Abstract / Summary
Abstract Background Telehealth and remote physiologic monitoring (RPM) have transformed hypertension management and stroke prevention, but these benefits are not distributed equally. Safety-net health systems serving low-income, racially, and linguistically diverse populations face persistent barriers to telehealth adoption that threaten to widen existing disparities. This qualitative study explored the barriers and facilitators that providers and hospital administrators perceive as shaping telehealth adoption. Ultimately, these insights will inform the implementation of the Digital Equity for Stroke Approach (DESA), a telehealth-enabled, equity-focused stroke prevention pilot intervention within a safety-net academic medical center in Central Brooklyn. Methods As part of a larger mixed methods pilot randomized controlled trial evaluating DESA, 19 semi-structured key informant interviews were conducted with physicians and hospital administrators between April 2021 and February 2025. Interviews were audio-recorded, transcribed, de-identified, and analyzed using CFIR-guided deductive coding combined with inductive thematic analysis informed by interpretive phenomenological analysis. Results Thematic analysis yielded four overarching themes: (1) digital infrastructure and technological barriers, (2) health equity and the digital divide, (3) implementation process and organizational change, and (4) patient and provider experience and preferences. Conclusions Equitable telehealth implementation in safety-net settings requires coordinated investment across policy, infrastructure, and workforce levels rather than technology access alone. Sustained reimbursement parity for audio-only visits, expanded digital navigation staffing, and trust-building strategies represent actionable levers for health systems and policymakers seeking to prevent telehealth from reproducing existing health inequities.