Skip to main content Skip to main navigation menu Skip to site footer
Jurnal Keperawatan Indonesia
Articles
VIEWS: 27
10.7454/jki.v29i1.1781
Submitted: 2025-04-16
Published: 2026-03-31

A Systematic Review of Implementing IoT Healthcare Systems: Technological, Organizational, and Ethical Barriers in Rural Settings

College of Computing Studies, Mindanao State University-Sulu, Jolo, Sulu, Philippines
College of Computing Studies, Mindanao State University-Sulu, Jolo, Sulu, Philippines
College of Computing Studies, Mindanao State University-Sulu, Jolo, Sulu, Philippines
College of Computing Studies, Mindanao State University-Sulu, Jolo, Sulu, Philippines
College of Computing Studies, Mindanao State University-Sulu, Jolo, Sulu, Philippines
College of Computing Studies, Mindanao State University-Sulu, Jolo, Sulu, Philippines
College of Computing Studies, Mindanao State University-Sulu, Jolo, Sulu, Philippines
College of Health Sciences, Mindanao State University, Marawi City, Lanao Del Sur, Philippines
College of Computing Studies, Western Mindanao State University, Zamboanga City, Zamboanga del Sur, Philippines
digital health equity ethical challenges implementation barriers IoT healthcare rural health systems

Abstract

The implementation of Internet of Things (IoT) technologies holds transformative potential for healthcare delivery in rural and underserved regions. This systematic review focuses on technological, organizational, and ethical barriers. A comprehensive literature search across six major academic databases yielded eleven empirical studies published between 2015 and 2025. The review adhered to PRISMA protocols, with data synthesized using the Synthesis Without Meta-Analysis (SWiM) guidelines. Findings revealed that technological challenges—such as unreliable internet connectivity, lack of device interoperability, and power supply issues—are widespread across rural implementations. Organizational limitations included inadequate training, resistance to workflow changes, and financial constraints. Ethical concerns primarily involved informed consent, data security, and privacy, often exacerbated by weak regulatory structures and digital illiteracy. Despite these obstacles, successful implementation efforts were marked by community engagement, phased integration strategies, and culturally adapted frameworks. The review underscores the necessity of comprehensive approaches that combine infrastructure development, workforce preparedness, and locally contextualized ethical safeguards. These findings provide a critical foundation for policymakers, system designers, and healthcare practitioners aiming to scale digital health solutions in low-resource settings.

