Understanding telemedicine adoption: evidence, gaps, and future perspectives for sustainable healthcare

Abstract

Telemedicine has expanded significantly, especially during the COVID-19 pandemic. It provides medical care remotely and has proven beneficial for remote areas. However, a lack of internet access hinders its adoption. Its significance is emphasized in child care and rural areas. Research gaps persist, such as a deficiency in systematic evaluations of its effectiveness in comparison to traditional medical care. The main goal is to identify the primary theories of telemedicine adoption in scientific literature. Following PRISMA guidelines, we carefully selected a dataset of 18 relevant documents from Scopus and Web of Science. Our analysis reveals the chronological distribution of publications, highlights influential researchers, and tracks keyword trends. By identifying prevalent theoretical models and frequently used variables, this study offers insights into the methodological landscape of telemedicine adoption research. The resulting research agenda not only underscores current gaps but also offers recommendations for future research directions, contributing to the evolving discourse on this vital topic, catalyzed by the pandemic’s impact on telemedicine adoption.

Keywords:

• Telemedicine
• systematic review
• sustainability
• E-health
• technology

REVIEWING EDITOR:

• Guangchao Charles Feng, School of Communication, Hong Kong Baptist University, Hong Kong

SUBJECTS:

• Health Communication
• Health & Society

1. Introduction

Telemedicine is the provision of medical care and health services at a distance through the use of information and communication technologies, such as video conferencing, email, text messages, and mobile applications (Ali & Ghertner, 2023). It has a wide range of applications in healthcare services, including medical consultations, home care, rehabilitation, and therapy (Rodriguez et al., 2021).

Telemedicine can be particularly important for healthcare in rural or isolated regions where access to healthcare is limited (Chen et al., 2021). It can also help reduce inequalities in medical care and improve access to health services in regions where patients face difficulties in obtaining care (Pierce & Stevermer, 2023).

The COVID-19 pandemic has led to a significant increase in the adoption of telemedicine worldwide, as many people have avoided in-person healthcare services due to the fear of contracting the disease (Bahl et al., 2020; Pierce & Stevermer, 2023). Telemedicine has proven to be effective in medical care during the pandemic, particularly in managing chronic diseases (AlAhmad et al., 2022; Ali & Ghertner, 2023; Bahl et al., 2020; Chen et al., 2021; Pierce & Stevermer, 2023; Rodriguez et al., 2021) and postoperative care of patients (Gaj et al., 2023).

While telemedicine provides significant benefits, its widespread adoption and use face obstacles, particularly the lack of high-speed internet access and broadband in low-income and rural areas (Chen et al., 2021). Furthermore, certain patients may encounter barriers to accessing healthcare online due to the technology required (Stifani et al., 2021).

The adoption of telemedicine was crucial during the COVID-19 pandemic to maintain healthcare while adhering to social distancing guidelines. This led to the unprecedented importance of this technology (Blue et al., 2020). Therefore, it is important to examine the perspective of doctors and relevant satisfaction indicators in the rapid adoption of telemedicine. The improved availability of technology can contribute to better access to medical care in general (Saiyed et al., 2021), as well as quality of life and patient satisfaction (Banks et al., 2021).

Technology applied to the provision of health services can be beneficial in various contexts (Banks et al., 2021). For instance, a study has emphasized the significance of telemedicine in children’s medical care. The study focused on the use of telemedicine in behavioral pediatric practices during the COVID-19 pandemic and highlighted how this technology enabled the continuation of care in a safe environment for both the patient and the healthcare provider (Wallis et al., 2021).

Research has been conducted on differences in the use of telemedicine based on medical specialty and patient demographics. This information could prove valuable in identifying areas where improvements are needed to ensure fair healthcare (Drake et al., 2022). Additionally, an innovative solution has been proposed to improve medical care for veterans with opioid use disorders in rural areas through the use of telemedicine. The study suggests that telemedicine adoption could be particularly beneficial in improving medical care access in remote or underserved areas where traditional medical care is limited (Brunet et al., 2022).

Despite telemedicine being an essential tool in healthcare during the COVID-19 pandemic, there are still several research gaps in this field. One of the main gaps in the research is the absence of a systematic evaluation of its effectiveness when compared to traditional medical care for different populations and conditions (Díaz & Guzmán-Pérez, 2019). Moreover, the application of adoption theories to diverse cultures and communities, particularly in countries with cultural diversity, remains incompletely understood. It is also unclear whether certain adoption models are more effective in specific cultural contexts. Therefore, it is crucial to comprehend the specific factors that impact the adoption of telemedicine (Ye et al., 2023). Addressing these gaps can significantly enrich the understanding of how people adopt telemedicine and help develop more effective strategies for its implementation and widespread use in diverse contexts.

Telemedicine serves as a bridge between patients and healthcare providers through electronic means to monitor medical services in distant locations. Recent studies have identified the effective use of mobile devices for remote healthcare delivery. This enables telemonitoring of wound care, which is a crucial technological advancement for remote medical diagnosis (Chakraborty, 2019). Additionally, the utilization of these technologies in urban areas presents opportunities for recommending optimal treatments for chronic wounds that require an intricate healing process (Chakraborty et al., 2015). Telemedicine through mobile devices can help patients receive timely medical advice without the need to physically travel to a healthcare facility (Chakraborty et al., 2014).

Furthermore, there was no correlation found between the use of telemedicine and increased medication retention in patients with a given diagnosis. This indicates the need for further studies on the effectiveness of telemedicine in treatment (Jones et al., 2022). Additionally, the effectiveness of telemedicine in the treatment of medical emergencies needs to be examined, as this area has been the subject of little research and current information is scarce (Laub et al., 2022). Furthermore, it has been emphasized that patient perceptions of telemedicine, particularly for vulnerable populations, must be investigated to ensure accessibility and satisfaction for all patients (Scott et al., 2021).

As a result, a systematic review of the literature is necessary to address current evidence and research gaps in the field of telemedicine adoption. The aim of this research is to identify the primary theories of telemedicine adoption in scientific literature. This text aims to identify gaps and create a research agenda. To achieve this, the following guiding questions for the review are considered:

• What are the bibliometric trends regarding the adoption of telemedicine?

• What is the evolution of the main keywords for analysis in the scientific literature on telemedicine adoption?

• What theories do researchers use to determine the adoption of telemedicine?

• What are the main variables used to understand the adoption of telemedicine?

• - What research gaps exist in the literature on telemedicine adoption and what future research questions can be formulated based on them?

• - What elements should a research agenda include to integrate the identified gaps and the growing and emerging themes of research on the adoption of telemedicine?

The article starts with a review of the relevant literature in the field of telemedicine adoption. The language used is clear, concise, and objective, adhering to a formal register. The text follows a logical structure with causal connections between statements. No changes in content have been made, and the improved text is as close as possible to the source text. In the methodology section, the study design and data collection and analysis methods are described in detail to answer the previously posed questions. The results section presents relevant data and statistics, and the results are interpreted and discussed in the final section of the article.

The value of conducting a comprehensive systematic review on the adoption of telemedicine lies in its ability to consolidate and analyze the available evidence. This review will provide an updated overview of the current state of research in this field, identifying emerging trends and research gaps.

This study will analyze academic and scientific literature sources to identify relevant authors, journals, and countries in the field of telemedicine. It will also explore the thematic evolution of telemedicine adoption over time, highlighting prominent areas of focus and recurring keywords as indicators of future research directions.

This systematic review focuses on identifying the most commonly used theories in studies on the adoption of telemedicine, analyzing their applicability and effectiveness in different contexts. The review aims to understand how these theories have contributed to the understanding of the telemedicine adoption process and whether they have provided a solid foundation for the development of effective strategies.

Additionally, this study will conduct a thorough analysis of the variables most commonly studied in relation to telemedicine adoption. The study will investigate the variables’ influence and relevance in the results obtained, identifying areas that require further research and exploration. The study will investigate the variables’ influence and relevance in the results obtained, identifying areas that require further research and exploration.

