?In a country where public health facilities are often overburdened and under-resourced, telemedicine services — the use of technology, such as video calls, apps, or online platforms, to provide healthcare services and consultations remotely — have become a vital lifeline by providing many South Africans access to primary care.
“It is, therefore, important to tailor primary care telemedicine services in a way that builds and maintains patients' trust — especially given the sensitivity around health-related needs. Providers have the significant opportunity to receive and treat patients when they're often at their most vulnerable and should always do so with the utmost care and respect," says Dr Grethe van Tonder, who recently obtained her doctorate in business management at Stellenbosch 中国体育彩票.
?“We need to understand the driving factors in patients' unique contexts causing them to continue using (app-based) primary care telemedicine services to make sure this kind of service delivery can continue to benefit South Africa's healthcare system in the long run," adds Van Tonder.
As part of her study, Van Tonder focused on the Kena Health app that was developed by Kena Health and was launched in 2022. It connects users to nurses, doctors and mental health professionals via text, audio, or video, and provides medical advice, diagnoses, prescriptions, sick notes, referrals, and mental-health counselling — all without requiring scheduled appointments.
Novel factors
Her study identified two novel factors influencing the acceptance of app-based telemedicine for primary care, specifically considering the South African public sector context: perception of privacy and perception of care. Prior theories had not included these perceptions as factors influencing the acceptance of telemedicine.
According to Van Tonder, privacy perception refers to the extent to which an individual may perceive a telemedicine service as more or less private than in-person healthcare alternatives.
“While prior literature often associates telemedicine with more privacy risks compared to in-person alternatives, the study found that patients preferred the perceived privacy of app-based teleconsultations to in-person consultations at public clinics — the latter generally being the frame of reference of the research participants.
“During data collection, participants explained that app-based consultations allow for 'anonimity' where they don't have to be seen — such as when text or voice calls are used instead of video. Furthermore, others can't overhear their conversations with the healthcare professional, unlike in many under-resourced public healthcare facilities. Participants regard these circumstances as key to their acceptance of the app-based telemedicine service."
Van Tonder says patients' care perception had the strongest statistical effect on their acceptance of the telemedicine service and encompasses aspects such as empathy, kindness and respect associated with the telemedicine service experience.
“Participants repeatedly said their experience of receiving treatment through the app-based telemedicine service is very different from what they were used to at public healthcare facilities, like clinics, which they would normally rely on if telemedicine wasn't available.
“They added that overburdened public healthcare facilities often don't allow private conversations with a healthcare professional. Staff tend to be rude and rushed, leaving patients without a chance to fully explain their symptoms and concerns.
“Consequently, patients often feel disrespected, as if the healthcare professional made a diagnosis without adequately enquiring about their actual needs or concerns."
Listen
Van Tonder adds that participants also described being shouted at or scolded by medical staff, which often left them feeling judged and ashamed of the healthcare need that brought them to the public facility in the first place.
“In contrast to such experiences, participants said their interactions with healthcare professionals on the Kena Health app were the exact opposite — highlighting how their highly positive perceptions of care shaped their acceptance of, their satisfaction with, and their willingness to continue using the app-based telemedicine service."
The study found that patients' experience of genuine care while consulting with healthcare professionals via the Kena Health app had the strongest statistical effect on their acceptance of this telemedicine service. It further had statistically significant effects on their satisfaction with the service, as well as their general trust in this type of primary healthcare service delivery.
“Whether the consultation happened via text, phone call, or video, many said that feeling listened to and cared for was pivotal for their acceptance of the service."
?Pharmacy services
Van Tonder states her study could help app-based telemedicine service providers of primary care to tailor their services according to patient-specific needs, considering patients' unique contexts and frames of reference to address the factors that would most significantly influence their acceptance of such a service. The insights could also benefit other healthcare providers looking to add app-based telemedicine services to their existing offerings.
She says that even though a digital platform is used, the human ability to show empathy, kindness and genuine care is what primary healthcare providers should focus on to build patient trust and satisfaction during app-based digital consultations.
Asked what she would change about the use of telemedicine, especially in the public healthcare sector, Van Tonder responds: “To enhance patient care, pharmacy services could be included in the service offering in future. While app-based telemedicine for primary care improves access to consultations and prescriptions, patients who typically rely on the public sector may still face challenges in obtaining their prescribed medication.
“Adding a delivery-based pharmacy service to an app-based primary care telemedicine platform could help patients access essential medication quickly, promoting faster recovery after consultation."
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