Research
| Volume 8, Article 22, 16 Apr 2025
Eric Yila1, Nathaniel Birdling Noel1,2,&, Jonathan Chi Daboer3
1Department of Community Medicine, College of Medical Sciences, University of Jos, Jos, Plateau State, Nigeria, 2Department of Public Health, Modibbo Adama University Teaching Hospital, Yola, Adamawa State, Nigeria, 3Department of Community Medicine, Jos University Teaching Hospital, Jos and College of Medical Sciences, University of Jos, Jos, Plateau State, Nigeria
&Corresponding author: Dr. Nathaniel Birdling Noel, Department of Public Health, Modibbo Adama University Teaching Hospital, Yola, Adamawa State, Nigeria, Email: natebirdling@gmail.com ORCID: https://orcid.org/0000-0002-0167-6032
Received: 3 Jan 2025, Accepted: 10 Apr 2025, Published: 16 Apr 2025
Domain: Health Informatics; Health Information System; Electronic Health Records and Data Sharing
Keywords: Telemedicine, Perception, Intention, Health workers, Nigeria, Teaching Hospital
©Eric Yila et al Journal of Interventional Epidemiology and Public Health (ISSN: 2664-2824). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Cite this article: Eric Yila et al Intention to practice telemedicine by health workers in a teaching hospital in Northcentral Nigeria, 2022. Journal of Interventional Epidemiology and Public Health. 2025;8:22. https://doi.org/10.37432/jieph-d-25-00005
Introduction: The practice of telemedicine is generally poor in low and middle-income countries, including Nigeria, which has utilization rates below 5%, unlike the nearly 80% reported in high-income countries. This study assessed the intention of health workers in a teaching hospital in Northcentral Nigeria to practice telemedicine.
Methods: This was a cross-sectional study conducted in 2022 among 313 health workers in Jos University Teaching Hospital, Northcentral Nigeria, selected using a stratified sampling technique. A self-administered questionnaire was used to collect data; it comprised 13 questions on knowledge, 8 items on the perception of benefits, 7 items on the perception of ease of use, and 1 item on intention to practice telemedicine. A respondent was adjudged to have good knowledge, good perception of benefits, and perceiving telemedicine as easy to use if they scored ≥ 80% of the maximum points in the knowledge, perception of benefits, and perception of ease of use section correspondingly, while the intention to practice was defined as answering in the affirmative to the question in the section.
Results: A total of 313 participants were included in the study, with a response rate of 100%. One hundred and sixty-seven (53.4%) respondents had adequate knowledge, 139 (44.4%) had a good perception of the benefits, and 131 (41.9%) had a good perception of the ease of use of telemedicine. Only 126 (40.3%) respondents intended to practice telemedicine. Multivariable logistic regression analysis indicated that pharmacists (AOR: 6.30, 95% CI: 1.65-24.14) and nurses (AOR: 2.60, 95% CI: 1.25-5.43) had higher odds of intention to practice telemedicine compared to doctors. Similarly, study participants with adequate knowledge (AOR: 2.52, 95% CI: 1.28-4.99), perceiving telemedicine as easy to use (AOR: 5.02, 95% CI: 2.65-9.51) and having a good perception of the benefits of telemedicine (AOR: 2.63, 95% CI: 1.47-4.72) had significantly higher odds of intention to practice telemedicine.
Conclusion: The intention to practice telemedicine was low, and it was influenced by knowledge, perception, and cadres. This suggests that improving knowledge and perception could improve the intention to practice telemedicine.
Healthcare delivery worldwide is undermined by inequitable access, rising costs, increasing demand for services and critical shortages of manpower. As a result, healthcare for all continues to be an elusive goal [1] Onaleye T. Telemedicine Could Bring Doctors Closer to Nigerians, But Here’s Why It’s Not Yet Our Thing [Internet]. Lagos (Nigeria): Technext; 2020 Mar 18 [cited 2025 Apr 14]; [about 17 screens]. Available from: https://technext.ng/2020/03/18/telemedicine-could-bring-doctors-closer-to-nigerians-but-heres-why-its-not-yet-our-thing/ . Telemedicine has the potential to bring the needed healthcare services to all by expanding access, particularly in underserved areas [2] World Health Organization (WHO). WHO issues consolidated guide to running effective telemedicine services [Internet]. Geneva (Switzerland): WHO; 2022 Nov 10 [cited 2025 Apr 14]. [about 5 screens]. Available from: https://www.who.int/news/item/10-11-2022-who-issues-new-guide-to-running-effective-telemedicine-services ,[3] Alvandi M. Telemedicine and its Role in Revolutionizing Healthcare Delivery. AJMC [Internet]. 2017 Mar 10 [cited 2025 Apr 14];5(1): 5p. Available from: https://www.ajmc.com/view/telemedicine-and-its-role-in-revolutionizing-healthcare-delivery Download PDF to view full text [4] Hajli MN. Developing online health communities through digital media. International Journal of Information Management [Internet]. 2014 Feb 19 [cited 2025 Apr 14];34(2):311–4. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0268401214000073 https://doi.org/10.1016/j.ijinfomgt.2014.01.006 Subscription or purchase required to view full text . The COVID-19 pandemic has drawn attention to how telemedicine is capable of assuring and sustaining access to healthcare services for all [2] World Health Organization (WHO). WHO issues consolidated guide to running effective telemedicine services [Internet]. Geneva (Switzerland): WHO; 2022 Nov 10 [cited 2025 Apr 14]. [about 5 screens]. Available from: https://www.who.int/news/item/10-11-2022-who-issues-new-guide-to-running-effective-telemedicine-services .
