Accepted for/Published in: JMIR Formative Research
Date Submitted: Nov 1, 2025
Open Peer Review Period: Nov 1, 2025 - Dec 27, 2025
Date Accepted: Jul 9, 2026
(closed for review but you can still tweet)
Acceptability and Useability of Telemedicine for Older Veterans: Mixed-Methods Behavioral Observation Analysis in a Pilot Sample
ABSTRACT
Background:
Telemedicine offers promising solutions for improving access to care among older adults with chronic conditions, but there is limited evidence on how older patients navigate and engage with video telehealth in their home environments.
Objective:
To assess older adults’ acceptability, useability, comfort, and engagement with pharmacist-led telemedicine visits conducted at home, using behavioral observation separate from the telehealth platform.
Methods:
This descriptive pilot study included 20 older adult veterans (aged ≥65, ≥2 chronic conditions, ≥5 medications) recruited from a Veterans Affairs (VA) healthcare system. A project manager observed and video-recorded participant preparation for and conduct during in-home telemedicine visits with a clinical pharmacist. Recordings were coded using structured protocols to assess verbal and nonverbal behavior, technological challenges, and environmental factors. Trained and reliable coders rated verbal and nonverbal comfort, frustration, and engagement during technology setup and the telemedicine appointment using Likert-type impression scales. Video data were also transcribed and coded for behavioral events (e.g., troubleshooting, verbal expressions of age or technology ability, nonverbal adaptation) and analyzed using rapid qualitative analysis.
Results:
Participants expressed moderate engagement and comfort with technology overall. Verbal and nonverbal engagement significantly increased from setup to appointment (t = 3.33, p = .004, Cohen’s d = .74). Technology-related challenges (e.g., audio/video lag, troubleshooting) occurred in over half the visits but were often resolved through participant adaptation or support from the research staff. Participants displayed both frustration (e.g., sighing, leaning away) and adaptability (e.g., propping up tablets, retrieving medications). Verbal expressions reflected a mix of technology confidence and age-related limitations. Environmental distractions were present in some visits (e.g., dogs barking or phones ringing), but also allowed for rich clinical engagement (e.g., home tours, direct observation of medications).
Conclusions:
Older adults showed high levels of engagement and adaptability during in-home telemedicine visits despite technological and contextual barriers. Addressing technical support, home environment considerations, and age-related perceptions of technology may increase telehealth usability and satisfaction among aging populations. Clinical Trial: n/a
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