JMIR Publications

ABSTRACT

Background:

The shortage of medical resources in rural China reflects the health inequity in resource-limited settings, while telemedicine could provide opportunities to fill this gap. However, evidence of patient’s acceptance of telemedicine services from low and middle-income countries is still lacking.

Objective:

This study aims to understand the profile of patient end-user telemedicine utilization and identify factors influencing telemedicine service utilization in rural China.

Methods:

Our study followed a mixed-method approach, with a quantitative cross-sectional survey followed by in-depth semi-structured interviews to describe telemedicine usage and its associated factors among rural residents in Guangdong Province, China. In quantitative analysis, explanatory variables include environmental/context factors, household-level factors, individual sociodemographic factors, access to digital health care, and health needs/demand factors. Univariate analysis and multivariable analysis were conducted using Firth logistic regression to examine correlates of telemedicine uptake. A thematic approach was used, guided by Social Cognitive Theory for the qualitative analysis.

Results:

A total of 2101 households were recruited for the quantitative survey. With a mean age of 61.4 (61.40.65) years old, more than 70% (72.9%) of the household respondents were male. Less than 1% (0.67%, 14/2101)of the respondents reported experience of using telemedicine. The quantitative results supported that villagers living with family members who caught a fever in the past two weeks (aOR: 6.96, 95% CI:2.20~21.98, P=.001) or having smartphones/computers (aOR: 3.71, 95% CI: 0.64~21.32, P=.14) had marginally higher telemedicine uptake, while the qualitative results endorse these findings. Results of qualitative interviews (n=27) also supplemented the potential barriers to telemedicine utilization from the lack of knowledge, trust, demand, low self-efficacy, and sufficient physical and social support.

Conclusions:

The present study found extremely low utilization of telemedicine in rural China and potential factors affecting telemedicine uptake. This work also suggests main issues to address for enhancing telemedicine scaling up in rural China, including improving digital literacy, building trust and self-efficacy, and strengthening the technical support and delivery system. Clinical Trial: ChiCTR2100053872