[12].
The association between awareness and level of education was statistically significant as p = 0.038, with the highest percent of awareness was recorded among master’s degree HCWs (66.7%). Biruk and Abetu had similar findings as the percentage of awareness among participants with bachelor’s degree was higher than among others (82.1%, p=0.000) [13]. It can be concluded that education plays a major role in the HCWs awareness.
The association between telehealth awareness and the professions’ categories is statistically significant as P= 0.048. Telehealth awareness was the highest among physicians than other HCWs as they represented 49.1% of the total awareness and 64.3% of the physicians were aware of telehealth and the lowest were dentists and physical therapists both representing 9.1%. This agrees with Abodunrin and Akande as they found a significant association between profession and telehealth knowledge (p= 0.0012) [14] . These results could be because physicians are engaged in more post graduate courses than nurses and this allows them to be more up to date with new technologies. On the other hand, there was no relationship between the level of awareness to telehealth and the specialty of participating Physicians, with Family physicians showing the highest percentage of awareness (63.0%).
In this study Physicians and nurses (n=69) awareness assessment was further investigated according to the effect of the presence of corona. It was found that the percentage of physicians and nurses, aware of telehealth increased during the COVID-19 era from 30.0% before the corona pandemic to 59.2% after. This increase was statistically significant (P= 0.036). This result is similar to a study in Lebanon, who found that the perception of physicians towards telehealth increased from 42% to 74% after the COVID-19 era [15].
The knowledge domain mean score before and after the program was (15.94 ± 9.431, 25.00± 5.841 respectively) and the difference was statistically significant as P= 0.000, which is the lowest pre score in comparison with other weighted mean domains scores similar to Zayapragassarazan and Kumar as they found that the participants total knowledge score (9.34 ± 4.26) which was the least of all parameters [16]. The knowledge of the participants was highly impacted by the program as it improved by more than 25% of the total score in all domains.
The domain of advantages showed a mean score 23.64 ± 5.694 before the program that rose to 28.43 ± 3.949 which is statistically significant as P= 0.000. The same with the disadvantages perception domain that reflected the HCWs sense of the drawbacks and negativity of telehealth technology which was mainly attributed to lack of face to face communication and technical problems, this agrees with Baig and collaborators, which could be due to the similarity in culture and norms of participants of both studies [17]. This domain scored 26.96 ± 5.734 before and 28.92± 5.273 after the program and the difference was statistically significant as P= 0.004.
The necessity domain mean score, that measures HCWs consideration to the importance of applying telehealth in the daily practice, was (21.19 ± 4.502). This constitutes of 70.6% of the total domain’s score which is considered the highest weighted mean domain scores before and after (24.89± 3.604, 83%) and the difference is significant (P= 0.000). This is similar to Baig and collaborators who found that 52.78% of the participants stated the importance of the availability of telehealth throughout Pakistan, and this similarity in both studies can be explained by the similarity in culture and infrastructure in both communities [17].
As for the use easiness perception domain recorded the second lowest minimum and weighted mean domain score after the knowledge domain as most of HCWs weren’t comfortable with using technology but after application of the program and the HCWs got the opportunity to know more about telehealth, a significant rise in the scores of the domain was recorded (P= 0.000). This is similar to a study in Saudi Arabia, as they found that the perception of the easiness of using telehealth recorded the lowest mean score among participants working at health sector adopting telemedicine (2.80 ± 0.643) [18] . This similarity could be due to the fact that both studies were conducted in countries of similar customs. Subsequently, this throws light on the importance of continuous orientation and training programs that are essential to increase awareness of telehealth.
The last domain of the questionnaire was assessing the security perception of the HCWs to find out their insight on the safety and privacy needed in telehealth application which was considerably high in comparison to other domains given mean scores (23.04 ±5.353 and 25.49 ±5.206, P=0.001). This result may be due to the belief of the HCWs that more legislations and efforts need to be done to ensure protection of data and prevent breeching. This agrees with Biruk and Abetu that found that 66.0% of the participants were skeptical about the safety of Telehealth [13].
The difference between the five different professions’ groups and the mean total score before the orientation program, was compared using ANOVA test which showed statistical significance as P= 0.004 with the highest mean for physicians (141.15±22.941) and the lowest for pharmacists (114.10±22.283). Post Hoc test shows a significant difference between physicians and pharmacists (P=0.008). On the other hand, there is no significant difference between different physicians’ specialties after comparing the mean total score using ANOVA test (p=0.707). This result is different with Ayatollahi and collaborators as they found significant difference between clinicians’ perception (P=0.003) [9]. This difference could be due to difference in working specialties and the experience duration of Physicians participated in the later study while in this study all Clinicians were from the same work environment (primary healthcare centers).
The experience duration was believed to be one of the predictive factors affecting the awareness of healthcare workers about telehealth, but it was statistically insignificant P= 0.142. Also, the correlation between the experience duration and the different domains scores and the total score of the questionnaire was statistically insignificant as p>0.05. This result is differed from Biruk and Abetu as they found that years of experience was associated with HCWs knowledge of telehealth (P=0.008) and the same in Eshita’s study in Bangladesh who found that knowledge was influenced by experience as there was a statistical significant relationship between years of experience and knowledge [13,19]. The difference between the latter two studies and this study could be due to faster emergence and facilitated adoption of telehealth lead to earlier exposure of HCWs to such technology.
As regards the age of HCWs, it was found out that it is a predictive value for the awareness of telehealth with statistical significance (OR= 1.13, CI= 1.006-1.270, P= 0.040). This means that younger age of HCWS are more knowledgeable and aware of telehealth. Thus, it should be considered that educational programs should be targeting older age to raise their awareness of telehealth and this can be explained as younger ages are more familiar with new technology.
Regards the willingness of healthcare workers to use telehealth, they were asked about the degree of their satisfaction to implement telehealth before and after the program. The result demonstrated that most of the participants after the application of the program were strongly agreeing (37.6%) or agreeing (42.2%) to implement telehealth and the majority was represented by the physicians followed by nurses, while the majority of disagree was by the pharmacists. There was a statistical significance concerning levels of satisfaction before and after the orientation programs as well as between HCWs professions and degree of satisfaction as P=0.000. This is the same as in Joseph and collaborators’ study as they found that 78.1% are willing to use telehealth in their practice as well as in Dey and Bhattacharya as they found that 76% are willing to use telemedicine [20,21].So, it can be concluded that HCWs are enthusiastic to use telehealth but they only lack knowledge and experience in the field.
Finally, this study proved the successfulness of the education program by using the same questionnaire before and after delivering the session and comparing the mean score of different domains. The comparison showed that the score of different domains increased after the application of the program and the differences were statistically significant. The difference between total mean score before and after the program (130.36 ± 23.538 and 156.49 ± 18.456 respectively) was statistically significant as P= 0.000. This shows the importance of continuous teaching and training of HCWs in order to be knowledgeable and skillful, this change in the scores besides the rise in the awareness percentage after COVID-19 emergence, reflects the eagerness of HCWs to learn and their readiness to acquire experience for new approaches that will improve the healthcare delivery.
The impact of adoption of telehealth interventional educational programs on wide base should be investigated and focused on, as it will help in disseminating the concept of telehealth among HCWs which will improve their knowledge and prepare them for the new era of technology. Telehealth is essential to achieve universal health coverage and is one of the pillars of a comprehensive health system. Therefore, it is recommended that continuous education and training, policies implementation and national guidelines are needed for sustainable application of telehealth.