Assessing patient confidence in telehealth: Comparing across 17 medical specialties

Abstract

Background

Telehealth has become an increasingly vital component of healthcare delivery, particularly after the COVID-19 pandemic. As telemedicine expands its reach, understanding patient confidence in using telehealth services across different medical specialties is crucial for its continued adoption.

Objective

This study aims to address this need by exploring patient confidence in telemedicine for various health conditions.

Methods

A cross-sectional study was conducted using an online self-administered survey. We collected data from 390 respondents, examining demographic information, patient confidence levels, and factors influencing their confidence. The survey included 27 questions and focused on health conditions where telehealth is most applicable, such as chronic disease management, mental health services, and preventive care. Participants rated their confidence in using telehealth for various conditions on a 5-point Likert scale.

Results

The overall confidence score averaged 3.3 (SD = 0.713), indicating moderate confidence among participants. The Friedman test revealed significant variability in patients’ reported confidence levels regarding the use of telehealth across different medical specialties. General consultations were rated the highest (mean rank = 11.97), while emergency scenarios received the lowest confidence ratings (mean rank = 6.19).

Conclusions

These findings suggest that patient confidence in telehealth varies significantly across different medical scenarios, emphasizing the need for tailored telehealth strategies to address specific patient concerns and improve confidence in its use. Developing specialty-specific guidelines and policies can further support the effective integration and adoption of telehealth in the delivery of care.

Keywords

Telemedicine telehealth digital health virtual health patient preference physician-patient relations patient-centered care

Introduction

Telehealth defined as “the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health, and health administration”.¹ In recent years, the adoption of telehealth has accelerated significantly, primarily driven by the COVID-19 pandemic.² Its benefits include improved accessibility, cost effectiveness, and convenience, making it a viable alternative to in-person visits.^3,4 In response to the pandemic, many countries, including Saudi Arabia, implemented telehealth at the national level. The Saudi Ministry of Health (MOH) launched key initiatives such as Sehhaty, a digital platform for Telemedicine Service, and the Saudi Virtual Hospital (SVH).^5,6 However, the appropriateness of telehealth remains concern particularly regarding its ability to fully replace face-to-face consultations.⁷

Despite its potential, telehealth cannot entirely replace face-to-face medical visits. Several factors determine the appropriateness of telehealth, including the timing of the visit, personal preferences, technological availability, individual patient factors, and clinical considerations.⁴ These factors collectively influence whether telehealth is a suitable option for a particular patient or condition.

Previous studies have assessed the appropriateness of telehealth from both patient and physician perspectives, identifying challenges in comparing their views.^8,9 These challenges include accounting for confounding variables such as the severity of the medical condition, the urgency of care required, and specific patient demographics.¹⁰ Therefore, a comprehensive understanding of telehealth's appropriateness requires considering these variables. While many studies have examined the challenges and barriers of telehealth, including technological limitations, privacy concerns, digital literacy, and disparities in access,¹¹ fewer have focused on patient confidence and perceived usefulness as key determinants of telehealth adoption. Existing research highlights concerns about clinical accuracy, trust, and the ability of telehealth to fully replace in-person care,¹² but there is limited understanding of how confidence varies across medical specialties. This study addresses this gap by systematically analyzing patient confidence in telehealth across different conditions while considering factors such as disease severity, prior knowledge, and specialty-specific variations.

While telehealth is valued for its accessibility and convenience, there is limited understanding of patient confidence across medical specialties. This study addresses this gap by systematically examining patients’ perceived appropriateness of telehealth for various conditions, offering insights into its clinical suitability in specialties such as neurology, cardiology, and mental health. Although many studies have explored telehealth appropriateness, few have compared patient perspectives across multiple specialties, including routine checkups, neurology, cardiology, and mental health.¹³

