Allied health professionals and nurses are an integral part of our health care system. The allied health professions do not constitute a clearly defined group of professions, as definitions and classifications vary at the international level [1]. For the purposes of this review, the allied health professions are occupational therapists (OTs), physical therapists (PTs), speech and language therapists (SLTs), audiologists, dietitians, orthoptists, and midwives. In addition, nurses were identified as a crucial professional group within the context of allied health services. Allied health professionals and nurses have in common that they play an important role in patient care to protect, restore, and maintain physical, sensory, psychological, cognitive, social, and cultural functions [2].

The COVID-19 pandemic has profoundly challenged the work of health care professionals because of contact restrictions and the risk of infections [3,4]. Access to health services was limited worldwide [5,6] and affected, among others, access to rehabilitation services [7,8] and maternal health services [9]. The health care contacts of acute [10] and chronically ill patients [10-12] decreased during this period. Therefore, the pandemic has led to fundamental changes in service provision and advanced the integration of telehealth services in various disciplines and health fields [13]. Telehealth offers advantages for allied health professionals by overcoming barriers related to distance [14] and addressing health and services disparities [15-17]. This facilitates improved access to services and supports individuals with chronic illnesses in maintaining continuity of care, ultimately optimizing health and well-being [15,16,18]. However, there remains a concern that telehealth may inadvertently exacerbate health care disparities for susceptible populations, particularly those with limited digital literacy or restricted access to digital resources [19].

Telemedicine or telehealth can be defined as “the use of information and communication technology (ICT) to provide health services where there is physical separation between providers of care and/or recipients over long and short distances” [20]. Terminology in this area lacks agreement on the definitions of the telehealth or telemedicine concepts [21]. Telehealth might be related to telemedicine in the same way that health is related to medicine [22]. Consequently, the World Medicine Association describes telehealth and telemedicine to be used for remote clinical services to serve for patient-physician consultation where access is limited and to be used for consultation with ≥2 physicians [23]. Furthermore, telehealth refers to remote clinical and nonclinical services, such as preventive health support, research, training, and continuing medical education for health professionals [23]. Similar terms, such as telerehabilitation, telecare, telepractice, or telephysiotherapy, refer to specializations, the context of care, or a specific profession. Telehealth services can be divided into 3 types: synchronous, where health information is delivered in real time; asynchronous, where health information is stored and forwarded; and patient monitoring, where patient clinical status is continuously evaluated over the distance [24].

Video calls are a common method for providing telehealth services synchronously, as they have become prevalent in personal and professional lives. Everyday technologies, such as computers, tablets, smartphones, webcams, videoconferencing software, and an internet connection, make such services relatively accessible. Especially during the COVID-19 pandemic, there was a demand for readily available solutions without the need for additional infrastructure or equipment. The rapid implementation of video visits with health care professionals prevented infections [25] and kept the health care system running [26-29]. For instance, telehealth services offered by physiotherapists were used to support patients in isolation [30] or to address the ongoing needs of children with neurodevelopmental or musculoskeletal issues [31]. This approach enabled the provision of acute care while maintaining continuity in therapeutic interventions.

Telehealth also has potential benefits in addition to the prevention of infections. Such services have been established long before facing a pandemic, especially in rural areas, to increase access to physical or occupational therapy, speech and language therapy, nursing, and other health services [32-34]. People who are bedridden or have limited mobility can also benefit from easier access [35]. Furthermore, increased independence and reassurance have been described through telehealth use [36]. Studies have shown that telehealth can yield equivalent or even superior clinical outcomes for patients [18,37,38]. However, such services are not a common component of health services.

The implementation of telehealth faces organizational, personal, and technological barriers, such as the lack of infrastructure, missing skills, poor strategic alignment, resistance to necessary cultural changes, and cost or reimbursement issues [39]. However, to date, no review has systematically mapped these barriers. An illustration and analysis of telehealth barriers is important to address them in the future by tailored actions such as training, organizational redesigns, or infrastructure measurements.

To systematically map barriers to video call–based telehealth from nonmedical health professionals, a mapping and scoping review with the following research question was conducted: What barriers are indicated and described by allied health professionals and nurses toward video call–based telehealth?

