Telemedicine Acceptance in Rural Settings: A Systematic Review of Definitions, Methods, and Measurement Practices

Technological advances, particularly in e-health and telemedicine, have significantly influenced the evolution of healthcare services, especially after COVID-19. Telemedicine, according to the WHO, is defined as “the delivery of health services where distance is a critical factor, or would be using appropriate technologies, by all healthcare professionals using information and communication technologies in the exchange of valid information for diagnosis of patients, treatment, and prevention of disease and injuries”. Telemedicine is gaining popularity by extending the available services from urban centers to rural areas and technology acceptance frameworks have been widely used to asses telemedicine acceptance level. However, the heterogeneity of assessments leads to fragmentation, which limits methodological rigor and generalizable results. The current systematic review aims to answer three questions: (1) How is “acceptance” defined and measured in telemedicine? (2) What methods are most used to assess the acceptability of telemedicine delivered in rural areas? (3) To what extent do rural health care practitioners and patients accept telemedicine? The review incorporated a final sample of 104 studies published between 2018 and 2024 that show a balance between quantitative, qualitative, and mixed methods approaches. Unfortunately, the same can’t be said for the number of studies that referenced a theoretical framework when evaluating acceptance (29%) and studies that used standardized research tools (36%). The combination of these results with the fact that most of the authors (78%) claimed to have measured high levels of acceptance, calls for a critical look into the literature and the generalizability of published results.