Influential Factors Affecting the Adoption and Use of Health IT Tools in Hypertension Management: Motivational Drivers and Inhibitory Factors

doi:10.21203/rs.3.rs-3424107/v1

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Influential Factors Affecting the Adoption and Use of Health IT Tools in Hypertension Management: Motivational Drivers and Inhibitory Factors

https://doi.org/10.21203/rs.3.rs-3424107/v1

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Background: Health information technology (IT) significantly improves patient self-care and the health outcomes of those with conditions like hypertension.

Methods: In 2022, we conducted a comprehensive literature review to identify factors impacting health IT adoption in hypertension management. We extensively searched databases like Scopus, Web of Science, IEEE, and PubMed for articles between 2013 and 2022.

Results: Initially, we gathered 827 articles, rigorously screening them to select 50 for our study. These factors can be grouped into two categories: motivating drivers and inhibitory factors, each comprising eight elements. Motivating drivers include perceived usefulness, ease of use, incentives, autonomy, patient empowerment, education, peer influence, and organizational support. Inhibitory factors encompass limited technology access, inadequate training, cost, workflow disruption, technical challenges, knowledge gaps, resistance to change, and privacy concerns.

Conclusions: Recognizing these factors is vital for optimizing health IT use in hypertension management, leading to increased acceptance, cost-effectiveness, reduced complications, and an improved quality of life for those managing hypertension.

Health information technology

hypertension management

patients’ management

motivating factors

Hypertension, commonly known as high blood pressure, is a prevalent chronic condition that affects millions of people worldwide [1]. Effective management of hypertension is crucial to prevent complications and improve patient outcomes [1, 2]. In recent years, health information technology (IT) has emerged as a promising tool for enhancing the management of hypertension [3]. Health IT encompasses various technologies, such as electronic health records, telemedicine, mobile applications, and wearable devices, that enable the collection, storage, and exchange of health information [2]. However, the use of health IT in hypertension management is influenced by several factors that can either promote or hinder its adoption and utilization. Understanding these factors is essential for healthcare providers, policymakers, and stakeholders to effectively leverage health IT tools and maximize their potential benefits in hypertension management.

The fact that only half of hypertensive patients are aware of their disease and can be properly treated and controlled is important [4]. Most patients with hypertension suffer from complications caused by this disease and face various challenges, and they need continuous education and awareness, and self-management for treatment and empowerment [5, 6]. The education and awareness includes the patient's understanding of the disease status, receiving timely instructions to take the necessary measures, and acquiring awareness about the risks and consequences of the disease, which can be effective in improving self-management and disease control [7, 8]. Recent advancements in medical technology have significantly improved the ability to educate and inform patients compared to the past. In fact, the integration of mobile devices (including smartphones, tablets, and wearable technology) and other technologies (such as artificial intelligence and the Internet of Things) has transformed how clinical data is collected, organized, and interpreted. These innovations are instrumental in assisting patients in understanding their medical conditions and encouraging behavioral changes tailored to their specific health needs, thereby promoting greater adherence to treatment protocols [7, 9–12]. A systematic review, which included 27 randomized controlled studies and 16 cross-sectional studies, revealed that around 67% of digital health technologies have a positive impact on patient care. Additionally, approximately 57% of these studies demonstrated that digital technologies make a meaningful contribution to the improvement of chronic disease management [13].

The utilization of digital health technologies, including mobile health strategies, telemedicine, and health monitoring devices, in the context of hypertension management as a chronic disease, underscores the profound transformation occurring in the performance and delivery of healthcare services. These technologies play a pivotal role in facilitating lifestyle changes and improving hypertension management, highlighting their substantial impact on the healthcare landscape [13–16]. Despite the favorable attitudes towards the potential impact of health IT, which includes enhancing patient safety, service quality, and reducing mortality rates, its actual impact has fallen short of expectations. This gap can be attributed to the intricate interplay between processes and technologies, as well as the challenge of engaging users effectively with digital health technologies to establish and sustain new digital infrastructures. This issue becomes apparent in various research studies, shedding light on the need for a deeper understanding of these complex dynamics [17–20]. As advancements in health information technologies continue to unfold, an expanding array of tools for hypertension management is anticipated to emerge. Consequently, it is paramount to delve into the factors that drive their adoption. Hence, our study is dedicated to investigating the determinants that influence the utilization of health IT within the context of hypertension management.

