Strengthening Community Health Systems Through Novel eHealth Initiatives? Commencing a Realist Study of the Virtual Health Rooms in Rural Northern Sweden

Background: Unlike the large body of research that has examined the ‘success’ or ‘failure’ of eHealth in terms of patientand provider perceptions or cost- and clinical effectiveness, the current study teases out ways through which a noveleHealth initiative in rural northern Sweden might result in more distal or systemic beneficial outcomes. More specifically,this paper aims to explore how and under what circumstances the so-called virtual health rooms (VHRs) are expectedto improve access to person-centred care and strengthen community health systems, especially for elderly residents ofrural areas. Methods: The first phase of the realist evaluation methodology was conducted, involving qualitative interviews with 8key stakeholders working with eHealth, business development, digitalisation, and process management. Using thematicanalysis and following an abductive-retroductive analytical process, an intervention-context-actor-mechanism-outcome(ICAMO) configuration was developed and elicited into an initial programme theory. Results: The findings indicate that a novel eHealth initiative, which provides reliable technologies in a customizedfacility that connects communities and providers, might improve access to person-centred care and strengthencommunity health systems for rural populations. This is theorized to occur if mechanisms acting at individual (suchas knowledge, skills and trust) and collective (like a common vision and shared responsibilities) levels are triggered incontexts characterised by supportive societal transitions, sufficient organisational readiness and the harnessing of ruralcohesiveness and creativity. Conclusion: The elicited initial programme theory describes and explains how a novel eHealth initiative in ruralnorthern Sweden is presumed to operate and under what circumstances. Further testing, refinements and continuedgradual building of theory following the realist evaluation methodology is now needed to ascertain if the ‘VHRs’ work asintended, for whom, in what conditions and why