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Volume 12, Issue 4 (2024)
Health Educ Health Promot 2024, 12(4): 661-674 |
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Received: 2024/10/31 | Accepted: 2024/12/2 | Published: 2024/12/12
Received: 2024/10/31 | Accepted: 2024/12/2 | Published: 2024/12/12
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Dahmardeh Kemmak F, Sarbaz M, Mousavi Baigi S, Marouzi P, Sheykhotayefeh M, Kimiafar K. Physicians’ and Nurses’ Attitudes, Awareness, Knowledge, and Skill in Telemedicine. Health Educ Health Promot 2024; 12 (4) :661-674
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URL: http://hehp.modares.ac.ir/article-4-77768-en.html
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Authors
F. Dahmardeh Kemmak1 
, M. Sarbaz2 , S.F. Mousavi Baigi1 , P. Marouzi2 , M. Sheykhotayefeh2 , Kh. Kimiafar *2
, M. Sarbaz2 , S.F. Mousavi Baigi1 , P. Marouzi2 , M. Sheykhotayefeh2 , Kh. Kimiafar *2
1- “Department of Health Information Technology, School of Paramedical and Rehabilitation Sciences†and “Student of Research Committeeâ€, Mashhad University of Medical Sciences, Mashhad, Iran
2- Department of Health Information Technology, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
2- Department of Health Information Technology, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
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Introduction
Telemedicine is defined as using web-based sources and electronic information together with advanced digital network technology to promote remote professional health services, publish medical safety reports, present health-related training to people, and monitor public health [1]. Indeed, telemedicine is a branch of medicine that uses electronic media to build relationships among healthcare employees, including physicians, nurses, healthcare providers, and patients. As a vital factor for health specialists, telemedicine facilitates the exchange of information for the diagnosis, treatment, and prevention of diseases and traumas, as well as assessment, research, and healthcare providers’ training, improving individual and social health [2]. Today, telemedicine, employed by numerous medical specialists, such as cardiologists, neurologists, surgeons, optometrists, radiologists, and pediatricians is recognized as an approach to improving care access, quality, and efficiency [3]. In addition, telemedicine shortens patients’ hospitalization time, reduces the number of visits and care-associated costs, improves healthcare access, decreases care traveling time and cost, and enhances patient satisfaction [4, 5]. Many care professionals prefer to work in metropolises, and this issue results in the shortage of healthcare services in rural and underprivileged regions. In the meantime, telemedicine can be a promising solution for many of these drawbacks by eliminating the barriers of physical distance [6]. On the other hand, the World Health Organization (WHO) recommends introducing telemedicine in locales with high patient demands [7]. Despite numerous likely barriers, such as the inability to examine physically, and limited access to sensitive communities with low literacy, like villagers, ethnic minorities, elderly patients, and poor socioeconomic communities, telemedicine is counted as a helpful tool for physicians and patient care [6]. Telemedicine is historically used to provide healthcare to rural populations to manage chronic diseases, psychological and medical conditions, and real-time visits in acute care settings and facilitates video counseling and the use of mobile apps to provide medical consultation, diagnosis, and treatment and reduce the risk of infection. On the whole, many physicians believe that telemedicine is extensively promising for the management of patient care [8, 9].
Although the present advantages of telemedicine have been proved, the health domain has been slow to adopt Information and Communication Technology (ICT) compared to other sectors [10]. There are many reasons why the implementation of e-health systems is still challenging despite the existing studies on its clinical benefits, efficient cost, and high healthcare accessibility at macro levels [11-13]. Regardless of the merits and potential technical superiority of telemedicine, its acceptance is often considered a failed project [14], and user non-acceptance is one of the pivotal causes of failure in this respect [15]. In other words, to ensure telemedicine acceptance and use, it is necessary to possess gross resource capital and human forces and attempt to recognize its utility [4]. On the other hand, since the success of every novel technology depends on many factors, such as the respective professionals’ knowledge and perceptions of the concept, acquired skills, and working environments [16], health specialists’ attitudes, awareness, knowledge, and skill in telemedicine are among the imperatives of the successful implementation of telemedicine [17].
