Wentink et al.

BMC Medical Education (2019) 19:343

[Link]

RESEARCH ARTICLE Open Access

Teachers’ and students’ perceptions on

barriers and facilitators for eHealth
education in the curriculum of functional
exercise and physical therapy: a focus
groups study
M. M. Wentink1,2*, P. C. Siemonsma3, L. van Bodegom-Vos4, A. J. de Kloet5, J. Verhoef3, T. P. M. Vliet Vlieland1,6 and
J. J. L. Meesters1,5,6

Abstract
Background: Despite the growing importance of eHealth it is not consistently embedded in the curricula of
functional exercise and physical therapy education. Insight in barriers and facilitators for embedding eHealth in
education is required for the development of tailored strategies to implement eHealth in curricula. This study aims
to identify barriers/facilitators perceived by teachers and students of functional exercise/physical therapy for uptake
of eHealth in education.
Methods: A qualitative study including six focus groups (two with teachers/four with students) was conducted to
identify barriers/facilitators. Focus groups were audiotaped and transcribed in full. Reported barriers and facilitators
were identified, grouped and classified using a generally accepted framework for implementation including the
following categories: innovation, individual teacher/student, social context, organizational context and political and
economic factors.
Results: Teachers (n = 11) and students (n = 24) of functional exercise/physical therapy faculties of two universities
of applied sciences in the Netherlands participated in the focus groups. A total of 109 barriers/facilitators were
identified during the focus groups. Most related to the Innovation category (n = 26), followed by the individual
teacher (n = 22) and the organization (n = 20). Teachers and students identified similar barriers/facilitators for uptake
of eHealth in curricula: e.g. unclear concept of eHealth, lack of quality and evidence for eHealth, (lack of) capabilities
of students/teachers on how to use eHealth, negative/positive attitude of students/teachers towards eHealth.
Conclusion: The successful uptake of eHealth in the curriculum of functional exercise/physical therapists needs a
systematic multi-facetted approach considering the barriers and facilitators for uptake identified from the perspective
of teachers and students. A relatively large amount of the identified barriers and facilitators were overlapping between
teachers and students. Starting points for developing effective implementation strategies can potentially be found in
those overlapping barriers and facilitators.
(Continued on next page)

* Correspondence: [Link]@[Link]; [Link]@[Link]

1
Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden
University Medical Centre, Leiden, The Netherlands
2
Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam,
The Netherlands
Full list of author information is available at the end of the article

© The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License ([Link] which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
([Link] applies to the data made available in this article, unless otherwise stated.
Wentink et al. BMC Medical Education (2019) 19:343 Page 2 of 8

(Continued from previous page)

Registration: The study protocol was a non-medical research and no registration was required. Participants gave
written informed consent.
Keywords: eHealth, Education, Students, Learning, Technology, Curricula

