Table 3 Discussion key messages and potential actions

Workforce shortages and retention issues hinder implementation and sustainability

- Regional and rural healthcare providers face high workloads, limited specialist support, and high attrition, making implementation challenging

- Invest in rural workforce training and retention programs

- Support multidisciplinary team models to optimize workforce distribution

- Explore financial incentives for rural healthcare staff

Intervention feasibility and fit are essential for implementation success

- Rigid interventions that do not align with local workflows and resources hinder implementation

- Conduct pre-implementation needs assessments to tailor interventions to regional and rural settings

- Engage healthcare leaders, frontline staff and local communities in the co-design and adaptation of interventions

Strong leadership and organizational support drive implementation

- Leadership buy-in facilitates staff engagement and access to resources

- Develop leadership training programs for regional and rural healthcare managers

- Foster organizational buy-in through transparent communication

- Designate implementation champions to drive change within regional and rural healthcare organizations

Digital health interventions show promise but require long-term investment

- Telehealth has the potential to improve implementation and alleviate access issues associated with geographic vastness but is limited by infrastructure gaps, digital literacy, and confidentiality concerns

- Invest in rural broadband and digital health infrastructure

- Provide digital literacy training for healthcare providers and patients

- Address privacy and confidentiality concerns through secure platforms

Regional and rural healthcare settings have strengths that should be leveraged to support implementation

- Strong community links, flexible healthcare services that can adapt to local needs, long-term patient-provider relationships, and informal peer networks all facilitate implementation

- Engage trusted local leaders in healthcare initiatives to foster long-term community buy-in

- Foster regional collaboration networks to share resources and knowledge, building on existing community ties

Implementation science frameworks and geographic classification systems are underutilized

- Most studies did not use structured implementation frameworks to assess barriers and facilitators or use standardized geographic classification systems to define their context

- Build capacity of the rural health workforce relating to implementation science

- Encourage the use of geographical classification reporting (e.g., Modified Monash Model, Rural–Urban Continuum Codes)

Limited focus on priority populations

- Few studies targeted priority populations, such as Indigenous or culturally diverse groups

- Engage priority populations in research through participatory methodologies

- Apply equity-focused frameworks (e.g., Health Equity Implementation Framework)