The perceived suitability of telehealth for a given health condition directly influences patient confidence. When patients perceive telehealth as capable of delivering an accurate diagnosis or effective treatment, they are more likely to trust and accept it as a viable mode of care. According to the Technology Acceptance Model (TAM), patient confidence in telehealth can be understood through perceived usefulness.¹⁴ Confidence plays a crucial role in the acceptance and use of telehealth services. During the COVID-19 pandemic, patient confidence in telehealth varied widely based on individual experiences and perceptions.¹³ One study found that building trusting medical relationships and assessment accuracy were significant concerns, with 93% of clinicians and 86% of patients rating telemedicine as worse than face-to-face for assessment accuracy.¹⁵ Another study found that patients are more likely to trust Telehealth services if they know the healthcare professional they are talking with.¹⁶ This emphasize the importance of confidence in telehealth's effectiveness and patient satisfaction.

Measuring Telehealth confidence provides a valuable framework for measuring patient confidence by focusing on key dimensions such as clinical accuracy and trust. By measuring patients confidence, we will be able to understand the variation across specialties, adjusting for factors like disease severity and prior patient knowledge. The Telehealth Confidence Tool, which measures confidence across four areas, reveals variations in confidence based on health conditions.¹⁷ This study focuses on these variations while adjusting for other factors, providing a clearer understanding of confidence dynamics in telehealth.

Measuring patient confidence in telehealth across different specialties provides deeper understanding to evaluating its effectiveness and predicting its acceptance and long-term adoption.¹⁸ TAM offers a valuable framework for this analysis, as it posits that patient confidence is influenced by perceived usefulness, or the extent to which patients believe telehealth enhances the quality and accessibility of their care.¹⁴ High confidence levels are likely to lead to increased acceptance and consistent usage of telehealth, while lower confidence may result in reluctance to adopt this mode of care, particularly in more complex or high-risk medical specialties.¹⁸ Furthermore, variations in confidence can directly influence health outcomes. Patients with lower confidence in telehealth may postpone seeking medical care, particularly for conditions they believe require in-person evaluation. This reluctance could contribute to delays in diagnosis and treatment, potentially worsening health outcomes and exacerbating existing healthcare disparities.

Furthermore, patient confidence in telehealth has important implications for healthcare policy and the effective implementation of telemedicine services. Identifying the factors that influence confidence can enable health systems to develop specialty-specific telehealth strategies and adapt services to the needs of diverse patient populations. This can enhance the effectiveness and equitable adoption of telehealth, ensuring its optimal integration into healthcare delivery. A better grasp of these dynamics could also inform the development of training programs for clinicians, designed to improve virtual care delivery and patient communication.¹⁹ Ultimately, the findings from this study could guide future telehealth policies aimed at improving accessibility, satisfaction, and health outcomes across a diverse patient population.

Qualitative studies reveal that doctors often speculate on what they believe patients want or need from telehealth services. These insights can sometimes misalign with actual patient preferences, highlighting the need for direct patient feedback.²⁰ For instance, some doctors believe patients prefer the convenience of telehealth, while patients might prioritize accurate assessments and personal interaction.²¹ Despite the increasing number telehealth studies in the recent years, limited evidence is available in the perceived effectiveness and confidence in telehealth across the different health specialties.^22,23

This study aims to fill this gap in telehealth research by systematically comparing patient confidence across different specialties. The study focuses on the following objectives:

Assess patient confidence in telehealth across various medical specialties.

Assess key factors that influence patient decisions regarding telehealth usage, including disease severity, type of disease, prior knowledge, and time constraints.

By examining the confidence patients have in telehealth across different specialties, this study not only fills a significant gap in current research but also offers critical insights that could guide more effective, patient-centered telehealth practices in the future.

Methods

Study design

A cross-sectional quantitative study was conducted to evaluate patients’ confidence in using telehealth for various health condition visits. Data were collected using an online self-administered survey. The survey contained three sections: demographic information, patients’ confidence in telemedicine, and factors influencing their confidence in telehealth (Appendix 1). The survey included a total of 27 questions and estimated time to complete the survey was 15 minutes.