Background tracking, etc.). Since the work and patient groups of

Application of eHealth, which is defined as ‘the use of physical therapists differ from those of nurses, it is ex-
new Information and communication technologies (ICT) pected that barriers and facilitators for eHealth educa-
to improve or support health and health care’ [1], varies tion are different from those already identified in studies
largely in health care, e.g. web and mobile applications, in medical and nursing literature. Second, there is a need
electronic patient records, health-sensors and wearable for more in-depth knowledge of barriers and facilitators
devices, telecommunication, home automation and for the uptake of eHealth in education, in terms of the
robotics and serious gaming [1]. Physical therapists factors that may critically influence uptake [14]. Third,
mainly use eHealth to support patients in maintaining previous studies mainly focused on single groups of
independency in daily functioning but also for health teachers, students or professionals although it would be
care processes and services (e.g. telemedicine and interesting to simultaneously contrast teachers’ and
electronic patient files) [2]. students’ points of view on barriers and facilitators for
The availability of technology in health care is growing eHealth education.
and there is an urgent need for health professionals who This study aims to provide insight in the barriers and
can use eHealth competently and confidently in clinical facilitators for uptake of eHealth in the education for
practice. This means that there is large responsibility for physical therapy and functional exercise therapy, more
the institutions for the education of future health profes- specific to answer the research question: what are the
sionals to ensure that students acquire knowledge, skills barriers and facilitators perceived by teachers and
and attributes to work with eHealth, and this requires students for implementing eHealth in education?
revision of curricula of education [3, 4]. Students should
be actively taught how to find, understand, apply and ap- Methods
praise eHealth innovations [5] to constantly update their Design
skills and knowledge [2, 6, 7]. Ideally, students should A qualitative study was conducted among teachers and
become early adaptors and lead eHealth initiatives in students to explore the perceived barriers and facilita-
settings where eHealth adoption is still low [8]. tors for uptake of eHealth education in the curricula of
Despite the growing importance of eHealth in the the education for physical therapy and functional exer-
work field, curricula are currently underdeveloped in cise therapy. ‘EHealth education’ was defined as teach-
teaching eHealth in the field of e.g. dietetics, nursing, ing how to provide treatments using technology. Focus
occupational therapy, physiotherapy, psychology, or so- groups were conducted to collect data that contributes
cial work [5–7, 9, 10]. Therefore, a systematic approach to a better understanding of teachers’ and students’
to design, teach, assess or accredit eHealth education in attitudes, experiences with and expectations of eHealth
the curriculum is needed. In the literature, a number of in education [Kitzinger, 2006]. Participants were in-
barriers for the uptake of eHealth education in curricula formed that data would remain confidential and would
were identified: outdated and rigid curricula with narrow be anonymously used for scientific research and for
focus on technology [7], teachers’ limited experience improvement of eHealth education. The COnsolidated
with and knowledge of the emerging field of eHealth criteria for REporting Qualitative research (COREQ)
[2, 10, 11] and health care teachers not feeling guidelines were used for adequate reporting of the
confident with technology [2, 12, 13]. study [15].
There are several gaps in the knowledge of uptake of
eHealth education in the curriculum. First, research Recruitment and inclusion
about eHealth education predominantly comes from the Teachers and students were recruited from two depart-
medical and nursing literature [8]. However, the para- ments teaching functional exercise therapy and physical
medical education for physical and functional exercise therapy in a 4 years full-time program, in the
therapy, should also equip students to confidently use of Netherlands: (1) Functional Exercise Therapy, Faculty
eHealth, especially because eHealth innovations are in- of Health, University of Applied Sciences in Amsterdam
creasingly used in daily practices of the physical and ex- (HvA) and (2) Physical Therapy, Division of Health
ercise therapist (e.g. Fysiogaming, eExercise, activity Care, University of Applied Science in Leiden (HSL).
Wentink et al. BMC Medical Education (2019) 19:343 Page 3 of 8

Functional Exercise Therapy and Physical Therapy have (e.g. opinion of colleagues, work culture), Organizational
similarities (both focus on restoring activities of daily context (e.g. organization of the curriculum, capacities,
life by means of exercises), but also have differences resources, structures) and Political and Economic factors
and are seen as two different paramedical health profes- (e.g. financial arrangements, regulations, policies). By
sions in the Netherlands. Two different health care including questions according to each level of the frame-
educations from two different universities of applied work the research team aimed to contribute to the need
sciences were included to ensure a diversity in the for more in-depth knowledge of factors (barriers and
population of this study to improve the transferability facilitators) that may critically influence the uptake of
of the findings. eHealth in education [8].
Teachers from the departments of functional exercise At the beginning of each focus group a brief descrip-
therapy or physical therapy were included if they were: tion of eHealth was given. Open-ended questions within
1) working as a health professional, OR 2) working as a each level were asked to facilitate interactions and in
researcher in the field of eHealth. Students were able to depth discussion between the participants about eHealth
participate if they were in year 3 or 4 of the study and education [17]. Examples of questions are: “What do you
completed successfully their placement. Thus both need in order to be able to use eHealth in education?” or
teachers and students were able to reflect on the eHealth “Why would you use eHealth in your lessons?”. Prompts
education in the curriculum as well as on requirements were used (e.g. pictures expressing emotions) to facilitate
for successful use of eHealth in clinical practice. participants in verbalizing thoughts. The interview guide
Teachers and students were invited to participate via the was discussed and pilot tested in a group of students.
internal web page and a short oral presentation. Those The focus groups were planned to last approximately
who were willing to participate, received an email with 1 hour and were aimed to continue until data satur-
study information, an informed consent form, and were ation was reached (not more than two new subthemes
invited for the focus group. retrieved from the focus groups).

