The acceptance of telemedicine by physicians in Brazil: An institutional theory view

Telemedicine comprises different health services held at a distance and is a promising practice for inclusive health care. However, there is still no consensus in the literature about the factors that influence the acceptance and dissemination of these practices. Thus, this study analyzes the factors that influence the acceptance of telemedicine, more specifically, of teleconsultations, by physicians, and seeks to understand how institutional factors act to disseminate or prevent their acceptance. An exploratory and qualitative study was carried out in Brazil, through interviews with physicians from different specialties and documents analyzes. We analyzed documents from public hearings on the regulation of telemedicine, and reports, discussions, and videos about teleconsultations. We conducted two coding cycles of data and we identified 12 factors influencing the acceptance of telemedicine/teleconsultations. Seven of these factors had previously been identified in the literature, namely: Regulatory Factors, Level of Instruction and Preparation of Users, Resistance to Change, Technological Infrastructure, Value Perception, Organizational Characteristics, and Financial Support. Five other acceptance factors emerged from our empirical data: Corporatism, Possibilities by Medical Specialization, In-Person Physical Examination, Commoditization of Telemedicine, and Previous Doctor–Patient Relationship. Based on Institutional Theory, we associated all the acceptance factors identified to the three institutional pillars, as in the study by Scott in 2014: Regulative, Normative, and Cultural Cognitive, also identifying main themes to which these factors are related, in each one of the three institutional pillars, respectively: regulation, structure, and lack of knowledge.