 5 TDF domains.
- Barriers included operational challenges and doubts about efficacy, while enablers included convenience and hospital support.
- Six intervention strategies were proposed to improve telemedicine utilization.

## Abstract

Telemedicine has rapidly expanded worldwide due to its convenience and accessibility. In China, an increasing number of hospitals have begun offering telemedicine services; however, patient utilization remains relatively low. Limited research has examined patients’ behaviors during the process of adopting telemedicine services.

This study aimed to identify barriers to and enablers for patients using telemedicine services and to formulate implementation strategies.

We conducted semistructured qualitative interviews based on the Theoretical Domains Framework (TDF) to identify barriers and enablers to telemedicine utilization. Twenty-one patients who had used Peking University Third Hospital’s telemedicine services were included in the interviews. Data were analyzed using NVivo 12.0 with deductive thematic analysis guided by the TDF. Moreover, a group of experts was assembled to devise potential intervention strategies.

A total of 28 themes were identified, including 14 barriers and 14 enablers across 5 of the 14 TDF domains. The most frequently reported barriers were operational challenges, prolonged waiting periods from asynchronous communication, and doubts about therapeutic efficacy, whereas the most frequently mentioned enablers were the convenience of telemedicine, time conservation, and support from hospitals. On the basis of these factors, we devised 6 intervention strategies.

This study demonstrated that patients’ utilization of telemedicine services was affected by several barriers and enablers, including system architecture and design, patient interactions using telemedicine, and external assistance. To enhance the utilization, these factors must be meticulously considered. This study also suggests strategies to enhance the utilization of telemedicine.