Factors associated with the intention of telehealth service utilization among Bangladeshi people: a cross-sectional study

Introduction

Over the last few decades, Bangladesh’s healthcare system has made significant advancements; in particular, made tremendous progress in public health while focused on meeting the Millennium Development Goal.¹ It has also had considerable success in lowering maternal and newborn mortality and morbidity rates, as well as diarrheal illnesses, malaria, and tuberculosis.² However, challenges still exist, such as Bangladesh is staying a long way from obtaining universal health care for all from vulnerable groups, e.g., low socio-economic status and people from remote locations.³ The shortages of skilled healthcare personnel, climate-induced environmental changes,⁴ and transportation constraints are the most pressing issues in accessing the healthcare system.⁵ Telehealth, in which people have benefited from recent technological advancements, has the potential to overcome many of these healthcare system-related constraints.³ Telehealth utilization was shown to be acceptable and effective in meeting the demands of individuals with chronic diseases and was associated with improved healthcare utilization and positive clinical outcomes.⁶

Telehealth uses telecommunications and electronic information to support and continue long-distance clinical health service, healthcare management, and patient-focused health education.⁷ This term also refers to a wide range of remote healthcare service delivery strategies. Telehealth is recommended as one of the most essential and promising technology-based services for addressing many challenges the Bangladeshi healthcare system usually faces.⁸ Nevertheless, the effectiveness of the telehealth service is contingent on healthcare professionals’ and the general public’s acceptance and willingness to utilize it.⁹ As individuals can be benefited from how telehealth services are offered,¹⁰ it is crucial to understand their intentions and the significance of other elements in their decision to utilize telehealth to build services that people will embrace.¹⁰

However, the intention of the general population to utilize telehealth services was not widely documented; the literature generally focuses on physicians’ and clients’ impressions of telehealth services. There were a few reports on peoples’ attitudes, but they did not focus on the elements that can influence their decision to adopt telehealth. Jennett et al. (2003) conducted a study in Canada to assess the preparation of rural people to utilize telehealth,¹¹ and Schwarz et al. (2014) conducted a study in New South Wales, Australia, to investigate the preparedness of Australia’s distant population.¹² However, both studies drew their samples from key informants or persons who had already used telehealth services rather than the general population. Likewise, several studies conducted in different places in the world emphasized the physician’s views toward telehealth, but general people’s perceptions or intentions toward telehealth service utilization were merely investigated.^13–15

In Bangladesh, the majority of telehealth research has focused on the role and importance of telehealth service,^16,17 how it may be used in disease or outbreak management,¹⁸ and methods to promote the telehealth sector.¹⁹ Furthermore, few pieces of research focused on healthcare providers’ perceptions of telemedicine and potential hurdles in Bangladesh.^20,21 Those studies only included specific samples yet focused on the general people’s intentions. Despite the fact that a study described the people’s economic view⁸ and the perception of people with chronic diseases, they have yet to examine the influence of demographic or health-related factors on intention to utilize the telehealth service.^8,22 Therefore, this research investigated the factors associated with the intention to utilize telehealth services among the general population of Bangladesh.

Methods

Results

Sample

A flow diagram of the sample recruitment procedure in detail is presented in Figure 1. In total, 1038 responses were analysed.

Figure 1. Flow diagram of sample recruitment procedure.

Discussion

Several pieces of research around the world have already shown how people’s and health care providers’ views and intentions influence their usage of telehealth services.^{13–15,20,21} Meanwhile, few pieces of research in Canada looked at the impact of social, cultural, economic, and environmental factors on people’s decisions to utilize telehealth-care services.^28,29 In Bangladesh, the intention of telehealth service utilization of the general population was yet to be investigated. Therefore, in this study, we examined the associated factors such as sociodemographic factors, perceived health status, knowledge, perceived benefit, perceived concern, and predisposition with the intention to utilize telehealth services.

Our study found a significant association between telehealth of knowledge and the intention to utilize the service. We found that as the knowledge score improved, the level of intention to utilize the telehealth service increased. Albarrak et al. (2021) reported that Saudi Arabian participants had an average level of understanding were more intended to utilize the telehealth service.³⁰ Albarrak et al. (2021) believed that training on telehealth could improve understanding, and this was expected to influence people’s intention to utilize the telehealth service.³⁰ Malhotra et al. (2020) in India and Woo & Dowding (2019) in the United States also drew a similar conclusion as our study findings.^31,32

