[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.