Assessment of Patients' Perception of Telemedicine Services Using the Service User Technology Acceptability Questionnaire

Determinants of the intention to use mHealth in the future: Evidence from an intervention study of patients with chronic diseases in Slovenia

BACKGROUND

Mobile health (mHealth) implementation is crucial for developing sustainable healthcare systems, but it faces the challenge of user acceptance. Extending traditional acceptance models allows for the cognitive, emotional and social aspects of engaging with mHealth to be captured, creating a more comprehensive understanding of users' intentions to use it in the future. User-centred intervention studies based on users' real experiences with mHealth are essential for accurate assessments and for improving upon studies that rely merely on anticipated mHealth use.

METHODS

An intervention study was conducted with 103 patients with at least one chronic condition (type 2 diabetes and/or arterial hypertension) who had used an mHealth service for three months. They were recruited through purposive sampling at a community health centre in Slovenia. Path analysis was applied to the survey data collected after a three-month testing period to validate an explanatory model with eight hypotheses.

RESULTS

The intensity of mHealth use affected usability, which in turn affected acceptability, the psychosocial impacts of engagement with mHealth and intention for future use. The results showed that the intensity of mHealth use did not affect mHealth acceptability. Likewise, acceptability did not affect the psychosocial impacts of engagement with mHealth or the intention for its future use. Notably, perceptions of the psychosocial impacts of mHealth had no significant effect on the intention for future use.

CONCLUSION

Usability and intensity of use play a central role in the post-intervention usage of mHealth, offering valuable insights for policymakers and healthcare providers involved in the delivery of mHealth-based treatment to patients with chronic diseases.

Telemedicine Utilization in Tertiary, Specialized, and Secondary Hospitals in Thailand

Introduction

COVID-19 has accelerated the adoption of telemedicine for counseling, follow-up examination, and treatment purposes. The official guidelines in Thailand were launched to regulate or frame the protocols for health care professions and teams in different organizations.

Objectives

To explore the trend of telemedicine utilization in selected hospitals in Thailand and to understand the characteristics of patients who used telemedicine from 2020 to 2023.

Methods

This retrospective secondary data analysis was conducted in four hospitals in Thailand: two tertiary care (T1 and T2) hospitals, one secondary care (SN) hospital, and one specialized (SP) hospital. Data were routinely collected when services were provided and were categorized into telemedicine outpatient department (OPD) visits or onsite OPD visits. The data included demographic information (age, sex), date and year of service, location (province and health region), and primary diagnosis (using International Statistical Classification of Diseases and Related Health Problems 10th Revision codes). Descriptive analysis was conducted using R and STATA software.

Results

All four hospitals reported an increase in telemedicine use from 2020 to 2023. The majority of telemedicine users were female (>65%) at all hospitals except for the SP hospital (44%). Participants aged 25-59 years reported greater utilization of telemedicine than did the other age-groups. The within-hospital comparison between OPD visits before and after telemedicine was significant (p < 0.001).

Conclusion

The situation during the COVID-19 pandemic and the transition to the post-COVID-19 era impacted telemedicine utilization, which could support national monitoring and evaluation policies. However, further studies are needed to explore other aspects, including changes in telemedicine utilization over time for longer timeframes, effectiveness of telemedicine, and consumer satisfaction.

Expert Opinion on the Utility of Telemedicine in Obesity Care: Recommendations on a Hybrid Multidisciplinary Integrated Care Follow-Up Algorithm

PURPOSE OF REVIEW

The proposed expert opinion was prepared by a panel of obesity and law specialists from Turkey to review the utility of telemedicine in obesity care and to provide a guidance document with recommendations on a hybrid multidisciplinary integrated care follow-up algorithm and the legislation governing telemedicine practice to assist obesity specialists in practicing the telemedicine.

RECENT FINDINGS

The efficacy and feasibility of telemedicine interventions in supporting obesity management programs even during pandemics confirm that obesity is a particularly well-suited field for telemedicine, emphasizing the strong likelihood of continued utilization of telemedicine in obesity management, beyond the pandemic period. Telemedicine has great potential to address several barriers to ongoing weight-management care, such as challenges of access to specialized care, cost, and time limitations as well as patient adherence to treatment. However, telemedicine practice should complement rather than replace the in-person visits which are unique in building rapport and offering social support. Accordingly, the participating experts recommend the use of a hybrid integrated care model in the management of obesity, with the use of telemedicine, as an adjunct to in-person visits, to enable the provision of suggested intensive obesity management via frequent visits by a multidisciplinary team of obesity specialists. Further research addressing the utility of telemedicine in terms of optimal modality and duration for successful long-term obesity management outcomes is necessary to develop specific guidelines on telemedicine practice. In addition, the legislation governing the norms and protocols on confidentiality, privacy, access, and liability needs to be improved.

A web-based resource for exercise training in children treated for brain tumours to improve cognitive sequelae: Development and usability

Improving cognitive sequelae in children treated for brain tumours (CTBT) requires accessible interventions. While instructor-led exercise in a hospital setting is efficacious, it is not extended to communities.