Telemedicine is “the use of electronic information and communications technologies to provide and support health care when distance separates the participants” [5] Institute of Medicine (US) Committee on Evaluating Clinical Applications of Telemedicine. Telemedicine: a guide to assessing telecommunications for health care [Internet]. Field MJ, editor. Washington (DC): National Academies Press (US); 1996. Available from: http://www.nap.edu/catalog/5296 https://doi.org/10.17226/5296 Subscription or purchase required to view full text . It comprises remotely provided medical services such as consultations, monitoring of patients, diagnostic tests, and robotic surgeries [6] United States Federal Communications Commission. Telehealth, Telemedicine, and Telecare: What’s What? [Internet]. Washington (DC): United States Federal Communications Commission; c2025 [cited 2025 Apr 14]. [about 3 screens]. Available from: https://www.fcc.gov/general/telehealth-telemedicine-and-telecare-whats-what . However, access to telemedicine through routine usage has been a challenge to health systems worldwide [2] World Health Organization (WHO). WHO issues consolidated guide to running effective telemedicine services [Internet]. Geneva (Switzerland): WHO; 2022 Nov 10 [cited 2025 Apr 14]. [about 5 screens]. Available from: https://www.who.int/news/item/10-11-2022-who-issues-new-guide-to-running-effective-telemedicine-services .
Despite its proven benefits, telemedicine adoption remains low globally, with many healthcare professionals in both high- and low-income countries reluctant to embrace it [7] Ahmed MH, Awol SM, Kanfe SG, Hailegebreal S, Debele GR, Dube GN, Guadie HA, Ngusie HS, Klein J. Willingness to use telemedicine during COVID-19 among health professionals in a low income country. Informatics in Medicine Unlocked [Internet]. 2021 Nov 6 [version of record 2021 Nov 8: cited 2025 Apr 14];27:100783. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2352914821002549 https://doi.org/10.1016/j.imu.2021.100783 ,[8] Grassl N, Nees J, Schramm K, Spratte J, Sohn C, Schott TC, Schott S. A web-based survey assessing the attitudes of health care professionals in germany toward the use of telemedicine in pregnancy monitoring: cross-sectional study. JMIR Mhealth Uhealth [Internet]. 2018 Feb 11 [cited 2025 Apr 14];6(8):e10063. Available from: http://mhealth.jmir.org/2018/8/e10063/ https://doi.org/10.2196/10063 ,[9] Lawrence K, Nov O, Mann D, Mandal S, Iturrate E, Wiesenfeld B. The impact of telemedicine on physicians’ after-hours electronic health record “work outside work” during the covid-19 pandemic: retrospective cohort study. JMIR Med Inform [Internet]. 2022 Jul 28 [cited 2025 Apr 14];10(7):e34826. Available from: https://medinform.jmir.org/2022/7/e34826 https://doi.org/10.2196/34826 ,[10] Welcome M. The Nigerian health care system: Need for integrating adequate medical intelligence and surveillance systems. J Pharm Bioall Sci [Internet]. 2011 Oct- Dec [cited 2025 Apr 14];3(4):470-8. Available from: https://journals.lww.com/10.4103/0975-7406.90100 https://doi.org/10.4103/0975-7406.90100 ,[11] Saag HS, Shah K, Jones SA, Testa PA, Horwitz LI. Pajama time: working after work in the electronic health record. J Gen Intern Med [Internet]. 2019 May 9 [cited 2025 Apr 14];34(9):1695–6. Available from: http://link.springer.com/10.1007/s11606-019-05055-x https://doi.org/10.1007/s11606-019-05055-x . Successful implementation depends on provider acceptance and readiness. Key barriers include concerns about increased clinical and administrative workload, extended documentation time, and reduced efficiency compared to in-person consultations, exacerbating fears of burnout.
More so, in sub-Saharan Africa, telemedicine is perceived as new andmet with reservations among health workers, which has led to unfavourable intentions toward its adoption [12] Ajala F, Adetunji A, Akande N. Telemedicine Acceptability in South Western Nigeria: Its Prospects and Challenges. International journal of advanced computer technology [Internet]. 2015 Sep [cited 2025 Apr 14];4(9):1970–6. Available from: https://eprints.lmu.edu.ng/id/eprint/2717 Download PDF to view full text ,[13] Kitsiou S, Paré G, Jaana M. Effects of home telemonitoring interventions on patients with chronic heart failure: an overview of systematic reviews. J Med Internet Res [Internet]. 2015 Mar 12 [cited 2025 Apr 14];17(3):e63. Available from: http://www.jmir.org/2015/3/e63/ https://doi.org/10.2196/jmir.4174 ,[14] Ekanoye F. Telemedicine diffusion in a developing country: a case of Nigeria. SJPH [Internet]. 2017 Jul 18 [cited 2025 Apr 14];5(4):341-6. Available from: http://www.sciencepublishinggroup.com/journal/paperinfo?journalid=251&doi=10.11648/j.sjph.20170504.20 https://doi.org/10.11648/j.sjph.20170504.20 Download PDF to view full text . This highlights the need for an enabling environment for telemedicine where service providers perceive it positively and are ready to take advantage of its benefits. Human factors, notably behavioural intention, are key to the success of the adoption of new technologies [15] Bonder S, Zajtchuk R. Changing the paradigm for telemedicine development and evaluation: a prospective model-based approach. Socio-Economic Planning Sciences [Internet]. 1997 Dec [cited 2025 Apr 14];31(4):257–80. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0038012197000189 https://doi.org/10.1016/S0038-0121(97)00018-9 Subscription or purchase required to view full text . Therefore, an understanding of the factors that influence health workers’ willingness to provide telemedicine-based services can provide useful insights for healthcare administrators during the implementation and scaling-up of such services. Our study assessed the intention of health workers in a teaching hospital in Northcentral Nigeria to practice telemedicine.
This study was carried out at Jos University Teaching Hospital (JUTH), situated in Jos metropolis of Plateau State, Northcentral Nigeria. JUTH is a 500-bed tertiary health institution providing specialist care and training for various health professionals – doctors, nurses, pharmacists, and laboratory scientists. It serves as a referral centre for health facilities in Plateau State and neighbouring states. It is the largest health facility in the state, and an unpublished administrative source reported that it has about 1,400 skilled health workers (doctors, nurses, pharmacists, and laboratory scientists). Telemedicine is not operational in JUTH; the traditional face-to-face health worker-client interaction is the mode of service delivery.