First, a scoping review was conducted based on the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines [40,41]. Before initiating the review, a review protocol was developed, stored in the institutional database, and followed. It was not published publicly. Second, the identified barriers were systematically mapped with respect to the health profession, the context of care, and the research method.

Only articles that have been published since June 2017 were eligible to ensure that the studies applied technology that is comparable with current standards. Publications that met the inclusion criteria were eligible (Textboxes 1 and 2).

A comprehensive literature search was carried out in the PubMed and CINAHL databases on June 22, 2022, and updated on January 3, 2023. In addition, citation tracking was performed to identify additional relevant literature. Relevant topics for the search were video call–based telehealth; barriers or challenges; health professions of interest; and resources from interviews, focus groups, surveys, or questionnaires. The complete search strings can be found in Multimedia Appendix 1.

All references were imported to Zotero (Corporation for Digital Scholarship). In a first step, all duplicates were eliminated, and then all titles and abstracts of the sources were screened for inclusion criteria. The full text of the remaining articles was obtained, thoroughly reviewed for eligibility, and searched for further publications that met the inclusion criteria by citation tracking.

The full-text articles of the selected publications were imported into MAXQDA (2022; VERBI GmbH), a software for qualitative content analysis. Each publication was coded for country, health profession, and target group of telehealth intervention to compare basic characteristics. The sample sizes were noted. Furthermore, all articles were thoroughly examined for the mentioned barriers, and codes were inductively assigned to text passages. The inductive coding process involved identifying patterns, themes, and categories in the data without the use of preexisting codes to allow for the identification of new and unexpected themes that may not have been anticipated. The codes were continuously refined, structured, and consolidated.

Finally, every publication had a code for country, health profession, target group, and if applicable, the following barrier codes were assigned: interpersonal issues, administration issues, practice issues, patient issues, environmental issues, telehealth attributes, technology issues, policy and regulation issues, and others. Subcodes for topics requiring further refinement were created.

Individual coding (passages with an assigned code) was analyzed and summarized for each code topic narratively. Similarities in the barriers mentioned were identified, and barriers for specific health professions or target groups were determined. Each barrier mentioned was equal in weight. A quantitative outline of barriers was performed only with respect to the number of articles that mentioned each barrier but not in terms of how often it was mentioned within an article.

The search yielded 786 records (n=609 in June 2022 and n=177 in January 2023). A total of 611 records were screened (n=474 in June 2022 and n=137 in January 2023), and 107 full-text papers were assessed for eligibility (n=77 in June 2022 and n=30 in January 2023). Finally, the review included 56 publications (n=44 in June 2022 and n=12 in January 2023). The selection process is illustrated in the flowchart (Figure 1).

Table 1 presents all included publications with details for authors, publication year, country, included professions, health context, and assessment methods.

The included studies were published in 2017 (n=1) [42], 2018 (n=2) [43,44], 2019 (n=2) [45,46], 2020 (n=2) [47,48], 2021 (n=23) [49-71], and 2022 (n=26) [29,72-96]. Of the 56 papers, 48 (86%) papers focused on COVID-19 [29,47,49,51-56,58-96]. In total, 80% (45/56) of publications focused on 1 specific health care profession [29,42-47,49-51,53-59,63-66,68-75,77-81,83-86,88-91,93,94,96], and 20% (11/56) of articles targeted a mix of health care professions [48,52,60-62,67,76,82,87,92,95]. Most articles covered barriers for PTs (29/56, 52%) [43,48,49,51-53,55-57,59,61-65,67,74,76-82,84,85,87,92,95], followed by those for SLTs and audiologists (18/56, 32%) [29,48,50,52,59-61,73,79-81,83,85,92-94,96]. Furthermore, publications were concentrated on OTs (15/56, 27%) [45,47,52,60-62,67,72,73,76,82,87,92,95,96], nurses (5/56, 9%) [42,44,69,86,88], dieticians (4/56, 7%) [48,58,68,70], and midwives (2/56, 4%) [46,60]. No studies with orthoptists were included.