References

  1. Arnaert, A., Ponzoni, N., Sanou, H., & Nana, N.G. (2019). Using the BELT framework to implement an mHealth pilot project for preventative screening and monitoring of pregnant women in Rural Burkina Faso, Africa. Telehealth and Medicine Today, 4, 1–10. doi: 10.30953/tmt.v4.100.
  2. Boonchieng, W., Chaiwan, J., Shrestha, B., Shrestha, M., Dede, A.J.O., & Boonchieng, E. (2021). mHealth technology translation in a limited resources community—Process, challenges, and lessons learned from a limited resources community of Chiang Mai Province, Thailand. IEEE Journal of Translational Engineering in Health and Medicine, 9, 1–8. doi: 10.1109/JTEHM.2021.3055069.
  3. Bressan, T., Valdivia-Gago, A., Silvera-Ccallo, R.M., Llanos-Cuentas, A., Condor, D.F., Padilla-Huamantinco, P.G., Vilcarromero, S., Miranda, J.J., & Zavaleta-Cortijo, C. (2022). Challenges of design, implementation, acceptability, and potential for, biomedical technologies in the Peruvian Amazon. International Journal for Equity in Health, 21 (1), 183. doi: 10.1186/s12939-022-01773-7.
  4. Brockman, T.A., Shaw, O., Wiepert, L., Nguyen, Q.A., Kelpin, S.S., West, I., Albertie, M., Williams, S., Abbenyi, A., Stephenson, N., Almader-Douglas, D., & Patten, C.A. (2023). Community engagement strategies to promote recruitment and participation in clinical research among rural communities: A narrative review. Journal of Clinical and Translational Science, 7 (1), e84. doi: 10.1017/cts.2023.16.
  5. Castillo, V.S., Cano, C.A.G., & Gonzalez-Argote, J. (2023). Telemedicine and mHealth applications for health monitoring in rural communities in Colombia: A systematic review. EAI Endorsed Transactions on Pervasive Health and Technology, 9, e5. doi: 10.4108/eetpht.9.3400.
  6. Fischer, B., Jackson, Y., Roberts, C., Robinson, C., Early, R., & Sprang, R. (2024). Increasing primary and specialty healthcare access for rural older adults: Facilitators, barriers, and opportunities of telehealth in rural community centers. Alzheimer's and Dementia, 20 (S8), e095045. doi: 10.1002/alz.095045.
  7. Geetha, N., & Sankar, A. (2020). An intelligent IoT-based health monitoring system for tribal people. In Incorporating the internet of things in healthcare applications and wearable devices (pp. 137–149). IGI Global. doi: 10.4018/978-1-7998-1090-2.ch008.
  8. Harris, D.R., Harper, T.J., Henderson, D.W., Henry, K.W., & Talbert, J. (2016). Informatics-based challenges of building collaborative healthcare research and analysis networks from rural community health centers. IEEE-EMBS International Conference on Biomedical and Health Informatics, 2016, 513–516. doi: 10.1109/BHI.2016.7455947.
  9. Hayudini, M., & Escorial, J.E.A.A. (2025). Community-based healthcare automation: Development of integrated IoT sensor devices with mobile and web monitoring systems. In 2025 IEEE Symposium on Industrial Electronics & Applications (ISIEA) (pp. 1–10). IEEE. 10.1109/ISIEA65768.2025.11138339.
  10. Iyamu, I., Gómez-Ramírez, O., Xu, A.X., Chang, H.J., Watt, S., Mckee, G., & Gilbert, M. (2022). Challenges in the development of digital public health interventions and mapped solutions: Findings from a scoping review. Digital Health, 8, 20552076221102255. doi: 10.1177/20552076221102255.
  11. Keenan, A.J., Tsourtos, G., & Tieman, J. (2022). Promise and peril-defining ethical telehealth practice from the clinician and patient perspective: A qualitative study. Digital Health, 8, 20552076211070394. doi: 10.1177/20552076211070394.
  12. Kuntagod, N., Paul, S., Kumaresan, S., & Ganti, S. (2014). Practical challenges for large-scale deployment of mHealth solution insights from a field trial. IEEE Global Humanitarian Technology Conference, 235–241, doi: 10.1109/GHTC.2014.6970287.
  13. Leader, J., Bighead, C., Hunter, P., & Sanderson, R. (2023). “Working on a Shoestring”: Critical resource challenges and place-based considerations for telehealth in Northern Saskatchewan, Canada. Journal of Bioethical Inquiry, 20, 215–223. doi: 10.1007/s11673-023-10233-y.
  14. Li, C., Wang, J., Wang‎, S., & Zhang, Y. (2024). A review of IoT applications in healthcare. Neurocomputing, 565, 127017. doi: 10.1016/j.neucom.2023.127017.