Study design
This was a cross-sectional study conducted between January and February 2022.
Study population
The study population were clinical health workers – doctors, nurses, pharmacists, and laboratory scientists. Those not available at the time of data collection because they were on leave or postings outside the hospital were excluded.
Sample size and sampling technique
The minimum sample size was determined using the sample size determination formula for a cross-sectional study (n = Zα2pq/d2) [16] Katz DL, Elmore JG, Wild D, Lucan SC. Jekel’s epidemiology, biostatistics, preventive medicine, and public health. 4th ed. London: Saunders; 2013 Nov 2. 405 p. . The standard normal deviate, z, was considered at a 95% confidence interval as 1.96, the prevalence, p, for intention to adopt telemedicine among workers from a previous study, 78% [17] Shittu LAJ, Adesanya AO, Izegbu CM, Oyewopo AO, Arigbabuwo A, Ashiru AO. Knowledge and perception of health workers towards tele-medicine application in a new teaching hospital in Lagos. Scientific Research and Essays [Internet]. 2007 Jan 31 [cited 2025 Apr 14];2(1):016–9. Available from: https://academicjournals.org/journal/SRE/article-full-text-pdf/1E9EB8322303 Download PDF to view full text , q (i.e., 1-p) is 22%, degree of precision, d, of 5%, and non-response rate of 10%. The minimum sample size was 291. Stratified sampling with proportionate allocation, using these cadres (doctors, nurses, pharmacists, and laboratory scientists) as strata, was done. The allocated size for each cadre was selected using consecutive sampling of eligible staff at different points of service – clinics, wards, laboratories, pharmacies, and diagnostic centres. Practically, 313 healthcare workers – 156 doctors, 115 nurses, 16 pharmacists, and 26 laboratory scientists – filled out and returned the questionnaires distributed through the unit heads.
Data was collected using a pretested semi-structured self-administered questionnaire adapted from a similar previous study [18] El-Mahalli AA, El-khafif SH, Al-Qahtani MF. Successes and challenges in the implementation and application of telemedicine in the eastern province of saudi arabia. Perspect Health Inf Manag [Internet]. 2012 Oct 1 [cited 2025 Apr 14];9(Fall):1f. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3510649/ . The questionnaire had five sections comprising sociodemographic information, knowledge of telemedicine, perceived benefits of telemedicine, perceived ease of use of telemedicine, and intention to practice telemedicine. It had 13 questions on knowledge, 8 items on the perception of benefits, 7 items on the perception of ease of use, and 1 item on the intention to practice telemedicine. Responses were elicited using a 5-point Likert response scale consisting of strongly agree, agree, not sure, disagree, and strongly disagree.
Dependent and Independent Variables
The dependent variables include knowledge of telemedicine, perception of benefits, perception of ease of use, and telemedicine practice intention. The independent variables were age, sex, highest educational qualification, cadre, years of work experience, self-rated ability to use a computer, and previous history of receiving teaching and attending training/continuous education sessions on telemedicine.
Data analysis
Data was analyzed using IBM-SPSS software version 23. Descriptive statistics (frequencies, proportions, mean, and standard deviation) and inferential statistics (bivariate and multivariable logistic regression) were computed. The response to each item in the knowledge, perception of benefits, and perception of ease-of-use sections were scored as follows: strongly agree = 5, agree = 4, not sure = 3, disagree = 2, and strongly disagree = 1, giving a maximum attainable score of 65, 40, and 35 points for the knowledge (13-items), perception of benefits (8-items), and perception of ease of use (7-items) questions respectively. For knowledge, a score of 52-65 points (≥ 80% of the maximum) corresponding to the two highest points of preferable response (strongly agree and agree) was adjudged as good.
Similarly, perception of benefits and perception of ease of use scores of 32-40 points (≥ 80% of the maximum) and 28-35 points (≥ 80% of the maximum), respectively, was adjudged as good. On the other hand, knowledge scores of <52 points, perception of benefits scores of <32 points, and perception of ease of use scores of <28 points which are equivalent to <80% of the maximum attainable scores and correspond to an indecisive response (not sure) to the least favourable responses (disagree and strongly disagree) was adjudged as poor. The intention to practice was defined as answering in the affirmative to the statement – “I intend to use telemedicine to provide services to a patient both physically present and remotely (not physically present) as soon as my hospital adopts it”. Bivariate and multivariate logistic regression analyses were used to determine the correlates of intention to practice telemedicine. Variables with a p-value <0.20 in the bivariate analysis were fitted into the multivariate logistic regression model.
Ethical considerations
Ethical clearance with approval number JUTH/DCS/IREC/127/XXXI/2529 was granted by the Institutional Research Ethical Committee of the Jos University Teaching Hospital. In addition, written informed consent was provided by the study participants.
A total of 313 participants responded to the questionnaire, giving a 100% response rate. The mean age of the participants was 38.2 ± 9.1 years. One hundred and sixty (51.1%) were males, 189 (60.4%) and 76 (24.3%) had graduate and postgraduate level education, respectively. Doctors comprised most of the study participants, 156 (49.8%), while 184 (58.8%) participants had a working experience spanning less than 10 years. Nineteen (6.1%) participants reported having low levels of computer use competence, and 230 (73.5%) had no previous training/continuing education on telemedicine (Table 1).
Two hundred and forty-six (78.6%) participants strongly agreed/agreed that telemedicine disseminates patient health information from one department to another, 89.5% (280) strongly agreed/agreed that telemedicine is the use of telecommunication to provide medical information and services, 85% (266) strongly agreed/agreed telemedicine provides healthcare services where distance is a barrier, and 65.2% (204) strongly agreed/agreed that telemedicine enables face-to-face interaction between patients and healthcare providers. Similarly, 72.5% (227) of the health workers were affirmative that patients’ management using drugs is possible via telemedicine, 73.5% (230) and 80.5% (252) affirmed that patients’ examinations and investigations, respectively, could be communicated via telemedicine while 77.3% (242) were in agreement that patients’ follow-up was possible through the same medium. Less than half of the participants, 48.6% (152), were affirmative that surgeries were possible through telemedicine. Overall, 167 (53.4%) participants had a good knowledge of telemedicine (Table 2).