Objectives

We aimed to (i) develop a website with educational resources/tools for community health and fitness professionals (HFP) to deliver exercise for CTBT in community settings to improve cognition and (ii) assess its usability by community HFP. It was hypothesized that the website would be learnable, clear, satisfactory and efficient to deliver exercise.

Methods

A scoping review determined the state of eHealth resources to support exercise for CTBT and identified knowledge and resource gaps. Three focus groups with HFP who served cancer survivors in hospital or community settings (n = 13) identified user needs; content analysis identified themes. Gaps from the scoping review and themes from focus groups informed website content. A questionnaire assessed its usability by community HFP (n = 4). Descriptive statistics inferred the website's learnability, clarity, satisfaction and efficiency. Open-ended responses identified issues.

Results

The scoping review revealed a lack of eHealth resources supporting exercise to improve cognition in CTBT and education for HFP to deliver exercise. Six themes were identified in the focus groups. HFP rated the website as sufficiently learnable, clear, satisfactory and efficient. Two minor issues were reported and addressed.

Conclusion

The website marks one of the first eHealth resources to increase accessibility of intervention to improve cognitive sequelae and ultimately quality of life in CTBT. HFP also gain access to education and tools to deliver exercise in community settings.

Feasibility and Acceptability of Community-Based Telehealth to Prevent Long-Term Care Readmission

Background

Transitioning to community living after long-term care requires multiple complex individualized interventions to prevent readmission. The current focus of home and community-based services (HCBS) is on increasing consumer engagement and individualizing care. Telehealth interventions provide additional services without the burden of face-to-face encounters and have yet to be evaluated for feasibility and acceptability in rural HCBS.

Methods

West Virginia Bureau for Medical Services and West Virginia University implemented and evaluated a telehealth intervention with 26 Aged and Disabled Waiver or Traumatic Brain Injury Waiver participants who were transitioning back into their communities from a long-term care facility. Feasibility was assessed through recruitment process, fidelity to planned intervention, number of people eligible for participation, number of individuals enrolling in the intervention, enrollment process, completed enrollment, engagement in the intervention, number of weeks participating in the intervention, type of devices provided, attrition, and fidelity to original intervention. Satisfaction with services was used as a marker of acceptability for both participants and providers.

Results

Half (n = 12) of the enrolled population completed the full 24-week telehealth monitoring period and modification of the original intervention was necessary for most. Provider and participant satisfaction was high. Recruitment and enrollment may have been affected by COVID-19.

Conclusion

Future implementation will continue to track recruitment and retention efforts. Individualized care plans, demonstration and practice with equipment, family or direct-care worker presence, and live technical support through the phone are needed. Primary care provider and in-home direct-care worker satisfaction workflow planning and evaluation are required.

Telemedicine Acceptability Among Patients of Primary Health Care Clinics in the Western Region, Saudi Arabia

Background Telemedicine has become increasingly important during recent years. Investigating the acceptability of telemedicine among patients is an important first step in adapting and maintaining the use of telemedicine and gaining the advantages of technologies in daily practice. Objective To measure the acceptability of telemedicine among the patients of primary health care centers (PHCC) using the Service User Technology Acceptability Questionnaire (SUTAQ) at King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia. Methods This cross-sectional study utilized a validated questionnaire in phone call interviews with patients of PHCC clinics. All patients who had a telemedicine visit at PHCC within the past month of data collection were eligible for inclusion. The SUTAQ tool was used to measure the acceptability of telemedicine technology. Results Out of 365 people selected for participation, 73.9% responded. The study found that the median age was 40 years old with an interquartile range of 30-52. The majority of participants were female (61.1%) and married (86.7%). The median total SUTAQ score was 4.3, out of a maximum score of 6. The medians for SUTAQ subscales were as follows: the perceived benefits score was 5.4, the privacy and discomfort score was 2.1, the health care personnel concerns score was 3, the satisfaction score was 5.7, and the kit as substitution score was 4.3. Patients who had not previously experienced telemedicine visits showed a higher score in "health care personnel concerns" (P-value=0.009), while first-time patients had a higher score in "kit as substitution" (P-value=0.006). Conclusion This study provided positive evidence that telemedicine is an acceptable service among PHCC patients. However, PHCC providers should prioritize patient education and awareness about telemedicine to improve utilization. Addressing privacy, discomfort, and personnel concerns could increase patient satisfaction. Future studies investigating telemedicine utilization can help in understanding its impact on clinical outcome.

Translation and validation study of the Chinese version of the service user technology acceptability questionnaire

Objective

This study aimed to assess the reliability and validity of the translated Chinese version of the Service User Technology Acceptability Questionnaire (C-SUTAQ).

Methods

Patients with cancer (n ​= ​554) from a tertiary hospital in China completed the C-SUTAQ. Item analysis, content and construct validity test, internal consistency test, and test-retest reliability analysis were conducted on the instrument to test its applicability.

