The evolution of the healthcare system towards digitization has modelled the efficiency of the contemporary care matrix around call centres as pivotal communication points. According to Gordon et al., ¹ call centres are patients’ first point of contact, shaping their initial impressions, influencing satisfaction, and improving patient access, retention, and service quality. ² For example, directing patients to appropriate services early reduces hospital readmissions significantly. ³ Also, the appointment calendars created at call centres enhance the management of appointments, increase internal referrals, and optimize physician availability, which minimize wasted clinical time. ⁴ On the other hand, inefficiencies in call centres can lead to misdirected care, higher patient readmissions, and skyrocketing healthcare costs.

Many healthcare systems worldwide are grappling with the rapid landscape evolution towards digitization. Nunes and Ferreira ⁵ posit that digitization has transformed traditional call centres into comprehensive contact points that handle phone calls and manage emails, text messages, and digital health records. However, as patients increasingly rely on these centres for immediate responses and convenient remote access to medical information, many medical call centres lack the resources to handle the complexity and volume of modern patient inquiries. ⁶ Hence, the context presents a care gap, showing the unpreparedness of health systems to adapt to evolving patient and healthcare landscapes. Mehta, Pandit, and Kulkarni ⁷ noted that modern healthcare systems should meet the rising demands linked to digitization and the evolving patient population, with targeted initiatives for recruiting skilled personnel capable of navigating the clinical and technical domains of the contemporary healthcare landscape. ^{4, 8} Hence, digitization initiatives should balance priorities between quality and efficiency of services.

The 151-call center, run by Kuwait’s Ministry of Health, ⁹ is an inbound service where patients call to ask questions, make appointments, or speak with medical experts regarding contemporary care issues. Most healthcare call centers in Kuwait deal with patients or their families, who frequently contact these centers during emergencies or under stress. ¹⁰ Hence, users anticipate prompt, succinct, and reliable responses when contacting Kuwait’s healthcare call centers. However, the overarching challenges reported in contemporary healthcare call centers revolve around long wait times and unclear information, leading to caller frustration and high abandonment rates, ^{11, 12} which has been a notable challenge in Kuwait. Yet, limited published evidence is available on the operational efficiency of Kuwait’s 151 call service regarding user satisfaction with service quality and communication effectiveness. This study explores patient experiences with Kuwait’s Ministry of Health 151 call center regarding quality of call center services (CCS), employee skills (ES), communication with doctors (CWD), remote consultations, and utility of the 151 service, as well as the factors that could be influencing them.

Most of the participants who were aware of the 151 call center had enough knowledge and experience with it, and reported above-average satisfaction rates. The service received relatively high ratings for sound clarity, instruction clarity, and language diversity. User satisfaction in telemedicine is dependent on the technical soundness of the foundational concepts and the ease of platform accessibility, ¹³ hence the 151 call center service is technically sound and accessible. However, the speed of connection to the call centre’s services received the lowest satisfaction rating, indicating the possibility of an operational problem. Zinger et al. ¹⁴ also reported response delays as among the most frequent complaints among users of medical helplines similar to the 151 call center. Hence, in emergency cases, such helplines may not be optimally effective.

Most participants were satisfied with the skills of the employees operating Kuwait’s 151 call centres, identifying them with professionalism, communication, courteousness, attentiveness, and knowledge. Patients are often happy with virtual consultation services when staff members show empathy and clear communication. ¹⁵ On the other hand, the relatively low satisfaction with the response time and the accuracy of referrals are common challenges in contemporary healthcare call centres. ¹⁴ Therefore, the skills and responsiveness of employees are integral in the performance of a health call center.

Satisfaction with doctors’ communication during consultations was high, with participants identifying the communication as respectful, transparent, and empathetic. Kruse et al. ¹⁶ affirm that clear and respectful doctor communication is a major driver of satisfaction in telemedicine contexts. Doctors that engage patients make remote calls effective in healthcare by enhancing clarity of the health issues and care plans they discuss with patients.