Despite the increasing contribution of telemedicine to healthcare and studies on physicians’ and nurses’ attitudes toward telemedicine, a few systematic reviews have synthesized the best evidence and provided a general view in this domain, and neither has so far examined physicians’ and nurses’ attitudes, awareness, knowledge, and skill as health professionals. Hence, the present systematic review investigated physicians’ and nurses’ attitudes, knowledge, awareness, and skills in telemedicine.
Information and Methods
Design
This systematic review followed PRISMA guidelines to report evidence from included studies [18, 19]. In this respect, the researchers searched some keywords in titles, abstracts, and the PubMed, Embase, Scopus, and Web of Sciences databases on March, 2023, and employed the MeSH and Emtree keywords and terms in the three below categories to search the databases.
1. Physicians OR Physician OR Doctors OR Doctor OR Nurses OR Nurse OR Personnel, nursing OR Nursing personnel OR Registered nurses OR Nurse, registered OR Nurses, registered OR Registered nurse.
2. Attitude OR Attitudes OR Knowledge OR Awareness OR Awarenesses OR Skill OR Skills.
3. Telemedicine OR Telerehabilitation OR telehealth OR Mobile Health OR Health, Mobile OR Virtual Medicine OR Medicine, Virtual OR eHealth OR mHealth (Table 1).
Table 1. Search strategy for each database
![src=./files/hehp/images/HTML_Publish/77768/1.png]()
Eligibility criteria
Studies that possessed the following inclusion criteria were entered into the examination process:
1) Cross-sectional studies investigating physicians’ and nurses’ attitudes, awareness, knowledge, and skill in telemedicine;
2) Studies examining physician and nurse populations.
On the other hand, the exclusion criteria were:
1) Publication types other than papers of high-prestigious journals, such as books, review papers, and letters to editors-in-chief;
2) Not accessing the full text of the paper in English;
3) Irrelevance of the title, abstract, or full text to the purpose of the study.
Data extraction and synthesis
After the extraction of studies from the databases, repeated studies were removed. First, titles and abstracts were screened independently based on the eligibility criteria. Papers lacking the inclusion criteria were omitted from the investigation. Then, the full texts were retrieved and screened independently by two researchers based on the eligibility criteria. The inter-researcher conflicts were solved through discussions. A similar checklist was used for data extraction. The data items in this checklist included the reference, examined country, publishing year, applied instruments, study purposes, telemedicine attitudes, telemedicine knowledge, telemedicine awareness, telemedicine skills, and main findings.
Quality assessment
Joanna Briggs Institute’s (JBI) critical appraisal checklist specific to cross-sectional studies was used for the quality assessment of the included studies [20]. In particular, with eight questions for assessing the quality of studies, this checklist involves the following issues: The inclusion criteria of samples, examined population, examined setting, and valid and reliable measurement instruments (mentioning the validity and reliability of the questionnaires). The included studies used standard measurement criteria, identified confounding factors, pursued strategies to cope with confounding factors, reported valid results, and followed appropriate statistical analyses. The responses to the questions included four yes, no, unclear, and not applicable categories. Positively and negatively answered questions received scores of 1 and 0, respectively, and the maximum quality score of every study was 8. If the quality score of a study was <5, it was omitted from the review.
Findings
Selection of studies
The search into scientific databases led to the retrieval of a total of 9398 studies initially. After the omission of repetitive cases (2873), 6525 studies remained for the title and abstract examination. 6494 studies not aligning with the purpose of the study were removed. Then, 31 remaining papers were examined with their full texts, and finally, 13 eligible papers were entered into the study (Table 2; Figure 1).
Table2. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist
![src=./files/hehp/images/HTML_Publish/77768/2-1.png]()
![src=./files/hehp/images/HTML_Publish/77768/2-2.png]()
![src=./files/hehp/images/HTML_Publish/77768/f1.png]()
Figure 1. Study selection PRISMA
Quality assessment
No considerable bias was observed in the studies, and all studies were entered into the systematic review (Table 3).