Results

The critical ratio of each item of the C-SUTAQ ranged from 11.869 to 29.656; the correlation of each item and subscale ranged from 0.736 to 0.929. The Cronbach's α value for each subscale ranged from 0.659 to 0.941, and the test-retest reliability ranged from 0.859 to 0.966. The content validity index of the scale level and the item level content validity index of the instrument were both 1. Exploratory factor analysis indicated it was reasonable that the C-SUTAQ consists of six subscales after rotation. Confirmatory factor analysis demonstrated good construct validity (χ²/df ​= ​2.459, comparative fit index ​= ​0.922, incremental fit index ​= ​0.907, standardized root mean square residual ​= ​0.060, root-mean-square error of approximation ​= ​0.073, goodness of fit index ​= ​0.875, normed fit index ​= ​0.876.

Conclusions

The C-SUTAQ had good reliability and validity and may be useful to assess Chinese patients' acceptability of telecare. However, the small sample size limited generalization and there is a need to expand the sample to include persons with other diseases. Further studies are required using the translated questionnaire.

Patient characteristics associated with the acceptability of teleconsultation: a retrospective study of osteoporotic patients post-COVID-19

BACKGROUND

Due to the COVID-19 pandemic, teleconsultations (TCs) have become common practice for many chronic conditions, including osteoporosis. While satisfaction with TCs among patients increases in times of emergency, we have little knowledge of whether the acceptability of TCs persists once in-person visits return to being a feasible and safe option. In this study, we assess the acceptability of TCs across five dimensions for osteoporosis care among patients who started or continued with TCs after the COVID-19 pandemic had waned. We then explore the patient characteristics associated with these perceptions.

METHODS

Between January and April 2022, 80 osteoporotic patients treated at the Humanitas Hospital in Milan, Italy, were recruited to answer an online questionnaire about the acceptability of TCs for their care. The acceptability of TCs was measured using a modified version of the Service User Technology Acceptability Questionnaire (SUTAQ), which identifies five domains of acceptability: perceived benefits, satisfaction, substitution, privacy and discomfort, and care personnel concerns. Multivariable ordinary least squares (OLS) linear regression analysis was performed to assess which patient characteristics in terms of demographics, socio-economic conditions, digital skills, social support, clinical characteristics and pattern of TC use were correlated with the five domains of acceptability measured through the SUTAQ.

RESULTS

The degree of acceptability of TCs was overall good across the 80 respondents and the five domains. Some heterogeneity in perceptions emerged with respect to TCs substituting for in-person visits, negatively impacting continuity of care and reducing the length of consultations. For the most part, acceptability was not affected by patient characteristics with a few exceptions related to treatment time and familiarity with the TC service modality (i.e., length of osteoporosis treatment and number of TCs experienced by the patient).

CONCLUSIONS

TCs appear to be an acceptable option for osteoporosis care in the aftermath of the COVID-19 pandemic. This study suggests that other characteristics besides age, digital skills and social support, which are traditionally relevant to TC acceptability, should be taken into account in order to better target this care delivery modality.

Telemedicine and its acceptance by patients with type 2 diabetes mellitus at a single care center during the COVID-19 emergency: A cross-sectional observational study

INTRODUCTION

When Italy was placed under lockdown to contain the COVID-19 pandemic from 9 March to 18 May 2020, alternative approaches to delivering care-such as telemedicine-were promoted for patients with chronic diseases like diabetes mellitus (DM). The aim of this study was to analyze patients' perception of, and satisfaction with the telehealth services offered during the COVID-19 emergency at an outpatient diabetes care unit in Italy.

METHODS

A cross-sectional survey was conducted on 250 patients with type 2 diabetes mellitus who regularly attended our diabetes care unit. Data were collected by means of telephone interviews, asking patients how they perceived the telehealth services, and their satisfaction with the televisit and computer-based care. A standardized questionnaire was administered: there were questions answered using a five-point Likert scale, and one open-ended question. Patients' demographic, anthropometric and biological data were collected from their medical records. Correlations between patients' characteristics, their perception of telemedicine, and their satisfaction with the televisit were examined. Spearman's rank-order correlation coefficient ρ (rho) and Kendall's rank correlation coefficient τ (tau) were used as nonparametric measures of the strength of the association between the scores obtained for the two ordinal variables, Perception and Satisfaction, and between other clinical parameters. Principal component analysis (PCA) was also used to assess overall links between the variables.

RESULTS

Almost half of the interviewees expressed a strongly positive perception of the medical services received, and more than 60% were very satisfied with the telehealth service provided during the COVID-19 emergency. There was a strong correlation between patients' perception and satisfaction ratings (p<0.0001). Duration of disease showed a significant positive correlation with patients' satisfaction with their medical care. By means of PCA, it was found that BMI correlated inversely with both perception and satisfaction. Following a qualitative analysis of patients' answers to the open-ended question, contact with their specialist was important to them: it was reassuring and a source of scientifically correct information about their disease and the association between COVID-19 and diabetes.

CONCLUSIONS

Based on our telephone interviews, patients appreciated the telehealth approach and were satisfied with it, regardless of the characteristics of their disease. Telemedicine proved essential to avoid interrupting the continuity of care, and therefore had not only clinical, but also psycho-social repercussions.

