Adoption of Telemedicine in Low-Resource Settings Through the Lens of Frugal Innovation: Protocol for a Systematic Review.

Background: Access to health care, especially in low-resource settings, remains a critical challenge for marginalized and underserved populations. Telemedicine, delivering medical advice remotely, has the potential to improve access to health care by reducing geographic and economic barriers. Its adoption, however, especially in low-resource settings, remains limited. Frugal innovation, characterized by solutions developed under tremendous resource constraints and prioritizing affordability, accessibility, and simplicity, offers valuable insights for enhancing telemedicine adoption. Rooted in a sociocultural approach, it is particularly relevant in low-resource health systems where complex, intersectoral challenges occur. Despite this potential, insights from frugal innovation have not been compared, contrasted, or studied alongside telemedicine in a systematic way. Objective: Our review aims to examine how frugal innovation contributes to the adoption of telemedicine in low-resource settings, with a particular focus on identifying frugal innovation characteristics that facilitate telemedicine adoption. Methods: Our PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-guided systematic review will examine case studies of adopted telemedicine applications in low-resource settings. Eligible studies need to demonstrate evidence of adoption and use in real-world health care settings. We will examine functions and features of telemedicine, along with frugal innovation characteristics, as demonstrated by each telemedicine application. The following databases were searched: MEDLINE ALL, Embase, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, CINAHL, PsycInfo, Scopus, Dimensions, IEEE Xplore Digital Library, EconLit, the International HTA Database, LILACS (Latin American and Caribbean Literature on Health Sciences), the World Health Organization (WHO) Global Index Medicus, and the WHO Global Health Observatory. Results: Insights from our review will deepen the understanding of how health care technologies such as telemedicine can be positioned and configured to improve adoption in low-resource settings. Search results, delivered in February 2025, were followed by title and abstract screening in March 2025, full-text screening in April 2025, and final study selection and quality appraisal by November 2025. With dataset updates requested in December 2025, the data synthesis remains ongoing. The expected results will be published in 2026. Conclusions: This combined assessment will examine how frugal innovation can contribute to the adoption of telemedicine in low-resource settings. As a result, we expect that our findings will contribute to the development of frugal telemedicine as a sociotechnical artifact. The protocol is submitted to enhance transparency and rigor.