For the perception of benefits of telemedicine, the majority of the participants reported that telemedicine would maximize the use of limited manpower (82.1%, 257), provide convenience in the provision of services (84.3%, 264), enhance access to healthcare (77.6%, 243), improve the efficiency in healthcare provision (76.4%, 239), and make information sharing more efficient (82.4%, 258). Also, 54.6% (171) participants strongly agreed/agreed that telemedicine will lessen the financial burden on the government. However, only 40.9% (128) of the health workers believed that the use of computers at work would unnecessarily increase their work burden. Overall, 139 (44.4%) participants had a good perception of the benefits of telemedicine in healthcare (Table 3).
In reporting their perception of how easy telemedicine is to use, the majority of the health workers were affirmative that telemedicine is easy and convenient to use (76.4%, 239), they will be at ease when using it (71.6%, 224), learning how to use telemedicine would be easy for them (75.1%, 235), becoming skilful at telemedicine use would be easy (75.4%, 236), and their jobs will be made easier by telemedicine (74.8%, 234). Additionally, 63.3% (198) of the health workers were affirmative that they would have control over their jobs while using telemedicine while only 43.4% (136) believed telemedicine would not alter the way they currently do their jobs. Overall, 131 (41.9%) participants perceived telemedicine as easy to use (Table 3). One hundred and twenty-six (40.3%) participants were affirmative they will practice telemedicine when it becomes operational in the hospital (Table 3).
Bivariate logistic regression showed educational level, cadre, previously taught telemedicine at school, previous attendance at training/continuing education sessions on telemedicine, knowledge, perception of ease of use, and perception of benefits were statistically significantly associated to the intention to practice telemedicine. Bachelors Degree holders were more likely (COR: 2.10, 95% CI: 1.17-3.74) to be affirmative to practice telemedicine compared to those with postgraduate qualifications. Pharmacists (COR: 4.80, 95% CI: 1.58-14.58) and nurses (COR: 2.29, 95% CI: 1.30-3.53) had higher odds of intending to practice telemedicine when compared to doctors. Likewise, higher odds of intention to practice telemedicine were found among participants who had been taught telemedicine at school (COR: 2.10, 95% CI: 1.31-3.37), ever attended training/continuing education sessions on telemedicine (COR: 1.67, 95% CI: 1.01-2.76), good knowledge (COR = 4.90, 95% CI: 2.97-8.08), perceived telemedicine as easy to use (COR = 7.76, 95% CI: 4.65-12.92), and good perception of the benefits of telemedicine (COR = 4.00, 95% CI: 2.48-6.46) (Table 4).
Multivariate logistic regression analysis showed only cadre, assessed knowledge, perception of ease of use, and perception of benefits were associated with the intention to practice telemedicine. Pharmacists (AOR: 6.30, 95% CI: 1.65-24.14) and Nurses (AOR: 2.60, 95% CI: 1.25-5.43) had higher odds of intending to practice telemedicine compared to doctors. Similarly, study participants with a good knowledge (AOR: 2.52, 95% CI: 1.28-4.99), perceiving telemedicine as easy to use (AOR: 5.02, 95% CI: 2.65-9.51), and a good perception of the benefits of telemedicine (AOR: 2.63, 95% CI: 1.47-4.72) had significantly higher odds of intending to practice telemedicine (Table 4).
This study assessed the intention to practice telemedicine among health workers in a teaching hospital in Northcentral Nigeria. While more than half of the health workers had a good knowledge of telemedicine, fewer had a good perception of the benefits, perceived it as easy to use, and had intentions to practice telemedicine when it becomes operational in the hospital. The factors significantly associated with the intention to practice telemedicine were cadre, knowledge of telemedicine, perception of the ease of use of telemedicine, and the perception of its benefits.
More than half of the participants had adequate knowledge of telemedicine. The considerable extent of inadequate knowledge of telemedicine (46.6%) observed in this study may be related to the fact that most of the participants had no prior teaching, training, or continuing education on telemedicine. Nonetheless, our finding of adequate knowledge among most of the participants corroborates previous findings in India, where 57% (95% CI: 52.1-61.8%) had adequate knowledge [19] Malhotra P, Ramachandran A, Chauhan R, Soni D, Garg N. Assessment of knowledge, perception, and willingness of using telemedicine among medical and allied healthcare students studying in private institutions. TMT [Internet]. 2020 Nov 27 [cited 2025 Apr 14]; 14p. Available from: https://telehealthandmedicinetoday.com/index.php/journal/article/view/228 https://doi.org/10.30953/tmt.v5.228 Download PDF to view full text . On the contrary, only 16% of health workers in a study in Uganda had good knowledge of telemedicine [20] Isabalija DSR, Mayoka KG, Rwashana DAS, Mbarika PVW. Factors affecting adoption, implementation and sustainability of telemedicine information systems in Uganda. Journal of Health Informatics in Developing Countries [Internet]. 2011 Dec 9 [cited 2025 Apr 14];5(2): 299-316. Available from: https://www.jhidc.org/index.php/jhidc/article/view/72 Download PDF to view full text . The variation in findings may be explained by the dissimilarity in the cadre of healthcare workers included as study participants, besides nurses and doctors, our study included pharmacists and laboratory scientists, unlike the Ugandan study.