Within the survey, participants were asked to rate their confidence in using telehealth for different health conditions on a 5-point Likert scale, ranging from “Very Confident” to “Very Unconfident.” The selection of health conditions for the survey was informed by a review of existing literature on telehealth applications, scope of services, and utilizations.^23–26 This process ensured that the survey included a comprehensive list of health conditions where telehealth is most relevant, such as chronic disease management, mental health services, and preventive care. The survey was developed by the researcher and validated for face and content validity using Lawshe's method, which involved a group of experts consisting of a statistician, two health informatics specialists, a public health professional, and a medical doctor.^27,28 Pre-testing with 32 participants was conducted to refine survey questions and evaluate clarity, content validity, and internal reliability. The instrument demonstrated excellent internal consistency, with a Cronbach's alpha of 0.917.²⁹

Sampling and setting

The sample size for our study was calculated using G*Power 3.1.9.7.³⁰ The Wilcoxon-Mann-Whitney test was selected for its suitability in comparing two independent samples. The analysis aimed to detect a medium effect size (d = 0.5), with an alpha error probability set at 0.05 and statistical power at 0.95 to ensure sufficient sensitivity for identifying significant differences. Based on these parameters, the required total sample size was determined to be 220, allocating 110 participants to each group. To account for potential dropouts and increase the robustness of our findings, we recruited a total of 390 participants.

Participants were recruited using convenience sampling from Jazan University, Jazan, Saudi Arabia. A university setting chosen to ensure adequate technological proficiency and minimize potential confounding effects related to digital literacy. This enabled us to focus on assessing participants’ confidence in using telehealth for various health conditions without technological barriers influencing their responses.

Ethical considerations

This study was approved by the Ethics Approval Committee at Jazan University (Approval Number: REC-45/07/962). Participants were provided with detailed study information and an informed consent form before participation. The study information and consent form outlined the study objectives, voluntary nature of participation, potential risks, and data handling procedures.

To ensure anonymity and confidentiality, no personal identifying information was collected. Data were stored securely within the Research Electronic Data Capture (REDCap) system, a secure, web-based platform that adheres to stringent data protection standards. Participants had the right to withdraw at any time or skip any question without justification.

Data collection

Data collection was conducted between December 2023 and March 2024. A total of 1083 individuals agreed to participate in the study and received an invitation letter containing a URL and QR code linking to the survey materials. The survey materials included an informed consent form, a detailed description of the study, and the survey instrument. Of those invited, 477 participants (44.0%) completed the survey. During the analysis, 87 responses (18.2%) were excluded due to missing data, resulting in a final sample of 390 participants. Participants eligible for inclusion in the study were individuals aged 18 years or older with sufficient technological proficiency to complete an online survey. They were required to provide informed consent and demonstrate familiarity with telehealth services. Exclusion criteria included individuals below 18 years of age. Written informed consent was obtained from all participants prior to their participation in the study. Participation was voluntary, and invited participants were able to withdraw or skip questions at any point. The survey utilized convenience sampling and was administered online via REDCap, a secure, web-based platform that supports robust data collection and management, complying with stringent research standards.³¹

Statistical analysis

Data analysis was performed using SPSS software v23.³² Descriptive statistics, including means and percentages, were calculated to summarize the data. Friedman test was conducted to assess differences in participant ratings across various health conditions. The Mann-Whitney U test was also conducted to determine significant differences in telemedicine confidence between male and female participants.

Results

Of the 477 responses received, 87 (18.2%) were excluded due to missing data, resulting in a final analytical sample of 390 participants. Of the 390 sample, 37.95% were male, and 61.79% were female. The majority of participants were single (n = 312, 80.2%), followed by married (n = 69, 17.7%) and the remaining participants were either divorced or had missing data. The majority of participants were aged 18 to 24 (n = 309, 78.8%), followed by those aged 25 to 34 (n = 41, 10.5%). The remaining participants were distributed across older age groups, with fewer than 5% in each category.

