A scoping review of barriers and facilitators to implementing tele-mental health solutions for rural, remote and underserved populations in low- and middle-income countries

The increasing mental health gap in low- and middle-income countries (LMICs) represents a significant global public health concern. Access to mental healthcare remains challenging due to stigma, lacking quality treatment options, and skilled workforce shortages. Tele-mental health, which involves remote access to care through information and communications technologies (ICTs) and mobile communication systems, may represent a promising solution. However, most research in this area has been conducted in high-income countries. This scoping review aimed to explore known barriers and facilitators to implementing tele-mental health solutions to populations in remote, rural, and underserved communities in LMICs to inform evidence-based development and implementation of digital interventions and strategies that can improve access to quality and affordable mental healthcare. Studies published between 2010 and 2024 were identified through comprehensive searches across four databases, namely PubMed, PsycINFO, Web of Science, and SpringerLink. Nine studies were included for analysis. Barriers and facilitators were categorised using the Capability, Opportunity, and Motivation = Behaviour (COM-B) model. A narrative synthesis revealed several barriers for patients, primarily related to limited physical and social opportunities, such as lack of mobile devices, unstable or limited internet access, and lack of private space at home. Barriers for mental health providers were predominantly linked to psychological capability, including insufficient knowledge concerning tele-mental health interventions. Time and cost efficiencies were key facilitators for both service users and mental health service providers, which enhanced access to care. Infrastructure development, educational initiatives, and training for providers are essential to create a more equitable tele-mental healthcare system.Author summary: Mental health conditions affect people worldwide, yet those living in rural, remote, and disadvantaged communities in lower-income countries often have the least access to care. Delivering mental healthcare remotely using technology such as phone calls, video calls, and text messaging offers a promising way to bridge this gap. However, we know surprisingly little about what makes these digital approaches work, or what gets in the way, for the communities who need them most. We reviewed published studies to map out the key barriers and challenges, as well as the things that help when delivering remote mental health services to underserved communities in lower-income countries. We found only nine studies that met our criteria, which itself signals how little research has been done in this area. Our findings show that practical obstacles such as unreliable internet, lack of personal devices, and absence of private space at home are the most common barriers for people seeking care. For providers, limited knowledge and training around digital tools were key challenges. On the positive side, both patients and providers valued the time and cost savings that remote care offers. These findings can help guide investment in infrastructure, training, and policy to make remote mental healthcare more equitable and accessible.