Consistent with a previous study in Ethiopia (53%) [7] Ahmed MH, Awol SM, Kanfe SG, Hailegebreal S, Debele GR, Dube GN, Guadie HA, Ngusie HS, Klein J. Willingness to use telemedicine during COVID-19 among health professionals in a low income country. Informatics in Medicine Unlocked [Internet]. 2021 Nov 6 [version of record 2021 Nov 8: cited 2025 Apr 14];27:100783. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2352914821002549 https://doi.org/10.1016/j.imu.2021.100783 , most of the participants in our study perceived telemedicine as not easy to use. Similarly, poor perception of the benefits of telemedicine was more prevalent and in keeping with a previous study in Ghana (65%) [21] Frimpong K, Asare S, Nomah D, Antwi-Asante D. Knowledge and Perception of Telemedicine Among Health Professionals At the Koforidua Regional Hospital, Ghana. International Journal of Healthcare Sciences [Internet]. 2016 Oct- 2017 Mar [cited 2025 Apr 14];4(2):96–103. Available from: https://www.researchpublish.com/papers/knowledge-and-perception-of-telemedicine-among-health-professionals-at-the-koforidua-regional-hospital-ghana Download PDF to view full text . The concurrence of poor perception of ease of use and poor perception of benefits gives credence to the evidence that perceived ease of use directly influences perceived benefits [22] Wen-Hung W, Yi-Jyun L. Attitude, Behavioral Intention and Usage: An Empirical Study of Taiwan Railway’s Internet Ticketing System. Proceedings of the SWDSI/FBD Conference; 2009 Feb 24-28; Oklahoma (OK): National Taiwan Ocean University; 2009. . Our findings may be attributed to the substantial extent of poor knowledge, as knowledge exerts a direct positive effect on perception [19] Malhotra P, Ramachandran A, Chauhan R, Soni D, Garg N. Assessment of knowledge, perception, and willingness of using telemedicine among medical and allied healthcare students studying in private institutions. TMT [Internet]. 2020 Nov 27 [cited 2025 Apr 14]; 14p. Available from: https://telehealthandmedicinetoday.com/index.php/journal/article/view/228 https://doi.org/10.30953/tmt.v5.228 Download PDF to view full text . In contrast to our findings, studies in Nigeria, Libya, and Saudi Arabia reported a good perception of telemedicine to be more prevalent [17] Shittu LAJ, Adesanya AO, Izegbu CM, Oyewopo AO, Arigbabuwo A, Ashiru AO. Knowledge and perception of health workers towards tele-medicine application in a new teaching hospital in Lagos. Scientific Research and Essays [Internet]. 2007 Jan 31 [cited 2025 Apr 14];2(1):016–9. Available from: https://academicjournals.org/journal/SRE/article-full-text-pdf/1E9EB8322303 Download PDF to view full text ,[23] Elhadi M, Elhadi A, Bouhuwaish A, Bin Alshiteewi F, Elmabrouk A, Alsuyihili A, Alhashimi A, Khel S, Elgherwi A, Alsoufi A, Albakoush A, Abdulmalik A. Telemedicine awareness, knowledge, attitude, and skills of health care workers in a low-resource country during the covid-19 pandemic: cross-sectional study. J Med Internet Res [Internet]. 2020 May 29 [cited 2025 Apr 14];23(2):e20812. Available from: http://www.jmir.org/2021/2/e20812/ https://doi.org/10.2196/20812 ,[24] Albarrak AI, Mohammed R, Almarshoud N, Almujalli L, Aljaeed R, Altuwaijiri S, Albohairy T. Assessment of physician’s knowledge, perception and willingness of telemedicine in Riyadh region, Saudi Arabia. Journal of Infection and Public Health [Internet]. 2019 May 3 [version on record 2021 Jan 4: cited 2025 Apr 14];14(1):97–102. Available from: https://linkinghub.elsevier.com/retrieve/pii/S187603411930139X https://doi.org/10.1016/j.jiph.2019.04.006 . However, most participants in those studies had prior experience with telemedicine either through usage or training, unlike the participants in our study.
The intention to use technology is contingent upon the potential user’s knowledge and perception of ease of use and usefulness [25] Davis FD. Perceived usefulness, perceived ease of use, and user acceptance of information technology. MIS Quarterly [Internet]. 1989 Sep [cited 2025 Apr 14];13(3):319-340. Available from: https://www.jstor.org/stable/249008?origin=crossref https://doi.org/10.2307/249008 Subscription or purchase required to view full text ,[26] Davis FD, Bagozzi RP, Warshaw PR. User acceptance of computer technology: a comparison of two theoretical models. Management Science [Internet]. 1989 Aug [cited 2025 Apr 14];35(8):982–1003. Available from: https://www.jstor.org/stable/2632151 Subscription or purchase required to view full text , so it is not far-fetched that few of the participants in this study intended to practice telemedicine as there was a preponderance of poor knowledge, perception of ease of use and benefits. This finding is consistent with a previous study conducted in Ethiopia (46.5%) [7] Ahmed MH, Awol SM, Kanfe SG, Hailegebreal S, Debele GR, Dube GN, Guadie HA, Ngusie HS, Klein J. Willingness to use telemedicine during COVID-19 among health professionals in a low income country. Informatics in Medicine Unlocked [Internet]. 2021 Nov 6 [version of record 2021 Nov 8: cited 2025 Apr 14];27:100783. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2352914821002549 https://doi.org/10.1016/j.imu.2021.100783 but different from a study in Saudi Arabia that reported the majority (83%) of the health workers were willing to practice telemedicine [27] Thapa S, Nielsen JB, Aldahmash AM, Qadri FR, Leppin A. Willingness to use digital health tools in patient care among health care professionals and students at a university hospital in saudi arabia: quantitative cross-sectional survey. JMIR Med Educ [Internet]. 2021 Feb 19 [cited 2025 Apr 14];7(1):e18590. Available from: http://mededu.jmir.org/2021/1/e18590/ https://doi.org/10.2196/18590 . The variation in findings may be related to the marked difference in the proportion of participants who had previously been trained on telemedicine in our study and the Saudi study, 26% versus 71%. Our finding implies that the participants were unlikely to use telemedicine when it becomes operational in the hospital, as intention positively influences usage [22] Wen-Hung W, Yi-Jyun L. Attitude, Behavioral Intention and Usage: An Empirical Study of Taiwan Railway’s Internet Ticketing System. Proceedings of the SWDSI/FBD Conference; 2009 Feb 24-28; Oklahoma (OK): National Taiwan Ocean University; 2009. .