This manuscript follows the PRISMA-ScR checklist and explanation for preferred reporting of systematic or literature reviews [21]. It should be noted that this manuscript has not been previously registered in PROSPERO or any comparable database. We would like to highlight that although PROSPERO registration is commonly associated with systematic reviews, we consciously chose not to register this particular review. Our decision was based on the specific scope of our review, which does not strictly align with PROSPERO's eligibility criteria, as well as practical considerations within the constraints of our project. We want to reassure readers that our literature search and selection process adhered to rigorous methodology, and we have transparently reported our findings to address any concerns regarding the credibility of our research.

Inclusion and Exclusion Criteria

An eligible article must be an original piece published in English within a peer-reviewed journal. Consequently, reports, letters to the editor, review articles, and meta-analyses were not considered for inclusion. We excluded reports because they often lack sufficient detail and rigorous methodology compared to peer-reviewed articles. Letters to the editor were also excluded as they typically present opinions, comments, or responses to previously published articles, rather than original research. Review articles were not included as our focus was on original research studies. Additionally, meta-analyses were excluded due to their own inclusion and exclusion criteria, which may differ from ours.

An article must focus on the use of health IT in the management of hypertension. Thus, articles not dealing with the use of health IT in hypertension management were excluded.

Research Question

This study addressed the following research question: What factors affect the use of health IT for hypertension management?

Databases and Search Method

We conducted searches on PubMed, ISI Web of Science, Scopus, and IEEE databases from 2013 to March 2022 to identify studies that analyzed factors influencing the utilization of health IT in the context of hypertension management (Table 1). In addition to our initial search, we conducted a nested search by reviewing the references cited in the articles selected for our study. Furthermore, we performed a manual search on Google Scholar to further broaden our search results.

We downloaded the studies identified during the database search from the respective journals. The initial screening of study titles and abstracts was primarily conducted by one of the co-authors, AF. Subsequently, the full texts of these studies, including those employing health IT for hypertension management, were independently reviewed by two experts, MR.S. and HR.S.

Table 1

Search strategies used in the different databases.
Databases	Search items
PubMed, ISI Web of Science, Scopus, and IEEE	(health information technology[Title/Abstract]) OR (health informatics[Title/Abstract])) OR (e-health[Title/Abstract])) OR (ehealth[Title/Abstract])) OR (health IT[Title/Abstract])) OR (electronic health record[Title/Abstract])) OR (medical record[Title/Abstract])) OR (telehealth[Title/Abstract])) OR (telemedicine[Title/Abstract])) AND (self care[Title/Abstract])) OR (self-care[Title/Abstract])) OR (self-managment[Title/Abstract])) OR (selfmanagment[Title/Abstract])) OR (disease managment[Title/Abstract])) AND (hypertension[Title/Abstract])) OR (hypertension care[Title/Abstract])) OR (blood pressure[Title/Abstract])

Study Selection

The study selection process consisted of two separate stages. In the first stage, one of the co-authors (HR.S.) reviewed the titles and abstracts of all the studies that were identified. In the second stage, two specialists (MR.S. and M.SH.) conducted a detailed examination of the full texts for the final screening. Any discrepancies or disagreements between the two reviewers were resolved through discussion and reaching a mutual consensus.

Study Quality Appraisal

To assess the quality of the included reviews, two researchers (HR.S. and MR.S.) utilized the CASP Systematic Review Checklist (See supplementary file). In cases where there were differences in opinion, we resolved them through discussion and reached a consensus on the quality assessment of the study.

A PRISMA flow diagram, which summarizes the study screening process (Fig. 1), illustrates that the initial search yielded a total of 827 potentially relevant papers. Subsequent screening of their titles and abstracts led to the exclusion of 517 articles. The full texts of the remaining 343 papers were then thoroughly assessed to ascertain if they met the inclusion criteria. Additionally, no further articles were identified through the references of the eligible studies. Eventually, the screening procedure resulted in 50 papers. The results revealed that the factors influencing the utilization of health IT in hypertension management could be categorized into motivational and inhibitory factors. Among the findings, 40 articles encompassed both motivational and inhibitory factors, 9 articles exclusively addressed Motivational Drivers, while one article solely focused on inhibitory factors.

Motivational Drivers

Motivating factors in the adoption of health IT have been emphasized in 49 studies. These motivating factors play a substantial role in the utilization of health IT for hypertension management. By recognizing and proactively addressing these motivating factors, healthcare providers and organizations can foster the effective integration and utilization of health IT in hypertension management, resulting in enhanced patient outcomes and satisfaction. These motivating factors can be categorized into eight distinct items, as detailed in Table 2.