Finally, based on the compiled evidence, identified gaps, and emerging trends, a research agenda will be proposed that is solid and future-oriented. This agenda aims to address current knowledge gaps and focus on key aspects that require greater attention. The goal is to promote significant progress in understanding and successful implementation of telemedicine.

2. Materials and methods

To achieve the research objective, this study proposes a literature review and an exploratory methodology that includes a bibliometric analysis. This analysis will facilitate the assessment of scientific activities recorded in available scientific and academic databases. Currently, the literature review process adheres to the parameters established by the PRISMA international declaration of 2020. This ensures a clear and replicable methodology by defining eligibility criteria, sources of information, search strategy, and data management. These parameters are important resources for the methodological design, as evidenced in Page et al. (2021) and Vera Ávila et al. (2022).

2.1. Eligibility criteria

The PRISMA 2020 international declaration defines eligibility criteria that are divided into inclusion and exclusion criteria. Inclusion criteria are based on the presence of the concepts ‘telemedicine’ or ‘telehealth’ and ‘acceptance’ or ‘adoption’ in both the title and keywords of the documents to be analyzed. This ensures that all obtained documents are relevant for the adoption of telemedicine.

On the other hand, the exclusion criteria consist of three consecutive elimination stages, as established by the PRISMA 2020 declaration. Initially, articles with incorrect indexing are discarded based on the titles of the documents. Incorrectly indexed documents are academic or scientific materials that may be relevant to a specific research topic but are not fully indexed or cataloged within the consulted databases for the systematic literature review. This may be due to data entry errors, lack of updating, or limitations in the database indexing systems. Similarly, documents written in less commonly used languages or non-standard formats may have lower visibility or limited indexing in some databases. Additionally, certain materials may be subject to access restrictions, making their inclusion in certain open or publicly accessible databases challenging.

Unrelated records are documents that do not align with the objective of this study, which aims to analyze the adoption of telemedicine through technology acceptance theories. Unretrieved reports are documents that could not be accessed at the time of the review. Documents without access to the full text are eliminated. Finally, irrelevant documents such as books, notes, meeting abstracts, and editorial materials are excluded from the analysis. Conference documents are also excluded as they limit the scope of this research.

2.2. Information sources

Web of Science and Scopus were selected as the databases for searching and selecting articles related to the adoption of telemedicine. These databases are widely used for publishing academic articles and are the most commonly used by researchers from different countries and regions, making them the world’s leading databases for searching scientific documents (Zhu & Liu, 2020).

2.3. Searching strategy

To guarantee efficient information retrieval, we have developed two similar search equations that differ depending on the database interface. It is crucial to define the search criteria and keywords to ensure that all the documents to be analyzed are found. The equations we created are as follows:

• For Scopus: (TITLE (telemedicine OR telehealth) AND TITLE (adoption OR use OR acceptance))

• For Web of Science: (TI = (telemedicine OR telehealth) AND TI = (adoption OR use OR acceptance))

2.4. Data management

After applying the search strategy to the selected information sources using the designed search equations, a total of 2513 documents related to the adoption of telemedicine were collected. Of these, 2174 belong to Web of Science and 339 to Scopus. The documents range from the year 1978 to the present year 2023. Using Microsoft Excel^®, we stored all the relevant documents and applied the exclusion criteria that were previously defined. We obtained a total of 18 articles for analysis. Next, we generated bibliometric indicator graphs using the free software VOS viewer to facilitate data analysis.

2.5. Selection process

Following the parameters established by the PRISMA 2020 international declaration, we conducted a thorough review of each selection method and analyzed the documents to reduce data bias. We carefully examined each item to identify similarities or convergences between them, in order to resolve any differences found during the exclusion process. Finally, the methodological design used in this research is summarized in Figure 1, following the PRISMA 2020 statement.

Figure 1. PRISMA-2020 flow chart.

This is a flowchart that illustrates the PRISMA-2020 guidelines for conducting systematic reviews on the adoption of telemedicine.

The flowchart illustrates the initial stage of the study, where 2,578 documents were identified. Of these, 231 were excluded as duplicates. Following this, three exclusion phases were conducted, applying the defined criteria, which resulted in the elimination of 2264 publications. Finally, 18 articles were selected for bibliometric analysis.

3. Results

The adoption of telemedicine has been extensively researched in 2020, particularly due to the COVID-19 pandemic. Our study, guided by 18 selected articles, aims to address research inquiries by conducting a comprehensive bibliometric analysis. This analysis aims to identify key contributors, such as authors, prominent journals, and countries involved. Our focus is on analyzing keywords to identify current research trends related to this subject. We examine the recurring research theories on telemedicine adoption, as well as the most frequently studied variables. Lastly, we propose a research agenda to outline potential future investigations in this field.

3.1. Bibliometric analysis of telemedicine adoption literature

Upon initial examination, the results present the most notable figures in the field of study through a thorough analysis of their productivity and impact. These aspects are evaluated using standard bibliometric indicators, which are commonly used to accurately identify the most significant contributors within the domain. The analysis focuses on the quantity of work produced by these figures, as well as the impact and relevance of their contributions to the field. By doing so, it provides a more comprehensive view of their influence in the researched discipline.

This bibliometric review analyzes prominent researchers who have contributed to the scientific discourse on telemedicine adoption. Figure 2 depicts an examination of scientific productivity factors, such as the number of publications, and academic impact, which is measured by the total citations garnered by each author.

Figure 2. Principal authors.

List of main authors who have contributed to the research on the adoption of telemedicine.

The analysis does not reveal significant evidence of authors making a substantial impact within the research field, as they lack a simultaneous increase in both publication count and citations. However, the study conducted by Kohnke A., Cole M. L., and Bush R. on the predictors of behavioral intention in utilizing telehealth equipment among patients, physicians, and staff at the Henry Ford e-Home Health Care agency (90 citations) (Kohnke et al., 2014) is noteworthy. Author Tsai C-H is a highly cited researcher (76 citations) who is credited with formulating a comprehensive behavioral model for telehealth systems exploration (Tsai, 2014) by integrating diverse theories. Tsai C-H deserves notable recognition for this influential study.

Figure 3 shows the main journals related to telemedicine adoption, evaluated based on their productivity and impact within the scientific community. The figure illustrates two categories: orange denotes primary reference journals, which have the highest publication frequency and citation rates, and blue represents impactful journals that publish less frequently but receive substantial citations. Meanwhile, the green color highlights journals with the highest publication volume.

Figure 3. Main journals.

List of major journals that contribute to research on the adoption of telemedicine.

The Journal of Technology Management and Innovation has the highest number of citations, totaling 90 for the study conducted by Kohnke, Cole, and Bush. The International Journal of Environmental Research and Public Health has accumulated 76 citations for Tsai’s study and another study by Walczak et al. (2022). The studies focus on the evaluation of telehealth acceptance among General Practitioners (GPs) during the COVID-19 pandemic in Poland, with Walczak et al. (2022) receiving three mentions.

Digital Health features two publications of lesser impact in terms of citations. Anderson et al. (2022) conducted a study that received six citations, analyzing online conversations about telemedicine during the pandemic’s onset and a year later. Rouidi et al. (2022) proposed a conceptual model for health professionals’ acceptance and use of telemedicine technology, which garnered two citations.

Figure 4 highlights the primary countries in telemedicine research, indicating their prominence. The countries marked in orange are leaders in both publication frequency and citation rates, while those highlighted in blue generate substantial impact despite lower publication rates. Countries marked in green have a higher number of publications. The countries with the most substantial impact in telemedicine research are the United States and Taiwan. Additionally, Indonesia has the highest number of publications, although with only two studies.

Figure 4. Main countries.

List of countries that have contributed significantly to research on the adoption of telemedicine.

