title: Factors affecting front line staff acceptance of telehealth technologies: a mixed-method systematic review.
abstract: OBJECTIVE
  To synthesize qualitative and quantitative evidence of front-line staff acceptance of the use of telehealth technologies for the management of Chronic Obstructive Pulmonary Disease and Chronic Heart Failure.
  
  
  BACKGROUND
  The implementation of telehealth at scale is a governmental priority in countries including the UK, USA and Canada, but little research has been conducted to analyse the impact of implementation on front-line nursing staff.
  
  
  METHODS
  Six relevant data bases were searched between 2000-2012.
  
  
  METHODS
  Mixed-method systematic review including all study designs.
  
  
  METHODS
  Centre for Reviews and Dissemination approach with thematic analysis and narrative synthesis of results.
  
  
  RESULTS
  Fourteen studies met the review inclusion criteria; 2 quantitative surveys, 2 mixed-method studies and 10 using qualitative methods, including focus groups, interviews, document analysis and observations. Identified factors affecting staff acceptance centred on the negative impact of service change, staff-patient interaction, credibility and autonomy, and technical issues. Studies often contrasted staff and patient perspectives, and data about staff acceptance were collected as part of a wider study, rather than being the focus of data collection, meaning data about staff acceptance were limited.
  
  
  CONCLUSIONS
  If telehealth is to be implemented, studies indicate that the lack of acceptance of this new way of working may be a key barrier. However, recommendations have not moved beyond barrier identification to recognizing solutions that might be implemented by front-line staff. Such solutions are imperative if future roll-out of telehealth technologies is to be successfully achieved.
authors.affiliation: Department of Health Sciences, University of Leicester - Social Science Applied to Healthcare Improvement Research (SAPPHIRE) Group, UK.
authors.forename: Liz
authors.initials: L
authors.lastname: Brewster
authors.affiliation: University of Sheffield - School of Health and Related Research, UK.
authors.forename: Gail
authors.initials: G
authors.lastname: Mountain
authors.affiliation: University of Sheffield - Sociology, UK.
authors.forename: Bridgette
authors.initials: B
authors.lastname: Wessels
authors.affiliation: University of Sheffield - Psychology, UK.
authors.forename: Ciara
authors.initials: C
authors.lastname: Kelly
authors.affiliation: University of Sheffield - Health and Related Research, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Hawley
mesh_terms: D001291:Attitude of Health Personnel; D004059:Diffusion of Innovation; D004509:Education, Nursing, Continuing; D004812:Epidemiologic Methods; D006333:Heart Failure / Q000451:nursing*; D006801:Humans; D007400:Interprofessional Relations; D009723:Nurse-Patient Relations; D009740:Nursing Staff / Q000523:psychology*; D061214:Patient Safety; D017009:Professional Autonomy; D029424:Pulmonary Disease, Chronic Obstructive / Q000451:nursing*; D018570:Risk Assessment; D012944:Social Support; D055817:Telenursing
keywords: attitudes; chronic obstructive; health services research; heart failure; pulmonary disease; systematic reviews and meta-analyses; technology