The studies focused on various health contexts. Health professionals treated various target groups (27/56, 48%) [42,45,47-51,53,54,58,60,63,67,73,75,78,79,81,83,85,86,89-94] or focused on specific target groups, such as children (13/56, 23%) [29,45,52,55,61,66,71,72,76,82,84,87,95] or older adults (2/56, 4%) [59,96], or patients with specific diseases or issues, such as musculoskeletal disorders (2/56, 4%) [62,77], cancer (3/56, 5%) [44,69,88], osteoarthritis (3/56, 5%) [43,74,80], vestibular disorders (1/56, 2%) [56], early labor (1/56, 2%) [46], diabetes (1/56, 2%) [70], pelvic health (1/56, 2%) [64], and Achilles tendinopathy (1/56, 2%) [57]. Overall, 2% (1/56) of studies focused on the execution of assessments via telehealth [65]. Figure 2 shows the study characteristics based on the included professions and health contexts [29,42-96].

The publications were from the United States (12/56, 21%) [45,47,52,55,56,68,70,72,76,81,87,88], Australia (12/56, 21%) [43,48,51,57,62-64,71,78,83-85], the United Kingdom (5/56, 9%) [42,46,66,86,90], Israel (4/56, 7%) [58,61,73,96], India (4/56, 7%) [53,75,79,89], Canada (3/56, 5%) [29,65,95], Germany (2/56, 4%) [59,92], Kuwait (2/56, 4%) [49,77], Norway (2/56, 4%) [44,69], Iran (1/56, 2%) [50], Hong Kong (1/56, 2%) [54], Switzerland (1/56, 2%) [60], Austria (1/56, 2%) [67], Belgium (1/56, 2%) [94], Singapore (1/56, 2%) [91], South Africa (1/56, 2%) [93], the Philippines (1/56, 2%) [82], Sri Lanka (1/56, 2%) [80], and Saudi Arabia (1/56, 2%) [74]. Study participants from a variety of continents and countries were included: 27% (15/56) of the participants were from North America, 21% (12/56) were from Europe and Australia each, 14% (8/56) were from the Middle East and South and East Asia each, and 2% (1/56) were from Africa. A visual representation of the worldwide distribution of study participants can be found in Figure 3.

Questionnaires (37/56, 66%) were used with a total of 10,245 health professionals [43,45,47,51-56,58,60-62,64-68,70-73,75,76,78-80,82,83,87,89-94,96], and interviews or focus groups (17/56, 30%) were conducted with 288 health professionals [29,42,44,46,48,50,57,59,63,69,77,81,84-86,88,95]. The methods used were mixed in 2 publications [49,74]. The evaluation methods, according to the included professions and their combined sample sizes, are presented in Table 2.

Barriers were assigned to 8 categories: technology issues, practice issues, patient issues, environmental issues, attributions, interpersonal issues, policies and regulations, and administration issues. Technology issues were found to encompass several subcategories, including limited access to technology, concerns about the reliability and usability of technology, network issues, a lack of technology skills among health care providers and patients, and other unspecified technological barriers. The analysis indicated that practice issues covered aspects such as diminished fidelity of observations and poor conditions for visual instructions; a lack of knowledge, skills, or experience; a lack of training, guidelines, or protocols; and the inability to provide hands-on care. Subcategories attributed to patient issues included addressing inappropriate target groups, managing patient behaviors, and addressing safety issues. Furthermore, physical, sensory, and social environmental issues were identified. Barriers to telehealth identified under the attributions category were negative attitudes toward telehealth from providers, patients, and caregivers, along with perceived drawbacks associated with telehealth use. Moreover, policy and regulation issues, which included privacy and security issues, billing and reimbursement topics, and workplace or health policies, were relevant barriers. Interpersonal barriers included reduced client-practitioner interaction and communication as well as the presence of ethical and cultural concerns. Finally, administration issues, such as a lack of support and a perceived increase in workload, were identified. A detailed description of the barriers for each subcategory and their references are provided in Table 3. The percentages of publications mentioning this barrier are depicted in Figure 4.

Publications reporting the barriers of PT, OT, and SLT covered all main categories, whereas nurse publications did not report any policy and regulation barriers. Dietitian and midwife publications had no information about patient issues, and midwife publications did not address category attributions. An overview of the distribution of reported barriers in the health profession is shown in Figure 5.

For further reference, Multimedia Appendix 2 provides an overview of the categories and subcategories of the barriers addressed in the individual studies [29,42-96].