3.2. Thematic components in the telemedicine adoption literature

The results present an analysis of keywords that identifies thematic trends in the adoption of literature. This analysis offers a comprehensive view of the topics that have been prominently addressed in the past and currently, enabling a prospective analysis of themes that might gain more traction in the future. Examining prevalent keywords can provide valuable insights into potential directions within the field of study that may become more significant in future research and discussions regarding literature adoption.

Table 1 shows the evolution of prevalent keywords used in exploring telemedicine adoption from 2014 to 2022 in relation to the research question of the main keywords for analysis in the scientific literature on telemedicine adoption. There has been a growing trend towards the use of the Unified Theory of Acceptance and Use of Technology (UTAUT) model in 2014, 2020, and 2021. This highlights its importance in evaluating the factors that affect the adoption of telemedicine. In recent years, there has been a shift in focus towards acceptance models related to technology. There is a current trend towards studies focused on COVID-19, which reflects the global increase in the use of telemedicine services due to the pandemic’s impact.

Table 1. Thematic evolution.

Keyword	Year
Covid-19	2022
Utaut	2021
Utaut	2020
Utaut	2014

Figure 5 presents information on the key terms contained in the articles investigated regarding the study of Telemedicine Adoption. With this, we seek to answer the question what the bibliometric trends on the adoption of telemedicine are. In this, four quadrants are pro-posed from the graph of a Cartesian plane, each one represents the behavior of the concepts with the highest level of appearance and at the same time they have decreased in importance currently associated with the aforementioned theme. Quadrant IV does not have any words. The quadrant IV displays terms that are more frequent but less current. In this specific case, no terms have been identified that belong to this set of keywords, indicating the need to discover more updated terms (see Quadrant I).

Figure 5. Frequency and validity of keywords.

This chart displays the frequency and validity of keywords used in studies on the adoption of telemedicine.

Figure 6. Research agenda.

Diagram outlining the research agenda for the adoption of telemedicine.

During the systematic literature review on telemedicine adoption, a specific quadrant, Quadrant III, has been delineated within a Cartesian plane graph. Quadrant III includes concepts that have not yet attained substantial consolidation within the scientific literature. These concepts occupy an intermediate position, neither among the most frequently used nor the most current within the field of study.

Keywords such as ‘Technology Acceptance Model’ are situated within this quadrant, signifying their relevance to telemedicine adoption while not holding significant prominence in terms of frequency or current discourse within scientific literature. The keywords present in quadrant III indicate potential for research development and knowledge advancement in those specific areas.

Quadrant II, which is characterized by low frequency yet high validity, encompasses emerging concepts in the telemedicine adoption research domain. These nascent ideas hold paramount importance in both current and forthcoming contexts, offering promising avenues for advancing telemedicine. Key words identified in this quadrant include the ‘perceived usefulness’ and ‘perceived ease of use’ variables of the UTAUT model, which represent two of the most studied factors.

In addition, this text integrates various theories to investigate the acceptance of telemedicine technologies. It includes key terms such as ‘primary healthcare’, ‘Twitter’, ‘Telemedicine Technology Acceptance’, ‘TPB’ (Theory of Planned Behavior), ‘user behavior’, ‘plasticity’, ‘rural and remote areas’, ‘hospital’, and ‘chronic disease management’. These theories focus on user behavior and emphasize the inherent benefits of telemedicine in providing initial medical aid, managing chronic illnesses, and facilitating access to remote rural areas through virtual platforms.

The analysis of the Cartesian plane graph reveals that in quadrant I, there are concepts related to the keyword ‘Covid-19’, which are among the most frequent and current in the scientific literature on the adoption of telemedicine. The Covid-19 pandemic has led to the emergence of important concepts that are relevant both currently and in the near future. One of these concepts is the rapid adoption of telemedicine in various healthcare settings, as discussed in the cited studies. The UTAUT model is a pivotal precursor in this domain and is the most widely employed technology adoption model. The significance of this framework lies in its ability to serve as a foundation for the application of similar models in diverse contexts, particularly in the realm of post-pandemic telemedicine services.

3.3. Analysis of theories on telemedicine adoption

Thirdly, this paper conducts a comprehensive analysis of theories related to users’ adoption of telemedicine technology. The analysis aims to delve deeper into the foundations of human behavior that have been studied in recent years and offer a detailed perspective on the most prevalent theories and those that require further exploration. This exploration can be crucial for scholars and professionals interested in this field. It helps identify the theory most pertinent to employ in their research by comprehending the various theories applied in telemedicine adoption. This facilitates the selection and application of a robust and relevant theoretical framework in future studies, thereby enhancing the understanding of factors influencing the acceptance and use of this technology.

The following section reports the findings related to the theories used to determine the adoption of telemedicine, in order to answer the research question: What are the theories used by researchers? Table 2 provides a clear understanding of the data analysis, including the design of the investigations, interpretation of the results, and refinement of the theoretical perspectives behind the articles. It also explains how the theories were applied to expose the investigated phenomenon.

Table 2. Articles included in the review and theories of telemedicine adoption.

Theory	n	Title	Country	Authors
Extended UTAUT	8	Adoption of Telemedicine Applications among Saudi Citizens during the COVID-19 Pandemic: An Alternative Health Delivery System	Saudi Arabia	(Yamin & Alyoubi, 2020)
		Decision-making factors associated with telehealth adoption by patients with heart failure at home: a qualitative study	United States	(Chan et al., 2022)
		Acceptance of Telemedicine and Preferred Modalities among Healthcare Providers during COVID-19 Pandemics in a Low-Resource Setting: An Extended UTAUT Model	Ethiopia	(Shiferaw et al., 2021)
		Modifying UTAUT2 for Cross-Country Comparison of Telemedicine Adoption	United States/Germany	(Schmitz et al., 2022)
		Factors Influencing Telehealth Acceptance During the COVID-19 Outbreak: An Extension of the UTAUT Model	Indonesia	(Napitupulu et al., 2021)
		Incorporating UTAUT predictors to understand the acceptance of healthcare telemedicine equipment by home care patients and clinicians.	United States	(Kohnke et al., 2014)
		Readiness and Acceptance of Philippine General Hospital Medical Staff for Telemedicine as an Alternative Method of Patient Consultation during the COVID-19 Pandemic and Post-Enhanced Community Quarantine Period	Philippines	(Ang-Muñoz et al., 2022)
		Factors Affecting the Acceptance of Pediatric Telemedicine Services in China: A Study Using Cross-Sectional Analysis	China	(Shi et al., 2021)
Extended TAM	7	Factors Affecting Patients’ Acceptance and Satisfaction with Cloud-Based Telehealth for Chronic Disease Management: A Workplace Case Study	No country mentioned	(Su et al., 2020)
		Indonesian Hospital Telemedicine Acceptance Model: The Influence of User Behavior and Technological Dimensions	Indonesia	(Alexandra et al., 2021)
		Integrating social capital theory, social cognitive theory, and the technology acceptance model to explore a behavioral model of telehealth systems	Taiwan	(Tsai, 2014)
		Telemedicine Technology Use among General Practitioners during COVID-19: A Study of the Modified Technology Acceptance Model in Poland	Poland	(Walczak et al., 2022)
		This article examines the acceptance of telemedicine by cancer patients in an ambulatory care setting using the technology acceptance model.	Singapore	(Chan et al., 2022)
		Predicting Telemedicine Adoption: An Empirical Study on the Moderating Effect of Plasticity in Brazilian Patients	Brazil	(Ramírez-Rivas et al., 2021)
		Translation and Validation of the Questionnaire on Acceptance of Telemedicine based on the Technology Acceptance Model (TAM) for Use in Malaysia	Malaysia	(Husin et al., 2022)
TAM	3	Determinants of Health Seekers’ Acceptance and Adoption of Telemedicine in Emerging Economies	Bangladesh	(Shiferaw et al., 2021)
		Acceptance and Use of Telemedicine Technology by Health Professionals: Development of a Conceptual Model	Taiwan	(Rouidi et al., 2022)
		Telehealth Adoption During the COVID-19 Pandemic: A Textual and Network Analysis on Social Media	No country mentioned	(Anderson et al., 2022)
UTAUT	1	Acceptance and Use of Telemedicine Technology by Health Professionals: Development of a Conceptual Model	Taiwan	(Rouidi et al., 2022)

Fifteen articles analyzing telemedicine adoption primarily focused on four main theories, including UTAUT. UTAUT was applied eight times, emphasizing user behavior, perceived benefits, and habits in adopting telehealth technologies (Cardador, 2015; Kyungmi & Dowding, 2020; Yamin & Alyoubi, 2020). Furthermore, articles in Ethiopia highlighted the significant impact of factors such as self-efficacy, effort expectancy, and social influence on healthcare professionals’ attitudes toward telemedicine use (Shiferaw et al., 2021).