Table 3. Summary of the quality assessment of articles using the JBI critical appraisal checklist
![src=./files/hehp/images/HTML_Publish/77768/3.png]()
Characteristics of studies
Out of 13 studies, three (23%) were conducted in India [22, 26, 32], two (15%) in Pakistan [27, 31], and the rest in Scotland, Malesia, Iran, Uganda, Saudi Arabia, Sweden, Ethiopia, and Egypt [21, 23-25, 28-30, 33]. In addition, only one study [29] belonged to a developed country, and 12 were performed in developing nations [21-28, 30-33]. The data were collected by questionnaires in all studies; Two studies had posted their questionnaires [21, 26], three had administered in-person questionnaires [28, 30, 31], one had used online questionnaires [29], and seven had provided no relevant details (Table4 & 5) [22, 25, 27, 32, 33].
Table 4. Summary of characteristics of studies
![src=./files/hehp/images/HTML_Publish/77768/4-1.png]()
![src=./files/hehp/images/HTML_Publish/77768/4-2.png]()
![src=./files/hehp/images/HTML_Publish/77768/4-3.png]()
Table 5. Summary of included studies
![src=./files/hehp/images/HTML_Publish/77768/5-1.png]()
![src=./files/hehp/images/HTML_Publish/77768/5-2.png]()
![src=./files/hehp/images/HTML_Publish/77768/5-3.png]()
Physicians’ and nurses’ attitudes toward telemedicine
Seven of the studies included in this review evaluated health specialists’ attitudes toward telemedicine, and all revealed the positive and promising attitudes of the examined physicians and health specialists toward telemedicine (Tables 2 & 3) [21, 22, 25, 26, 29, 31, 33].
Richards et al. [21] report that when their participants have been asked to explain their e-health programs, 112 respondents (54%) were familiar with the internet-based informing of laboratory results, 20% were acquainted with video conferences held for education or clinical purposes, and 27% were informed of other applied programs. 68% declare that they have good or excellent experiences and positively evaluate the experiences of easy equipment utilization (74%), equipment performance (75%), clinical utility (76%), technical support (44%), and education (39%). Also, Meher et al. [22] document that many physicians are aware of telemedicine technology, and a total of 86 physicians are using telemedicine. The majority of these 86 physicians express their willingness to cooperate with other centers. In Olok et al.’s [25] study, many healthcare specialists maintain positive attitudes toward e-health properties (Mean=3.5), and the average comparative advantage of ICT, adaptability, testability, and observability is 4.3, 3.8, 3.2, and 3.5, respectively. Zayapragassarazan & Kumar [26] report that many physicians hold high and positive attitudes toward telemedicine. 29% of the respondents possess high altitudes, 31% moderate attitudes, and 30% low attitudes. The maximum and minimum averages associated with attitudes toward telemedicine are obtained for 51-60-year-old (35.61±3.12) and paraclinical respondents (33.21±3.76). Likewise, Glock et al. [29] report that first-care doctors express generally positive attitudes toward digitalization and are almost impatient for it. They assert that enormous sources should be accessed in healthcare and particularly perceived that, along with simplifying physicians’ responsibilities, telemedicine enhances patient empowerment and improves medical care, though some physicians held skeptical attitudes. Furthermore, Kumar et al. [31] show their respondents have agreed that telemedicine can help enhance the interrelationships of healthcare providers (141 individuals), decrease the number of references to health centers (151 individuals), accelerate the accomplishment of tasks (118 individuals), improve clinical decisions (67 individuals), and present more inclusive health services. In addition, Fouad et al. [33] have found high attitudes of mental health providers toward telemedicine and a statistically significant relationship between attitudes toward telemedicine and every one of the following cases: Being heard of telemedicine, willingness to participate in every telemedicine educational program, time spent on individual or collective treatments with telemedicine, time spent on tele-assessment, advantages of telemedicine, reasons for using telemedicine, and telemedicine in specific psychotherapies.
Physicians’ and nurses’ awareness of telemedicine
Among the included studies, all in developing countries, five have evaluated health specialists’ awareness of telemedicine [26, 30, 31, 33]. Only one study addresses nurses and reports their moderate awareness [33]. Three studies document high telemedicine awareness of healthcare specialists [26, 30, 31], and two uncover healthcare specialists’ moderate awareness of telemedicine [32, 33].