Focus groups Ethical issues and approval

The focus groups took place in October and November All participants gave written informed consent prior to
2016 at the Universities of Applied Sciences in Amsterdam participation. Participants were informed that their state-
and in Leiden. Separate groups were organized for teachers ments were confidential, would be used for research and
and students to ensure that both groups could talk freely to improve eHealth education and would not affect their
about their experiences with eHealth in education. Group position as a teacher or student.
size was 5–8 participants to include a diversity of opinions
and perspectives, and to allow optimal interaction between Data analysis
participants [16]. The focus groups were conducted by 1) a Focus groups were audiotaped, transcribed in full and
moderator (MW, female), 2) an assistant (student 1, female) analyzed using direct content analysis. The implementa-
who supported the moderator and managed the tape- tion framework of Grol and Wensing (2004) is often
recorders and time, and 3) an observer (student 2, female) used for implementing interventions and innovations in
who took notes and made sure every participant was given health care. Because the framework is highly structured
the opportunity to speak freely. The moderator has a and generally accepted in the field of implementation it
master’s degree in Health Sciences and functional exercise was used in this study to structure and describe barriers
therapy and had formal training in conducting focus and facilitators for implementing eHealth in education
groups. The moderator was a colleague of some of the fromthe perspective of both students and teachers [18].
participating teachers and a former teacher of some of the First step in the analyses was to identify barriers and
participating students. Participants did not receive reim- facilitators for each level of the framework (innovation,
bursement for their participation. individual teacher, individual student, social context,
An interview guide was developed based on the imple- organizational context and political and economic
mentation model of Grol and Wensing. This model was factors) by initial coding of quotes. Second, quotes with
chosen, since it offers a framework to identify and comparable content for barriers and facilitators were
categorize barriers and facilitators for the uptake of categorized into (sub)themes. These (sub)themes were
innovations within a specific context, in this case the further analyzed and categorized into main themes. Data
uptake of eHealth education in the curriculum. The analysis was performed by two students who independently
framework includes six levels: Innovation (e.g. advan- coded and categorized the data. Each step of the data
tages, feasibility, accessibility, attractiveness of eHealth), analyses was discussed among the students until consensus
Individual (e.g. motivation, awareness, knowledge, skills was reached. The completed analyses was verified by a third
and attitude of students and teachers), Social context researcher [MW]. Again, discrepancies were discussed
Wentink et al. BMC Medical Education (2019) 19:343 Page 4 of 8

