INTERNATIONAL JOURNAL OF EVIDENCE-BASED MEDICINE
Review Article
Jun 17, 2026 18 9

Digital Healthcare Communication Barriers in Telemedicine: A Patient-Centered Framework for Equitable, Trustworthy, and Inclusive Virtual Care

Jennifer Tettey 1,
Hammed Adekunle Abdulazeez 2 * ,
Taofeek Adeshina Yusuff 3,
Oluwaseye Olabanji 4,
John Terungwa Akor 5
1 Department of Communication, Texas State University, San Marcos, TX, USA2 Department of Biomedical Engineering University of Ilorin, Ilorin, Kwara State, Nigeria3 Department of Business Analytics, Pompea College of Business, West Haven, University of New Haven, West Haven, CT, USA4 Department of Technology, Management and Budget, State of Michigan, Lansing, MI, USA5 Department of Mangement and Operations, Centers for Disease Control and Prevention, Abuja, Nigeria* Corresponding Author
International Journal of Evidence-Based Medicine, 1(1), 2026, jebm004
Publication date: Jun 17, 2026
Full Text (PDF)

ABSTRACT

Telemedicine has transformed healthcare delivery by expanding access to digitally mediated clinical services; however, growing dependence on virtual healthcare systems has intensified concerns regarding communication quality, patient trust, and equitable healthcare participation. Communication remains a central determinant of healthcare effectiveness because it influences diagnostic accuracy, treatment adherence, patient satisfaction, continuity of care, and therapeutic trust. Despite rapid technological advancement, many telemedicine systems remain insufficiently equipped to support inclusive, empathetic, and patient-centered communication across diverse patient populations. This critical narrative review synthesized current evidence on communication barriers in telemedicine and examined their implications for healthcare quality and equity. Literature was identified through searches conducted in PubMed, Scopus, Web of Science, and Google Scholar using terms related to telemedicine communication, digital healthcare barriers, patient-centered virtual care, digital trust, and healthcare inequity. The review included empirical studies, reviews, and policy papers published between 2015 and 2026. Thematic synthesis and systems-level analysis were applied using a patient-centered care lens. The findings indicate that communication barriers in telemedicine extend beyond technological limitations and include digital exclusion, low digital literacy, linguistic and cultural mismatch, disability-related accessibility challenges, weakened relational interaction, fragmented healthcare coordination, and emerging AI-mediated communication risks. Collectively, these barriers contribute to reduced patient engagement, trust erosion, diagnostic misunderstanding, lower treatment adherence, and unequal healthcare outcomes, particularly among vulnerable populations. In response, this review proposes the Integrated Patient-Centered Digital Communication Framework (IPCDCF), which integrates technological inclusivity, empathy-focused communication, equity-centered accessibility, ethical AI governance, and coordinated healthcare systems. Strengthening communication quality within telemedicine is essential for developing equitable, trustworthy, and patient-centered digital healthcare ecosystems.

KEYWORDS

Telemedicine Patient-Centered Care Digital Health Communication Health Equity Digital Trust

CITATION (Vancouver)

Tettey J, Abdulazeez HA, Yusuff TA, Olabanji O, Akor JT. Digital Healthcare Communication Barriers in Telemedicine: A Patient-Centered Framework for Equitable, Trustworthy, and Inclusive Virtual Care. International Journal of Evidence-Based Medicine. 2026;1(1):jebm004.
APA
Tettey, J., Abdulazeez, H. A., Yusuff, T. A., Olabanji, O., & Akor, J. T. (2026). Digital Healthcare Communication Barriers in Telemedicine: A Patient-Centered Framework for Equitable, Trustworthy, and Inclusive Virtual Care. International Journal of Evidence-Based Medicine, 1(1), jebm004.
Harvard
Tettey, J., Abdulazeez, H. A., Yusuff, T. A., Olabanji, O., and Akor, J. T. (2026). Digital Healthcare Communication Barriers in Telemedicine: A Patient-Centered Framework for Equitable, Trustworthy, and Inclusive Virtual Care. International Journal of Evidence-Based Medicine, 1(1), jebm004.
AMA
Tettey J, Abdulazeez HA, Yusuff TA, Olabanji O, Akor JT. Digital Healthcare Communication Barriers in Telemedicine: A Patient-Centered Framework for Equitable, Trustworthy, and Inclusive Virtual Care. International Journal of Evidence-Based Medicine. 2026;1(1), jebm004.
Chicago
Tettey, Jennifer, Hammed Adekunle Abdulazeez, Taofeek Adeshina Yusuff, Oluwaseye Olabanji, and John Terungwa Akor. "Digital Healthcare Communication Barriers in Telemedicine: A Patient-Centered Framework for Equitable, Trustworthy, and Inclusive Virtual Care". International Journal of Evidence-Based Medicine 2026 1 no. 1 (2026): jebm004.
MLA
Tettey, Jennifer et al. "Digital Healthcare Communication Barriers in Telemedicine: A Patient-Centered Framework for Equitable, Trustworthy, and Inclusive Virtual Care". International Journal of Evidence-Based Medicine, vol. 1, no. 1, 2026, jebm004.

