TELEHEALTH ADOPTION IN FRAGILE STATES: A TRUST-BASED MULTIDIMENSIONAL FRAMEWORK FOR LIBYA

Abstract

Telehealth offers transformative potential for improving healthcare access and service delivery, particularly in low-resource and fragile state contexts. However, its adoption in countries like Libya remains limited due to a confluence of infrastructural, institutional, and socio-cultural barriers. This study develops and proposes a multidimensional framework for telehealth adoption in Libya, emphasizing the critical mediating role of trust in technology. By integrating elements from the Technology-Organization-Environment (TOE) framework, the Diffusion of Innovation (DOI) theory, and the Unified Theory of Acceptance and Use of Technology (UTAUT), the framework provides a comprehensive lens through which to examine the complex dynamics of telehealth adoption in resource-constrained settings. The study identifies key adoption determinants, technological readiness, organizational leadership, regulatory environment, and individual user factors, and explores how trust in telehealth platforms mediates the relationship between these determinants and actual usage behavior. In the Libyan context, where political instability, weak institutional capacity, and public aspect toward government-led ICT initiatives prevail, trust is shaped by perceptions of system reliability, data privacy, institutional credibility, and prior user experience. The study’s findings underscore the importance of embedding trust-building strategies into policy and implementation efforts, including clear regulatory frameworks, transparency in digital health initiatives, and targeted capacity-building for both healthcare providers and patients. This research advances existing telehealth adoption literature by centering trust as a key mediating factor, offering a contextually grounded model applicable not only to Libya but also to other LMICs facing similar healthcare and governance challenges. The framework provides actionable insights for policymakers, healthcare leaders, and technology developers seeking to promote sustainable telehealth integration in fragile and resource-constrained environments.