Developing and Prioritizing a Telemedicine Implementation Model to Enhance Access to Health Services in Iran: A Mixed-Methods DANP Study

Abstract

Background: Despite increasing investment in telemedicine, many health systems—particularly in developing contexts—lack a prioritized, context-specific implementation model that integrates governance, resource allocation, and digital infrastructure. In Iran, existing telemedicine initiatives remain fragmented, with no empirically grounded framework for identifying which strategic dimensions exert the greatest leverage on healthcare access. Objectives: This study aims to develop and prioritize a native telemedicine implementation model to improve access to health services in Iran by identifying causal relationships and the relative importance among key dimensions and indicators. Methods: A mixed-methods exploratory design was employed. In the qualitative phase, semi-structured interviews with 10 experts (each with ≥ 10 years of experience in health services management, e-health, or health policy) were analyzed using thematic analysis in MAXQDA (v2018). Theoretical saturation was achieved when no new codes or dimensions emerged across consecutive interviews, and the extracted themes were validated through member checking and iterative expert review. In the quantitative phase, the finalized indicators were prioritized using the DEMATEL-based analytic network process (DANP) via an expert influence assessment questionnaire. Results: The DANP results showed that service planning (D = 0.2189) was the most influential dimension, followed closely by service coordination (E = 0.2093) and the proper allocation of financial and human resources (B = 0.1985). This pattern suggests that planning-related functions retain a slight systemic dominance, whereas coordination and resource allocation exert comparably strong influences within the telemedicine system. At the indicator level, the highest priorities were reducing telemedicine technology costs (E1 = 0.0612), providing services based on existing standards (E4 = 0.0570), identifying legal gaps and removing barriers (E2 = 0.0508), and gaining patients’ trust (A3 = 0.0496). Notably, the leading role of cost reduction reflects its function as a structural enabler that supports standard compliance, legal readiness, and user trust, thereby shaping coordination efficiency and the overall sustainability of the telemedicine network. Conclusions: The proposed model provides an evidence-based, prioritized decision-support tool for telemedicine implementation in Iran by identifying high-leverage intervention points rather than merely describing success factors. Although the framework is grounded in Iran’s institutional context, its methodological logic and prioritization structure may inform similar analyses in other developing health systems with comparable governance and infrastructure constraints, subject to contextual recalibration.