The overall confidence in using telemedicine, including diagnosis and delivery of care, had a mean score of 3.3 (SD = 0.713), indicating a moderate level of confidence. A gender-based analysis revealed that males (N = 148) reported a higher confidence rating in telemedicine (M = 3.44, SD = 0.682, 95% CI [3.33, 3.55]) compared to females (N = 241), who had a mean confidence rating of 3.22 (SD = 0.721, 95% CI [3.12, 3.31]). The Mann-Whitney U test showed a significant difference in confidence levels between males and females (p = 0.006), with males demonstrating slightly higher confidence.

In response to the inquiry regarding prior use of telehealth, 120 participants reported having used telehealth before, 200 participants had not, and 70 participants were unsure or had missing data. The Mann-Whitney U test results indicated a significant difference in confidence ratings between participants who had used telehealth and those who had not (p = 0.001). Those with prior telehealth experience reported higher confidence (mean rank = 180.37, mean = 3.48, SD = 0.799) compared to those without experience (mean rank = 148.58, mean = 3.20, SD = 0.665). This suggests that prior use of telehealth significantly influences confidence levels in telemedicine, with experienced users exhibiting greater confidence.

The Friedman test was conducted to compare participants ratings of their confidante in using telehealth for each of the 17 different health conditions. The results revealed significant differences in the mean ranks of the health conditions (Chi-square = 1120.614, df = 16, p < 0.001). The mean ranks for the health conditions varied significantly (see Table 1). The highest mean rank was observed for condition general consultations (11.97), indicating it was rated most favorably, while the lowest mean rank was observed for emergency (6.19), indicating it was rated least favorably (Figure 1). The significant p-value (< 0.001) suggests that there are statistically significant differences in the ratings of the health conditions. This indicates variability in participants’ confidence levels in using telehealth across different medical specialties.

Figure 1.

Bar chart comparing the mean rank of participants confidence in using telehealth across the different medical specialties.

Table 1.

Participants’ confidence ratings in using telehealth for various medical specialties.

Medical specialty	Mean	SD*	Mean rank
General consultation	3.95	0.878	11.97
Diagnosis of disease	3.05	1.018	8.20
Pharmacy and medication refill	3.97	0.974	11.91
General medical checkups and preventive care	3.35	1.134	9.58
Managing chronic diseases	3.62	1.118	10.79
Common respiratory infections	3.57	1.107	10.55
Dermatological conditions	3	1.195	7.94
Managing chronic pain conditions	3.09	1.174	8.39
Mental health	3.5	1.239	9.98
Gynecology and reproductive health consultations	3.09	1.206	8.29
Musculoskeletal conditions	3	1.137	7.91
Managing neurological conditions	3.14	1.18	8.63
Pediatric health consultations	3.12	1.218	8.53
Ophthalmology and eye-related consultations	2.83	1.234	7.26
Cardiovascular conditions	2.59	1.269	6.23
Minor injuries or wounds	3.64	1.155	10.65
Emergency or acute conditions	2.53	1.367	6.19

Standard deviation.

Figure 2, highlight clear variations across the four primary care categories: Basic and Preventive Care, Chronic Care, Acute Care, and Specialty Care. Patients demonstrated the highest confidence in Basic and Preventive Care, with mean scores exceeding 3.9. Chronic Care received moderate ratings, reflecting variability in managing long-term conditions. Acute Care, represented by a mix of lighter shades, displayed the widest range, with emergency conditions scoring the lowest (2.53). Lastly, Specialty Care had comparatively lower confidence scores, indicating potential challenges in telehealth's suitability for specialized or complex medical needs.

Figure 2.

Mean scores of patients’ confidence in using telehealth services across medical specialties, rated on a 5-point Likert scale (1 = not confident, 5 = highly confident).

Participants rated the importance of various factors affecting their decision to use telehealth, as shown in Table 2. Severity of disease and the type of health condition received the highest importance ratings, with means of 4.26 (SD = 0.931, 95% CI [4.15, 4.35]) and 4.24 (SD = 0.966, 95% CI [4.12, 4.33]), respectively. Previous knowledge about one's condition and available time were also influential, scoring 4.11 (SD = 0.941, 95% CI [3.99, 4.19]) and 3.97 (SD = 1.045, 95% CI [3.84, 4.06]), respectively. Analysis revealed no significant differences in these ratings between genders, highlighting uniform perceptions across the demographic. Additionally, comparisons between groups who had previously used telehealth and those who had not revealed no significant differences in the ratings of these factors.