We found cadre, knowledge, and perception of ease of use and benefits to be independently associated with the intention to practice telemedicine, and this was consistent with a systematic review [28] Kurniawan A, Gamelia E, Anandari D. The theory behind and factors influencing the use of telemedicine during the COVID 19 pandemic: A systematic review. Journal of Public Health in Africa [Internet]. 2023 Dec 30 [cited 2025 Apr 14];14(12):a8. Available from: https://publichealthinafrica.org/index.php/jphia/article/view/8 https://doi.org/10.4081/jphia.2023.2592 Download PDF to view full text and previous reports among health workers in Ethiopia and Ghana [7] Ahmed MH, Awol SM, Kanfe SG, Hailegebreal S, Debele GR, Dube GN, Guadie HA, Ngusie HS, Klein J. Willingness to use telemedicine during COVID-19 among health professionals in a low income country. Informatics in Medicine Unlocked [Internet]. 2021 Nov 6 [version of record 2021 Nov 8: cited 2025 Apr 14];27:100783. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2352914821002549 https://doi.org/10.1016/j.imu.2021.100783 ,[29] Mensah NK, Adzakpah G, Kissi J, Boadu RO, Lasim OU, Oyenike MK, Bart-Plange A, Dalaba MA, Sukums F. Health professional’s readiness and factors associated with telemedicine implementation and use in selected health facilities in Ghana. Heliyon [Internet]. 2023 Mar 18 [cited 2025 Apr 14];9(3):e14501. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2405844023017085 https://doi.org/10.1016/j.heliyon.2023.e14501 . Our results revealed that doctors were less willing to practice telemedicine compared to nurses, this is in contrast to a study in Germany [8] Grassl N, Nees J, Schramm K, Spratte J, Sohn C, Schott TC, Schott S. A web-based survey assessing the attitudes of health care professionals in germany toward the use of telemedicine in pregnancy monitoring: cross-sectional study. JMIR Mhealth Uhealth [Internet]. 2018 Feb 11 [cited 2025 Apr 14];6(8):e10063. Available from: http://mhealth.jmir.org/2018/8/e10063/ https://doi.org/10.2196/10063 . The participants in that study differed from ours; they were professionals in obstetrics, and a few were nurses, 16% as against the 37% in our study. It is plausible to find doctors less interested in practising telemedicine because telemedicine-based services seldom be viewed as less efficient than traditional face-to-face care by being more time-consuming and often requiring after-hours clinical and administrative tasks [9] Lawrence K, Nov O, Mann D, Mandal S, Iturrate E, Wiesenfeld B. The impact of telemedicine on physicians’ after-hours electronic health record “work outside work” during the covid-19 pandemic: retrospective cohort study. JMIR Med Inform [Internet]. 2022 Jul 28 [cited 2025 Apr 14];10(7):e34826. Available from: https://medinform.jmir.org/2022/7/e34826 https://doi.org/10.2196/34826 . The findings of perception of benefits and perception of ease of use as predictors of telemedicine practice intention are in keeping with the technology acceptance model (TAM) [26] Mensah NK, Adzakpah G, Kissi J, Boadu RO, Lasim OU, Oyenike MK, Bart-Plange A, Dalaba MA, Sukums F. Health professional’s readiness and factors associated with telemedicine implementation and use in selected health facilities in Ghana. Heliyon [Internet]. 2023 Mar 18 [cited 2025 Apr 14];9(3):e14501. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2405844023017085 https://doi.org/10.1016/j.heliyon.2023.e14501 . The TAM posits that perceptions of benefits and ease are the two primary determinants of an individual’s intention to use a new technology; individuals who perceive that a specific technology will be beneficial to their work and requires less effort to use are more likely to be frequent users. Therefore, a targeted improvement of healthcare workers’ perceptions of telemedicine could go a long way in entrenching positive behavioural intentions towards telemedicine adoption. Our finding that knowledge is a significant factor in telemedicine use intention gives credence to the “unified theory of acceptance and use of technology” [30] Venkatesh, Morris, Davis, Davis. User acceptance of information technology: toward a unified view. MIS Quarterly [Internet]. 2003 Sep [cited 2025 Apr 14];27(3):425-478. Available from: https://www.jstor.org/stable/10.2307/30036540 https://doi.org/10.2307/30036540 Subscription or purchase required to view full text . The theory predicates the knowledge to support the use of technology as a facilitating condition that influences usage intention either directly or mediated by positively shaping how an individual perceives the technology as easy to use. The identification of knowledge as a predictor suggests that inadequate awareness and understanding of telemedicine could serve as barriers to its adoption by healthcare workers. Addressing these gaps in knowledge by incorporating telemedicine-related educational interventions into the continuous professional development of health workers can improve their willingness to engage in telemedicine services.
Limitations of the study
The cross-sectional design of this study implies that causal inference cannot be inferred. In addition, social desirability bias could result in overreporting the intention to practice telemedicine, however, ensuring that the questionnaire was self-administered and filled out anonymously will reduce the pressure to provide socially desirable responses.
There was generally poor knowledge, perception of ease of use and benefits, and intention to practice telemedicine. Knowledge and perception influenced the intention to practice; this suggests that improving knowledge and perception of ease of use and benefits through education and training on telemedicine would improve the intention. Doctors were less willing to practice telemedicine. Therefore, they should be prioritized for interventions.