Readiness for Telemedical Services in Patients With Cardiovascular Diseases: Cross-sectional Study

BACKGROUND

Telemedicine solutions, especially in the face of epidemiological emergencies such as the COVID-19 pandemic, played an important role in the remote communication between patients and medical providers. However, the implementation of modern technologies should rely on patients' readiness toward new services to enable effective cooperation with the physician. Thus, successful application of patient-centric telehealth services requires an in-depth analysis of users' expectations.

OBJECTIVE

This study aimed to evaluate factors determining readiness for using telehealth solutions among patients with cardiovascular diseases.

METHODS

We conducted a cross-sectional study based on an investigator-designed, validated questionnaire that included 19 items (demographics, health status, medical history, previous health care experience, expected telehealth functionalities, and preferred remote communication methods). Multivariate logistic regression was applied to assess the relationship between readiness and their determinants.

RESULTS

Of the 249 respondents, 83.9% (n=209) consented to the use of telemedicine to contact a cardiologist. The nonacceptance of using telemedicine was 2 times more frequent in rural dwellers (odds ratio [OR] 2.411, 95% CI 1.003-5.796) and patients without access to the internet (OR 2.432, 95% CI 1.022-5.786). In comparison to participants living in rural areas, city dwellers demonstrated a higher willingness to use telemedicine, including following solutions: issuing e-prescriptions (19/31, 61.3% vs 141/177, 79.7%; P=.02); alarming at the deterioration of health (18/31, 58.1% vs 135/177, 76.3%; P=.03); and arranging or canceling medical visits (16/31, 51.6% vs 126/176, 71.6%; P=.03). Contact by mobile phone was preferred by younger patients (OR 2.256, 95% CI 1.058-4.814), whereas older patients and individuals who had no previous difficulties in accessing physicians preferred landline phone communication.

CONCLUSIONS

During a nonpandemic state, 83.9% of patients with cardiovascular diseases declared readiness to use telemedicine solutions.

Readiness, acceptance and use of digital patient reported outcome in an outpatient clinic

Use of digital patient-reported outcomes is being introduced in care of chronic conditions, including Inflammatory Bowel Disease. The aim is to supplement face-to-face follow-up sessions through symptom screening, and to inform follow-up through questions about mental health and quality of life. However, little is known about who is using this as intended. This study aimed to map differences between users and non-users among people with IBD and explore the mechanisms behind. We administered a questionnaire including the Readiness and Enablement Index for Health Technology (ReadHy) and the Service User Technology Acceptability Questionnaire (SUTAQ) to all people with IBD registered at Silkeborg Regional Hospital. Comparison between users and non-users and cluster analysis was conducted. Effect size (Cohen's d) was used to estimate magnitude of difference between groups. The user and non-user groups differed most strongly by level of emotional distress (d = 0.45). Cluster analysis of the ReadHy scales showed profiles have different sets of difficulties and reservations towards digital solutions. These difficulties correlated moderately with SUTAQ dissatisfaction and low acceptability. The dimensions of ReadHy may help to better understand particular needs of people with IBD when accessing digital PROs, which may lead to higher acceptability and improved quality of care.

Drivers for Teleconsultation Acceptance in Brazil: Patients’ Perspective during the COVID-19 Pandemic

ABSTRACT Context: teleconsultation can be a strategic technological tool for patients to access quality healthcare while dealing with resource challenges within health industry. It can be particularly relevant during and after the COVID-19 pandemic, when the social distancing world had to scramble for new technological solutions to offer quality healthcare services with reduced personal contact. Objective: our research proposes an integrative technology acceptance model to evaluate the drivers of teleconsultation adoption by patients, aligning constructs from the technology acceptance model with other drivers, such as technology readiness, trust, and self-efficacy. Methods: analyses included descriptive statistics and structural equations modeling based on survey’s data from a sample of 415 consumers. Results: results indicate significant relationships between the assessed constructs, with particular relevance on the effects of perceived usefulness, anteceded by trust and technology readiness, on attitude and intention to use teleconsultation. Conclusion: our findings provide helpful insights for health organizations and regulators associated with the diffusion of teleconsultation. The study findings also indicate that the challenging COVID-19 pandemic context may be affecting patients’ intention to adopt teleconsultation.

Exploring patient perspectives on telemedicine monitoring within the operating room

BACKGROUND

Clinical decision support systems and telemedicine for remote monitoring can together support clinicians' intraoperative decision-making and management of surgical patients' care. However, there has been limited investigation on patient perspectives about advanced health information technology use in intraoperative settings, especially an electronic OR (eOR) for remote monitoring and management of surgical patients.

PURPOSE

Our study objectives were: (1) to identify participant-rated items contributing to patient attitudes, beliefs, and level of comfort with eOR monitoring; and (2) to highlight barriers and facilitators to eOR use.

