Barriers and facilitators to implementing synchronous telehealth interventions for people with dementia - a systematic review

Introduction: Behavioural interventions, such as those provided by allied health professionals and psychologists, help manage symptoms of people living with dementia. Access to such interventions depends on individual factors (e.g., support, travel) and service availability. One way to improve access and availability is via synchronous telehealth. However, there may be challenges implementing telehealth interventions. Method: A systematic review was conducted to explore barrier and facilitators to implementing synchronous telehealth intereventions for people living with dementia. The review protocol was registered on PROSPERO (CRD42024508098). Five databases were systematically searched in February 2024. Implementation determinants were extracted and analysed deductively using the Theoretical Domains Framework (TDF) and COM-B behaviour change models. Determinants that did not correspond with the TDF or COM-B were described inductively using content analysis. Determinants were further analysed as to whether they pertained to the intervention, or to the technology used to deliver it. Results: 25 papers were included in the review, including group, dyadic and individual interventions from 14 countries including those from the Global South. Key implementation determinants corresponded to the TDF domains Environmental Context & Resources and Knowledge. Two inductively created domains were developed: Creativity & Safety. Most implementation barriers were to do with technology. These were often clear problems with potentially straightforward, linear, implementation solutions related to the COM-B concepts of Capability and Opportunity. Most implementation facilitators involved the telehealth intervention itself. These were often complex issues, with potentially complex and non-linear implementation strategies, most often related to the concept of Motivation. Reporting quality was variable in the literature. Conclusion: Use of implementation and behaviour change frameworks may enhance reporting, reproducibility, and improve implementation. Such frameworks may also help prioritise determinants to address and delineate potential implementation strategies.