What is already known about the topic
What this study adds
EY and NBN conceived the study design, developed the data collection tools, supervised data collection, and wrote the manuscript. NBN performed the data analysis and interpretation. JCD supervised, reviewed, and made substantial contributions to conception, design, analysis, and manuscript writing. All authors read and approved of the final manuscript.
| Variable | Frequency | Percent (%) |
|---|---|---|
| Sex | ||
| Male | 153 | 48.9 |
| Female | 160 | 51.1 |
| Age group (years) | ||
| 20–29 | 58 | 18.5 |
| 30–39 | 136 | 43.5 |
| 40–49 | 68 | 21.7 |
| 50–59 | 51 | 16.3 |
| Mean age ± SD (years) | 38.2 ± 9.1 | |
| Highest educational qualification | ||
| Diploma | 28 | 8.9 |
| Higher National Diploma | 20 | 6.4 |
| Bachelors Degree | 189 | 60.4 |
| Postgraduate | 76 | 24.3 |
| Cadre | ||
| Doctor | 156 | 49.8 |
| Pharmacist | 16 | 5.2 |
| Nurse | 115 | 36.7 |
| Laboratory Scientist | 26 | 8.3 |
| Working experience (years) | ||
| < 10 | 184 | 58.8 |
| 10–19 | 76 | 24.3 |
| ≥ 20 | 53 | 16.9 |
| Self-rated ability to use computer | ||
| Low | 19 | 6.1 |
| Average | 222 | 70.9 |
| High | 72 | 23.0 |
| Taught telemedicine in School | ||
| Yes | 112 | 35.8 |
| No | 201 | 64.2 |
| Training/Continuing education in telemedicine | ||
| Yes | 83 | 26.5 |
| No | 230 | 73.5 |
| Statement | Strongly Agree f (%) |
Agree f (%) |
Not Sure f (%) |
Disagree f (%) |
Strongly Disagree f (%) |
|---|---|---|---|---|---|
| Telemedicine disseminates patient health information from one department to another | 118 (37.7) | 128 (40.9) | 48 (15.3) | 10 (3.2) | 9 (2.9) |
| Telemedicine is the use of telecommunication to provide medical information and services | 153 (48.9) | 127 (40.6) | 30 (9.5) | 3 (1.0) | 0 (0.0) |
| Telemedicine is part of medical education technology | 136 (43.5) | 126 (40.2) | 43 (13.7) | 1 (0.4) | 7 (2.2) |
| Telemedicine provides health care services where distance is a problem | 144 (46.0) | 122 (39.0) | 40 (12.8) | 3 (1.0) | 4 (1.2) |
| Face-to-face interaction between patients and healthcare workers is possible through telemedicine | 85 (27.2) | 119 (38.0) | 72 (23.0) | 24 (7.6) | 13 (4.2) |
| Patients’ management with drugs can be done through telemedicine | 78 (24.9) | 149 (47.6) | 67 (21.4) | 10 (3.2) | 9 (2.9) |
| Patients’ examinations can be communicated through telemedicine | 76 (24.3) | 154 (49.2) | 61 (19.5) | 17 (5.4) | 5 (1.6) |
| Patients’ investigations can be communicated through the telemedicine | 98 (31.3) | 154 (49.2) | 48 (15.3) | 6 (2.0) | 7 (2.2) |
| Follow-up of patients can be done through telemedicine | 99 (31.6) | 143 (45.7) | 53 (16.9) | 7 (2.2) | 11 (3.6) |
| Electronic medical records of patients’ registration can be maintained through telemedicine | 130 (41.5) | 136 (43.5) | 41 (13.1) | 6 (1.9) | 0 (0.0) |
| Telemedicine can be used in battlefield casualties, prisons, for disabled patients and during natural and man-made calamities | 91 (29.1) | 112 (35.8) | 84 (26.8) | 17 (5.4) | 9 (2.9) |
| Surgical treatment for patients can be done through telemedicine | 72 (23.0) | 80 (25.6) | 85 (27.1) | 54 (17.3) | 22 (7.0) |
| Health care through the Internet is a recognized service | 89 (28.4) | 140 (44.8) | 63 (20.1) | 12 (3.8) | 9 (2.9) |
| Overall Knowledge | |||||
| Poor | 146 | 46.6% | |||
| Good | 167 | 53.4% | |||
| Statement | Strongly Agree f (%) | Agree f (%) | Not Sure f (%) | Disagree f (%) | Strongly Disagree f (%) |
|---|---|---|---|---|---|
| Perception of Benefits of Telemedicine | |||||
| Telemedicine would maximize the use of limited human resources | 126 (40.3) | 131 (41.8) | 44 (14.1) | 10 (3.2) | 2 (0.6) |
| Using telemedicine would provide convenience in providing health services | 111 (35.5) | 153 (48.8) | 40 (12.8) | 9 (2.9) | 0 (0.0) |
| Using telemedicine would reduce the cost of treatment | 67 (21.4) | 98 (31.3) | 98 (31.3) | 49 (15.7) | 1 (0.3) |
| Using telemedicine would enhance access to healthcare services | 88 (28.1) | 155 (49.5) | 55 (17.6) | 11 (3.5) | 4 (1.3) |
| Using telemedicine would improve efficiency in healthcare services | 87 (27.8) | 152 (48.6) | 58 (18.5) | 13 (4.1) | 3 (1.0) |
| Using telemedicine would make information dissemination more efficient | 112 (35.8) | 146 (46.6) | 46 (14.7) | 6 (1.9) | 3 (1.0) |