REFERENCES

  1. Lawal OP, Igwe EP, Olosunde A, Chisom EP, Okeh DU, Olowookere AK, et al. Integrating Real-Time Data and Machine Learning in Predicting Infectious Disease Outbreaks: Enhancing Response Strategies in Sub-Saharan Africa. Asian Journal of Microbiology and Biotechnology. 2025 May;10(1):147–63. doi:10.56557/ajmab/2025/v10i19371
  2. Baudier P, Kondrateva G, Ammi C, Chang V, Schiavone F. Digital transformation of healthcare during the COVID-19 pandemic: Patients’ teleconsultation acceptance and trusting beliefs. Technovation. 2023 Feb;120:102547. doi:10.1016/j.technovation.2022.102547
  3. Rabbani MG, Alam A, Prybutok VR. Digital Health Transformation Through Telemedicine (2020–2025): Barriers, Facilitators, and Clinical Outcomes—A Systematic Review and Meta-Analysis. Encyclopedia. 2025 Dec 3;5(4). doi:10.3390/encyclopedia5040206
  4. Wosik J, Fudim M, Cameron B, Gellad ZF, Cho A, Phinney D, et al. Telehealth transformation: COVID-19 and the rise of virtual care. J Am Med Inform Assoc. 2020 May 17;27(6):957–62. doi:10.1093/jamia/ocaa067
  5. Sharkiya SH. Quality communication can improve patient-centred health outcomes among older patients: a rapid review. BMC Health Serv Res. 2023 Aug 22;23:886. doi:10.1186/s12913-023-09869-8
  6. Gobburi RK, Olawade DB, Olatunji GD, Kokori E, Aderinto N, David-Olawade AC. Telemedicine use in rural areas of the United Kingdom to improve access to healthcare facilities: A review of current evidence. Informatics and Health. 2025 Mar 1;2(1):41–8. doi:10.1016/j.infoh.2025.01.003
  7. Lawal OP, Egwuatu EC, Akanbi KO, Orobator ET, Eweje OZ, Omotayo EO, et al. Fighting Resistance With Data: Leveraging Digital Surveillance to Address Antibiotic Misuse in Nigeria. Path of Science. 2025 Mar 31;11(3):3. doi:10.22178/pos.115-25
  8. Alakeel AN, Alskait BK, Binshafi GB, AlAmro HA, Alkharji SK, Elsherbini M, et al. The Impact of Telehealth Adoption on Patient Outcomes: A Systematic Review. Cureus. 17(10):e94328. doi:10.7759/cureus.94328
  9. Roy S, Lartey ST, Durneva P, Jha N, Ofori MA, Zeba Z, et al. Digital Health Technology Infrastructure Challenges to Support Health Equity in the United States: Scoping Review. J Med Internet Res. 2025 Sep 15;27:e70856. doi:10.2196/70856
  10. Anawade PA, Sharma D, Gahane S. A Comprehensive Review on Exploring the Impact of Telemedicine on Healthcare Accessibility. Cureus. 16(3):e55996. doi:10.7759/cureus.55996
  11. Okeke EB, Forman D, Taylor E, Hyde E, Parente F, Kanmodi KK, et al. Barriers and facilitators to digital health adoption: a thematic analysis of healthcare professionals’ perspectives in rural Oyo State, Nigeria. BMC Digit Health. 2025 Nov 18;3(1):85. doi:10.1186/s44247-025-00227-8
  12. Xia X, Zhu M. The impact of digital literacy on older adults’ utilization of community-based home care services: a cross-sectional study. BMC Health Serv Res. 2025 Oct 15;25:1367. doi:10.1186/s12913-025-13427-9
  13. Haleem A, Javaid M, Singh RP, Suman R. Telemedicine for healthcare: Capabilities, features, barriers, and applications. Sens Int. 2021;2:100117. doi:10.1016/j.sintl.2021.100117