METHODS

We surveyed 324 individuals representing surgical patients across the United States using Amazon Mechanical Turk, an online platform supporting internet-based work. The structured survey questions examined the level of agreement and comfort with eOR for remote patient monitoring. We calculated descriptive statistics for demographic variables and performed a Wilcoxon matched-pairs signed-rank test to assess whether participants were more comfortable with familiar clinicians from local hospitals or health systems monitoring their health and safety status during surgery than clinicians from hospitals or health systems in other regions or countries. We also analyzed open-ended survey responses using a thematic approach informed by an eight-dimensional socio-technical model.

RESULTS

Participants' average age was 34.07 (SD = 10.11). Most were white (80.9%), male (57.1%), and had a high school degree or more (88.3%). Participants reported a higher level of comfort with clinicians they knew monitoring their health and safety than clinicians they did not know, even within the same healthcare system (z = -4.012, p < .001). They reported significantly higher comfort levels with clinicians within the same hospital or health system in the United States than those in a different country (z = -10.230, p < .001). Facilitators and barriers to eOR remote monitoring were prevalent across four socio-technical dimensions: 1) organizational policies, procedures, environment, and culture; 2) people; 3) workflow and communication; and 4) hardware and software. Facilitators to eOR use included perceptions of improved patient safety through a safeguard system and perceptions of streamlined care. Barriers included fears of incorrect eOR patient assessments, decision-making conflicts between care teams, and technological malfunctions.

CONCLUSIONS

Participants expressed significant support for intraoperative telemedicine use and greater comfort with local telemedicine systems instead of long-distance telemedicine systems. Reservations centered on organizational policies, procedures, environment, culture; people; workflow and communication; and hardware and software. To improve the buy-in and acceptability of remote monitoring by an eOR team, we offer a few evidence-based guidelines applicable to telemedicine use within the context of OR workflow. Guidelines include backup plans for technical challenges, rigid care, and privacy standards, and patient education to increase understanding of telemedicine's potential to improve patient care.

Remote cognitive assessment of older adults in rural areas by telemedicine and automatic speech and video analysis: protocol for a cross-over feasibility study

INTRODUCTION

Early detection of cognitive impairments is crucial for the successful implementation of preventive strategies. However, in rural isolated areas or so-called 'medical deserts', access to diagnosis and care is very limited. With the current pandemic crisis, now even more than ever, remote solutions such as telemedicine platforms represent great potential and can help to overcome this barrier. Moreover, current advances made in voice and image analysis can help overcome the barrier of physical distance by providing additional information on a patients' emotional and cognitive state. Therefore, the aim of this study is to evaluate the feasibility and reliability of a videoconference system for remote cognitive testing empowered by automatic speech and video analysis.

METHODS AND ANALYSIS

60 participants (aged 55 and older) with and without cognitive impairment will be recruited. A complete neuropsychological assessment including a short clinical interview will be administered in two conditions, once by telemedicine and once by face-to-face. The order of administration procedure will be counterbalanced so half of the sample starts with the videoconference condition and the other half with the face-to-face condition. Acceptability and user experience will be assessed among participants and clinicians in a qualitative and quantitative manner. Speech and video features will be extracted and analysed to obtain additional information on mood and engagement levels. In a subgroup, measurements of stress indicators such as heart rate and skin conductance will be compared.

ETHICS AND DISSEMINATION

The procedures are not invasive and there are no expected risks or burdens to participants. All participants will be informed that this is an observational study and their consent taken prior to the experiment. Demonstration of the effectiveness of such technology makes it possible to diffuse its use across all rural areas ('medical deserts') and thus, to improve the early diagnosis of neurodegenerative pathologies, while providing data crucial for basic research. Results from this study will be published in peer-reviewed journals.

Acceptability of digital health interventions: embracing the complexity

Acceptability is a core concept in digital health. Available frameworks have not clearly articulated why and how researchers, practitioners and policy makers may wish to study the concept of acceptability. Here, we aim to discuss (i) the ways in which acceptability might differ from closely related concepts, including user engagement; (ii) the utility of the concept of acceptability in digital health research and practice; (iii) social and cultural norms that influence acceptability; and (iv) pragmatic means of measuring acceptability, within and beyond the research process. Our intention is not to offer solutions to these open questions but to initiate a debate within the digital health community. We conducted a narrative review of theoretical and empirical examples from the literature. First, we argue that acceptability may usefully be considered an emergent property of a complex, adaptive system of interacting components (e.g., affective attitude, beliefs), which in turn influences (and is influenced by) user engagement. Second, acceptability is important due to its ability to predict and explain key outcomes of interest, including user engagement and intervention effectiveness. Third, precisely what people find acceptable is deeply contextualized and interlinked with prevailing social and cultural norms. Understanding and designing for such norms (e.g., through drawing on principles of user centered design) is therefore key. Finally, there is a lack of standard acceptability measures and thresholds. Star ratings coupled with free-text responses may provide a pragmatic means of capturing acceptability. Acceptability is a multifaceted concept, which may usefully be studied with a complexity science lens.

Oncophone20 study: Patients' perception of telemedicine in the COVID-19 pandemic during follow-up visits for gynecological and breast cancers

Objective

To analyze oncological patients’ perception of telemedicine during the COVID‐19 pandemic.