  15. López, O.L.A., Rosabal, O.M., Ruiz-Guirola, D.E., Raghuwanshi, P., Mikhaylov, K., Lovén, L., & Iyer, S. (2023). Energy-Sustainable IoT connectivity: Vision, Technological enablers, challenges, and future directions. IEEE Open Journal of the Communications Society, 4, 2609–2666. doi: 10.1109/OJCOMS.2023.3323832.
  16. Meunier, P.-Y., Raynaud, C., Guimaraes, E., Gueyffier, F., & Letrilliart, L. (2023). Barriers and facilitators to the use of clinical decision support systems in primary care: A mixed-methods systematic review. The Annals of Family Medicine, 21 (1), 57–69. doi: 10.1370/afm.2908.
  17. Miiro, C., Ndawula, J.C., Musudo, E., Nabuuma, O.P., Mpaata, C.N., Nabukenya, S., Akaka, A., Bebembeire, O., & Sanya, D. (2022). Achieving optimal heath data impact in rural African healthcare settings: measures to barriers in Bukomansimbi District, Central Uganda. International Journal for Equity in Health, 21 (1), 187. doi: 10.1186/s12939-022-01814-1.
  18. Mishkin, A.D., Zabinski, J.S., Holt, G., & Appelbaum, P.S. (2023). Ensuring privacy in telemedicine: Ethical and clinical challenges. Journal of Telemedicine and Telecare, 29 (3), 217–221. doi: 10.1177/1357633x221134952.
  19. Morris, M.E., Brusco, N.K., Jones, J., Taylor, N.F., East, C.E., Semciw, A.I., Edvardsson, K., Thwaites, C., Bourke, S.L., Raza Khan, U., Fowler-Davis, S., & Oldenburg, B. (2023). The widening gap between the digital capability of the care workforce and technology-enabled healthcare delivery: A nursing and allied health analysis. Healthcare, 11 (7), 994. doi: 10.3390/healthcare11070994.
  20. Mumtaz, H., Riaz, M.H., Wajid, H., Saqib, M., Zeeshan, M.H., Khan, S.E., Chauhan, Y.R., Sohail, H., & Vohra, L.I. (2023). Current challenges and potential solutions to the use of digital health technologies in evidence generation: A narrative review. Frontiers in Digital Health, 5, 1203945. doi: 10.3389/fdgth.2023.1203945.
  21. Perez-Pozuelo, I., Spathis, D., Gifford-Moore, J., Morley, J., & Cowls, J. (2021). Digital phenotyping and sensitive health data: Implications for data governance. Journal of the American Medical Informatics Association, 28 (9), 2002–2008. doi: 10.1093/jamia/ocab012.
  22. Pourhomayoun, M., Alshurafa, N., Dabiri, F., Yadav, K., Sideris, C., Tseng, L.Y., Ghasemzadeh, H., Nyamathi, A., & Sarrafzadeh, M. (2017). A robust remote health monitoring and data processing system for rural area with limited internet access. 11th International Conference on Body Area Networks. doi: 10.4108/eai.15-12-2016.2267661.
  23. Roossien, C.C., de Jong, M., Bonvanie, A.M., & Maeckelberghe, E.L.M. (2021). Ethics in design and implementation of technologies for workplace health promotion: A call for discussion. Frontiers in Digital Health, 3, 644539. doi: 10.3389/fdgth.2021.644539.
  24. Serafini, B., Kim, L., Saour, B., James, R., Hannaford, B., Hansen, R., Kohno, T., Monsky, W., & Seslar, S.P. (2022). Exploring telerobotic cardiac catheter ablation in a rural community hospital: A pilot study. Cardiovascular Digital Health Journal, 3 (6), 313–319. doi: 10.1016/j.cvdhj.2022.10.003.
  25. Shafi, I., Din, S., Farooq, S., Díez, I.T., Breñosa, J., Espinosa, J.C.M., & Ashraf, I. (2024). Design and development of patient health tracking, monitoring and big data storage using Internet of Things and real time cloud computing. PLoS ONE, 19 (3), e0298582. doi: 10.1371/journal.pone.0298582.
  26. Takenga, C., Preik, P., Berndt, R.D., Arnold, A., Juenger, M., & Vikandy, M. (2020). Design of a telehealth system adapted for health care delivery in rural areas: Tele-consults between general practitioners and specialists. International Journal of Innovation and Scientific Research, 48 (2), 38-46. Retrieved from https://ijisr.issr-journals.org/abstract.php?article=IJISR-19-322-01.

How to Cite

Hayudini, M., Jimpoy, A. J., Alibasa, J., Carolino, A., Julkamri, J., Muhadja, N., Aming, A. R. H., Pangandaman, H., & Escorial, J. E. A. (2026). A Systematic Review of Implementing IoT Healthcare Systems: Technological, Organizational, and Ethical Barriers in Rural Settings. Jurnal Keperawatan Indonesia, 29(1), 1–11. https://doi.org/10.7454/jki.v29i1.1781