Table 2

Motivating Factors influencing the utilization of health IT in hypertension management.
Motivational Drivers	Point	Reference
Perceived usefulness	If healthcare providers and patients perceive that health IT tools can effectively support hypertension management and improve outcomes, they are more likely to be motivated to use them. Demonstrating the benefits and advantages of health IT, such as improved medication adherence, better blood pressure control, and more efficient communication, can increase motivation.	[22–60]
Perceived ease of use	The ease of use of health IT tools can influence motivation. If healthcare providers and patients find the technology to be user-friendly, intuitive, and easy to navigate, they are more likely to be motivated to incorporate it into their hypertension management routine.	[23–25, 27, 31, 32, 34, 35, 37, 40, 43, 46–49, 52, 56, 58–65]
Incentives and rewards	Offering incentives or rewards for using health IT tools can be a powerful motivator. This can include financial incentives, such as reimbursement or bonuses for healthcare providers, or non-financial rewards, such as gamification elements that provide a sense of achievement or recognition for patients.	[25, 27, 30, 32, 35, 36, 39–41, 43, 48–50, 52, 53, 56–58, 60, 61, 63, 65–67]
Autonomy and control	Allowing healthcare providers and patients to have control over their own health IT usage can increase motivation. Providing options for customization, personalization, and flexibility in how health IT tools are used can enhance motivation and engagement.	[22, 23, 25, 28, 32–35, 40, 42, 43, 46, 49, 51, 54, 56, 58, 60, 61, 63–65, 67–69],
Patient empowerment	Empowering patients to take an active role in their own hypertension management can increase motivation. Health IT tools that provide patients with access to their own health information, educational resources, and self-monitoring capabilities can enhance motivation and engagement.	[24, 27, 28, 32, 33, 35–42, 46, 48, 49, 51, 52, 57, 58, 60, 61, 65, 67, 68],
Training and education	Adequate training and education on the use and benefits of health IT tools can increase motivation. Healthcare providers and patients who feel confident and competent in their ability to use health IT tools are more likely to be motivated to incorporate them into hypertension management.	[22, 26–28, 30–40, 42, 48, 50, 51, 53–56, 58–62, 65, 66, 68, 70]
Peer influence and social support	The influence of peers and social support networks can impact motivation. If healthcare providers and patients see their colleagues or peers successfully using health IT tools in hypertension management, they may be more motivated to adopt and utilize these tools themselves.	[22–25, 27–29, 31, 32, 34, 36, 40, 42, 45–48, 50, 52, 54, 56, 58–60, 65–68]
Organizational support	Support from healthcare organizations, such as leadership endorsement, dedicated resources, and infrastructure, can enhance motivation. When healthcare providers feel supported by their organization in their use of health IT tools for hypertension management, they are more likely to be motivated to incorporate them into their practice.	[23–25, 27, 28, 30–32, 34–36, 38–52, 54–61, 64, 65, 67–71]

Inhibitory factors

Inhibitory factors affecting the adoption of health IT have been emphasized in 41 studies. These inhibitory factors can impede the utilization of health IT in hypertension management. To mitigate these barriers, healthcare providers and organizations can focus on strategies such as education, training, infrastructure enhancements, and addressing privacy concerns. By doing so, they can work towards overcoming these inhibitory factors and facilitating the successful integration and utilization of health IT in hypertension management. Similar to motivating factors, inhibitory factors can also be categorized into eight distinct items, as outlined in Table 3.