In their research, Zayapragassarazan & Kumar [26] show that telemedicine awareness is low for 12%, moderate for 25%, and high for 63% of the respondents. The maximum telemedicine awareness belongs to the 30-40-year age group. Moreover, Kumar et al. [31] Considering the perspectives of 183 participants, express that telemedicine can save time for healthcare specialists and physicians. In contrast, Sukumaran et al. [32] discover moderate telemedicine awareness among the majority of their participants (431 individuals), and 19 physicians maintain poor awareness. In the current COVID-19 scenario, many medical webinars and seminars are held remotely worldwide. A total of 249 participants believe in the training of specific software for telemedicine practices. Almost 262 individuals are concerned with the complaints about arising problems for patients during telemedicine operations. The researchers also have found a weak positive and significant correlation between awareness and skill scores (Pearson correlation=0.20; P<0.0001). Furthermore, Fouad et al. [33] report moderate telemedicine awareness of their participants and show telemedicine awareness maintained statistically significant relationships with being heard of the telemedicine terminology and the spent time. On the other hand, they have found out telemedicine awareness had statistically significant relationships with the benefits of providing mental health services remotely, reasons for using remote mental health services, reasons for not employing telemedicine, and using telemedicine for specific cases. Assaye et al. [30] have discovered that telemedicine awareness is strongly related to knowledge, such that healthcare professionals are aware of telemedicine services. In this respect, 77.1% of the participants are aware of the clinical telemedicine uses for radiology, and 51.6% are aware of the conventional uses of public health in the telemedicine domain. Teaching about telemedicine is strongly associated with awareness of telemedicine services in this study. Those receiving telemedicine training are likely 2.33 times more aware of telemedicine services than untrained ones. Another factor influencing telemedicine awareness was access to computers in hospitals where health specialists worked. Those accessing computers in their hospitals were apparently 1.42 times more aware of telemedicine than those not accessing this technology.
Physicians’ and nurses’ knowledge of telemedicine
Ten examined studies, all in developing countries, evaluated health specialists’ knowledge of telemedicine [21-24, 26-28, 30, 32, 33]. Seven studies reported high and excellent telemedicine knowledge and its application [21-23, 26, 27, 30, 32]. Only one studies investigated nurses and reported their moderate knowledge and sufficient experience in employing telemedicine equipment [25]. Among these studies, one documented moderate knowledge [33], and two found poor telemedicine knowledge of healthcare specialists. In conclusion, they argued that constant education and meetings and conferences held on telemedicine were among the helpful approaches to knowledge enhancement [24, 28].
Richards et al. [21] have reported that many general practitioners consider the effect of counseling on patient privacy useful (44%), and only one-fourth claimed its detrimental impact (13%). 44% hve positively evaluated access to general practitioners, and just one-third hold positive attitudes toward the effect of counseling on patient privacy (16%). 32% consider it harmful, and 21% agree that e-health increases enjoyment. Meher et al. [22] report that the majority of their participants possess high knowledge, while a few lack any knowledge of telemedicine in large and remote hospitals. Ibrahim et al. [23] have found out that many of their respondents employ CD-ROMs (82%), emails (84%), and modems (76%), while more than three-fourths of the respondents are inexperienced in using smart cards, Computer-Assisted Learning (CAL), tele-radiology, tele-surgery, telenursing, and tele-pharmacy. On the other hand, their general awareness of the components are 82% for CAL, 66% for telenursing, 57% for tele-surgery, 55% for tele-radiology, 55% for tele-pharmacy, and 46% for smart cards. Likewise, Zayapragassarazan & Kumar
Telemedicine is defined as using web-based sources and electronic information together with advanced digital network technology to promote remote professional health services, publish medical safety reports, present health-related training to people, and monitor public health [1]. Indeed, telemedicine is a branch of medicine that uses electronic media to build relationships among healthcare employees, including physicians, nurses, healthcare providers, and patients. As a vital factor for health specialists, telemedicine facilitates the exchange of information for the diagnosis, treatment, and prevention of diseases and traumas, as well as assessment, research, and healthcare providers’ training, improving individual and social health [2]. Today, telemedicine, employed by numerous medical specialists, such as cardiologists, neurologists, surgeons, optometrists, radiologists, and pediatricians is recognized as an approach to improving care access, quality, and efficiency [3]. In addition, telemedicine shortens patients’ hospitalization time, reduces the number of visits and care-associated costs, improves healthcare access, decreases care traveling time and cost, and enhances patient satisfaction [4, 5]. Many care professionals prefer to work in metropolises, and this issue results in the shortage of healthcare services in rural and underprivileged regions. In the meantime, telemedicine can be a promising solution for many of these drawbacks by eliminating the barriers of physical distance [6]. On the other hand, the World Health Organization (WHO) recommends introducing telemedicine in locales with high patient demands [7]. Despite numerous likely barriers, such as the inability to examine physically, and limited access to sensitive communities with low literacy, like villagers, ethnic minorities, elderly patients, and poor socioeconomic communities, telemedicine is counted as a helpful tool for physicians and patient care [6]. Telemedicine is historically used to provide healthcare to rural populations to manage chronic diseases, psychological and medical conditions, and real-time visits in acute care settings and facilitates video counseling and the use of mobile apps to provide medical consultation, diagnosis, and treatment and reduce the risk of infection. On the whole, many physicians believe that telemedicine is extensively promising for the management of patient care [8, 9].
