**2. Acceptance and feasibility**

The majority of the projects undertaken to evaluate telehealth have been small scale pilots that include only small numbers of patients and run for relatively short periods, reporting short-term outcomes. This presents difficulty in determining the effect of telehealth on clinical outcomes and obtaining evidence on other benefits such as economic outcome. For this reason such projects generally report on measurable outcomes that include feasibility and acceptance of the technology by the users; patient and/or clinician, with the majority of studies on the clinicians. Despite the limited outcome of such studies, they can provide valuable information on understanding how technology should be introduced to promote successful adoption, and data to direct larger studies.

Most studies on acceptance are based on one of the models of user acceptance, with the Technology Acceptance Model (TAM) [7, 8] being particularly popular, which considers perceived usefulness and ease of use to be its primary constructs. However this approach has limitations when applied to evaluation of telehealth.

#### **2.1 Acceptance by the clinician**

A systematic review [9] on factors affecting front-line staff acceptance of telehealth technologies identified the factors that can act as facilitators (**Table 1**) or barriers (**Table 2**), and their importance.

A further systematic review of the experiences of nursing professionals [10] reinforced the findings of [9] and expanded detail on some of the topics to include aspects such as prior experience with technology. It also focussed on the postexperience of telehealth rather than prospective perspectives of participants and recognised that, although the nature and practice of delivering care may have changed during the project, this brought advantages, such as the ability to monitor more parameters and provided a continuous flow of information.

Longitudinal studies such as [11] are therefore invaluable in identifying the preconceptions of the users and understanding how these might change during the course of usage of the technology. Such studies also show how certain personality types will remain resistant and seek to influence the group dynamic to thwart the
