The rise of telehealth during the COVID-19 pandemic marked a critical evolution in healthcare delivery, enabling continued patient access amidst unprecedented disruptions. Despite this momentum, telehealth has not translated into equitable usage across all patient populations. A recent scoping review, which analysed 395 studies from around the world, revealed that barriers to telehealth are complex, multifaceted and span individual, structural and technological levels. This evidence provides essential insights for policymakers, healthcare providers and system administrators who aim to ensure that the digital transformation of care does not reinforce existing disparities.
Individual-Level Barriers to Engagement
The most commonly reported barrier to telehealth use was the lack of skills or ability, cited in 55% of the studies. This includes challenges with digital literacy, basic technological competency and in some cases, physical or cognitive limitations that make technology use difficult. Many patients, particularly older adults and those from marginalised backgrounds, reported difficulties navigating telehealth platforms, often requiring assistance. A lack of interest in telehealth, found in 49% of studies, emerged as another significant factor. This disinterest often stemmed from preferences for in-person consultations or perceptions that telehealth lacked relevance for specific medical conditions. Concerns about the perceived quality of telehealth services also played a major role, with 42% of studies highlighting this issue. Patients cited the absence of physical exams, weakened provider–patient communication and diminished trust in digital care formats as key deterrents. Other less frequent barriers included a lack of awareness about telehealth options and prior negative experiences, which reinforced hesitancy and disengagement.
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Structural and Technological Challenges
Access to technology emerged as a core structural barrier, with 45% of studies identifying patients' limited or non-existent access to necessary devices, internet connectivity or data plans. These challenges were further exacerbated for patients from rural areas, those with lower socioeconomic status or individuals from racial and ethnic minority groups. Prohibitive costs—whether related to equipment, internet services or insurance coverage—also limited telehealth adoption. Cultural and linguistic mismatches between providers and patients created additional friction, as did the environments in which patients were expected to conduct virtual consultations. Distractions, lack of privacy and inadequate home infrastructure undermined effective care delivery.
On the technology front, 45% of studies cited platform limitations as barriers. These included software glitches, connectivity problems and user-unfriendly interfaces. Such issues not only hindered access but also negatively shaped perceptions of telehealth's reliability. Notably, during the pandemic, concerns about data security and trust declined, possibly due to the increased normalisation of digital services. However, structural and technical challenges became more visible as the urgency to adopt telehealth exposed vulnerabilities in healthcare systems not yet optimised for virtual care delivery.
Geographic and Pandemic-Specific Variations
The scoping review found minimal differences in the overall types of barriers reported before and during the COVID-19 pandemic and across the United States and international contexts. However, some notable trends were observed. During the pandemic, patients more frequently cited lack of access to technology and lower perceptions of care quality as key barriers. This likely reflected the rapid, widespread rollout of telehealth services and the inability of some patients to keep pace with the changes. Interestingly, trust-related concerns were reported less often during this period, perhaps due to the sheer necessity of remote care. At the same time, issues related to cultural competency became more pronounced, especially among minority communities heavily impacted by the pandemic.
From a geographic perspective, US-based studies reported more barriers related to technological access than those from other countries, possibly reflecting higher levels of digital inequality. Conversely, studies from outside the United States more frequently noted a lack of interest in or relevance of telehealth, which may suggest that in some regions, telehealth had not yet become integrated into routine care or that cultural expectations around care delivery remained rooted in in-person interactions.
The scoping review underscores the layered nature of barriers to telehealth use and uptake. These barriers cut across individual capabilities, social determinants and the technological ecosystem, with significant variations by context and population. While telehealth offers great promise for expanding access and continuity of care, its benefits cannot be realised equitably without targeted interventions. Improving digital literacy, addressing structural inequities and refining technology platforms are critical steps. Additionally, tailoring approaches to the cultural and contextual needs of diverse populations will be essential in ensuring that telehealth evolves as a tool for inclusion rather than division.
Source: JAMIA Open
Image Credit: iStock
