Exploring the interdependence between telemedicine and frugal innovation in the context of adoption and diffusion in low-resource settings: a systematic review protocol

IntroductionAccess to healthcare remains a critical challenge, particularly in underserved health systems. Telemedicine, a technology-driven solution offering remote medical services, has the potential to enhance healthcare access. However, it remains primarily studied in high-resource settings and continues to face challenges in adoption and scale-up (diffusion). Insights from frugal innovation could offer valuable contributions to overcome these obstacles, promoting greater affordability and accessibility. Frugal innovation is a resource-scarce solution, typically emerging from extreme constraints, emphasizing affordability, accessibility, simplicity, efficiency, and resourcefulness. Rooted in a culturally contextualized and creative approach to problem-solving, it is particularly relevant in low-resource health systems where complex, inter-sectoral challenges occur. Despite its potential, insights from frugal innovation have not been compared, contrasted, or studied alongside telemedicine. Therefore, we will review the existing literature to analyze how both concepts and their relationships are discussed, comparing and contrasting findings. We will conduct a systematic review of empirical studies of technologies, encompassing both concepts, namely telemedicine features and frugal innovation characteristics, and explore how these features and characteristics affect adoption and diffusion pathways for the studied technologies. While we anticipate complementary aspects to arise between both concepts, our focus is to examine their reciprocal relationship and interdependence, while contributing to a more comprehensive understanding of how they impact adoption and diffusion of technology within health systems and communities in extreme resource-limited settings. Insights from our review will contribute to a deeper understanding of how to address the challenges related to the adoption and diffusion of innovative health applications in extreme resource-limited settings. Furthermore, we will advance understanding of how frugal innovation characteristics can align with traditional, non-frugal, and more advanced technologies, such as telemedicine, thereby enabling the development of innovation systems that are resource-efficient, contextually adaptive, and yet scalable. Methods and analysisFollowing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we will perform a systematic search across various databases, including Medline ALL, Embase, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO, Scopus, Dimensions, IEEE Xplore Digital Library, EconLit, International HTA database, Latin America, the Caribbean Literature on Health Sciences (LILACS), WHO Global Index Medicus, Global Health Observatory WHO. We will consider peer-reviewed studies without language or geographic restrictions and manage extracted data using Covidence. To ensure the accuracy and quality of translations, we will implement a standardized translation protocol. The search will be conducted by an information specialist. Data synthesis will be documented via a data extraction table. Two independent reviewers will conduct screening and data extraction, checking for conflicts and consistency by a third reviewer. We will provide a narrative synthesis and ensure accessibility for non-expert audiences by avoiding jargon, explaining terms as needed, and adhering to open-access standards. Ethics and disseminationWe will not collect primary data, making ethical approval unnecessary. The review findings will be shared through peer-reviewed journal publications, conferences, and stakeholder meetings. PROSPERO registration numberCRD42025649418 STRENGTHS AND LIMITATIONS OF THIS STUDYO_LIWe will initiate an exploration about the interdependence between telemedicine and frugal innovation, in the context of adoption and diffusion in low-resource settings. C_LIO_LIWe will assess features of telemedicine, e.g. remote monitoring, Electronic Medical Records (EMR) integration, prescription management, and characteristics of frugal innovation, e.g. resource efficiency, local adaptation, scalability, et cetera. C_LIO_LIWe will include findings published without language and geographical region restrictions. C_LIO_LIWe will include studies employing a diverse range of experimental designs, both qualitative and quantitative, with a focus on adoption and diffusion, which may lead to a high degree of heterogeneity. C_LIO_LIDepending on findings, we aim to conduct a Latent Class Analysis (LCA) to uncover subgroups based on features and characteristics, aiming to examine how identified classes influence the adoption and diffusion of innovation in low-resource settings. C_LI