The satisfaction ratings with the call center were relatively higher among female respondents. Gendered perceptions of service effectiveness are mostly linked to communication preferences and expectations related to service. ¹⁷ Hence, customization of the call services to match gendered perceptions is worth exploring to ensure high satisfaction rates across all genders.

The variations of satisfaction levels among participants with various education levels aligns with conclusions by Seguí et al. (2020) that digital literacy levels, awareness, and expectations, which are dependent on education level, determine satisfaction with a healthcare service like teleconsultation. Participants with at least a high school diploma could be having better digital literacy and more knowledge about call centres, translating into better utilization and comprehension of call centres. The low satisfaction ratings among participants with advanced degrees requires further studies.

The gender influence on satisfaction with doctor communication follows a trend of females reporting higher satisfaction rates with verbal empathy and medical explanations that potentially aid in resolving health issues (Downes et al., 2017; Bouman et al., 2017). The low rate of resolving issues through the 151 calls is a limitation of teleconsultation in solving complex cases. Portnoy et al. (2020) noted that telemedicine services are more effective for initial assessments than complete treatment plans, hence a high likelihood of unresolved or stagnated health issues when the call center is tasked with delivering more comprehensive care plans beyond the basic initial assessments.

The Kuwaiti had positive reviews regarding most aspects of the 151 call center. The call center promotes healthcare awareness in the country, saves significant time needed for in-person visits, and reduces unnecessary visits to healthcare facilities (Ohannessian et al., 2020). However, Capozzo et al. ¹³ indicated that many patients prefer in-person visits and do not believe in teleconsultation and telehealth. Additionally, the cross-demographic comparisons in this study revealed gender and education level disparities regarding patient satisfaction with call center services, which were earlier reported by Seguí et al. ¹⁸ and Tai-Seale et al. ⁸

Participants who had never used the 151-call service in Kuwait cited service unawareness, prior negative call feedback experiences like unanswered calls, and the lack of a perceived need for the service. Inadequate promotion, limited awareness, and unclear messaging impede the usage of telehealth services in many contexts. ¹⁹ Thus, limited public knowledge is a technology adoption barrier. Despite implementing targeted outreach tools, the limited awareness about Kuwait’s 151 healthcare call center model propagates disengagement, implying that the MOH’s initiatives have been inefficient in disseminating accurate and precise information about the service. This disparity highlights the need for more focused public education initiatives to raise awareness and promote service use.

A key strength of this study is its robust internal consistency, demonstrated by high Cronbach’s alpha values across all the subscales since they exceeded the commonly accepted threshold of 0.70. ²⁰ Another strength is the study’s large and diverse sample, which is representative since it included participants from all major governorates in Kuwait. Additionally, the wide range of ages and education levels enhanced the generalizability of the findings in the Kuwaiti context. However, a key limitation is using a non-probabilistic convenience sampling method via social media, which may have introduced selection bias and limited the sample’s representativeness. ²¹ Individuals without internet access or with lower digital literacy may have been excluded, potentially skewing satisfaction ratings.

Continued use of the 151 call center is recommended since users were satisfied with most of its aspects. However, response time and service awareness should be optimized. Future studies should test gender- and education level-customized 151 call center interventions using a pre-test post-test quasi-experimental study design to generate stronger evidence on how the call center services can be improved. A qualitative study is also recommended to investigate reasons for the low satisfaction rates among people with advanced degrees.

The user satisfaction survey conducted in this study anonymously assessed a service rather than humans without collecting any personal identifiers or sensitive data of the respondents, posing minimal risk to the respondents, hence waiver of ethical review was granted by the Health Sciences Center Ethical Committee, Kuwait University, Kuwait. The privacy of the respondents was guaranteed by anonymizing the data collection as defined in the latest issue of the Declaration of Helsinki. All the respondents provided informed consent before answering the survey questions by reading a statement about the purpose of the survey and respondents’ rights including confidentiality of responses and non-obligation to participate on the first page of the survey, then choosing to participate or exit the survey by clicking either of “I agree to participate” or “I choose to exit” buttons.