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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