title: Conditions for success in introducing telemedicine in diabetes foot care: a qualitative inquiry.
abstract: BACKGROUND
  The uptake of various telehealth technologies to deliver health care services at a distance is expanding; however more knowledge is needed to help understand vital components for success in using telehealth in different work settings. This study was part of a larger trial designed to investigate the effect of an interactive telemedicine platform. The platform consisted of a web based ulcer record linked to a mobile phone to provide care for people with diabetic foot ulcers in outpatient clinics in specialist hospital care in collaboration with primary health care. The aim of this qualitative study was to identify perceptions of health care professionals in different working settings with respect to facilitators to engagement and participation in the application of telemedicine.
  
  
  METHODS
  Ten focus groups were conducted with health care professionals and leaders in Western Norway between January 2014 and June 2015 using Interpretive Description, an applied qualitative research strategy.
  
  
  RESULTS
  Four key conditions for success in using telemedicine as a new technology in diabetes foot care were identified: technology and training that were user-friendly; having a telemedicine champion in the work setting; the support of committed and responsible leaders; and effective communication channels at the organizational level.
  
  
  CONCLUSIONS
  Successful larger scale implementation of telemedicine must involve consideration of complex contextual and organizational factors associated with different work settings. This form of new care technology in diabetes foot care often involves health care professionals working across different settings with different management systems and organizational cultures. Therefore, attention to the distinct needs of each staff group seems an essential condition for effective implementation.
authors.affiliation: Faculty of Health and Social Science, Centre for Evidence-Based Practice, Bergen University College, Bergen, Norway.
authors.forename: Beate-Christin Hope
authors.initials: BH
authors.lastname: Kolltveit
authors.affiliation: Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway ; Faculty of Health and Social Care, Molde University College, Molde, Norway.
authors.forename: Eva
authors.initials: E
authors.lastname: Gjengedal
authors.affiliation: Faculty of Health and Social Science, Centre for Evidence-Based Practice, Bergen University College, Bergen, Norway.
authors.forename: Marit
authors.initials: M
authors.lastname: Graue
authors.affiliation: Faculty of Health and Social Science, Centre for Evidence-Based Practice, Bergen University College, Bergen, Norway ; Department of Medicine, Section of Endocrinology, Stavanger University Hospital, Stavanger, Norway.
authors.forename: Marjolein M
authors.initials: MM
authors.lastname: Iversen
authors.affiliation: School of Nursing, University of British Columbia, Vancouver, Canada.
authors.forename: Sally
authors.initials: S
authors.lastname: Thorne
authors.affiliation: Faculty of Health and Social Science, Centre for Evidence-Based Practice, Bergen University College, Bergen, Norway ; Department of Nursing Science, Institute of Health and Society, University of Oslo, Oslo, Norway.
authors.forename: Marit
authors.initials: M
authors.lastname: Kirkevold
keywords: Diabetic foot ulcer; Focus groups interviews; Health care professionals; Interpretive description; Telehealth; Telemedicine