JMIR Publications

ABSTRACT

Background:

Noncommunicable diseases (NCDs) account for over 70% of global deaths, with hypertension and diabetes serving as major contributors. The COVID-19 pandemic disrupted traditional healthcare services for NCDs and highlighted telehealth as a crucial alternative. Telehealth – encompassing synchronous and asynchronous electronic communication to deliver clinical services remotely – can overcome geographical barriers and enhance patient engagement. However, telehealth usability among healthcare professionals (HCPs) remains understudied across low-, middle-, and high-income countries.

Objective:

This study aimed to examine which telehealth engagement patterns, technical infrastructure factors, and user profiles were most strongly associated with usability among HCPs, and to descriptively compare these across four diverse countries: Brazil (HMIC), Ghana (LMIC), Honduras (LMIC), and the United Kingdom (HIC).

Methods:

A multinational cross-sectional survey was conducted with 290 HCPs across four countries. Participants completed the System Usability Scale (SUS) and provided data on telehealth engagement (e.g., frequency, duration, number of systems used), technical infrastructure (connection stability, support satisfaction), and their user profile (demographics, job role, training received). Descriptive statistics summarized these patterns and usability scores. Multiple linear regression with bootstrap-based sensitivity analyses identified factors associated with telehealth usability. Given the non-probability design, no formal inferential comparisons were made between countries. Instead, observed patterns were reported descriptively.

Results:

Higher telehealth usability scores were associated with greater connection stability (95% CI = [2.71, 7.14]), higher satisfaction with online support information (95% CI = [2.91, 7.30]), more frequent use (95% CI = [1.32, 4.73]), longer duration of use (95% CI = [0.56, 2.64]), and being a physician by profession (95% CI = [0.02, 7.65]). Average usability scores were highest among users in Ghana (M = 79.75) and the UK (M = 79.00), followed by Brazil (M = 72.01) and Honduras (M = 63.09). According to SUS guidelines, scores corresponded to ‘good’ usability for users in Ghana, the UK, and Brazil, and below the ‘good’ threshold for users in Honduras. While the majority of users in Ghana (87.4%), Honduras (81.6%), and Brazil (71.3%) reported using only one telehealth system, two-thirds of UK users (66.7%) reported using two or more systems. User profiles also varied; pre-pandemic use was highest in Ghana (75.5%) and lowest in Honduras (18.4%). Other engagement patterns across countries are reported.

Conclusions:

Telehealth usability is driven by technical infrastructure reliability, a robust online support infrastructure, and an ‘experience effect’ from frequent and long-term engagement. Descriptive differences in engagement patterns and infrastructure highlight the need for tailored strategies to address setting-specific challenges. These are essential to optimize telehealth integration and improve healthcare outcomes for NCD patients globally.