among students and researcher until consensus was to use eHealth in the treatment process of a patient, and
reached. Microsoft Office Excel was used for data analysis. to learn to match available eHealth with the preferences
of a patient and to provide support to patients with
Results using eHealth. Both students and teachers referred to
Participants eHealth by mentioning applications, electronic patient
Eleven teachers and 26 students indicated their willing- records and digital exercises. Other available eHealth
ness to participate and were invited for the focus groups. applications (e.g. virtual reality, robotics/ house automa-
Two students were not present, since they had forgotten tion) were barely mentioned. When discussing eHealth
the appointment. A total of six focus groups was tools, both teachers and students wondered whether
conducted, two with teachers (n = 11) and four with they were aware of all the possibilities.
students (n = 24). Table 1 presents participants’ Lack of a quality mark and evidence for eHealth
characteristics. services was reported by both teachers and students.
Both groups related the lack of a quality mark (i.e.
Framework applicability, usability, content, privacy, safety) and the
In the first step of the analyses, a total number of 109 relative absence of evidence for eHealth interventions to
barriers and facilitators (codes) were retrieved from the a lack of eHealth in education. “Teacher K: It is tricky.
six focus groups with teachers and students, from which You can never implement something new in education if
44 were overlapping between teachers and students, 27 you waiting for the scientific evidence. The paradox with
were only identified by teachers and 38 only by students. eHealth is that you are not going to know until you give
Next, the barriers/facilitators were organized into 51 it a try”.
subthemes (see Additional file 1) and 14 main themes
within the six levels of the framework of Grol and The individual student
Wensing (see Table 2). Capabilities to use eHealth was rated highly by teachers,
In the following sections, the main themes within each since they agreed that current generations of students
level of the framework will be discussed, first those are in general competent with using technology. How-
themes identified by both teachers and students, then ever, this does not imply that students are also able to
those for teachers only and then those for students only. innovate health care through eHealth and apply this in
their professional work. Teacher A1: “Although students
The innovation are quite skilled in technical issues, I am often disap-
Unclear concept of eHealth was mentioned by both pointed in their innovativeness.” Students do think they
teachers and students. Both groups report it is important are capable to work with technology and eHealth, but do
for students’ to learn to motivate what, when and how not use it since they are unfamiliar with the available

Table 1 Characteristics of the participants in the focus groups

Characteristics Teachers (n = 11) Students (n = 24)
Age, median (range) 38 (29–52) 23 (20–25)
Gender; male, yes (%) 5 (45) 15 (63)
Year in study, number (%)
Third year – 13 (54)
Fourth year – 11 (46)
Profession, number (%)*
Exercise therapy 3 (27) –
Physical therapy 7 (64) –
Health Sciences / Human Movement Sciences 4 (36) –
Working experience in years, number (%)
2–3 2 (18) –
3–4 4 (36) –
>4 5 (46) –
Working as a health professional, yes (%) 7 (64) –
Working as a researcher, yes (%) 4 (36) –
*Multiple answers possible
Wentink et al. BMC Medical Education (2019) 19:343 Page 5 of 8

Table 2 Results on codes, themes and levels of perceived barriers (B) and facilitators (F) for eHealth education according to teachers
and students
Teachers Students
Codes (n = 109) Themes Level B F B F
26 Unclear concept of eHealth Innovation X X
Lack of a quality mark and evidence for eHealth services. X X
17 Capabilities of students on how to use eHealth Individual student X X X X
Attitude/behavior of students towards eHealth X X X
22 Capabilities of teachers on how to use eHealth Individual teacher X X X
Attitude/behavior of teachers towards eHealth (education) X X X
14 Inefficient use of expertise Social context X X
Communities of practice X
Interprofessional collaboration/education X X X X
20 (Lack of) a shared vision within the organization Organizational context X X
Situational factors (e.g. lack of time, slow curricula changes) X X
10 Financial aspects (e.g. no reimbursement, time and money investment) Economic and political context X X
Role of the government (e.g. quality mark for eHealth, reimbursement) X X
Role of profession bodies (e.g. provision of education for therapists) X

