7. The marginalization of the private sector and private health institutions undermines the potential of e-health initiatives.
For sustainable and widespread success in the realm of e-health, it is crucial to foster collaboration between the private sector and public entities. The demand generated by public services and the incentives put forth, along with the establishment of a legal framework by policymakers, will facilitate the supply of innovation and production by the private sector and academic entities. Detractors of e-health contend that the lack of cooperation among these stakeholders gives rise to concerns such as workforce depletion, inability to adequately test technical aspects such as algorithms utilized, failure to ensure fair competition circumstances, commercial conflicts of interest, and potential medicolegal challenges. Addressing these issues is vital to prevent the stagnation of e-health initiatives34-51-52.
8. Limited health and informatics literacy among society hinders the effective utilization of e-health.
The successful utilization of most e-health applications necessitates users to possess a reasonable degree of (health) literacy, along with a moderate understanding and proficiency in digital technology. When e-health exacerbates health inequalities, it is often associated with the exacerbation of existing disparities rather than the emergence of new inequities42 .
It has been observed that younger, healthier, and more educated individuals tend to utilize e-health services more frequently. Consequently, there is a genuine risk that e-health may primarily benefit the so-called ’anxious-well’ population, rather than the vulnerable and high-risk groups. In this regard, e-health has the potential to widen health inequalities21 .
Research has also explored the physical limitations that older adults face in accessing e-health services (75). Choi reported a decline in the rate of older adults using the Internet for health-related purposes, from 32.2% in the 65-74 age group to 14.5% in the 75-84 age group53 .
The complexity of e-health initiatives, spanning from simple information-based applications to intricate data-driven systems, directly influences patients’ adoption of these applications48 . Other factors that influence the utilization of e-health services include age, income, and education54 .
Innovative approaches have been proposed to enhance patient engagement and stimulate product sales in e-health applications. Examples include incorporating features like gamification and telepresence into e-health applications. Such measures can increase the interest of diverse age groups in e-health and strengthen the patient-physician relationship by fostering a heightened sense of reality for the patient. Currently, a significant number of e-health initiatives are either under development or in the implementation phase55 .
Conclusion
The implementation of e-health applications in primary care settings presents significant challenges. However, expanding the body of evidence-based knowledge concerning the barriers and facilitators influencing the adoption of e-health practices is crucial. Such knowledge can contribute to the widespread acceptance and utilization of this innovative healthcare initiative, thereby advancing public health objectives and fostering commercially successful, cost-effective service models. Major barriers identified include concerns related to cost, privacy, security, and the absence of universally accepted standards for e-health practices. Conversely, stakeholder engagement, robust implementation planning, availability of comprehensive training, and reliable support systems are viewed as facilitators. Scientific evidence will serve as the foundation for addressing all these factors. To overcome these challenges, it is essential to develop context-specific strategies tailored to the different stages of the implementation process.
Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Acknowledgements: Special thanks to Dokuz Eylül University Libraries for making printed and electronic databases available to us within the framework of the study.
Informed Consent Statement: Not applicable
Ethic statement: Not applicable
Conflicts of Interest: The authors declare that no competing financial interests exist.
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