JMIR Publications

ABSTRACT

Background:

Healthcare technologies such as telemedical systems for physician consultation are being used increasingly by general practitioners (GPs). Rural areas in particular exhibit a rapidly ageing population, with an increase in associated health issues, while the level of attractiveness for working in those regions is decreasing for young physicians. Accordingly, integrating telemedical approaches in treating patients can help to lessen the professional workload and counteract the ongoing trend towards the spatial undersupply that can be seen in many countries. However, these novel ways of care engender interactions with patients, their private lives, and norms in unprecedented ways, calling for studies that incorporate patient needs, concerns, expectations, and behavior into the design and application of telemedical health technology within the field of primary care.

Objective:

This study seeks to unveil and compare acceptance-promoting factors of patients without (pre-users) and with experiences (actual users) in using telemedicine in primary care settings and provide implications for the design and theory of telemedical technology in health care.

Methods:

Twenty semi-structured interviews were conducted with patients in two rurally located primary care practices in order to identify and analyze patient needs, attitudes, and perceptions that facilitate the acceptance of telemedical technology and adoption behavior. Both pre-users and actual users of a telemedical video consultation system were engaged, allowing for an empirical comparison. For data analysis, a three-fold procedure was followed based on open, axial, and selective coding.

Results:

The study delivers several factors and respective subdimensions that foster the attitudes and perceptions of patients towards telemedicine in rural primary care. Factors cover (1) attitudes and expectations towards telemedical technologies, (2) the patient-physician-relationship and its impact on technology assessment and use, (3) patients’ rights and obligations that emerge with the introduction of telemedicine in primary care, and (4) the influence of social norms on the use of telemedicine and vice versa. With regard to these factors, results indicate differences between pre-users and actual users of telemedicine, which imply dedicated ways of designing and implementing telemedicine concerning the respective user group. Actual users attach higher importance to the perceived benefits of telemedicine and their responsibility to use it appropriately, which might be rooted in the technological intervention they experienced. On the contrary, pre-users highly value the opinions and expectations of their peers.

Conclusions:

The way the limitations and potential of telemedicine are perceived varies across patients. When practicing telemedicine, different aspects should be in focus when dealing with pre-users, such as maintaining a physical interaction with the physician or incorporating social cues. Once the digital intervention takes place, patients tend to value benefits such as flexibility and effectiveness over potential concerns.