Barriers and Facilitators of Telenursing: A Theory of Planned Behavior Inquiry on Nurses’ Views

Abstract Background Telehealth has become increasingly widespread across healthcare systems worldwide. However, its integration into Israel's Maternal and Child Health Clinics (MCHCs) remains limited. These national clinics play a crucial role in disease prevention and public health, yet the use of telenursing by nurses during the COVID-19 pandemic and beyond was infrequent. This study aimed to explore the factors predicting nurses’ intention to adopt telenursing in MCHCs, based on the Theory of Planned Behavior. Methods A cross-sectional design was employed. An online anonymous survey was distributed among 279 MCHC nurses from three districts of Israel. A structural equation model was used to test the direct and indirect effects on nurses’ intention to use telenursing. Results Actual use was significantly lower than intention to use telenursing (p < 0.001). Direct associations were observed between digital literacy and attitudes (p < 0.01), subjective norms (p < 0.01), and perceived behavioral control (PBC; p < 0.01). In addition, direct associations were observed between subjective norms and intention (p < 0.01), and between PBC and intention (p < 0.01). Furthermore, indirect associations were observed among digital literacy and intention via subjective norms (p = 0.01), and PBC (p < 0.01). Conclusions Integrating telenursing services into MCHCs requires targeted training for nurses to support technology gaps. Interventions aimed at developing remote health services skills are essential for enhance nurses’ PBC and perception of subjective norm related to telenursing, which in turn will increase their intentions to engage in such service. Implementing remote health services in MCHCs may improve parental adherence and more frequent online follow-ups, ultimately support the health promotion of infants and mothers and benefit public health. Key messages • Nurses’ perceptions and technological skills influence their intentions to use telenursing in MCHCs. • Interventions should strengthen nurses’ digital literacy, thereby increasing their perceived behavioral control and social norms regarding telenursing, to facilitate its integration.