Table 3

Inhibitory factors affecting the use of health IT in hypertension management.
Inhibitory factors	Point	Reference
Limited access to technology	Limited access to technology, such as smartphones, computers, or internet connectivity, can hinder the use of health IT in hypertension management. In areas with inadequate technological infrastructure or among populations with low socioeconomic status, access to health IT tools may be limited.	[27, 29, 34–37, 40, 44–48, 50–53, 55, 57, 58, 60, 63–65, 70]
Lack of training and support	Insufficient training and support for healthcare providers and patients can inhibit the use of health IT tools. Without proper education and ongoing technical support, healthcare providers and patients may struggle to effectively use health IT tools for hypertension management.	[32, 33, 36, 37, 40, 42, 44, 45, 50, 52, 53, 56, 59, 65, 70]
Cost	The cost of implementing and maintaining health IT systems can be a barrier to their use in hypertension management. Healthcare organizations and patients may face financial constraints that limit their ability to invest in health IT infrastructure and tools.	[23–25, 27, 28, 30–61, 64, 65, 67–71]
Workflow disruption	The integration of health IT into existing healthcare workflows can be challenging. If the use of health IT tools disrupts established workflows or requires significant changes in documentation, communication, or patient management processes, healthcare providers may be hesitant to adopt and utilize these tools.	[22–25, 27–54, 56–65, 67, 68, 70, 71]
Technical difficulties	Technical difficulties, such as system glitches, slow performance, or difficulties in data entry or retrieval, can hinder the use of health IT tools. Frustration with technical issues can discourage healthcare providers and patients from using health IT in hypertension management.	[23, 32, 33, 35, 36, 38–40, 42, 44–47, 50, 53, 56, 61, 65, 67, 70]
Lack of awareness and knowledge	Limited awareness and knowledge about the benefits and functionalities of health IT tools can inhibit their use. Healthcare providers and patients may not be aware of the availability of health IT solutions for hypertension management or may lack knowledge about how to effectively use these tools.	[22, 24, 25, 27–42, 44–54, 56–59, 61, 62, 64, 65, 67, 68, 71]
Resistance to change	Healthcare providers and patients may be resistant to adopting and using health IT tools due to a fear of change or a preference for traditional methods of healthcare delivery. Resistance to change can create barriers to the successful implementation and utilization of health IT in hypertension management.	[22, 24, 25, 27–42, 44–54, 56–59, 61, 62, 64, 65, 67, 68, 70, 71]
Privacy and security concerns	Concerns about the privacy and security of health information stored and transmitted through health IT systems can be inhibitory factors. Patients and healthcare providers may hesitate to use health IT tools if they are unsure about the confidentiality and protection of their health data.	[24, 31, 35, 41, 48, 55, 58, 59, 62]

Summary of Findings

This study has demonstrated the utility of health IT in enhancing hypertension management [72–74]. Nevertheless, optimizing the use of health IT and understanding the motivating and inhibiting factors influencing its adoption is imperative [75, 76]. Our findings highlight that enhancing the patient-service provider relationship and promoting patient engagement are prominent motivating factors. Additionally, employing technologies for patient reminders through voice prompts, cost reduction, ensuring personal identity anonymity during sensitive situations, facilitating swift and straightforward access to information and services, and bolstering patient adherence to medication and treatment are key motivational drivers identified in this study.

Comparison With Existing Literature

The study conducted by Tieu et al. (2015) found that factors affecting the utilization of health information technologies could be grouped into five categories. These categories include the accessibility to a computer or the Internet, individuals' proficiency in and interest in technology, concerns related to information security and privacy, the quality of communication between patients and healthcare providers, and patients' ability to self-manage chronic diseases. These findings highlight the multifaceted nature of the factors that influence the adoption and use of health information technologies in healthcare settings. Understanding and addressing these categories of factors are essential for the effective integration of technology to improve patient care and health outcomes[77]. In another study, Abd-Alrazaq et al. (2019), divided these factors into four groups: individual factors (health and health literacy), technical factors (use of the system and human-computer interaction), organizational factors such as (financial support), and social factors such as culture (society) were classified [78]. According to Abdullah et al. (2016), the effective utilization of health IT requires system providers to have a deeper comprehension of patients' health literacy and technical skills. Furthermore, involving patients in the identification and resolution of inhibitory factors is recommended [79]. Another study's findings corroborate the significance of user acceptance as a crucial factor influencing technology utilization [80, 81]. Additionally, it underscores the importance of taking cultural readiness into account before implementing technology in healthcare [82] and emphasizes the need to consider user cooperation as a pivotal consideration [83]. Concerning other motivational drivers, findings from the study by Palacholla et al. (2019) indicate that government support, financial backing, and collaboration between governments and healthcare organizations can play a significant role in enhancing the effective utilization of technologies. These factors contribute to the improvement of network infrastructure, the establishment of application standards, and the development of guidelines for technology adoption [84]. Allocation of financial resources, proactive strategies to mitigate user resistance to new technologies, and a commitment to upholding patient privacy and confidentiality are recognized as additional motivating factors for technology utilization [85]. According to our study, several key barriers to the use of health IT in hypertension management have been identified. These barriers encompass factors such as heavy workloads, resistance to change, insufficient technical support and prompt resolution of technology-related issues, socioeconomic disparities, financial challenges, concerns regarding privacy, low motivation, limited awareness and knowledge (education), and a lack of computer proficiency. Additionally, a study by Hanley et al. (2013) found that patients who engaged in telemonitoring demonstrated increased involvement in the clinical management of their conditions. However, practitioners reported that telemonitoring posed challenges to existing roles and work practices and led to increased workloads due to the lack of seamless integration of remote monitoring data with electronic health records, thus serving as a significant obstacle in the adoption of such technologies [73].