eHealth services and have a lack of experience of apply- more enthusiastic about my lessons.” However, a barrier
ing it. Student M1: “I think I could apply eHealth, but in is that teachers feel insecure about eHealth education.
fact I know quite little about the possibilities. For this Teacher K1: “I do not feel that I know enough about
reason I will not use it just now.” eHealth, but that is what I want as a teacher before I use
Attitude/ behavior towards eHealth towards eHealth it in my lessons.” Students expressed that teachers have a
differs between individual students, according both negative attitude/behavior towards eHealth. Student S1:
teachers and students. Some students are highly inter- “Teachers often say: find something you like, because you
ested in technology and choose to get more involved, know better than me.” Student M2: “If a passionate teacher
whereas others do not. When discussing use of eHealth puts something forward, then I am more open for it. How-
as a (future) health professional, students’ expressed it is ever if a teacher says ‘you are the young generation. You
optional, in terms of having a choice. Student L1: “I surely know of some app, and give it a try’, then I am not.
think I will not really focus on it. I do want to know what And the latter is what I have been told so far.”
the options are, but personally I will not devote to it for
my future”. Student J1: “Once you have graduated you The social context
can make your own choice and decide whether you use Inefficient use of expertise of eHealth within the
it.” organization was mentioned as a barrier by both teachers
and students. Student L1: “Teachers do not collaborate.
The individual teacher For example get a lecturer who knows a lot about eHealth
Capabilities to use eHealth, i.e. the knowledge about to take over the lesson. All should be benefit from it, since
eHealth and skills on how to use eHealth, varies widely the less experienced teacher will catch up.” Teacher
between individual teachers according to both the M2: “More experienced teachers who are doing re-
teachers and students. Some teachers admitted to having search in technology or eHealth should share their
no overview of existing tools and eHealth interventions knowledge with less experienced teachers. A kind of
in their field of work or expressed to barely know how cross-fertilization”.
to use a projector, while others found themselves very Communities of practice were recognized as a facilita-
competent as researchers in the domain of eHealth. tor for eHealth education according to teachers. Such
Attitude and behavior towards eHealth were rated communities were seen as mixed groups (teachers,
positively towards eHealth education in general by students, researchers and/or the workfield) of people
teachers. Teacher V1: “As a teacher I want to use who share their passion and learn how to do it better by
eHealth in my lessons to provide ‘future proof’ education interacting regularly. Teacher A1: “we do quite a bit of
that is innovative and interactive. This makes learning research using eHealth. It would be great if we can get an
more fun and challenging for students and they would be exchange between research, education and practice and
Wentink et al. BMC Medical Education (2019) 19:343 Page 6 of 8