| The application of ICT in health care services would reduce the financial burden on the government | 63 (20.1) | 108 (34.5) | 92 (29.4) | 42 (13.4) | 8 (2.6) |
| Being made to use computers as part of my work will unnecessarily increase my workload | 47 (15.0) | 81 (25.9) | 65 (20.8) | 83 (26.5) | 37 (11.8) |
| Perception of Ease of Use of Telemedicine | |||||
| I will find telemedicine easy and convenient to use | 86 (27.5) | 153 (48.9) | 56 (17.8) | 14 (4.5) | 4 (1.3) |
| Using telemedicine, I will have control over my job | 71 (22.7) | 127 (40.6) | 87 (27.8) | 26 (8.3) | 2 (0.6) |
| I will be at ease using telemedicine | 79 (25.2) | 145 (46.4) | 63 (20.1) | 17 (5.4) | 9 (2.9) |
| Using telemedicine will not change anything I currently do | 57 (18.2) | 79 (25.2) | 80 (25.6) | 83 (26.5) | 14 (4.5) |
| Learning to use telemedicine will be easy for me | 69 (22.0) | 166 (53.1) | 64 (20.4) | 14 (4.5) | 0 (0.0) |
| It will be easy for me to become skilful at using telemedicine | 75 (24.0) | 161 (51.4) | 60 (19.2) | 11 (3.5) | 6 (1.9) |
| Using telemedicine will make my job easier | 74 (23.6) | 160 (51.2) | 63 (20.1) | 15 (4.8) | 1 (0.3) |
| Overall Perception of Benefits of Telemedicine | |||||
| Poor | 174 | 55.6% | |||
| Good | 139 | 44.4% | |||
| Overall Perception of Ease of Use of Telemedicine | |||||
| Not Easy | 182 | 58.1% | |||
| Easy | 131 | 41.9% | |||
| Intending to Practice Telemedicine | |||||
| No | 187 | 59.7% | |||
| Yes | 126 | 40.3% | |||
| Variable | Intention to practice telemedicine | COR (95% CI) | p-value | AOR (95% CI) | |
|---|---|---|---|---|---|
| No (n = 187) f (%) |
Yes (n = 126) f (%) |
||||
| Age Group (Years) | |||||
| 20 – 29 | 33 (56.9) | 25 (43.1) | 1 | 1 | |
| 30 – 39 | 78 (57.8) | 58 (42.6) | 0.98 (0.52–1.83) | 0.953 | 1.45 (0.61–3.46) |
| 40 – 49 | 39 (58.2) | 28 (41.2) | 0.92 (0.46–1.88) | 0.827 | 2.53 (0.85–7.51) |
| 50 – 59 | 15 (70.1) | 15 (29.4) | 0.55 (0.25–1.22) | 0.141 | 0.88 (0.15–5.37) |
| Sex | |||||
| Female | 93 (58.3) | 67 (41.9) | 1 | 1 | |
| Male | 94 (61.4) | 59 (38.6) | 0.87 (0.55–1.37) | 0.550 | |
| Educational Level | |||||
| Diploma | 12 (57.1) | 12 (42.9) | 1.96 (0.80–4.84) | 0.142 | 0.93 (0.27–3.16) |
| Higher National Diploma | 9 (55.0) | 9 (45.0) | 2.14 (0.78–5.91) | 0.141 | 1.61 (0.42–6.20) |
| Bachelors Degree | 105 (55.6) | 84 (44.4) | 2.10 (1.17–3.74)* | 0.012 | 1.42 (0.65–3.09) |
| Postgraduate | 55 (72.4) | 21 (27.6) | 1 | 1 | |
| Cadre | |||||
| Doctor | 107 (68.6) | 49 (31.4) | 1 | 1 | |
| Pharmacist | 5 (31.3) | 11 (68.7) | 4.80 (1.58–14.58)* | 0.006 | 6.30 (1.65–24.14)* |
| Nurse | 58 (50.4) | 57 (49.6) | 2.15 (1.30–3.53)* | 0.003 | 2.60 (1.25–5.43)* |
| Laboratory Scientist | 17 (65.4) | 9 (34.6) | 1.16 (0.48–2.73) | 0.746 | 0.59 (0.20–1.74) |
| Work Experience | |||||
| < 10 years | 102 (55.6) | 82 (44.4) | 1.86 (0.97–3.58) | 0.063 | 0.55 (0.11–2.92) |
| 10 – 19 years | 48 (63.2) | 28 (36.8) | 1.35 (0.64–2.85) | 0.434 | 0.38 (0.07–1.95) |
| ≥ 20 years | 17 (63.0) | 10 (37.0) | 1 | 1 | |
| Self-rated ability to use computer | |||||
| Low | 12 (63.2) | 7 (36.8) | 1 | 1 | |
| Average | 89 (60.0) | 89 (40.1) | 1.15 (0.44–3.03) | 0.781 | |
| High | 42 (58.3) | 30 (41.7) | 1.22 (0.43–3.48) | 0.704 | |
| Taught telemedicine in school | |||||
| No | 133 (66.2) | 68 (33.8) | 1 | 1 | |
| Yes | 54 (48.2) | 58 (51.8) | 2.10 (1.31–3.37)* | 0.002 | 1.22 (0.64–2.31) |
| Training/Continuing Education in telemedicine | |||||
| No | 85 (60.7) | 42 (49.4) | 1.67 (1.01–2.76)* | 0.049 | 0.76 (0.37–1.55) |
| Yes | 102 (59.7) | 84 (40.3) | 1 | 1 | |
| Knowledge | |||||
| Poor | 115 (78.8) | 31 (21.2) | 1 | 1 | |
| Good | 72 (43.3) | 95 (56.9) | 4.90 (2.97–8.08)* | <0.0001 | 2.52 (1.28–4.99)* |
| Perception of ease of use | |||||
| Not Easy | 144 (79.1) | 38 (20.9) | 1 | 1 | |
| Easy | 43 (32.8) | 88 (67.2) | 7.76 (4.65–12.92)* | <0.0001 | 5.02 (2.65–9.51)* |
| Perception of benefits | |||||
| Poor | 129 (74.1) | 45 (25.9) | 1 | 1 | |
| Good | 58 (41.7) | 81 (58.3) | 4.00 (2.48–6.46)* | <0.0001 | 2.63 (1.47–4.72)* |
| * Statistically significant at p < 0.05, COR = Crude Odds Ratio, AOR = Adjusted Odds Ratio, CI = Confidence Interval | |||||
Menu, Tables and Figures
Table 2: Knowledge of telemedicine and intention to practice telemedicine among study participants (n=313)