Experts have emphasized the need for robust organizational support for these technologies. Remote monitoring of hypertension within standard care settings has the potential to establish a dependable foundation for medication management and improved hypertension control. Moreover, it fosters increased patient engagement in the management of their condition [73]. In the study conducted by Tieu et al. (2015), it was observed that concerns regarding the privacy and confidentiality of information, as well as limited technology literacy, emerge as significant barriers for health service providers. [77]. Steinman et al. (2020) indicated that older individuals, particularly those from lower-income backgrounds and residing in rural areas, face challenges related to technology access. Even when they do have access, they often exhibit lower levels of digital literacy and computer skills. Due to these limitations, many middle-aged and elderly individuals require interfaces with minimal interaction and simplified designs, often relying on basic functions like pressing answer keys. Additionally, designing systems with voice alerts and messaging features can be particularly beneficial in accommodating individuals with limited education and digital literacy skills [86]. In summary, it is evident that health IT plays a pivotal role in the management of chronic diseases, including hypertension, offering substantial benefits to both patients and healthcare systems. Consequently, prior to the design and implementation of related technologies, it is crucial to identify the motivating and inhibiting factors that influence their utilization.

Three practical implications

Tailored Technology Solutions

Healthcare providers and organizations should consider tailoring health IT solutions for patients with varying levels of digital literacy and computer skills. Designing user-friendly interfaces with voice alerts and simplified designs can enhance technology adoption among older individuals, those from economically disadvantaged backgrounds, and rural communities, ultimately improving access to healthcare services.

Patient-Centered Approaches

To promote the successful adoption of health IT, healthcare providers should adopt patient-centered approaches that emphasize improving the patient-service provider relationship and increasing patient engagement. Strategies such as using technology for patient reminders, ensuring privacy and confidentiality, and providing quick access to information and services can enhance motivation and acceptance among patients.

Organizational Support

Health systems and organizations should recognize the importance of providing strong organizational support for the implementation of health IT. This includes addressing factors such as workload, resistance to change, and the integration of remote monitoring data with electronic health records. Adequate financial resources and technical support should be allocated to overcome these barriers and facilitate the effective use of technology in healthcare settings.

Strengths and Limitations

This review offers readers a comprehensive overview of the various approaches employed thus far in utilizing health IT for hypertension management. Tables 2 and 3 provide valuable information that can assist other researchers in evaluating and comparing their intervention strategies with those of previous studies. The primary objective of this study was to assess the strengths and weaknesses of prior research endeavors and, whenever possible, offer insights and methodologies to guide future researchers in enhancing their endeavors. It is worth noting that we did not include additional databases like Ovid and EMBASE in our search. While our search was extensive and encompassed a diverse range of sources and countries, it may not be considered exhaustive, potentially limiting the scope of the results we could have uncovered.

The utilization of health IT in hypertension management is subject to a spectrum of motivating and inhibiting factors. Identifying and proactively addressing these factors is paramount for fostering the effective adoption and utilization of health IT tools. Leveraging motivating factors like perceived usefulness, ease of use, incentives, and social support can significantly enhance motivation and engagement among patients and healthcare providers. Simultaneously, tackling inhibiting factors such as resistance to change, awareness gaps, privacy concerns, cost constraints, and workflow disruptions is crucial for surmounting obstacles and optimizing the integration of health IT in hypertension management practices.

Ethics approval and consent to participate: Ethics approval for conducting this systematic review was not required. No participants were involved in this research.

Consent for publication: Not applicable.

Availability of data and materials: Please contact the corresponding author if you would like access to the datasets used and/or analyzed during this study.

Competing Interests: Not applicable.

Funding: Not applicable.

Authors’ Contribution: MR.S. and M.SH. was responsible for the study's conception and design. HR.S. and A.GH. searched the relevant databases and included the appropriate articles according to the study objective. At the same time, N.G. supervised the whole study. A.L. and HR.S. Preparing the first draft of the manuscript and revising the manuscript. A.L. did the analysis of the results, made critical revisions to the paper for important intellectual content, and supervised the study. All authors have read and approved the final manuscript.

Acknowledgments: Not applicable.

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No competing interests reported.

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Influential Factors Affecting the Adoption and Use of Health IT Tools in Hypertension Management: Motivational Drivers and Inhibitory Factors

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Introduction

Methods

Research Question

Databases and Search Method

Study Selection

Study Quality Appraisal

Results

Motivational Drivers

Inhibitory factors

Discussion

Summary of Findings

Comparison With Existing Literature

Three practical implications

Strengths and Limitations

Conclusion

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