Methods

A total of 345 women, of whom 267 experienced breast cancer and 78 experienced a gynecological cancer, were enrolled. Specific questionnaires about their experiences and feelings about telemedicine in the COVID‐19 era were collected.

Results

In the breast group, “enhanced care” showed moderate positive perception (mean 4.40) among less‐educated women that was slightly lower among better‐educated women (mean 4.14) with a significant difference (P = 0.034). “satisfaction” had an opposite pattern: a mean of 3.99 for a lower level of education and 4.78 for a higher level of education, with a strong significant difference (P < 0.001). “privacy and discomfort” approached neutrality for less‐educated women, while for higher‐educated women the lower mean of 2.93 indicted a more positive perception (P = 0.007). In the pelvic group, younger women had a better perception towards telemedicine for “telemedicine as a substitution” (mean 3.68) compared to older women (mean 3.05). The privacy and discomfort subscale was in favor of better‐educated women (mean 2.57) compared to less‐educated women (mean 3.28; P = 0.042).

Conclusion

Telemedicine was generally well accepted, not only among younger and higher‐educated women but also by women needing intensive care, in both cancer groups.

Telemedicine represents a strategic tool for the control of COVID‐19 infection in patients, caregivers, and healthcare professionals and was generally well accepted.

Pilot Study to Assess the Feasibility of a Mobile Unit for Remote Cognitive Screening of Isolated Elderly in Rural Areas

Background: Given the current COVID-19 pandemic situation, now more than ever, remote solutions for assessing and monitoring individuals with cognitive impairment are urgently needed. Older adults in particular, living in isolated rural areas or so-called ‘medical deserts’, are facing major difficulties in getting access to diagnosis and care. Telemedical approaches to assessments are promising and seem well accepted, reducing the burden of bringing patients to specialized clinics. However, many older adults are not yet adequately equipped to allow for proper implementation of this technology. A potential solution could be a mobile unit in the form of a van, equipped with the telemedical system which comes to the patients’ home. The aim of this proof-of-concept study is to evaluate the feasibility and reliability of such mobile unit settings for remote cognitive testing. Methods and analysis: eight participants (aged between 69 and 86 years old) from the city of Digne-Les-Bains volunteered for this study. A basic neuropsychological assessment, including a short clinical interview, is administered in two conditions, by telemedicine in a mobile clinic (equipped van) at a participants’ home and face to face in a specialized clinic. The administration procedure order is randomized, and the results are compared with each other. Acceptability and user experience are assessed among participants and clinicians in a qualitative and quantitative manner. Measurements of stress indicators were collected for comparison. Results: The analysis revealed no significant differences in test results between the two administration procedures. Participants were, overall, very satisfied with the mobile clinic experience and found the use of the telemedical system relatively easy. Conclusion: A mobile unit equipped with a telemedical service could represent a solution for remote cognitive testing overcoming barriers in rural areas to access specialized diagnosis and care.

Using Telemedicine During the COVID-19 Pandemic: Attitudes of Adult Health Care Consumers in Israel

Introduction: The COVID-19 pandemic has affected health care services worldwide due to lockdowns, prevention measures, and social distancing. During this period, patients, including older adults and those with chronic conditions, need ways to obtain medical attention other than going physically to the clinic, such as telemedicine services. The purpose of the present study was to evaluate attitudes toward telemedicine during the COVID-19 lockdown in Israel, assess willingness to use such services in the future, and evaluate the extent to which consumers have changed their minds regarding these services. Method: A cross-sectional, descriptive, correlational study was conducted among adults (age 20-90) using social media networks (N = 693). Data were collected using an online questionnaire explicitly designed to measure attitudes toward telemedicine. Results: Most of the participants had to use telemedicine during the lockdown and were satisfied therewith. The majority also stated that they would continue using telemedicine in the future. However, only a third stated that they had changed their minds regarding telemedicine. The main predictors of willingness to use telemedicine in the future were the necessity of using such services during lockdown, preference for going to a clinic, and satisfaction with telemedicine, alongside gender and having a chronic illness. Importantly, we found that a preference for visiting the clinic was negatively correlated with willingness to use telemedicine in the future. Education and being single were predictors of the change of mind regarding telemedicine. Participants with chronic conditions are more likely to use these services, and specific attention should be directed to their needs. A small portion of the study sample prefers live appointments with a physician. Conclusions: Telemedicine use is rapidly changing. It is vital for health care providers to identify non-telemedicine users and their common characteristics. Monitoring patients' attitudes regarding telemedicine is essential in the future after the pandemic ends. Targeted outreach plans should be formulated. These plans should be directed at identifying barriers to using telemedicine, and they should generate specific, focused plans.

Goals of care conversations and telemedicine

Rapid expansion of telemedicine is one of the transformative healthcare consequences of the COVID pandemic. As a result, telemedicine has allowed clinicians to address the needs of older adults with cancer, who faced the highest risks from COVID, while maintaining safety at home. In light of the COVID experience, which is an important source of learning, this article provides guidance on approaches to enhance telemedicine-enabled supportive care for the geriatric cancer patient.

