The Determinants of Telemedicine Adoption: A Systematic Review

Abstract

Telemedicine has shifted from a peripheral service option to an important mode of healthcare delivery, yet adoption remains uneven across settings, professional groups, and patient populations. This systematic review synthesizes the determinants of telemedicine adoption and proposes an integrated multilevel framework. Guided by PRISMA 2020, the review searched PubMed, Scopus, Web of Science, and CINAHL for peer-reviewed English-language studies published between 2016 and 2025. Following screening, eligibility assessment, and quality appraisal, 40 studies were included in the final synthesis. The evidence indicates that adoption is shaped by interacting individual, technological, organizational, and environmental determinants. Perceived usefulness, usability, digital capability, and trust consistently influence acceptance; however, favorable perceptions do not translate into sustained use when connectivity is unreliable, privacy arrangements are ambiguous, workflows are poorly integrated, or reimbursement and regulatory conditions are unclear. Sustained adoption is more likely when organizations provide leadership support, training, technical assistance, interoperability, and implementation-ready workflows. The review also identifies persistent equity challenges, including age-related capability differences, rural connectivity constraints, and socioeconomic disparities in access. An integrative conceptual framework is proposed in which decision confidence and implementation fit mediate the transition from favorable perceptions to sustained adoption outcomes. The review contributes a clearer analytical structure for telemedicine adoption research and offers practical guidance for health systems seeking durable, scalable, and equitable telemedicine delivery.