Swedish Primary Care Physicians’ Intentions to Use Telemedicine: A Survey Using a New Questionnaire – Physician Attitudes and Intentions to Use Telemedicine (PAIT)

Abstract

Miriam Pikkemaat,1,2 Hans Thulesius,1,3 Veronica Milos Nymberg1,2 1Department of Clinical Sciences, Lund University, Malmö, Sweden; 2CPF, Centre for Primary Healthcare Research, Malmö, Sweden; 3Linnaeus University, Kalmar, SwedenCorrespondence: Veronica Milos NymbergClinical Research Centre (CRC), Skåne University Hospital, Building 28, Floor 11, Jan Waldenströms Street 35, Malmö, 205 02, SwedenTel [phone]Email [email protected]: Research on intentions to use telemedicine in primary care is sparse. This survey study explored primary care physicians’ intentions to use telemedicine by using a newly developed questionnaire: Physician Attitudes and Intentions to use Telemedicine.Methods: An anonymous web-survey with questions focusing on theory-based predictors of behavioral intentions such as Attitudes, Subjective norms and Perceived behavioral control was designed, validated, and sent to all primary care physicians at 160 primary health care centers in southern Sweden from May to August 2019. The questionnaire had 29 subject items (including 49 multiple-choice sub-items). Main outcome measures were intentions to use three domains of telemedicine and correlation between theory-based predictors and behavioral intentions for using telemedicine.Results: The survey was validated by an expert group, amended, and then tested and retested. A majority of the 198 physicians who returned the web-surveys reported that they did not use e-mails (68%), nor video consultations (78%), chat (81%), or text messages (86%) in their everyday patient work. Yet, most physicians described a positive intention to use telemedicine in patient care for all three studied domains with Attitudes and Perceived behavioral control being significant predictors (p< 0.01) for Intentions to use digital contacts (R2 = 0.54), chronic disease monitoring with digital tools (R2 = 0.47) and artificial intelligence (R2 = 0.54). A structural validation of a preliminary instrument – Physician Attitudes and Intention to use Telemedicine (PAIT) – containing 28 sub-items was done by exploratory factor analysis with acceptable explanatory, reliability and sampling adequacy measures. Five factors emerged with Eigenvalues between 1.6 and 11.1 explaining 72% of the variance. Total Cronbach’s alpha was 0.91 and Kaiser-Meyer-Olkirk 0.79.Conclusion: Before the covid-19 pandemic, Swedish primary care physicians reported a low use yet high behavioral intention to use telemedicine in a study where we developed the preliminary instrument Physician Attitudes and Intention to use Telemedicine. Perceived behavioral control had the largest predictive value of behavioral intention to use telemedicine. Thus, interventions aiming to increase the use of digital tools in primary care should possibly focus on empowering physicians’ self-efficacy towards using them.Keywords: telemedicine, survey, primary care, theory of planned behavior

Keywords

• telemedicine
• survey
• primary care
• theory of planned behavior