In our study, participants were more intent to utilize the telehealth services if they perceived a high level of benefit. Similarly, Alaboudi et al. (2016) and El-Mahalli et al. (2012) in Saudi Arabia found the same result that the participants who perceived the benefit of the service were more intended to utilize the service.^33,34 When participants had a high level of perceived concern, their intention to utilize this service was found low. Numerous studies around the world found that privacy issues were connected to the intention of technology-based health service utilization.^35,36 Furthermore, Bangladeshis who had a favorable predisposition were more interested in the telehealth service. In order to determine whether socio-demographics and technology-enabling factors may influence how telehealth is utilized, a study was carried out in the United States in 2021.³⁷ The researchers revealed that individuals with favorable predispositions toward ICT devices and internet access exhibited more enthusiasm for using telehealth.³⁷ Liñan et al. reported that Cancer patients are more predisposed to using virtual care during the COVID-19 pandemic, demonstrated optimal care for overweight and obese patients, with anthropometric and nutritional changes.³⁸

We found that several demographic factors were significantly associated with the intention to utilize telehealth services. Age influenced people’s intention to adopt telehealth services. The intention to utilize the service in the near future was 3.02 times higher among the youngest (<20 years) than it was among the oldest (≥40 years). Numerous studies also supported the findings of our research. Lee et al. (2019) and Raghunathan et al. (2018) found that younger participants had a stronger intention to utilize telemedicine or internet adaptive equipment, which could be due to their competence and past familiarity with the advanced technology.^39,40 However, Jenkins et al. (2016) reported that older stroke patients were more eager to employ telehealth observation with ongoing technical assistance than younger patients were.⁴¹

Our research focused on education status and found that those with better education were more likely to be utilizing telehealth services. More specifically, we found that graduate participants were 4.28 and 5.22 times more likely to “may utilize” and “will utilize” the service, respectively, than those with an education level up to SSC. Schulz et al. (2013) found that persons with higher levels of education were more likely to pay for and use technology-based health monitoring systems.⁴² Another study found that cancer patients with higher education were more likely to use mobile devices to utilize their health care services.⁴⁰ Education may frequently be mentioned as a component that influences people’s thoughts and actions, but few researchers have looked at this factor in the interaction between the fundamental indicators and people’s willingness to adopt technology-based health monitoring systems.⁴³

Our study revealed that unmarried participants were much more intent to utilize telehealth than married people were; 72% and 71% ‘may utilize’ and ‘will utilize’ the service, respectively. According to Choi et al. (2021) telehealth users were more likely to be married or in a relationship than non-users.³⁷ Additionally, they demonstrated in their research that during the COVID-19 outbreak, a more significant percentage of users than non-users either joined in with others or somebody came in with them.³⁷

The intention was also found higher among students than among other employed individuals. The possible reason could be as they were more likely to expose to distance learning and technology based service usability.^44–47 A similar study measuring nursing students’ readiness to use telenursing was carried out in Poland.⁴⁸ Amazingly, 69.49% of the students reported that they would be very likely to include telenursing in their course curriculum.⁴⁸ Additionally, students from a selected number of colleges demonstrated a noticeably greater desire to integrate telenursing courses into the nursing curriculum and a willingness to utilize telenursing services in their future professional practice.⁴⁸

Furthermore, we found that urban people were more intent on utilizing this service compared to rural individuals. However, according to Lin et al. (2004) the people of rural areas had a higher likelihood of adopting telehealth services.⁴⁹ Moreover, in Canada, Gagnon et al. (2004) did not find any influence of residential status on participants’ intention of telehealth service utilization.⁹

An association between perceived health status and the intention to utilize the telehealth service was found in our study. Our findings revealed that those with a low health status were more intended to utilize telehealth services than those with normal or good health status. Similarly, Ghaddar et al., (2020) conducted a study in the United States and found that participants with chronic diseases were more interested in utilizing the telehealth service than those with good perceived health status.³

Conclusions and recommendations

We found that respondents’ likelihood to utilize the service improved significantly who had more knowledge, perceived benefit, and predisposition. However, as perceived concern increased, the likelihood of utilizing the service decreased significantly. We also found that several factors, such as age, marital status, educational status, profession, residence, and perceived health status were significantly associated with the participants’ intention to utilize the telehealth service. The healthcare system seems successful when there is equal participation in services. However, many constraints may hinder people from getting access to the universal health system. Therefore, several initiatives can be considered to reach the health service to the people’s door, including the technology-based digital health system. Without addressing the digital constrain of accessing the existing healthcare system, the disparities at the community level may be unprivileged. Numerous factors were connected with people’s intention to utilize the telehealth service in this study. The appropriate authorities can consider the factors and conduct studies more broadly to investigate the containment of telehealth implementation. Specifically, initiatives should be taken by the appropriate authorities to increase knowledge, perceived benefits, and predisposition so that telehealth utilization may expand in Bangladesh. Similarly, initiatives should be taken to reduce the telehealth related concerns among the population. Moreover, we advocated for policy actions to make the telehealth system more accessible to the community and to enhance the understanding and awareness of the benefits of utilizing telehealth to improve usability among the underprivileged.