in this way create an inspiring environment around interventions and to lower the workload for health
eHealth.” professionals. According to the students, this would
Interprofessional collaboration education is, by both facilitate health professionals to apply eHealth and
teachers and students, regarded as a facilitator for consequently students can experience eHealth during
eHealth in education if students of different professions internships. Moreover, students want the government to
work together (e.g. technology, ICT, media, etc.). improve the quality of eHealth by a national quality
Student N1: “I think it would have an enormous added mark or at least a check list to determine quality of
value if you would work on a project on eHealth together eHealth services.
with students with an IT background; developing an app Role of profession bodies. Students noticed during their
for example.”. internships eHealth is not yet imbedded in the work
field. According to them, their professional organizations
The organizational context should facilitate uptake of eHealth in daily practice, for
(Lack of) shared vision/rationale in the university about instance by providing education to health professionals
what students should learn about eHealth is absent and incorporation of eHealth in practical guidelines.
according to teachers. Teacher D1: “As a school you have
to decide to what degree you want to integrate this in Discussion
your basic curricula. A choice can be to provide eHealth The aim of this study was to identify barriers and facili-
as a dedicated subject of choice. This can be a choice, tators for eHealth education as perceived by teachers
but you will have to have an idea.” Teachers felt that and students of physical therapy and functional exercise
what students learn about eHealth is too much of a therapy. Teachers and students equally contributed to
coincidence, depending on a students’ own interest in the number of facilitators and barriers for the use of
technology, the extent of eHealth experience during eHealth in professional education identified in this focus
their internships/study route and the teachers they had. group study. Main barriers for the innovation were a
“There is no clear approach for eHealth in the curricula lack of understanding the full concept of eHealth and a
in which connects to the professional roles (CanMeds) of lack of knowledge and skills in critically appraising
the care professionals (OT/PT).” Although there is not eHealth. For the individual users, the variety in know-
(yet) a clear vision about what students should learn, ledge and skills of individuals was a factor influencing
teachers did agree that there is a consensus within the uptake. On the level of the organization, identified
university about the importance of eHealth education. factors for uptake were the shared sense of importance
Situational factors, as mentioned by teachers, include of implementing eHealth in education, a shared vision
the following barriers for eHealth education: lack of time about what students should learn about eHealth and
for preparing lessons, failing technology, absence of didactic materials.. Economical barriers were seen in the
didactic materials and relative slow curricula changes. investments in technology and eHealth. Finally, political
Facilitators according to teachers would be: presence of factors were identified in the national government to
ICT professionals within the organization, direct accessi- manage future reimbursements for eHealth interventions
bility to materials (e.g. LivingLabs), (scheduled) time to and to improve the quality of eHealth by a quality mark.
prepare lessons, special interest group of teachers taking As expected, and based on the literature, we found
the lead and training for teachers to improve their unanimous support for implementing eHealth in educa-
competences. tion in the curricula of two departments in the
Netherlands. In line with literature, we found barriers
Economic and political context and facilitators on all levels of implementation as
Financial aspects are expressed by both teachers and described by Grol and Wensing (2014) [18]. The bar-
students in 10 quotes. The lack of reimbursement by riers to the uptake of the eHealth innovation found in
health insurance companies in the Netherlands for our study are in line with previous research: limited
eHealth interventions results in the absence of incentives skills and knowledge about the eHealth intervention in
to use eHealth in the field of work. Teachers specifically both teachers and students [5, 8, 11, 12, 14], limited
mentioned financial aspects such as the investments in confidence in working with technology in health prac-
technology and eHealth, needed for eHealth education, tice [6, 8, 12] and critically appraising and applying
are a financial barrier for uptake. technique [5]. Lam (2016) mentioned: ‘while students
The role of the government is to provide a definition of demonstrated the technical skills that would potentially
the future health professionals in relation to eHealth to enable them to engage in eHealth, they displayed a lack
give direction for eHealth education, according to the of understanding how these skills could be applied to
teachers. Students expressed that it is the role of the professional health contexts’ [8]. On the level of the
government to manage reimbursements for eHealth individual user, there is a marked diversity in knowledge
Wentink et al. BMC Medical Education (2019) 19:343 Page 7 of 8