The most used questionnaires for evaluating telemedicine services

Background

Questionnaires are commonly used tools in telemedicine services that can help to evaluate different aspects. Selecting the ideal questionnaire for this purpose may be challenging for researchers. This study aims to review which questionnaires are used to evaluate telemedicine services in the studies, which are most common, and what aspects of telemedicine evaluation do they capture.

Methods

The PubMed database was searched in August 2020 to retrieve articles. Data extracted from the final list of articles included author/year of publication, journal of publication, type of evaluation, and evaluation questionnaire. Data were analyzed using descriptive statistics.

Results

Fifty-three articles were included in this study. The questionnaire was used for evaluating the satisfaction (49%), usability (34%), acceptance (11.5%), and implementation (2%) of telemedicine services. Among telemedicine specific questionnaires, Telehealth Usability Questionnaire (TUQ) (19%), Telemedicine Satisfaction Questionnaire (TSQ) (13%), and Service User Technology Acceptability Questionnaire (SUTAQ) (5.5%), were respectively most frequently used in the collected articles. Other most used questionnaires generally used for evaluating the users’ satisfaction, usability, and acceptance of technology were Client Satisfaction Questionnaire (CSQ) (5.5%), Questionnaire for User Interaction Satisfaction (QUIS) (5.5%), System Usability Scale (SUS) (5.5%), Patient Satisfaction Questionnaire (PSQ) (5.5%), and Technology Acceptance Model (TAM) (3.5%) respectively.

Conclusion

Employing specifically designed questionnaires or designing a new questionnaire with fewer questions and more comprehensiveness in terms of the issues studied provides a better evaluation. Attention to user needs, end-user acceptance, and implementation processes, along with users' satisfaction and usability evaluation, may optimize telemedicine efforts in the future.

Acceptance of e-consult for Substance Use Disorders during the COVID 19 pandemic: A study from India

OBJECTIVES

The COVID 19 pandemic has created challenges in providing timely care for patients and families with Substance Use disorders (SUDs). With the difficulties in face-to-face consultations because of social distancing measures, telepsychiatry services can be beneficial. The study proposes implementing an e-consult for SUD management and measuring its acceptability among the health care providers (HCPs) in India.

METHODS

The mobile-based e-consult for SUD, connecting HCPs with addiction specialists, was implemented during the COVID lockdown period in India from 25 March to 31 May (71 days). A total of 153 HCPs, i.e., doctors, nurses, counselors, consulted for 110 cases of SUD. Sixty-eight provided feedback by filling the survey form derived from the Service User Technology Acceptability Questionnaire (SUTAQ).

RESULT

More than 60% of HCPs reported overall high satisfaction. More than 98% providers reported high acceptability concerning"access to specialist care," "trusted to work appropriately", "saving time," "would like torecommend to others," easier to get touch with a specialist." The doctors reported significantly high acceptability about "access to specialist care," "satisfied with recommendations,"recommend to others" compared to other HCPs.

CONCLUSION

During COVID 19 pandemic lockdown in India, e-consult was an acceptable tool in managing SUDs. The majority of HCPs could discuss their cases with addiction experts. There is a need to expand this further in other mental health conditions.

Primary Care Professionals' Acceptance of Medical Record-Based, Store and Forward Provider-to-Provider Telemedicine in Catalonia: Results of a Web-Based Survey

While telemedicine services enjoy a high acceptance among the public, evidence regarding clinician’s acceptance, a key factor for sustainable telemedicine services, is mixed. However, telemedicine is generally better accepted by both patients and professionals who live in rural areas, as it can save them significant time. The objective of this study is to assess the acceptance of medical record-based, store and forward provider-to-provider telemedicine among primary care professionals and to describe the factors which may determine their future use. This is an observational cross-sectional study using the Catalan version of the Health Optimum questionnaire; a technology acceptance model-based validated survey comprised of eight short questions. The online, voluntary response poll was sent to all 661 primary care professionals in 17 primary care teams that had potentially used the telemedicine services of the main primary care provider in Catalonia, in the Central Catalan Region. The majority of respondents rated the quality of telemedicine consultations as “Excellent” or “Good” (83%). However, nearly 60% stated that they sometimes had technical, organizational or other difficulties, which might affect the quality of care delivered. These negatively predicted their declared future use (p = 0.001). The quality of telemedicine services is perceived as good overall for all the parameters studied, especially among nurses. It is important that policymakers examine and provide solutions for the technical and organizational difficulties detected (e.g., by providing training), in order to ensure the use of these services in the future.

Cross-sectional study about the use of telemedicine for type 2 diabetes mellitus management in Spain: patient's perspective. The EnREDa2 Study

OBJECTIVES

The usefulness of telemedicine (TM) in type 2 diabetes mellitus (T2DM) has been discussed in recent years. The aim of this study is to describe patients' perceptions about TM and to identify preferences on TM resources, in Spain.

DESIGN

An observational, cross-sectional study was conducted using a structured questionnaire.

PARTICIPANTS

1036 patients with T2DM accepted to participate in the study (response rate: 68%).

