Implementation of telehealth in the local health unit of Algarve (ULS Algarve): Barriers, needs and opportunities: A participatory design study

Abstract

Despite national and European strategies promoting digital health, routine video-based teleconsultations remain uneven across regions. In Portugal’s Western Algarve, within the Local Health Unit of Algarve (ULS Algarve), adoption has been limited, revealing a policy–practice gap. This study examined factors underpinning the absence or delayed uptake of teleconsultations at ULS Algarve, identifying barriers, needs, and opportunities from multiple stakeholder perspectives. A qualitative exploratory case study was conducted through nineteen interviews with professionals, managers, ICT staff, patients, and caregivers. Data were analysed using a hybrid thematic approach guided by the Consolidated Framework for Implementation Research (CFIR) and informed by Participatory Design (PD) needs-assessment principles. Findings reveal widespread recognition of teleconsultation benefits for low-complexity follow-ups, results review, and care for geographically dispersed populations, with pragmatic acceptance among professionals and patients/caregivers. However, adoption faces organisational and infrastructural barriers: lack of video-enabled equipment and configured desktops, insufficient protected time and private spaces, unadapted workflows, and limited on-demand technical support. Stakeholders outlined requirements for a minimum viable setup (basic video infrastructure, protected scheduling, brief practice-oriented training, and clear eligibility and fallback rules) and emphasised equity safeguards to reduce digital exclusion, particularly among older adults. Limited implementation at ULS Algarve reflects last-mile implementation failures rather than resistance or lack of perceived value. Integrating CFIR and PD yielded actionable insights for a phased, context-aware, equity-focused roadmap to embed sustainable teleconsultations within the public system.