eHealth : An Exploration of Adoption and Implementation in Swedish Primary Care from Patients’ and Healthcare Professionals’ Perspectives

The World Health Organization (WHO) resolution on eHealth, adopted in 2005, served as a catalyst for global eHealth development. eHealth refers to the use of Information and Communication Technology (ICT) to support health. In line with this, Sweden, in its current strategy, aims to become a world leader in eHealth by 2025. While Sweden is arguably at the forefront of digitalisation, the use and optimism of eHealth services among citizens remains low. This research aimed to describe how Swedish primary care patients have adopted two eHealth services and to deepen our understanding of the influence of implementation on this process. The two eHealth services were: 1) video consultations (VCs) through the Alltid Öppet application and 2) the Swedish Patient Accessible Electronic Health Record (PAEHR) 1177 Journal. Six Studies were conducted. Studies I-IV, investigating patients’ adoption of VCs and PAEHR, using a quantitative approach, a cross-sectional design, surveying primary care patients. Descriptive and comparative analyses, as well as logistic regressions, were conducted. Studies V and VI, investigating the implementation of VCs and PAEHR, used a qualitative approach, collecting data using individual and focus group interviews. The studies found inequalities in eHealth adoption, which may worsen in the future. Patients' older age, negative perceptions, and low digital and information literacy were among the identified adoption barriers. Additionally, the low usability of eHealth services further discourages use. Healthcare professionals (HCPs) facilitate patients’ adoption, but they may also contribute to the digital divide. A lack of comprehensive implementation strategies, particularly for patients, is a major barrier to adoption, and infrastructure issues exclude certain populations. Lastly, the COVID-19 pandemic accelerated eHealth implementation and adoption, but it also contributed to the challenges with the need for a rushed and unprepared implementation. In conclusion, this research underscores the urgent need to address these barriers and reshape the development of eHealth to mitigate growing health disparities. Patients should be better supported and their literacy levels improved. HCPs should also be provided with comprehensive training and ongoing support. Developers must ensure high-quality eHealth services, implementers should adopt more comprehensive strategies, and policymakers must enhance the current infrastructure. Future research should not only delve deeper into these issues but also identify effective strategies to remove barriers and promote widespread adoption.