The article adapted the Unified Theory of Technology Acceptance and Use 2 (UTAUT2) to include perceived safety and product advantage barriers (Schmitz et al., 2022). Another study observed the factors that affect telemedicine adoption among early adopters, linking physician views and computer anxiety to performance and effort expectations (Napitupulu et al., 2021). The integration of UTAUT predictors also facilitated the understanding of the acceptance of telemedicine teams (Kohnke et al., 2014). Additionally, seven articles utilized the Technology Acceptance Model (TAM) to assess patient satisfaction, user behavior, and acceptance of cloud-based telehealth and hospital telemedicine models (Alexandra et al., 2021; Ang-Muñoz et al., 2022; Ramírez-Rivas et al., 2021; Shi et al., 2021; Su et al., 2020).

An article integrated social capital theory and Technology Acceptance Model (TAM) to analyze relationships in providing remote care (Tsai, 2014). Factors driving physicians’ implementation of telehealth during the COVID-19 pandemic in Poland were explained using a modified TAM (Page et al., 2021). Crucial areas of study were highlighted, including predicting telemedicine behaviors in developing countries and assessing healthcare providers’ acceptance using TAM (Husin et al., 2022; Zobair et al., 2021).

Less commonly used models include the initial versions of TAM and UTAUT, which were applied three and once, respectively, in related articles. These models explain social acceptance, diffusion patterns, and determinants of telemedicine adoption (Anderson et al., 2022; Rouidi et al., 2022). Furthermore, a qualitative study highlighted factors such as experience, knowledge, trust, satisfaction, and attitudes, rather than ease of use, among home heart failure patients who adopted telehealth (Kyungmi & Dowding, 2020).

3.4. Analysis of telemedicine adoption variables

The results present an analysis of the most commonly measured variables in telemedicine adoption theories. This finding identifies the variables that are most frequently studied in the selected articles for this analysis. Furthermore, less explored variables are identified, providing an opportunity for future research to investigate these variables further within this field of study. Additionally, this study identifies research gaps related to unexplored variables that could be applicable in this context. These unexplored areas may provide new perspectives and valuable contributions to the understanding and application of telemedicine adoption theories.

Table 3 presents the results of investigations related to the analyzed subject. It identifies the 18 fundamental variables most commonly used in models and theories, classified by frequency of use. This answers the research question: What are the main variables used to understand the adoption of telemedicine? The most frequently used variable is listed first. This approach allows for the explicit identification of the most significant concepts for measuring telemedicine adoption. To facilitate interpretation of the collected data, the primary variables are defined based on their usage in relevant articles.

Table 3. Main variables of telemedicine adoption.

Variable	Frequency
Behavioral intention	18
Enabling conditions	12
Social influence	12
Effort Expectation	9
Performance expectation	9
Perceived ease of use	9
Perceived utility	9
Attitude towards use	6
Self-efficacy	5
Anxiety	3
Output quality	3
Trust	3
Behavioral use	3
Experience	2
Gender	2
Image	2
Subjective norm	2
Current usage	2

Behavioral intention is the most influential variable in telemedicine adoption, as found in 18 articles. It is defined as one’s intention to use technology based on personal behavior (Husin et al., 2022). Articles that utilized the UTAUT model confirmed its applicability (Anderson et al., 2022; Cardador, 2015; Kohnke et al., 2014; Kyungmi & Dowding, 2020; Rouidi et al., 2022; Shiferaw et al., 2021; Tsai, 2014; Walczak et al., 2022; Yamin & Alyoubi, 2020). Following behavioral intention, social influence and facilitating conditions rank second, each explained in 12 articles. Facilitating conditions refer to the perceived organizational and technical infrastructure support, while social influence denotes indirect or direct influence from others in adopting new systems (Zobair et al., 2021).

Effort expectancy, performance expectation, ease of use, and perceived usefulness were each mentioned in nine articles as representing user expectations, ease of use perception, and utility of technology (Ang-Muñoz et al., 2022; Kyungmi & Dowding, 2020; Napitupulu et al., 2021; Schmitz et al., 2022; Shi et al., 2021; Shiferaw et al., 2021; Su et al., 2020). Attitude, self-efficacy, and service quality were featured in six, five, and three articles, respectively. Attitude refers to an individual’s positive or negative feelings towards an activity. Self-efficacy, on the other hand, pertains to perceived competence in using digital devices. Service quality, as measured by user satisfaction (Kohnke et al., 2014; Shiferaw et al., 2021; Zobair et al., 2021), is also an important factor to consider.

Three articles each identified anxiety, output quality, confidence, and behavioral use. These articles discussed user hesitancy, service reliability, user trust, and actual usage prediction (Alexandra et al., 2021; Kohnke et al., 2014; Zobair et al., 2021). Two articles each discussed variables such as gender, experience, image, subjective norm, and current use, which significantly contribute to telemedicine adoption. These variables encompass user traits, social influence, and perceived system usefulness (Anderson et al., 2022; Ang-Muñoz et al., 2022; Cardador, 2015; Kyungmi & Dowding, 2020; Napitupulu et al., 2021; Rouidi et al., 2022; Schmitz et al., 2022; Shi et al., 2021; Shiferaw et al., 2021; Su et al., 2020; Walczak et al., 2022; Yamin & Alyoubi, 2020). These variables provide a comprehensive understanding of the theories applied in telemedicine studies, which can facilitate future research proposals. However, it is important to consider cultural and social contexts when selecting these variables, and they should align with the interests and goals of the researchers.

3.5. Research gaps identified

Finally, the analysis presents research gaps in telemedicine adoption based on the most frequent theories and variables in the analyzed articles. This allows for the identification of significant research voids that can be addressed in future work within this field. By highlighting these knowledge gaps, promising directions for subsequent studies are emphasized. These gaps represent areas that are still underexplored or insufficiently investigated within the realm of telemedicine adoption. Therefore, a deeper and more comprehensive approach is needed in future research to enrich and broaden our understanding in this critical domain of remote healthcare.

Various theoretical models have been used in articles on the adoption of telemedicine, as mentioned above. In order to answer the research question, some identified research gaps are shared below: What research gaps exist in the literature on telemedicine adoption and what future research questions can be formulated based on them?

The Theory of Planned Behavior (TPB) identifies attitude, subjective norm, and perceived behavioral control as predictors of intention to use telemedicine (Siripipatthanakul et al., 2023), although it has been less explored in telemedicine adoption studies. Recognizing and addressing barriers to accessing telemedicine services, as well as understanding the social determinants of health (such as income, education, gender, race, and health insurance type), are crucial considerations. It is also important to recognize obstacles faced by various communities and populations, including those with disabilities (Annaswamy et al., 2020; Graves et al., 2020; Luo et al., 2021; Pang et al., 2022).

Although TAM and UTAUT are widely used, future research could combine these models to include adopters’ beliefs and perceptions in multidimensional approaches, particularly in emerging economies (Curfman et al., 2020). Table 4 outlines the research gaps identified in this review. Furthermore, investigating the phenomenon of study using self-determination theory, which includes variables such as perceived support for autonomy, work alliance, autonomous motivation, and perceived competence, could yield valuable insights (Arafat et al., 2021).

