From Constraint to Strategy: A Necessity-Based Perspective on Telemedicine Usage in Japan and China

Abstract

Objective:

Although public interest in telemedicine is growing, limited research has examined the necessary conditions for its usage. Therefore, this study aims to identify these conditions in Japan and China.

Methods:

A self-developed questionnaire was administered between 2022 and 2023, yielding 787 valid responses in Japan and 840 in China. In addition, 241 Japanese and 194 Chinese supplemental responses were collected in 2025. Factor analysis and necessary condition analysis (NCA) were applied.

Results:

Based on the initial samples, eight factors were extracted: cost and accessibility, social influence, safety and reliability, adaptive readiness, technology confidence, perceived data security, facilitating conditions, and perceived usefulness. NCA revealed cross-national differences. Japanese participants mainly regarded perceived usefulness (d = 0.12–0.31) and facilitating conditions (d = 0.15–0.29) as necessary conditions, whereas Chinese participants perceived a broader set of prerequisites. Subgroup analyses further indicated that safety and reliability were the most critical necessary conditions for experienced users in both countries (Japan: d = 0.44; China: d = 0.28). Hierarchical clustering analysis further revealed three bottleneck trajectories of constraints: gradual-bottleneck users (progressive constraints), high-bottleneck users (sudden demand surges), and early-bottleneck users (persistent initial constraints). Crucially, the supplemental samples further confirmed the reliability and validity of the eight-factor structure and the temporal consistency of the necessary conditions for sustained usage.

Conclusion:

The findings highlight the need for tailored telemedicine strategies. In particular, maintaining safety and reliability represents a nonnegotiable prerequisite for sustained telemedicine usage in both countries. The developed instrument, combined with NCA, offers a transferable approach for identifying constraints and developing more adaptive and equitable telemedicine strategies.