**Background:** Hypertension and diabetes are increasingly prevalent worldwide, with projections of 1.6 billion people with hypertension and 643 million with diabetes by 2030. Telemedicine offers an accessible and cost-effective means of supporting management of these conditions, especially accelerated by the COVID-19 pandemic. However, no prior review had examined contextual factors influencing telemedicine implementation for hypertension or diabetes using an implementation science framework.
**Methods:** This scoping review followed the 5-stage Arksey and O'Malley method and PRISMA-ScR guidelines. Searches were conducted in Ovid MEDLINE, Embase, CINAHL, Cochrane Library, Web of Science, and Google Scholar for English-language studies published from 2017 to 2022. The Consolidated Framework for Implementation Research (CFIR) guided data extraction and synthesis, covering 39 constructs across 5 domains: intervention characteristics, outer setting, inner setting, characteristics of individuals, and process. A 3-member team independently reviewed titles/abstracts and full texts.
**Key Results:** From 17,687 initial records, 35 studies (0.2%) were included. Most studies (32/35, 91%) were conducted in high-income countries, 40% (14/35) in the United States. Only 3 studies (9%) were from low- and middle-income countries. Qualitative designs predominated (15/35, 43%), and most reported patient perspectives (20/35, 57%). Diabetes was the focus of 83% (29/35) of studies. Intervention modalities included smartphone apps (13/35, 37%), SMS text messaging (10/35, 29%), web-based platforms (7/35, 20%), phone calls/voice messaging (7/35, 20%), and medical equipment (3/35, 9%). Self-monitoring was the aim in 51% (18/35) of studies.
KEY BARRIERS ACROSS CFIR DOMAINS INCLUDED
cost (9/35, 26%), complexity (6/35, 17%), unmet patient needs and resources (8/35, 23%), limited HCP buy-in and incompatible workflows (6/35, 17%), shortage of funding/staff/expertise (6/35, 17%), patient demographics such as male sex and age >65 years (12/35, 34%), and lack of patient knowledge/beliefs about telemedicine (6/35, 17%).
KEY FACILITATORS INCLUDED
user-friendly design and packaging (12/35, 34%), cost-effectiveness or free participation (5/35, 14%), consideration of patient needs and social environments (12/35, 34%), embedding interventions in existing workflows (10/35, 29%), patient belief that technology is supportive/convenient (11/35, 31%), patient self-efficacy (10/35, 29%), technical and health literacy (11/35, 31%), and cohesive partnerships through engaging stakeholders (6/35, 17%).
**Clinical Implications:** Successful telemedicine implementation requires comprehensive efforts across planning (user-friendly design, stakeholder engagement, financial planning), engagement (technical training, consistent communication, family involvement), execution (high-quality systems, data security), and reflection/evaluation (regular feedback mechanisms). Interventions must address challenges at individual, interpersonal, organizational, and environmental levels. The findings highlight that telemedicine implementation cannot focus solely on technology but must consider user context, cultural competence, workflow integration, and multilevel stakeholder engagement.