and skills in both teachers and students, which is in line advised to take a structured approach by addressing the
with previous studies [5, 8], and might hinder uptake of levels of uptake [18]. Using ‘a clear rationale for teaching
eHealth in the curricula. clinical informatics and a detailed list of desired compe-
On the level of organization, barriers and facilitators tencies are an important start’ [10], and keeping in mind
identified in our study add to the growing consensus that that ‘there is surprisingly little evidence about what works
the uptake of eHealth needs a multi-facetted approach and doesn’t work with regard to the eHealth education’
and not just ‘writing a new module’. In literature, static [14]. Finally, more tools should be provided by the organi-
curricula with narrow focus on technology were reported zations itself, such as didactic materials and eHealth
as important barriers [7], and a clear need for a shared facilities.
vision/rationale about what students should learn about This study provides insights into the many factors
eHealth and need didactic materials which is also reflected which influence the successful uptake of eHealth in the
in literature [10]. Political and economic factors, i.e. the curricula of functional exercise and physical therapy
influential role of government, policies and professional education. This is highly important given the fact that
bodies on uptake of eHealth in education, found in this the application of eHealth is irreversible and health
study, were also reported elsewhere: this was phrased by professionals do not seem to be fully equipped to work
Hilberts and Gray (2014) as the need for ‘an education with eHealth. Uptake of eHealth needs a systematic
infrastructure in large-scale eHealth strategies’ [14]. multi-facetted approach considering factors on the level
Strength of this study is that research in this field of the innovation, individual users, organization and
amongst physical therapists is relatively scare. Another political and economic levels. Important starting points
strength is the structured use of the model of Grol and for developing uptake strategies, for both teachers and
Wensing to gain a more in-depth knowledge of barriers students, are a limited knowledge of eHealth, a large
and facilitators for the uptake of eHealth in education diversity in eHealth skills, a lack of skills in critically
and to enable comparison between the perspectives of appraising eHealth and to development of a clear ration-
teachers and students. EHealth is a relatively new and ale for teaching eHealth. A recommendation for further
emerging field and, as a consequence, so is the imple- research is to re-examine the study in other health
mentation in education. There is surprisingly little professions for a good comparison of perceived barriers
evidence for the effectiveness of education focusing on and facilitators for eHealth education. Moreover, future
the use eHealth [14]. Last but not least, a strength is that research should provide evidence for what works and
both teachers’ and students’ perspectives were included, doesn’t work with regard to the eHealth education.
whilst most studies focused on single groups of teachers,
students or professionals. Limitations of this study are Conclusion
the professional relationship of the first author with The successful uptake of eHealth in the curriculum of
some of the teachers and students. For that reason it functional exercise/physical therapists needs a systematic
was made very clear to the participants that their state- multi-facetted approach, considering the barriers and
ments were confidential and not affected their position facilitators for uptake identified from the perspective of
as a teacher/student. However, some bias in their teachers and students. Moreover, a relatively large
responses cannot be ruled out entirely. Moreover, amount of the identified barriers and facilitators were
further focus groups might add to the data-saturation to overlapping between teachers and students (e.g. unclear
some degree. concept of eHealth, lack of quality/evidence for eHealth,
For uptake of eHealth in the curricula of physical and negative/positive attitude of students/teachers towards
functional exercise therapy it is eminent to recognize eHealth), so that starting points for developing effective
the multi-level character of it. This study highlighted implementation strategies can potentially be found in
the need for a vision on eHealth at a faculty level. those overlapping barriers and facilitators.
Besides a generally limited understanding of the width
of eHealth and the expected impact of eHealth in
Additional file
clinical practice, this study showed that both the lack of
skill in critically appraising the quality and usefulness Additional file 1: Results on codes, (sub)themes and levels of perceived
of eHealth and the diversity in background knowledge barriers (B) and facilitators (F) for eHealth education according to teachers
and skills in technology need to be a point of engage- and students. (DOCX 18 kb)
ment in future uptake plans. Moreover, the ‘higher
order’ influences on both education and professional Acknowledgements
practice need to be addressed in eHealth education, i.e. We thank all the students and teachers participating in this project. We are
grateful for the students Simone Timmers, Linda Oud, Beau Smit, Fenna
the role of government, policies and professional bodies. Jagtman, Naomi Lagerwerf and Bart Noordermeer who have contributed to
In addition, to further enhance uptake it is strongly this study.
Wentink et al. BMC Medical Education (2019) 19:343 Page 8 of 8

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Funding
school. Nurs Leadersh (CJNL). 2007;20(3):22–5.
Stichting Innovatie Alliantie supported this project financially (Grant 2014-
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Ethics approval and consent to participate perceptions, experiences and understandings. In: Holloway I (ed) qualitative
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Not applicable.

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Author details
1
Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden
University Medical Centre, Leiden, The Netherlands. 2Faculty of Health,
Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
3
Faculty of Health Care, University of Applied Sciences , Leiden, The
Netherlands. 4Department of Biomedical Data Sciences, section Medical
Decision Making, Leiden University Medical Centre, Leiden, The Netherlands.
5
Faculty of Health, Nutrition and Sports, The Hague University of Applied
Sciences, The Hague, The Netherlands. 6Innovation, Quality + Research, Basalt
Rehabilitation Centre, The Hague / Leiden, The Netherlands.

Received: 19 November 2018 Accepted: 30 August 2019

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