Table 4. Research gaps.

Gap type	Research gap	Research question
Issues related to theories’ gaps	1. Insufficiency in the application of the Diffusion of Innovations model in the adoption of telemedicine.	How can the Diffusion of Innovations model be adapted to better understand the factors that influence the adoption of telemedicine by healthcare professionals and patients?
	2. The role of behavior change theory in the adoption of telemedicine needs to be explored.	How can behavior change theory, such as the Stages of Change Model, be used to understand and promote the adoption of telemedicine among different user groups?
	3. There is a gap in understanding the social determinants that affect the adoption of telemedicine.	What is the impact of social determinants, such as socioeconomic status and education, on the adoption of telemedicine? How can associated inequalities be addressed?
	4. The article pays insufficient attention to psychobehavioral aspects, such as the Theory of Planned Behavior, which can help to understand the intention to adopt telemedicine.	What is the role of planned behavior theory in understanding the intention to adopt telemedicine?
	5. There is a gap in understanding the influence of access barriers on the adoption of telemedicine.	How are access barriers related to connectivity and technological infrastructure preventing the widespread adoption of telemedicine and how can they be overcome?
	6. The role of UTAUT and TAM theories, as well as their extensions, needs to be investigated in the context of emerging countries.	What are the primary variables in models like UTAUT and TAM for telemedicine adoption in emerging countries?
	7. The role of self-determination theory in the adoption of telemedicine needs to be investigated.	How can self-determination theory aid in understanding the intrinsic and extrinsic motivation of healthcare professionals and patients in adopting telemedicine?
Issues related to the primary variables’ gaps	1. There is a gap in understanding the subjective variables that influence behavioral intention in the adoption of telemedicine.	What subjective factors, such as individual beliefs and personal attitudes, influence behavioral intention towards the use of telemedicine, and how can they be addressed in future studies?
	2. Insufficient research has been conducted on the influence of trust in the adoption of telemedicine.	How does trust in technology, service providers, and privacy protection influence behavioral intent and adoption of telemedicine, and how can user trust be strengthened?
	3. Investigating emotional barriers to the adoption of telemedicine is necessary.	What emotional barriers affect the adoption of telemedicine, and how can they be addressed? This question explores the impact of anxiety, fear of technology, and lack of human connection on behavioral intention towards telemedicine. To promote telemedicine implementation, it is important to address these emotional barriers.
	4. There is a gap in understanding the role of confidentiality in the adoption of telemedicine.	What steps can be taken to ensure data privacy in the context of telemedicine, and how do concerns about the confidentiality of medical information affect behavioral intention and adoption of this technology?
	5. The impact of the digital divide on the adoption of telemedicine is not well understood.	What impact does the digital divide, caused by a lack of internet access or technological skills, have on the adoption and behavioral intention of telemedicine? Additionally, what strategies can be implemented to reduce this gap in various contexts?
	6. It is necessary to investigate the impact of personalization on the adoption of telemedicine.	How does personalization of the telemedicine experience, such as tailoring to individual patient needs or user interface personalization, affect behavioral intent and adoption of telemedicine?
	7. There is a gap in understanding the influence of communication quality on the adoption of telemedicine.	How does the quality of communication in telemedicine interactions affect behavioral intention and adoption of telemedicine, and what steps can be taken to improve this quality?
	8. There is insufficient research on the impact of telemedicine system interoperability.	How does the interoperability of telemedicine systems affect behavioral intent and adoption of telemedicine? What are the challenges to achieving interoperability and how can they be addressed?
	9. There is a gap in understanding the effects of economic costs on the adoption of telemedicine.	How does the economic cost of telemedicine, including equipment expenses and consultation fees, affect the behavioral intention and adoption of telemedicine, and how can financial barriers be addressed?
	10. It is necessary to investigate the impact of previous experience on the adoption of telemedicine.	How does previous experience with telemedicine, including familiarity with the technology or previous interactions with healthcare professionals, affect the intention to use and adoption of telemedicine?
	11. There is a gap in understanding the influence of the availability of technical support on the adoption of telemedicine.	How does the availability of technical support, such as online support or customer service, affect the behavioral intent and adoption of telemedicine, and what steps can be taken to ensure adequate technical support?
Gaps associated with the thematic focus	1. There is a gap in understanding the factors that influence the adoption of telemedicine during the COVID-19 pandemic.	What are the factors that drive the adoption and use of telemedicine during the COVID-19 pandemic, and how can they be effectively promoted?
	2. Insufficient research has been conducted on the challenges and opportunities of telemedicine in the field of electronic health (E-health).	What are the challenges and opportunities for adopting telemedicine in the context of eHealth, taking into account aspects such as interoperability, data security, and integration with other medical information systems?
	3. There is a lack of understanding regarding the adoption of telemedicine in the pediatric field.	How can telemedicine be safely and effectively adopted in pediatric care, considering privacy, communication with parents, and medical care quality?
	4. It is necessary to investigate the effects of telemedicine on mental health and psychological well-being.	What is the impact of telemedicine on mental health service delivery, including screening, diagnosis, and treatment? How can the benefits be optimized, and what are the associated challenges that need to be overcome?
	5. There is a gap in understanding the barriers that hinder the adoption of telemedicine.	How do barriers such as lack of internet access, resistance to change, or concerns about quality of care impede the widespread adoption of telemedicine, and how can they be addressed?
	6. Inadequate research has been conducted on the implementation of telemedicine in rural areas.	How can telemedicine be promoted in rural areas where medical services may be limited and healthcare needs may differ from those in urban areas?
	7. It is necessary to investigate the economic and financial impact of telemedicine.	What is the economic and financial impact of telemedicine adoption, both in terms of healthcare provider costs and patient and healthcare system benefits?
	8. There is a gap in the understanding of the ethical and legal aspects of telemedicine.	What are the ethical and legal challenges associated with telemedicine, such as medical data confidentiality, informed consent, and professional responsibility, and how can they be effectively addressed?
	9. There is insufficient research on the training of health professionals in the use of telemedicine.	What are the education and training requirements for healthcare professionals to successfully adopt telemedicine, and how can effective continuing education and skills development programs be designed?

One challenge highlighted in the adoption of telemedicine pertains to pediatric and neonatal treatment (Curfman et al., 2020). Telemedicine has seen increased use in various areas, including mental health and psychological well-being, particularly to address the gap in access to mental health services, in the wake of the COVID-19 pandemic. Further research is necessary to better understand the impacts of telemedicine on society (Arafat et al., 2021). According to (Zobair et al., 2020), there is limited knowledge regarding the obstacles linked to the implementation of telemedicine in rural public hospitals. This area of study has significant potential for the future. Therefore, further research is crucial to investigate this topic and its impact on the field of telemedicine.

It is essential to conduct research on the economic and social implications of telemedicine in both developed countries and emerging economies. This text provides a framework for decision-making in the area (Consilia Papavero et al., 2023). It is also essential to study the ethical and legal considerations related to telemedicine services. When providing remote clinical care to patients, including those at high risk, it is necessary to understand the ethical and legal implications. These considerations are crucial to ensure the safe and effective delivery of services (Haroon et al., 2022).

Finally, it is important to investigate the current knowledge of health professionals regarding telemedicine and the relevant considerations for providing this service. Therefore, it is necessary to provide training for professionals in line with the changes taking place in society regarding the use of these services and the implementation of new technologies. These aspects should be taken into consideration when continuously training healthcare professionals (Naqvi et al., 2022).