Table 2.

Participants rating of the importance of these factors on their decision to use telehealth.

Influencing factors	Mean	SD
Severity of disease	4.26	0.931
The type of health condition	4.24	0.966
My previous knowledge about my condition	4.11	0.941
Time available	3.97	1.045

Discussion

Our study has provided valuable insights into patients’ confidence in telehealth services. By assessing both general confidence levels and confidence across specific medical specialties, we identified significant patterns in how patients perceive telehealth for different medical specialties, as well as the factors that might impact their confidence levels. We also compared the level of telehealth confidence between male and female.

Our finding indicate a moderate level of confidence in telehealth, with a mean score of 3.3 (SD = 0.713). Our study also revealed that participants confidence levels varied across medical specialties, with patients expressing the highest confidence in general consultations and the lowest confidence in emergency care. This finding is consistent with existing literature that suggests telehealth is perceived as more appropriate for certain types of consultations, such as general checkups and follow ups, compared to emergency or acute care.^7,9 This reflects ongoing concerns about the perceived suitability of telehealth in providing accurate diagnoses and treatment for complex or urgent conditions.⁹ The reported difference in confidence between general consultations and specific diagnoses highlights a critical area where telehealth may not yet fully meet patient needs, as confidence was lower for diagnostic purposes. A study focusing on endocrinologists’ use of telehealth further supports the notion that telehealth is particularly more suited for managing low complexity conditions that do not require physical examinations, such as chronic disease management.³³ This finding is consistent with our observation that telehealth is more appropriate for general consultations, reinforcing the broader concern that telehealth may be less effective in scenarios requiring complex diagnostic evaluations.³³

Furthermore, in line with findings from other studies, we found that prior experience with telehealth was associated with higher levels of confidence.³⁴ The moderate levels of confidence observed in this study have important implications for the ongoing implementation and expansion of telehealth services. The rapid adoption of telehealth during the COVID-19 pandemic significantly increased its usage, leading to greater familiarity and comfort among both patients and healthcare providers.^19,24 This increased exposure likely contributed to the overall rise in confidence in telehealth services.^19,24 However, to maintain and further build this confidence, it is crucial to continue to define clearly the appropriate applications and limitations of telehealth use.

The variation in the reported level of confidence between specialties indicates a need for clear guidelines and better understanding of telehealth suitability for clinical visits. This could involve developing specific protocols to ensure the accuracy and reliability of telehealth-based diagnoses, as well as educating both healthcare providers and patients about the limitations and capabilities of telehealth in different contexts. Our study showed that among the factors influencing patients’ decisions to use telehealth are the severity of the disease and the type of health condition. This is consistent with prior studies on physicians’ perspective on Telehealth appropriateness for the different types of visits.^2,9 A study by Gray et al.² revealed that factors such as patient acuity, the need for additional tests, and changes in health status play a crucial role are important for determining the suitability of telemedicine. Moreover, seeking a second opinion through telehealth can be especially beneficial. Our findings suggest that prior knowledge of a condition is a key factor influencing telehealth confidence. In situations where patients are already familiar with the condition, obtaining a second opinion through telehealth can provide additional reassurance and improve the accuracy of the diagnosis.

Although we included a comprehensive list of medical specialties, the variation within each specialty can significantly impact confidence levels, making it challenging to capture the full range of conditions in a single survey.³⁵ Different conditions within each specialty may vary in their suitability for telehealth, which could influence patients confidence.³⁵ For future studies, we recommend exploring the specific factors related to the health condition or the reason for the visit on patient confidence in telehealth. For example, conditions that require physical examinations, diagnostic tests, or hands-on treatments may lead patients to perceive telehealth as less effective, thus reducing their confidence.⁹ On the other hand, routine follow ups, medication management, or consultations that primarily involve discussion may be seen as more suitable for telehealth, enhancing patient confidence.

