JMIR Publications

ABSTRACT

Background:

Kazakhstan lacks a validated, contextually adapted tool to assess the usability and effectiveness of telemedicine services among physicians. Existing international instruments (TUQ, MAST) require linguistic, cultural, and methodological adaptation to ensure accurate application in the national context.

Objective:

To develop and validate TUQ MAST KZ, a Kazakhstan-adapted version of the TUQ-MAST questionnaire, to evaluate usability and perceived effectiveness of telemedicine services among physicians.

Methods:

A multi phase cross sectional study was conducted, including: literature review, expert evaluation of content validity, linguistic and cultural adaptation, and pilot testing. An online survey (Google Forms) was administered to 156 physicians from urban and rural medical settings in Kazakhstan (polyclinics, hospitals, medical universities, health administration). Participants represented various specialties: general practitioners, surgeons, pediatricians, nephrologists, cardiologists, anesthesiologists, and others. Primary outcomes included Cronbach’s alpha for internal consistency and expert assessment of content validity; secondary outcomes focused on feedback regarding questionnaire clarity and practical usability.

Results:

The adapted TUQ MAST KZ questionnaire consists of 27 items organized into 7 thematic domains, reflecting a multidimensional approach to telemedicine assessment. Of these, 11 items are rated using a Likert scale to evaluate reliability, while the remaining 16 items are dichotomous or open-ended, addressing organizational and systemic factors such as leadership support, regulatory barriers, and infrastructure. Reliability Cronbach’s alpha was 0.93, indicating high (excellent) internal consistency among the Likert-scale items. Content Validity Expert evaluation confirmed that all 27 items are relevant and understandable for clinicians, ensuring the instrument’s practical significance. Face Validity Respondents noted that the questionnaire is: • clearly structured by domains; • easy to read and intuitively understood at first glance; • practically applicable in routine clinical practice. The inclusion of organizational system questions revealed key factors influencing telemedicine implementation—namely, leadership support, existing regulatory barriers, and infrastructure readiness. This highlights the comprehensive nature of the TUQ MAST KZ, which extends its assessment from usability to real-world implementation factors. Conclusions TUQ MAST KZ is a valid, reliable, and practical tool for assessing telemedicine services among physicians in Kazakhstan. It can support digital health monitoring, implementation analysis, and policymaking. Future comparative studies are recommended to confirm its applicability across regions and medical specialties.

Conclusions:

This study involved the development, cultural adaptation, and initial validation of the TUQ-MAST-KZ questionnaire designed to evaluate physicians' perceptions, usability, and perceived effectiveness of telemedicine services within the Kazakhstani healthcare context. The instrument integrates two internationally recognized frameworks—TUQ [13] and MAST [14] - which ensures both methodological continuity and local relevance. To our knowledge, TUQ-MAST-KZ is the first validated tool for comprehensive telemedicine assessment among physicians in Central Asia, as supported by a systematic literature review. A pilot survey conducted among 156 physicians of various specialties confirmed high reliability (Cronbach’s alpha coefficient α = 0.93) and strong content validity. Key findings from the analysis included: • positive perceptions of telemedicine platforms regarding usability, accessibility, and effectiveness; • a significant demand among healthcare professionals for additional training and methodological support; • inadequate implementation of telemonitoring and artificial intelligence tools in practical healthcare settings; • organizational barriers, such as the absence of standardized protocols and dedicated telemedicine coordinators within institutions; • the willingness of a considerable proportion of physicians to recommend telemedicine as an effective service model for certain patient groups. The proposed TUQ-MAST-KZ questionnaire can be effectively utilized for assessing the digital maturity of healthcare organizations, developing educational programs, planning telemedicine implementation, and scientifically monitoring technology acceptance. The results obtained form a foundation for future research stages, including large-scale validation of the instrument and the establishment of an evidence-based digital maturity index (KazTeleHealthIndex), which will be further elaborated in forthcoming studies. Clinical Trial: Not applicable (this study was not a clinical trial and therefore was not registered).