  14. Gallegos-Rejas VM, Guzman KRD, Kelly JT, Smith AC, Thomas EE. Strategies to improve telehealth access for culturally and linguistically diverse communities: a systematic review. Journal of Public Health (Oxford, England). 2025 Mar 19;47(3):e374. doi:10.1093/pubmed/fdaf030
  15. Al Shamsi H, Almutairi AG, Al Mashrafi S, Al Kalbani T. Implications of Language Barriers for Healthcare: A Systematic Review. Oman Med J. 2020 Apr 30;35(2):e122. doi:10.5001/omj.2020.40
  16. Soled D. Language and Cultural Discordance: Barriers to Improved Patient Care and Understanding. J Patient Exp. 2020 Dec;7(6):830–2. doi:10.1177/2374373520942398
  17. Annaswamy TM, Verduzco-Gutierrez M, Frieden L. Telemedicine barriers and challenges for persons with disabilities: COVID-19 and beyond. Disabil Health J. 2020 Oct;13(4):100973. doi:10.1016/j.dhjo.2020.100973
  18. Saidi T, Nenad P, Gazerani P, Pikkarainen MA. Bridging digital health gaps in South Africa: A qualitative study of the digital divide, interoperability and health equity. Digit Health. 2026 Apr 17;12:20552076261440967. doi:10.1177/20552076261440967
  19. Olayiwola QB, Sanusi OM, Amoo GS, Agboola OJ, Adeyemi JA, Suleiman HA, et al. Barriers to digital health implementation in low- and middle-income countries: a narrative review. Discov Public Health. 2026 Apr 12;23(1):499. doi:10.1186/s12982-026-01875-5
  20. Nguyen AD, White SJ, Tse T, Cartmill JA, Roger P, Hatem S, et al. Communication during telemedicine consultations in general practice: perspectives from general practitioners and their patients. BMC Prim Care. 2024 Sep 4;25:324. doi:10.1186/s12875-024-02576-1
  21. Rahmanti AR, Yang HC, Huang CW, Huang CT, Lazuardi L, Lin CW, et al. Validating nonverbal cues for assessing physician empathy in telemedicine: a Delphi study. Med Educ Online. 30(1):2497328. doi:10.1080/10872981.2025.2497328
  22. Ärlebrant L, Schimmer R, Edin-Liljegren A. Patients’ experiences of video consultations: A qualitative systematic review. Digit Health. 2026 Jan 5;12:20552076251404513. doi:10.1177/20552076251404513
  23. Zhang L, Hussain WMHW, Md Ali SH. Trust transfer in digital healthcare: The role of self-service systems in reducing patient treatment barriers. Digit Health. 2025 Nov 20;11:20552076251396560. doi:10.1177/20552076251396560
  24. Seuren LM, Ilomäki S, Dalmaijer E, Shaw SE, Stommel WJP. Communication in Telehealth: A State-of-the-Art Literature Review of Conversation-Analytic Research. Res Lang Soc Interact. 57(1):73–90. doi:10.1080/08351813.2024.2305045
  25. Zhang T, Mosier J, Subbian V. Identifying Barriers to and Opportunities for Telehealth Implementation Amidst the COVID-19 Pandemic by Using a Human Factors Approach: A Leap Into the Future of Health Care Delivery? JMIR Hum Factors. 2021 Apr 9;8(2):e24860. doi:10.2196/24860
  26. Keuper J, van Tuyl LHD, de Geit E, Rijpkema C, Vis E, Batenburg R, et al. The impact of eHealth use on general practice workload in the pre-COVID-19 era: a systematic review. BMC Health Serv Res. 2024 Sep 19;24(1):1099. doi:10.1186/s12913-024-11524-9
  27. Li E, Clarke J, Ashrafian H, Darzi A, Neves AL. The Impact of Electronic Health Record Interoperability on Safety and Quality of Care in High-Income Countries: Systematic Review. J Med Internet Res. 2022 Sep 15;24(9):e38144. doi:10.2196/38144