Additionally, the urgency of the medical condition and the perceived need for immediate, face-to-face interaction with a healthcare provider could influence patient trust in telehealth. Our findings showed the role of the severity of disease in influencing patient confidence in telehealth. Patients with more severe conditions, who perceive a higher urgency for face-to-face interaction and comprehensive physical examinations, may feel less confident in the effectiveness of telehealth for addressing their healthcare needs. Conversely, those with less severe conditions may find telehealth adequate for managing their care, thus expressing higher confidence levels.

However, the generalizability of our findings may be limited due to the study's convenience sampling from a university setting, which likely resulted in a participant pool with higher digital literacy and greater familiarity with telehealth than the general population. To improve external validity, future research should incorporate more diverse sampling methods, ensuring a broader representation of patients with varying levels of digital literacy and healthcare access.

Future research could explore the integration of emerging technologies, such as artificial intelligence (AI) and machine learning, to enhance the accuracy, efficiency, and user experience of telehealth services.²⁶ Advanced triage and pre-visit assessment tools, powered by these technologies, could play a crucial role in determining the suitability of telehealth for specific visits and managing patient expectations. By accurately assessing the severity and nature of a patient's condition before the consultation, these tools could help guide patients to the most appropriate type of visit, whether it be telehealth or an in-person visit. This could also account for patient-specific factors, barriers, and subgroup differences.

Conclusion

In conclusion, this study improved our understanding of patient confidence in telehealth services and the variation of their confidence across the different medical specialties. Our findings emphasized the importance of understanding patient perspectives on telehealth across different medical specialties and conditions to ensure that telehealth services meet their needs and expectations. The moderate level of confidence observed among participants suggests that despite telehealth promise to complement to traditional healthcare, there are areas where improvement is needed to fully understand and build trust and confidence.

Moreover, our study emphasized the significance of prior telehealth experience in patients’ confidence, suggesting that efforts to familiarize patients with telehealth services can positively impact their perception and willingness to use these services. Educating patients about the benefits and limitations of telehealth, particularly for different health conditions, is essential for informed decision making. The COVID-19 pandemic has highlighted the importance of telehealth, significantly boosting its popularity and adoption. The rapid and unplanned implementation of telehealth during the COVID-19 pandemic was an emergency response. As telehealth increasingly becomes a fundamental component of healthcare delivery, it is crucial to establish a well-defined scope for its use. This will help ensure its appropriate application across diverse medical specialties.

To ensure the effective implementation of telehealth, healthcare policies and clinical guidelines must account for variations in its suitability across medical specialties. Specialty-specific protocols should be established to maximize telehealth's effectiveness in areas such as chronic disease management and follow-up care, while maintaining its role as a complementary tool rather than a replacement for in-person visits in cases requiring physical examinations or complex diagnostics. Integrating these tailored approaches into healthcare systems can enhance patient confidence, improve clinical outcomes, and support the sustainable adoption of telehealth.

Finally, this study highlights the need for ongoing research to explore innovative strategies and technological advancements that can further enhance telehealth services and patient confidence. By addressing the challenges and opportunities identified in this study, healthcare providers and policymakers can work together to realize the full potential of telehealth as a valuable component of modern healthcare delivery.

Footnotes

Acknowledgements

The author would like to thank all participants who participated in this survey.

Guarantor

ORCID iD

Abdulrahman M Jabour

Ethical considerations

The Research Ethics Review Committee at Jazan University approved the study (approval: REC-45/07/962).

Author contributions/CRediT

The primary author AMJ has designed, conceptualized and conducted the study, including the analysis and writing.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: the funding was from the Deanship of Graduate Studies and Scientific Research, Jazan University, Saudi Arabia, through Project Number: GSSRD-24.

Conflicting interests

The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Appendix 1: Questioner

Part 1

Part 2

Part 3

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