RESULTS

Blood glucose values were recorded by 85.9% of the patients while data such as lifestyle habits were only recorded by 14.4% of the patients. Previous experience in TM was reported by 9.8% of the patients, out of which 70.5% were satisfied with its service and 73.5% considered that the use of TM had optimised their T2DM management. However, most of these patients noted aspects to be improved such as user-friendliness (81.4%), interaction with the medical team (78.4%) and time required for recording/transferring data (78.4%). Experienced patients had better perception about TM usefulness than naïve patients for all listed aspects (p<0.05). Among naïve patients, 38.2% expressed their willingness to participate in TM programmes, but only 4.7% were invited to do so. Patients considered that physicians' (77.5%) and pharmacists' (75.5%) encouragement can boost the use of TM.

CONCLUSIONS

In Spain, nearly 10% of patients with T2DM have experience with TM and it is well accepted, especially one based on glucometers. Nevertheless, in order to promote TM use, easier and time-saving programmes for patient-physician interaction should be optimised.

The Service User Technology Acceptability Questionnaire: Psychometric Evaluation of the Norwegian Version

Background

When developing a mobile health app, users’ perception of the technology should preferably be evaluated. However, few standardized and validated questionnaires measuring acceptability are available.

Objective

The aim of this study was to assess the validity of the Norwegian version of the Service User Technology Acceptability Questionnaire (SUTAQ).

Methods

Persons with type 2 diabetes randomized to the intervention groups of the RENEWING HEALTH study used a diabetes diary app. At the one-year follow-up, participants in the intervention groups (n=75) completed the self-reported instrument SUTAQ to measure the acceptability of the equipment. We conducted confirmatory factor analysis for evaluating the fit of the original five-factor structure of the SUTAQ.

Results

We confirmed only 2 of the original 5 factors of the SUTAQ, perceived benefit and care personnel concerns.

Conclusions

The original five-factor structure of the SUTAQ was not confirmed in the Norwegian study, indicating that more research is needed to tailor the questionnaire to better reflect the Norwegian setting. However, a small sample size prevented us from drawing firm conclusions about the translated questionnaire.

Patients' perception of using telehealth for type 2 diabetes management: a phenomenological study

Background

There is a growing body of evidence that supports the uses of telehealth to monitor and manage people with diabetes at a distance. Despite this, the uptake of telehealth has been low. The objective of this study is to explore patients’ perceptions of using telehealth for type 2 diabetes management.

Methods

Semi-structured interviews were undertaken with 10 patients from the NHS Newham area in London, UK. Data were collected using recorded semi-structured interviews. The interviews were transcribed verbatim and the analysis was guided by the phenomenological analysis approach.

Results

We identified three main themes for facilitating positive patient experience or acceptance of telehealth and these included: technology consideration, service perceptions and empowerment. All patients asserted that they were pleased with the technology and many also proclaimed that they could not see themselves being without it. Moreover, very few negative views were reported with respect to the use of telehealth.

Conclusion

The patients’ perceived telehealth as a potential to enhance their quality of life, allow them to live independently at home as well as help them take and be in more control over their own health state. The findings of this study therefore supports the use of telehealth for the routine care of people with type 2 diabetes. However, one must interpret the results with caution due to limitations identified in the sample.

The Model for Assessment of Telemedicine (MAST): A scoping review of empirical studies

The evaluation of telemedicine can be achieved using different evaluation models or theoretical frameworks. This paper presents a scoping review of published studies which have applied the Model for Assessment of Telemedicine (MAST). MAST includes pre-implementation assessment (e.g. by use of participatory design), followed by multidisciplinary assessment, including description of the patients and the application and assessment of safety, clinical effectiveness, patient perspectives, economic aspects organisational aspects and socio-cultural, legal and ethical aspects. Twenty-two studies met the inclusion criteria and were included in the review. In this article, research design and methods used in the multidisciplinary assessment are described, strengths and weaknesses are analysed, and recommendations for future research are presented.

Validity of the Model for Assessment of Telemedicine: A Delphi study

Introduction

In 2009, the Model for Assessment of Telemedicine (MAST) was developed within the MethoTelemed project as a framework for description of the effectiveness of telemedicine applications. The goal was for the assessments to be used as basis for decision-making in healthcare systems. Since then, MAST has been used in many European telemedicine studies and is now the most widely used model for assessment of telemedicine. The aim of this study was to assess the face validity of MAST.

Methods

A modified Delphi process was carried out and included a workshop with a sample of healthcare decision makers. A total of 56 decision makers and experts in telemedicine were invited and 19 persons participated in the two Delphi rounds. Thirteen hospitals or regional health authorities from 12 European countries and six research organisations were represented in the final sample. The participants were asked to assess the importance of the different domains and topics in MAST on a 0–3 Likert scale.

Results

All respondents completed the two rounds. Based on the answers, the face validity of all MAST domains was confirmed, since all domains were considered moderately or highly important by more than 80% of the respondents.

Discussion

Even though the study confirmed the validity of MAST, a number of supplements and improvements regarding study design and data collection were suggested. When considering the results it should be noticed that the sample size was small and larger studies are needed to confirm the results.