Although the present advantages of telemedicine have been proved, the health domain has been slow to adopt Information and Communication Technology (ICT) compared to other sectors [10]. There are many reasons why the implementation of e-health systems is still challenging despite the existing studies on its clinical benefits, efficient cost, and high healthcare accessibility at macro levels [11-13]. Regardless of the merits and potential technical superiority of telemedicine, its acceptance is often considered a failed project [14], and user non-acceptance is one of the pivotal causes of failure in this respect [15]. In other words, to ensure telemedicine acceptance and use, it is necessary to possess gross resource capital and human forces and attempt to recognize its utility [4]. On the other hand, since the success of every novel technology depends on many factors, such as the respective professionals’ knowledge and perceptions of the concept, acquired skills, and working environments [16], health specialists’ attitudes, awareness, knowledge, and skill in telemedicine are among the imperatives of the successful implementation of telemedicine [17].
Despite the increasing contribution of telemedicine to healthcare and studies on physicians’ and nurses’ attitudes toward telemedicine, a few systematic reviews have synthesized the best evidence and provided a general view in this domain, and neither has so far examined physicians’ and nurses’ attitudes, awareness, knowledge, and skill as health professionals. Hence, the present systematic review investigated physicians’ and nurses’ attitudes, knowledge, awareness, and skills in telemedicine.
Information and Methods
Design
This systematic review followed PRISMA guidelines to report evidence from included studies [18, 19]. In this respect, the researchers searched some keywords in titles, abstracts, and the PubMed, Embase, Scopus, and Web of Sciences databases on March, 2023, and employed the MeSH and Emtree keywords and terms in the three below categories to search the databases.
1. Physicians OR Physician OR Doctors OR Doctor OR Nurses OR Nurse OR Personnel, nursing OR Nursing personnel OR Registered nurses OR Nurse, registered OR Nurses, registered OR Registered nurse.
2. Attitude OR Attitudes OR Knowledge OR Awareness OR Awarenesses OR Skill OR Skills.
3. Telemedicine OR Telerehabilitation OR telehealth OR Mobile Health OR Health, Mobile OR Virtual Medicine OR Medicine, Virtual OR eHealth OR mHealth (Table 1).
Table 1. Search strategy for each database
Eligibility criteria
Studies that possessed the following inclusion criteria were entered into the examination process:
1) Cross-sectional studies investigating physicians’ and nurses’ attitudes, awareness, knowledge, and skill in telemedicine;
2) Studies examining physician and nurse populations.
On the other hand, the exclusion criteria were:
1) Publication types other than papers of high-prestigious journals, such as books, review papers, and letters to editors-in-chief;
2) Not accessing the full text of the paper in English;
3) Irrelevance of the title, abstract, or full text to the purpose of the study.
Data extraction and synthesis
After the extraction of studies from the databases, repeated studies were removed. First, titles and abstracts were screened independently based on the eligibility criteria. Papers lacking the inclusion criteria were omitted from the investigation. Then, the full texts were retrieved and screened independently by two researchers based on the eligibility criteria. The inter-researcher conflicts were solved through discussions. A similar checklist was used for data extraction. The data items in this checklist included the reference, examined country, publishing year, applied instruments, study purposes, telemedicine attitudes, telemedicine knowledge, telemedicine awareness, telemedicine skills, and main findings.