In the context of research on the adoption of telehealth, several areas have been identified where significant gaps exist in the scientific literature. These gaps represent key points that require further investigation and focus to enhance our understanding of how individuals, healthcare professionals, and communities adopt and utilize telehealth. Below are five of the most prominent gaps that need to be addressed to advance in this field:

Application of the Diffusion of Innovations Model: Despite its relevance in studying the adoption of health technologies such as telehealth, there is a notable lack of application of Rogers’ Diffusion of Innovations Model. This gap signifies the need to explore how this model can be adapted and improved to understand the factors influencing the adoption of telehealth by healthcare professionals and patients.

Behavior change theories, such as the Theory of Planned Behavior, have received less attention in studies on the adoption of telehealth. These theories consider factors such as attitudes, subjective norms, and perceived behavioral control. It is important to examine the role of behavior change theories in understanding the intention to adopt telehealth among different user groups.

The Social Determinants of Telehealth Adoption should also be considered. The influence of social determinants of health, such as socioeconomic status, education, gender, race or ethnicity, and the type of health insurance, on telehealth adoption is not yet fully understood. It is crucial to investigate these factors and address associated inequalities.

Comprehensive approaches are needed to capture the complexity of telehealth adoption issues, particularly in emerging economies. Integrating behavioral aspects from multiple theories, such as Technology Acceptance Model (TAM) and Unified Theory of Acceptance and Use of Technology (UTAUT), can provide a more comprehensive understanding of adoption dynamics.

Access barriers related to connectivity and technological infrastructure are critical impediments to widespread telehealth adoption. Research must investigate how these barriers hinder adoption and identify strategies to overcome them in diverse contexts.

4. Discussion

The scientific review on telemedicine adoption sheds light on various aspects within the research landscape. The bibliometric analysis evaluates researchers’ productivity and impact, offering insights into the contributions made by key figures in this domain. Although the correlation between publication count and citations does not show a significant impact of authors within the field, certain researchers have stood out for their impactful studies. Notably, Kohnke A., Cole M. L., and Bush R. have garnered significant attention with 90 citations for their research on predictors of behavioral intention in utilizing telehealth equipment. Equally significant is the work of Tsai C-H, whose comprehensive behavioral model for telehealth systems exploration has earned 76 citations, establishing Tsai as one of the most frequently cited contributors.

A nuanced categorization emerged when examining the primary journals associated with telemedicine adoption. The Journal of Technology Management and Innovation and the International Journal of Environmental Research and Public Health are highly cited and have published influential studies by Kohnke, Cole, Bush, and Tsai. Meanwhile, Digital Health features studies by Anderson et al. and Rouidi et al. Although these studies have comparatively lower citation rates, they provide valuable insights into online conversations regarding telemedicine and a conceptual model for health professionals’ acceptance and use of telemedicine technology, respectively.

The scientific review on telemedicine adoption yields multifaceted insights into prevalent thematic trends and keyword dynamics within the domain. The analysis of keywords shows a chronological evolution, highlighting the increasing dominance of the Unified Theory of Acceptance and Use of Technology (UTAUT) model in evaluating factors that influence telemedicine adoption. In recent years, there has been a shift towards acceptance models, particularly related to technology, coinciding with an increase in research focused on the impact of COVID-19. The adoption of telemedicine has surged due to the pandemic, bringing COVID-19-related concepts to the forefront and highlighting their significance as pivotal issues both now and in the future.

Research has provided valuable insights into telemedicine adoption, which are crucial for understanding the broader implications of this healthcare innovation. These empirical findings form the basis for our subsequent interpretations and implications, providing a comprehensive perspective on the subject.

Our findings confirm the central role of factors such as perceived ease of use, facilitating conditions, and social influence in telemedicine adoption, leveraging established theories such as the UTAUT and the TAM. These interpretations highlight the consistency of our results with existing literature, reinforcing the strength of these theories and their applicability in various contexts.

The findings provide vital guidance for healthcare stakeholders and policymakers, highlighting the nuanced influence of contextual elements, including cultural and socioeconomic factors. The study emphasizes the importance of tailoring telemedicine strategies to diverse contexts, recognizing that a one-size-fits-all approach may not effectively address the complexities inherent in healthcare delivery.

The importance of creating a user-friendly environment, providing strong facilitating conditions, and utilizing social influence for successful telemedicine adoption is emphasized. These findings can guide the creation of specific interventions to encourage telemedicine use among healthcare providers and patients.

From a public health perspective, telemedicine adoption has the potential to enhance healthcare accessibility, especially for marginalized communities. This could lead to improved health outcomes and reduced healthcare disparities, addressing long-standing healthcare inequities. However, it is important to acknowledge the limitations of our study in this regard. Although our research design was rigorous, we must acknowledge its limitations, such as sample size constraints and potential response bias inherent in survey-based research. These limitations emphasize the need for ongoing research to further explore the intricacies of telemedicine adoption.

Future research should build upon our findings and explore the applicability of the Diffusion of Innovations model in the context of telemedicine adoption. Investigating behavioral change theories, such as the Theory of Planned Behavior (TPB), can provide insights into the factors that influence adoption intentions, including individual attitudes, subjective norms, and perceived behavioral control. Additionally, future research should prioritize addressing the digital divide and disparities in telemedicine access. Examining barriers related to internet access, resistance to change, and quality concerns can guide targeted interventions aimed at reducing disparities in telemedicine adoption.

Further investigation is necessary to address the ethical and legal aspects of telemedicine, including data privacy, informed consent, and professional responsibilities. These aspects are crucial for ensuring ethical telemedicine practices and protecting patient rights.

In addition, we present the practical implications of our results. These implications can guide healthcare administrators and managers across various health systems. Our insights offer valuable guidance for decision-makers in shaping policies and programs aimed at improving healthcare service accessibility and enhancing user satisfaction. Furthermore, we contextualize our study’s results by comparing them with existing research. We identify commonalities, disparities, and research gaps. This analysis compares and contrasts information to develop a research agenda that will enhance our understanding of the issue at hand.

To enhance telemedicine, consider strategies based on research findings. Factors such as perceived ease of use, implementation conditions, and social influence are important for adoption. Strengthening these aspects could improve telemedicine adoption among healthcare professionals and patients.

This study emphasizes the impact of contextual elements, such as cultural and socioeconomic factors, on telemedicine adoption. Therefore, it is suggested to customize telemedicine strategies to different contexts to address the complexities in delivering healthcare services. Moreover, the results provide useful guidance for developing targeted interventions to promote telemedicine use among healthcare providers and patients. Therefore, it is recommended that decision-makers and policymakers concentrate on creating favorable conditions for telemedicine usage, optimizing facilitating conditions, and maximizing social influence.

Additionally, reducing disparities in telemedicine access by addressing barriers related to connectivity, resistance to change, and concerns about service quality, particularly in developing countries, should be a priority. Furthermore, it is crucial to continue examining the ethical and legal considerations surrounding telemedicine, including data privacy, informed consent, and professional responsibilities, in order to uphold ethical standards and protect patient rights.

4.1. Practical implications

This literature review highlights the practical and theoretical implications of the study. The findings account for the adoption of telemedicine, including the main theories (extended UTAUT and extended TAM) and key variables (behavioral intention, facilitating conditions, social influence, expectation of effort, expectation of performance, ease of use, and perceived usefulness). These findings have significant practical and theoretical implications in the field of telemedicine.

Additionally, this review provides a strong theoretical foundation for understanding the factors that influence the adoption of telemedicine. The Extended Unified Theory of Acceptance and Use of Technology (UTAUT) and the Extended Technology Acceptance Model (TAM) are widely recognized theories in the field of technology adoption. The application of telemedicine provides a comprehensive perspective of the key determinants that affect the acceptance and use of this healthcare approach. This allows healthcare professionals and policymakers to better understand the barriers and enablers associated with the adoption of telemedicine.

The identification of variables such as behavioral intention, facilitating conditions, social influence, effort expectancy, performance expectation, ease of use, and perceived usefulness provides practical guidance for the design of marketing strategies and successful implementation. By considering these variables, healthcare providers can develop specific interventions aimed at promoting the adoption of telemedicine. For instance, the focus can be on enhancing positive social influence and improving the perceived usefulness and ease of use of telemedicine. This will encourage greater behavioral intention.