This review aimed to map and condense the perceived barriers of allied health professionals concerning the use of video call–based telehealth, as understanding these barriers is crucial for improving telehealth adoption, efficiency, and effectiveness. By providing information to health care professionals and health services on barrier identification, this study serves as the first step toward addressing and overcoming these obstacles. We included 56 publications that reported barriers for OTs, PTs, SLTs and audiologists, dieticians, midwives, and nurses. Barriers were assigned to 8 topics: technology issues, practice issues, patient issues, environmental issues, attributions, policy and regulation issues, interpersonal issues, and administration issues. Previous publications on telemedicine barriers also used similar, but also different, classification schemes. The Pan American Health Organization refers to barriers by technological, organizational, human, and economic environments [39]. Almathami et al [98] described internal and external barriers, and Scott Kruse et al [99] differentiated between organizational barriers and patient barriers. However, similar barriers underpin these different classifications.

The barriers mentioned most frequently pertain to technological issues. Although video call technologies are widespread in a large part of the population, certain groups or individuals lack suitable hardware or network access. This could be the case not only for some older adults but also for patient groups living in rural areas or those who are socioeconomically disadvantaged. The limited access of patient groups should be considered when telehealth services are offered to avoid possible disadvantages. Furthermore, the risk of a digital divide extends beyond mere access to technology. It also encompasses a lack of knowledge of digital health or technology skills [100,101], as they were reported in numerous included studies of this and previous reviews [99]. To facilitate the acceptance and effective use of telehealth tools, hardware and software must be designed to accommodate users’ needs [98]. According to common frameworks, perceived usefulness and perceived ease of use affect the acceptance of a technology and are further influenced by experience [102]. To overcome these barriers, it is important to develop and use video call software that meets the specific needs of providers and patients and adheres to usability principles. In addition, health professionals, as well as patients, need to have the knowledge and skills to use technology. Thorough preparation of video visits or calling on e-helpers can facilitate successful implementation [51,86,95]. However, it is essential to recognize that network issues may still occur, potentially causing interruptions during video calls and affecting the overall telehealth experience. These were the second most cited barriers in this review, showing similarity to the review by Almathami et al [98], where this barrier held the top rank. To reduce network problems, it would be necessary to invest in and prioritize the development and maintenance of robust and reliable telecommunication infrastructure. This includes improving broadband connectivity in rural and underserved areas, which are often specifically addressed by telehealth services. In addition, providing telehealth users with guidelines for troubleshooting network-related problems could further enhance the overall experience and success of telehealth initiatives.

Second, most publications have reported barriers related to practice issues. Health care provision involves various physical, verbal, and observational measures. Providing care on the web on the screen involves a variety of challenges concerning this matter. Although physical therapy often involves whole body movements and hands-on techniques, dietitians are more based on conversation. Occupational therapy is often oriented toward daily activities, incorporating many different objects, and speech and language therapy is dependent on good sound quality. However, most practice-related barriers are applicable to all involved health care professions. First, hands-on methods cannot be applied to examinations, demonstrations, interventions, and assistance. This barrier was mentioned in 59% (33/56) of the publications and therefore seems to represent a core barrier for the explored health professions. Notably, it was not represented as a key barrier in earlier reviews that included a wider range of health professions [98,99] and might be more specific for the professions examined in this study. To address the lack of hands-on methods, they must be replaced by other actions that target the same outcome of comparable quality. For this, health professionals need specific training, guidelines, or protocols that expand their skill sets. However, if there are no adequate replacements for hands-on techniques, telehealth services may solely not be appropriate. Practitioners could combine telehealth and in-person services or work closely with local health care professionals to coordinate in-person care when needed. This collaborative approach ensures that patients receive comprehensive care that combines the convenience of telehealth with the benefits of in-person care. Second, limitations are also prevalent with respect to the diminished conditions for observations. Issues that negatively contribute to this are poor video and audio quality, difficulties with camera placement, and a lack of perception of body language, as described previously [98]. Establishing a professional setting on both sides can help minimize this barrier. However, these might be associated with additional costs, which were also found to hinder telehealth adoption [99]. Furthermore, encouraging the development and implementation of digital assessment tools tailored for telehealth sessions could aid health care professionals in making more accurate observations despite the limitations of the web-based setting [103,104]. Training, guidelines, or protocols are needed to guide health professionals in creating optimal conditions for valid observations and high-quality therapy.