  28. Rossi M, Rehman S. Integrating Artificial Intelligence Into Telemedicine: Evidence, Challenges, and Future Directions. Cureus. 17(8):e90829. doi:10.7759/cureus.90829
  29. Muthukumar K. Empathy AI in healthcare. Front Psychol. 16:1680552. doi:10.3389/fpsyg.2025.1680552
  30. Lawal OP, Opara IJ, Ayo-ige A, Eboh NA, Cos-Ibe U, Forson KAAM, et al. Artificial Intelligence-Integrated Biosensors for Antimicrobial Resistance Detection and Surveillance: A Review and Future Perspectives for Global Biosecurity. Cureus. 2025 Nov 29;17. doi:10.7759/cureus.98098
  31. Abbas Q, Jeong W, Lee SW. Explainable AI in Clinical Decision Support Systems: A Meta-Analysis of Methods, Applications, and Usability Challenges. Healthcare (Basel). 2025 Aug 29;13(17):2154. doi:10.3390/healthcare13172154
  32. Birati Y, Tzemah-Shahar R. Barriers to Digital Health Adoption in Older Adults: Scoping Review Informed by Innovation Resistance Theory. J Med Internet Res. 2026 Feb 2;28:e75591. doi:10.2196/75591
  33. Iversen HW, Riley H, Råbu M, Lorem GF. Building and sustaining therapeutic relationships across treatment settings: a qualitative study of how patients navigate the group dynamics of mental healthcare. BMC Psychiatry. 2025 Apr 28;25:424. doi:10.1186/s12888-025-06874-5
  34. Reed NS, Assi L, Pedersen E, Alshabasy Y, Deemer A, Deal JA, et al. Accompaniment to healthcare visits: the impact of sensory impairment. BMC Health Serv Res. 2020 Oct 29;20:990. doi:10.1186/s12913-020-05829-8
  35. Abou Hashish EA, Alnajjar H. The silent strain beyond the screen: conceptualizing digital compassion fatigue in nursing. BMC Nurs. 2025 Nov 28;24:1464. doi:10.1186/s12912-025-04143-0
  36. White SJ, Nguyen AD, Roger P, Tse T, Cartmill JA, Hatem S, et al. Tailoring communication practices to support effective delivery of telehealth in general practice. BMC Prim Care. 2024 Jun 27;25:232. doi:10.1186/s12875-024-02441-1
  37. Alamoudi A, Kontopantelis E, Zghebi SS, Brown B. AI Triage in Primary Care: Building Safer and More Equitable Real-World Evidence. J Med Internet Res. 2026 Mar 4;28:e88396. doi:10.2196/88396
  38. Inkster B, Knibbs C, Bada M. Cybersecurity: a critical priority for digital mental health. Front Digit Health. 2023 Sep 14;5:1242264. doi:10.3389/fdgth.2023.1242264
  39. Olabintan OAA, Dickson BE, Folorunso TN, Ikebudu JC, Okagbue OA. Diabetes Management Challenges During Intermittent Fasting Among Adolescents: A Narrative Review of Recent Evidence. Healthcare Studies. 2026 Feb 24;4(2026)(1):47–57. https://doi.org/10.58612/hs417
  40. Petretto DR, Carrogu GP, Gaviano L, Berti R, Pinna M, Petretto AD, et al. Telemedicine, e-Health, and Digital Health Equity: A Scoping Review. Clin Pract Epidemiol Ment Health. 2024 Feb 6;20:e17450179279732. doi:10.2174/0117450179279732231211110248
  41. Rico Fontalvo H, Rico F, de la Puente M, Torres J, Guzman H. When telehealth fails rural communities: The 40% internet threshold that changes everything. Digit Health. 2025 Nov 3;11:20552076251393407. doi:10.1177/20552076251393407
  42. Haimi M. The tragic paradoxical effect of telemedicine on healthcare disparities- a time for redemption: a narrative review. BMC Med Inform Decis Mak. 2023 May 16;23:95. doi:10.1186/s12911-023-02194-4