Additionally, this review emphasizes the significance of addressing the research gaps identified in the field of telemedicine adoption. These gaps may include areas that have not yet been sufficiently explored, such as understanding the barriers to accessing telemedicine services, the ethical and legal implications, and the education and training of health professionals to provide this service. Identifying these gaps provides guidance for future studies and research, allowing for the expansion of knowledge in critical areas and the development of innovative approaches to promote the adoption of telemedicine. Building on the previous discussion of the theoretical foundations and implications of telemedicine adoption, it is crucial to provide practical recommendations for healthcare leaders, policymakers, and researchers. This comprehensive approach is necessary to successfully navigate the complex landscape of telemedicine.

Given the increasing importance of telemedicine in modern healthcare, it is crucial to provide practical recommendations that address key stakeholders in the healthcare ecosystem. Although the previous section briefly discussed the practical implications of the study, we will now provide a more detailed discussion of specific recommendations tailored to healthcare leaders and legislators. To promote the widespread use of telehealth, it is important to explore effective strategies and interventions. These recommendations should provide guidance and consider potential barriers and challenges during implementation. Thorough analysis of feasibility can ensure that telemedicine’s benefits are fully realized and sustained over time.

As identified in this literature review, the study’s findings make a significant contribution to the understanding of telemedicine adoption. The extended UTAUT and extended TAM theories play a crucial role in comprehending the determinants that influence the acceptance and utilization of telemedicine, providing a robust theoretical foundation. Healthcare professionals and policymakers can use this knowledge to gain insights into the barriers and enablers of telemedicine adoption. The identification of critical variables, such as behavioral intention, facilitating conditions, social influence, effort expectancy, performance expectation, ease of use, and perceived usefulness, provides practical guidance for designing successful telemedicine implementation strategies.

For example, healthcare providers can customize interventions to enhance positive social influence, improve the perceived usefulness and ease of use of telemedicine, and ultimately increase behavioral intention among users. However, it is crucial to recognize the current research gaps in the field of telemedicine adoption. These gaps include areas that have not received sufficient exploration, such as understanding barriers to accessing telemedicine services, addressing ethical and legal implications, and devising comprehensive education and training programs for healthcare professionals.

Identifying and addressing these gaps is crucial for the future of telemedicine. This review serves as a guide for future studies and initiatives by shedding light on areas that require further research and development. It facilitates the expansion of knowledge in critical areas, driving the sustainable and effective adoption of telemedicine in healthcare systems globally.

4.2. Limitations

Some limitations of this study should be noted. Although the largest databases in terms of indexing were selected, other databases such as Scielo, PubMed or Google Scholar could also have been included. Firstly, it is important to highlight the availability and selection of the studies. Additionally, the selection of the documents could be subject to certain biases. The quality of results may be affected by publication bias in some articles, as studies with negative results may not have been published while those with positive results have a higher chance of being published.

The decision to exclude other databases was based on several factors, including limited resources that hindered access to additional databases. The decision to include certain databases was based on their relevance and focus to the research question. Furthermore, limitations in search resources and data format standardization made it unfeasible to include additional databases in the study.

However, it is important to consider the variability between studies. Although they may use theoretical models and measurement variables, the methodologies are not necessarily the same, making it difficult to directly compare results. Additionally, the study results are limited to the included studies only, which affects generalization to all populations and settings. Therefore, future studies should focus on generating reviews that are specific to a particular context. Finally, the results indicate a limitation up to the date of the study. This implies that future investigations can generalize the findings to similar exercises.

As for the authors’ limitations, the lack of resources is a hindrance to carrying out more specialized projects on telemedicine adoption in specific contexts, particularly in developing countries in Latin America. This presents an opportunity for future research to explore telemedicine implementation in environments that may pose unique challenges, such as those with cultural differences, limited technological infrastructure, and restricted access to healthcare services.

Furthermore, the study recognizes the importance of practically applying the analyzed theories in specific research settings, such as in Peru. This acknowledgement suggests a path to expand the understanding and validation of adoption theories in a real-world context, allowing for adjustments and refinements that could enhance the effectiveness of telemedicine implementation in Peru and other countries with similar characteristics.

To improve future research, it would be beneficial to allocate additional resources for more detailed studies in specific contexts, such as developing Latin American countries. Additionally, it is recommended to conduct field-applied studies involving the practical implementation of adoption theories in real-world settings in Peru or similar countries. This would validate and refine these theories, improving their applicability and accuracy in such scenarios.

4.3. Contrast with other studies

The findings of this study are supported by similar investigations in the literature. Telemedicine has been a relevant research topic in recent years, particularly after the COVID-19 pandemic, resulting in numerous articles being published on this subject. For instance (Stoumpos et al., 2023), conducted a study on technological acceptance and its application in the digital transformation of the healthcare industry. This study supports the conclusions of the present review by emphasizing the significance of comprehending the factors that affect the acceptance and implementation of technology in the context of telemedicine.

Furthermore, Pinto et al. (2023) investigated the implementation of telemedicine in Latin America during the COVID-19 pandemic. Although focused on a specific context, the results obtained align with the findings of the present review by emphasizing the importance of factors such as behavioral intention, facilitating conditions, and social influence in the successful adoption of telemedicine. In contrast, the article by Kruse et al. (2023) examines the impact of telemedicine on quality domains, exploring the facilitators and barriers to its adoption. This study complements the present review by examining how the adoption of telemedicine can influence the quality of medical care. The study highlights the importance of considering variables such as perceived performance expectation and ease of use.

The study carried out by Gass et al. (2022) focuses on the acceptance and efficacy of telemedicine in the context of preventive cardiology interventions. The present review’s conclusions are supported by the findings, which highlight the significance of technology acceptance for the success of telemedicine-based medical interventions. Additionally, the article by Garavand et al. (2022) examines physicians’ acceptance of telemedicine technology. This study offers an additional perspective to the current review by exploring physicians’ attitudes and perceptions towards telemedicine. It emphasizes the significance of comprehending factors related to social influence and perceived usefulness in this context.

Unlike previous studies that have conducted variable analysis, this study provides a perspective from adoption theories and identifies research gaps surrounding this subject. While some studies have focused solely on developing countries (Ye et al., 2023), rural areas (Arun et al., 2023), and post-pandemic scenarios (Gonçalves et al., 2023), this study offers a global perspective that spans both pre- and post-pandemic periods.

In contrast to previous research that has focused on specific contexts, such as developing nations (Ye et al., 2023), rural locales (Arun et al., 2023), or post-pandemic themes (Gonçalves et al., 2023), this study takes a more comprehensive approach. It presents a global analysis that encompasses the landscape before the pandemic, as well as the dynamics and challenges that emerged during and after this globally impactful event. This expanded view enables the identification of both continuities and significant changes in the adoption of telemedicine, providing a more comprehensive and enriched overview of the topic.

4.4. Researching agenda

A research agenda is proposed for this systematic review with the aim of assisting future scientific research. The agenda considers topics such as trends, emerging themes, and current gaps in research on the adoption of telemedicine. The research question to be answered is: what elements should a research agenda include to integrate the identified gaps and growing and emerging themes of telemedicine research? The 18 articles resulting from the application of the inclusion and exclusion criteria were initially reviewed according to the PRISMA methodology. Later, this agenda presents the 30 most important terms proposed by the authors in research on the adoption of telemedicine. Two crucial points are analyzed: (1) the time frame addressed in the literature and (2) the year in which each term had greater relevance in academic production.

This agenda analyzes recent terms found in current research trends. The term Covid-19 appeared in the literature in 2020 and continues to be a current term in scientific production on the adoption of telemedicine. Telemedicine has transformed the medical landscape, providing a safe and efficient alternative that emphasizes the importance of technology in healthcare. Future research should evaluate the effectiveness of telemedicine during the pandemic, including its impact on the quality of medical consultations.