Telehealth provision, in addition to visual observations, is highly dependent on communication. Therefore, a limited interaction between the client and the practitioner was described as a barrier. There exists the fear that information might be lost along the way, and misunderstandings can occur. Moreover, it was mentioned that it is more difficult to establish relationships or trust. Such communication issues and perceptions of impersonal care have been reported previously [98,99]. Therefore, special emphasis should be placed on expanding the communication skills of health care providers to overcome those barriers [105-107]. Health care professionals should be trained to be more aware of and skilled in nonverbal communication cues, such as facial expressions, gestures, and body language. This can help to better understand patients’ needs, emotions, and reactions during telehealth sessions, thereby improving overall communication and rapport building. Moreover, health care professionals reported a decrease in communication quality, especially when language barriers were present. By implementing appropriate strategies, telehealth on the other hand could also help overcome language barriers when providers on the web collaborate with professional interpreters [108] or integrate language support features, such as real-time translation [109]. Comprehensive training modules that familiarize health care providers with the available language support services and their use in telehealth settings would be needed.

When discussing patient selection for telehealth services, it is crucial to consider several factors, including the demographic, physiological, and personal characteristics of patients. Some health professionals expressed the need for algorithms to establish clear inclusion and exclusion criteria. Certain diagnoses or health restrictions may limit a patient’s ability to interact effectively through telehealth or pose risks that cannot be adequately managed within this service model. Ensuring patient safety and addressing potential risks should be integral to the planning and management of telehealth services [110]. In the context of telehealth for children, some publications highlighted challenges related to maintaining attention, engagement, and managing challenging behaviors. To address these issues, health professionals may need to use innovative approaches in adapting methods and materials to suit web-based settings [111-113]. In addition, prioritizing coaching and support for relatives can help overcome barriers associated with telehealth in children [100,101].

Caregivers can play an important role in supporting the patient with technology or other tasks. Furthermore, they are directly addressed by health professions for training or support [114]. If they are not available or struggle with the responsibilities assigned, telehealth provision can be challenging, especially if patients depend on them [98]. Therefore, the social system of patients should be considered to determine whether telehealth services are appropriate. Furthermore, it is important to evaluate the physical and sensory environments of patients, as described by Almathami et al [98]. Depending on the goals and types of health care provision, space and material needs should be considered and evaluated. If possible, providers could conduct home assessments to evaluate the physical and sensory environment of patients and make recommendations for modifications or improvements to the space. In addition, a lack of privacy at home can be an issue. To address this barrier, health care providers can offer guidance on how to create a private space for telehealth visits, such as using a separate room or wearing headphones to ensure confidentiality. Finally, health care providers should consider alternative methods of care for patients who do not have access to a private space for telehealth visits.

Privacy issues also refer to the transmission of sensible health data over the internet and have been widely discussed [98,99]. Many health professionals mentioned that they feared that their patient’s privacy was at risk and that they had concerns about data protection. Telehealth requires secure platforms where data are encrypted to protect patient privacy and confidentiality [115]. Therefore, it is important to educate health care professionals about suitable platforms and provide guidelines so that they can make informed decisions about IT security measures [116]. Commercial platforms are not always in compliance with the General Data Protection Regulations [115] or the Health Insurance Portability and Accountability Act [98] and should be transparent about how they store, transmit, encrypt, and use data so that health providers can compare those measures with current guidelines [117].

In addition to fear of a lack of data privacy, other negative attitudes toward telehealth influence the acceptance of telehealth. This applies to the reluctance to telehealth of health care providers, patients, and caregivers, also described as resistance to change [99]. Most often, statements about clinical effectiveness or clinical usefulness were reported as reasons. The body of evidence for telehealth effectiveness varies depending on the health context and the involved health care professions. To give some examples, 2 meta-analyses found positive clinical results, even comparable with conventional face-to-face rehabilitation approaches, for PT and OT telerehabilitation services [118,119]. A systematic review of telepractice for adult speech language therapy supports the use of telepractice as an appropriate service delivery model [120]. Moreover, the benefits of using telepractice to provide parent-implemented interventions to children with autism spectrum disorders have been described [121]. Telehealth services from dieticians or nutritionists can improve protein intake and quality of life in malnourished older adults [122]. Yet, there is a lack of high-quality evidence and training courses to inform health care providers about current evidence.