Quality assessment
Joanna Briggs Institute’s (JBI) critical appraisal checklist specific to cross-sectional studies was used for the quality assessment of the included studies [20]. In particular, with eight questions for assessing the quality of studies, this checklist involves the following issues: The inclusion criteria of samples, examined population, examined setting, and valid and reliable measurement instruments (mentioning the validity and reliability of the questionnaires). The included studies used standard measurement criteria, identified confounding factors, pursued strategies to cope with confounding factors, reported valid results, and followed appropriate statistical analyses. The responses to the questions included four yes, no, unclear, and not applicable categories. Positively and negatively answered questions received scores of 1 and 0, respectively, and the maximum quality score of every study was 8. If the quality score of a study was <5, it was omitted from the review.
Findings
Selection of studies
The search into scientific databases led to the retrieval of a total of 9398 studies initially. After the omission of repetitive cases (2873), 6525 studies remained for the title and abstract examination. 6494 studies not aligning with the purpose of the study were removed. Then, 31 remaining papers were examined with their full texts, and finally, 13 eligible papers were entered into the study (Table 2; Figure 1).
Table2. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist
Figure 1. Study selection PRISMA
Quality assessment
No considerable bias was observed in the studies, and all studies were entered into the systematic review (Table 3).
Table 3. Summary of the quality assessment of articles using the JBI critical appraisal checklist
Characteristics of studies
Out of 13 studies, three (23%) were conducted in India [22, 26, 32], two (15%) in Pakistan [27, 31], and the rest in Scotland, Malesia, Iran, Uganda, Saudi Arabia, Sweden, Ethiopia, and Egypt [21, 23-25, 28-30, 33]. In addition, only one study [29] belonged to a developed country, and 12 were performed in developing nations [21-28, 30-33]. The data were collected by questionnaires in all studies; Two studies had posted their questionnaires [21, 26], three had administered in-person questionnaires [28, 30, 31], one had used online questionnaires [29], and seven had provided no relevant details (Table4 & 5) [22, 25, 27, 32, 33].
Table 4. Summary of characteristics of studies
Table 5. Summary of included studies
Physicians’ and nurses’ attitudes toward telemedicine
Seven of the studies included in this review evaluated health specialists’ attitudes toward telemedicine, and all revealed the positive and promising attitudes of the examined physicians and health specialists toward telemedicine (Tables 2 & 3) [21, 22, 25, 26, 29, 31, 33].
Richards et al. [21] report that when their participants have been asked to explain their e-health programs, 112 respondents (54%) were familiar with the internet-based informing of laboratory results, 20% were acquainted with video conferences held for education or clinical purposes, and 27% were informed of other applied programs. 68% declare that they have good or excellent experiences and positively evaluate the experiences of easy equipment utilization (74%), equipment performance (75%), clinical utility (76%), technical support (44%), and education (39%). Also, Meher et al. [22] document that many physicians are aware of telemedicine technology, and a total of 86 physicians are using telemedicine. The majority of these 86 physicians express their willingness to cooperate with other centers. In Olok et al.’s [25] study, many healthcare specialists maintain positive attitudes toward e-health properties (Mean=3.5), and the average comparative advantage of ICT, adaptability, testability, and observability is 4.3, 3.8, 3.2, and 3.5, respectively. Zayapragassarazan & Kumar [26] report that many physicians hold high and positive attitudes toward telemedicine. 29% of the respondents possess high altitudes, 31% moderate attitudes, and 30% low attitudes. The maximum and minimum averages associated with attitudes toward telemedicine are obtained for 51-60-year-old (35.61±3.12) and paraclinical respondents (33.21±3.76). Likewise, Glock et al. [29] report that first-care doctors express generally positive attitudes toward digitalization and are almost impatient for it. They assert that enormous sources should be accessed in healthcare and particularly perceived that, along with simplifying physicians’ responsibilities, telemedicine enhances patient empowerment and improves medical care, though some physicians held skeptical attitudes. Furthermore, Kumar et al. [31] show their respondents have agreed that telemedicine can help enhance the interrelationships of healthcare providers (141 individuals), decrease the number of references to health centers (151 individuals), accelerate the accomplishment of tasks (118 individuals), improve clinical decisions (67 individuals), and present more inclusive health services. In addition, Fouad et al. [33] have found high attitudes of mental health providers toward telemedicine and a statistically significant relationship between attitudes toward telemedicine and every one of the following cases: Being heard of telemedicine, willingness to participate in every telemedicine educational program, time spent on individual or collective treatments with telemedicine, time spent on tele-assessment, advantages of telemedicine, reasons for using telemedicine, and telemedicine in specific psychotherapies.