A novel concept in the scientific production of telemedicine is the use of buprenorphine, which was introduced in the literature in 2021. Buprenorphine is a drug used to treat opioid addiction. However, regulatory barriers limit its use in clinical practice. Future research should focus on improving education and training of healthcare providers in the use of buprenorphine through telemedicine and addressing regulatory barriers to improve the acceptance of telemedicine for administering this drug.

Pediatrics is one of the terms that has been in use for several years and will continue to be a fundamental part of studies on the adoption of telemedicine. Pediatrics is a branch of medicine that focuses on the health care of children and adolescents. Its relevance in telemedicine lies in its potential to improve accessibility and quality of care for minors. In 2019, this term gained more prominence in proposed studies. It is important to maintain objectivity and avoid biased language when discussing this topic.

Another term that remains valid in the literature is ‘mental health’. The COVID-19 pandemic has increased the need for mental health services. Telemedicine has played a crucial role in providing safe and accessible care to patients. However, there are still unanswered questions regarding the quality and effectiveness of telepsychiatry services. Additionally, addressing gaps in access to nursing care for mental health remains a challenge.

Therefore, future research should investigate the development and implementation of information and communication technologies to improve medical care in the mental health field. Additionally, it is necessary to address different models of care, therapeutic interventions, and technological tools that could be more effective in addressing mental health problems through telemedicine.

Continuing the analysis, Acceptance and Commitment Therapy (ACT) is a form of psychotherapy that emphasizes full acceptance. It has been widely used to treat mental health problems and was introduced in academic literature around 2017. Telemedicine provides a platform for delivering ACT to patients in remote areas who have difficulty accessing care. To maximize the effectiveness and accessibility of acceptance and commitment therapy in telemedicine, it is recommended to investigate its adaptation. Additionally, it is important to explore methods for measuring the impact on patients’ mental health outcomes.

Successful implementation of telemedicine adoption requires identifying and addressing barriers that hinder its implementation. Currently, there are several barriers that limit the adoption of telemedicine. These include lack of access to technology, lack of training in the use of technology, and concerns for patient privacy and information security.

In constructing theoretical frameworks based on the adoption of telemedicine, relevant terms that have reached maturity or information saturation include E-health, a subset of digital health that involves the use of information and communication technologies in medical care. This term was first introduced in 2012 and gained significant relevance in 2018. Currently, e-health is important because it has the potential to improve the accessibility, efficiency, and quality of medical care.

This research agenda analyzes terms that were briefly relevant in the scientific and academic production of telemedicine adoption. These terms were important for scientific production during the years they were present. Among these terms are access to care, education, emergency medical care, and primary care. They appeared in the literature in 2012. In 2014, 2017, and 2018, telemedicine provided access to medical care and education, including emergency medical care and primary care, to people and medical students in remote or difficult-to-reach areas. However, the adoption of telemedicine in these sectors still faces several challenges, such as the need for a strong network infrastructure and limited access to technology (Figure 1).

Future research should focus on the sustainability of telemedicine adoption, recognizing it as a complex initiative requiring meticulous planning. Researchers should analyze how proposed solutions can be integrated into the healthcare system and upheld over time. This thorough investigation is necessary to ensure that telemedicine’s potential for transformation results in lasting and meaningful improvements in healthcare delivery and accessibility.

5. Conclusions

The use of telemedicine in healthcare has increased significantly, especially during the COVID-19 pandemic. This has led to advancements in the field, benefiting various applications such as medical consultations, rehabilitation, and home care. Telemedicine has proven to be particularly advantageous in rural or medically underserved areas, helping to mitigate disparities in healthcare access. Although telemedicine played a crucial role during the pandemic, there are still research gaps that need to be addressed. For instance, there is a need for systematic assessments of its effectiveness compared to traditional healthcare modalities and its efficacy in managing medical emergencies, particularly among vulnerable populations. Therefore, this study conducted a systematic literature review to address these research gaps in telemedicine adoption.

A keyword analysis was conducted to track the evolution of research focus over time. The analysis highlighted the dominance of COVID-19-related investigations in recent years, in contrast to pre-pandemic themes that encompassed technology and technological acceptance models. Additionally, the analysis outlined key areas with growth potential, including children’s healthcare, patient satisfaction, mental health, and virtual care. COVID-19 was prominently positioned in the first quadrant.

Moreover, a thorough analysis of the prevalent models and measurement variables in the literature on telemedicine adoption highlights a preference for the Technology Acceptance Model (TAM) and the Unified Theory of Acceptance and Use of Technology (UTAUT) models. Variables such as intention, facilitating conditions, and social influence are prominently featured. The investigation identified research gaps and proposed a research agenda, focusing on teleguidance, telerehabilitation, and patient satisfaction. In conclusion, the investigation achieved its objectives by comprehensively addressing the research questions.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Alejandro Valencia-Arias

Professor Alejandro Valencia-Arias received the Ph.D. degree in Management Engineering in 2018 from the National University of Colombia, the Master of Sciences degree in Computer Sciences in 2013 and Bs. Eng degree in Management Engineering in 2010. He has twelve years of experience as a university professor. He has published in his areas of interest, and among his offerings are three books and over 85 journal articles in national and international indexed journals (h-index in Scopus:14). Prof. Valencia-Arias has the distinction of Senior Researcher of the Ministry of Science, Technology, and Innovation (MinCiencias) in Colombia. He is a distinguished researcher at RENACYT (Peru). His research includes entrepreneurship, simulation, marketing research, and statistical science. He has experience in agent-based modeling and system dynamics, especially in the development of social models.

Ada Gallegos

Ada Gallegos is a university lecturer and researcher. She holds a Doctorate in Government and Public Policies as well as a Doctorate in Education. Her specialization in Public Affairs was completed as a Fulbright scholar through the Hubert Humphrey program, certified by then-President of the United States, Barack Obama. As a dedicated researcher, she leads research teams composed of both national and international scholars. On an international level, she serves as the Chair of the Board for the Consortium for Women Leaders in Public Service (CWLPS), headquartered in Washington DC.

Victoria Del Consuelo Aliaga Bravo

Victoria Del Consuelo Aliaga Bravo Obstetrician by profession, graduated from San Martín de Porres University. Master’s in Obstetrics with a specialization in Reproductive Health, Second Specialty in Fetal Monitoring with Obstetric Imaging Diagnosis, and a Doctorate in Education. Currently a university lecturer at the Faculty of Obstetrics and Nursing at USMP.

Flor Luna Victoria Mori

Flor Luna Victoria Mori Doctorate in Nursing from the Federal University of Rio de Janeiro and Master’s with a specialization in Adult and Elderly Health. University lecturer. Conducted research with undergraduate and postgraduate students, as well as Master’s and Doctoral-level multicentric investigations involving Brazil, Mexico, and Spain. Belongs to the Human Care Research Center and the Center for Comparative Latin American Studies and Complexity (NECLayC) at the Postgraduate School of the National University of Trujillo.

Hernán Uribe-Bedoya

Professor Hernán Uribe-Bedoya obtained his Master’s degree in Sustainable Development in 2019 from the Metropolitan Technological Institute and holds a Bachelor’s degree in Business Administration from Luis Amigó University in 2011. With 10 years of experience as a university teacher, he currently serves as a teacher-researcher at the Metropolitan Technological Institute. His research focuses on Sustainable Development topics, particularly Sustainable Mobility in cities, including the evaluation of cycle routes and the development of sustainable mobility management models for universities.

Lucia Palacios-Moya

Professor Lucia Palacios-Moya Health manager, public health master and PhD student in management. She is associate researcher of the Ministry of Science, Technology, and Innovation (MinCiencias) in Colombia and distinguished researcher at RENACYT (Peru). Her research includes health public, health management, sustainability in healthcare secto, chronic and infectious diseases.