Digital Health Transformation: A Cross-Country Study of Telemedicine Implementation in Australia and Italy.

This study examines the adoption of Telemedicine in Australia’s centralised and Italy’s decentralised Healthcare Systems between 2020 and 2024. It examines how Institutional Arrangements, Policy Alignment, and Cultural Factors influence Implementation Processes, Governance Scalability, and Stakeholder Outcomes, utilising a comparative framework to inform context-sensitive strategies. Motivated by uneven global uptake of Telemedicine following the COVID-19 pandemic, the research addresses key gaps in cross- national and equity-focused Digital Health Studies. Employing an explanatory sequential Mixed-Methods Design, the study integrates a systematic review of 76 peer-reviewed articles with primary data from 160 stakeholder surveys, 80 semi-structured interviews, six focus groups, and multiple stakeholder workshops. These data were analysed using both statistical and thematic techniques. Grounded in the Technology Acceptance Model (TAM), Diffusion of Innovations (DOI), and Institutional Theory, the research develops the Hybrid Governance Adoption Model (HGAM), a novel framework that synthesises User Perceptions, Innovation Attributes, and Governance Structures to explain adoption dynamics. Findings confirm all Four Hypotheses: Centralised Governance and Stakeholder Alignment enabled Australia’s more uniform adoption (71.4% provider usage, 78.5% clinician satisfaction), as exemplified by a provider who noted, “Clear policies make it routine, even in remote clinics.” Perceived usefulness and ease of use were strongly correlated with uptake (ρ = 0.686), while trust deficits and fragmented policy frameworks constrained Italy’s decentralised model (31.6% adoption, 30.8% satisfaction), with one patient reporting, “I would use it more if I trusted it would not crash.” Equity analyses highlight Digital Literacy gaps among elderly and female populations in southern Italy, as well as Infrastructure Challenges faced by Indigenous and rural communities in Australia. The HGAM offers a scalable framework for future innovations, such as AI-driven diagnostics, with relevance to low-resource settings. The study recommends Hybrid Governance Models and Culturally Sensitive Digital Inclusion Programs to enhance system resilience and equity. Future research should focus on longitudinal assessments and broader stakeholder engagement to inform sustainable and inclusive digital health transformation worldwide.