Physicians’ and nurses’ awareness of telemedicine
Among the included studies, all in developing countries, five have evaluated health specialists’ awareness of telemedicine [26, 30, 31, 33]. Only one study addresses nurses and reports their moderate awareness [33]. Three studies document high telemedicine awareness of healthcare specialists [26, 30, 31], and two uncover healthcare specialists’ moderate awareness of telemedicine [32, 33].
In their research, Zayapragassarazan & Kumar [26] show that telemedicine awareness is low for 12%, moderate for 25%, and high for 63% of the respondents. The maximum telemedicine awareness belongs to the 30-40-year age group. Moreover, Kumar et al. [31] Considering the perspectives of 183 participants, express that telemedicine can save time for healthcare specialists and physicians. In contrast, Sukumaran et al. [32] discover moderate telemedicine awareness among the majority of their participants (431 individuals), and 19 physicians maintain poor awareness. In the current COVID-19 scenario, many medical webinars and seminars are held remotely worldwide. A total of 249 participants believe in the training of specific software for telemedicine practices. Almost 262 individuals are concerned with the complaints about arising problems for patients during telemedicine operations. The researchers also have found a weak positive and significant correlation between awareness and skill scores (Pearson correlation=0.20; P<0.0001). Furthermore, Fouad et al. [33] report moderate telemedicine awareness of their participants and show telemedicine awareness maintained statistically significant relationships with being heard of the telemedicine terminology and the spent time. On the other hand, they have found out telemedicine awareness had statistically significant relationships with the benefits of providing mental health services remotely, reasons for using remote mental health services, reasons for not employing telemedicine, and using telemedicine for specific cases. Assaye et al. [30] have discovered that telemedicine awareness is strongly related to knowledge, such that healthcare professionals are aware of telemedicine services. In this respect, 77.1% of the participants are aware of the clinical telemedicine uses for radiology, and 51.6% are aware of the conventional uses of public health in the telemedicine domain. Teaching about telemedicine is strongly associated with awareness of telemedicine services in this study. Those receiving telemedicine training are likely 2.33 times more aware of telemedicine services than untrained ones. Another factor influencing telemedicine awareness was access to computers in hospitals where health specialists worked. Those accessing computers in their hospitals were apparently 1.42 times more aware of telemedicine than those not accessing this technology.
Physicians’ and nurses’ knowledge of telemedicine
Ten examined studies, all in developing countries, evaluated health specialists’ knowledge of telemedicine [21-24, 26-28, 30, 32, 33]. Seven studies reported high and excellent telemedicine knowledge and its application [21-23, 26, 27, 30, 32]. Only one studies investigated nurses and reported their moderate knowledge and sufficient experience in employing telemedicine equipment [25]. Among these studies, one documented moderate knowledge [33], and two found poor telemedicine knowledge of healthcare specialists. In conclusion, they argued that constant education and meetings and conferences held on telemedicine were among the helpful approaches to knowledge enhancement [24, 28].
Richards et al. [21] have reported that many general practitioners consider the effect of counseling on patient privacy useful (44%), and only one-fourth claimed its detrimental impact (13%). 44% hve positively evaluated access to general practitioners, and just one-third hold positive attitudes toward the effect of counseling on patient privacy (16%). 32% consider it harmful, and 21% agree that e-health increases enjoyment. Meher et al. [22] report that the majority of their participants possess high knowledge, while a few lack any knowledge of telemedicine in large and remote hospitals. Ibrahim et al. [23] have found out that many of their respondents employ CD-ROMs (82%), emails (84%), and modems (76%), while more than three-fourths of the respondents are inexperienced in using smart cards, Computer-Assisted Learning (CAL), tele-radiology, tele-surgery, telenursing, and tele-pharmacy. On the other hand, their general awareness of the components are 82% for CAL, 66% for telenursing, 57% for tele-surgery, 55% for tele-radiology, 55% for tele-pharmacy, and 46% for smart cards. Likewise, Zayapragassarazan & Kumar