Finally, all the mentioned barriers can lead to an increase in the workload and stress of health care professionals, especially when experience with telehealth has not been established. In such cases, providers may face challenges such as technological difficulties, ineffective communication with patients, and patient selection issues, which can lead to increased stress and a decrease in work efficiency. They need administrative and technological support, protocols, and guidelines to help them establish a well-functioning telehealth practice. To achieve sustainable telehealth services, it is important to ensure that health care professionals are willing and able to use these tools effectively. This means that health organizations must provide adequate resources and training to support the adoption and use of telehealth technology, as their acceptance is crucial to the success of sustainable telehealth services [123].

This review only covered original studies, which were found in the PubMed and CINAHL databases, in German or English language and were published since June 2017. Although these are widely recognized and commonly used databases in the field of health care research, this may have resulted in the exclusion of relevant studies published in other databases. However, efforts have been made to minimize this limitation using comprehensive search strings and citation tracking to identify additional relevant literature. Future studies could expand the search to include a wider range of databases to increase the comprehensiveness of the search strategy. Furthermore, only 1 researcher conducted the search, selection, and mapping process. A broader search process, with more languages and researchers included, might have increased the number of publications and reliability of the results.

Publications were selected based on included health care professions. In case, professions out of scope were involved, the author selected only information from health care professionals that were within the scope of all conscience but with the risk of interference. Furthermore, there were big differences between the number of publications and included participants in the health care profession of interest. Although more than half of the publications addressed barriers of PTs and another third addressed those of SLTs and audiologists, other professions were less represented. Furthermore, SLTs and audiologists were combined, as they are 1 profession in some countries, whereas in others, they are 2 separate professions. Owing to these quantitative differences, it is difficult to compare the mentioned barriers between these professions and discuss whether there are significant differences. Furthermore, the number of publications that mentioned a barrier might not reflect its relevance. Therefore, all numbers and corresponding figures should be interpreted with caution.

Another limitation is that this review focused on health contexts rather than health settings. The included studies covered a range of health professions and contexts of care but did not distinguish between different settings, such as acute, tertiary, or community settings. There may be differences in the barriers and challenges faced by telehealth interventions across different health settings; therefore, the findings of this study may not be generalizable to all health settings.

This review has a slightly more balanced distribution of publication sites when compared with other reviews that focused on telehealth barriers. It incorporates approximately half of the publications from North America (15/56, 27%) and Europe (12/56, 21%) and the other half from Australia (12/56, 21%), the Middle East (8/56, 14%), South and East Asia (8/56, 14%), and Africa (1/56, 2%). Earlier reviews that focused on telemedicine barriers reported nearly 73% [99] or even 84% [98] of references from North America or Europe. However, there is a huge underrepresentation of African countries especially.

This review covered most studies that were conducted during the COVID-19 pandemic. As this period was highly influenced by contact restrictions, many publications have included participants who used telehealth services as a matter of imperative necessity. This could have influenced their attitudes and may have led to increased confrontation with barriers that could have been prevented with more time for preparation. In addition, the review included only a limited number of prepandemic studies, which may limit the generalizability of our findings beyond the pandemic period. Nonetheless, no differences were observed in the reported barrier categories between studies with and without a COVID-19 context. However, further research is needed to examine the challenges and barriers to telehealth interventions in different settings and contexts.

Finally, qualitative and quantitative results from these studies were synthesized in this review. It should be considered that participants give different answers when they reply to open-ended or closed-ended questions.

This study systematically reports the barriers of allied health professionals toward video call–based telehealth within 59 original studies with OTs, PTs, SLTs and audiologists, dieticians, midwives, and nurses. Through the review, a range of barriers were identified, including technology, practice, patient, environmental, attributions, policy and regulation, interpersonal, and administration issues. The results emphasize the need for stable infrastructure, education, training, guidelines, policies, and support systems to establish high-quality allied telehealth services. The identification of these barriers is crucial, as it highlights the areas where improvements are needed in telehealth services to better meet the needs of allied health professionals, nurses, and their patients. The information gathered in this review can be used to improve telehealth services in health care organizations.