  43. He H, Ghazilla RAR, Abdul-Rashid SH. A Systematic Review of the Usability of Telemedicine Interface Design for Older Adults. Applied Sciences. 2025 May 12;15(10). doi:10.3390/app15105458
  44. Ko M, Azzopardi M, Loizou C, Logeswaran A, Ng B, Pacho A, et al. Telehealth and people with disabilities in the United Kingdom: a scoping review. Front Public Health. 2025 Feb 12;13:1504318. doi:10.3389/fpubh.2025.1504318
  45. Cheryka D, Elviana M, Sugiarto A, Andriani R. Telemedicine Adoption in Low and Middle Income Countries: A Review of Barriers, Opportunities, and Outcomes. Proceedings International Conference on Business, Economics & Management. 2025 Dec 31;3(1):352–8. doi:10.47747/icbem.v3i1.3269
  46. Hadian M, Jelodar ZK, Khanbebin MJ, Atafimanesh P, Asiabar AS, Dehagani SMH. Challenges of Implementing Telemedicine Technology: A systematized Review. Int J Prev Med. 2024 Feb 29;15:8. doi:10.4103/ijpvm.ijpvm_48_23
  47. Abou Hashish EA. Compassion through technology: Digital empathy concept analysis and implications in nursing. Digit Health. 2025 Mar 13;11:20552076251326221. doi:10.1177/20552076251326221
  48. Dickson BE, Gab-Obinna C, Eke DO, Akinlotan SO. Preoperative Anxiety Management: The Effectiveness of Nurse-Led Educational Interventions on Surgical Outcomes: A Narrative Review. Asian Journal of Research in Nursing and Health [Internet]. [cited 2026 May 20]. https://doi.org/10.9734/ajrnh/2026/v9i1308
  49. Wong M, Siddiqui S, Nnamdi G, Nguyen B, Harutyunyan N, Dermenchyan A. Addressing language barriers in U.S. healthcare: The role of CLAS standards, telehealth, and policy in supporting limited english proficiency populations. Health Sciences Review. 2025 Dec 1;17:100249. doi:10.1016/j.hsr.2025.100249
  50. Maleki Varnosfaderani S, Forouzanfar M. The Role of AI in Hospitals and Clinics: Transforming Healthcare in the 21st Century. Bioengineering (Basel). 2024 Mar 29;11(4):337. doi:10.3390/bioengineering11040337
  51. Lawal O, Oyebamiji HO, Kelenna IJ, Chioma FJ, Oyefeso E, Adeyemi BI, et al. A Review on Usage of Digital Health Literacy to Combat Antibiotic Misuse and Misinformation in Nigeria: Review Article. Journal of Pharma Insights and Research. 2025 Apr 5;3(2):258–69. doi:10.69613/dja1jc18
  52. Oo CTL, Wider W, Pang NTP, Koh EBY, Vasanthi RK, Thet KZZ, et al. The benefits and future potential of generative artificial intelligence (GAI) on mental health: a Delphi study. Int J Qual Stud Health Well-being. 21(1):2621802. doi:10.1080/17482631.2026.2621802
  53. Dickson BE. Hemodynamic Instability Following Major Surgery: Early Nursing Assessment and Intervention Outcomes: A systematic Review. Journal of Medicine and Health Research. 2026 Mar 18;11(1):221–36. doi:10.56557/jomahr/2026/v11i110362
  54. Msweli NT, Phahlane M. Health-Related Issues of Immersive Technologies: A Systematic Literature Review. Informatics. 2025 May 6;12(2). doi:10.3390/informatics12020047
  55. Mennella C, Maniscalco U, De Pietro G, Esposito M. Ethical and regulatory challenges of AI technologies in healthcare: A narrative review. Heliyon. 2024 Feb 15;10(4):e26297. doi:10.1016/j.heliyon.2024.e26297

LICENSE

Creative Commons License
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.