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Due to the upsurge of COVID-19, nations are increasingly adopting telemedicine programs in anticipation of similar crises. Similar to all nations worldwide, Jordan is implementing efforts to adopt such technologies, yet it is far from complete.
This study aims to assess the knowledge, attitudes, and perceptions of Jordanians toward telemedicine, to identify key factors predisposing individuals to its use or acting as barriers to its implementation.
We implemented a cross-sectional design using an online, self-administered questionnaire executed in Google Forms and distributed through social media. Differences in knowledge and attitude scores were examined using independent sample
A total of 1201 participants fully completed the questionnaire. Participants were characterized by a mean age of 36.3 (SD 14.4) years and a male-to-female ratio of nearly 1:1. About 50% (619/1201, 51.5%) of our studied population were aware of telemedicine, while nearly 25% (299/1201, 24.9%) declared they had observed it in action. Approximatively 68% (814/1201, 67.8%) of respondents were willing to use telemedicine. The majority of the sample portrayed favorable and positive views toward telemedicine. Higher educational degrees, living in urban districts, and having a higher perception of electronic usage ability were associated with higher knowledge and better attitudes toward telemedicine (all
Jordanians portray favorable perceptions of telemedicine. Nonetheless, concerns with regards to privacy, medical errors, and capacity for accurate diagnoses are prevalent. Furthermore, Jordanians believe that integrating telemedicine within the health care system is not applicable due to limited resources.
Telemedicine is defined by the World Health Organization as the use of information and communication technologies to promote health, provide medical care, exchange medical information, and educate health care providers and patients over long distances [
Although the literature recognizes the myriad of benefits of telemedicine, such as reducing travel time, decreasing consultation fees, and increasing access to medical services to residents of remote, low-resource regions [
Along those challenges, there are some aspects that are particularly important in the Arab context, specifically those pertaining to social and religious restrictions [
In the Arab world, the concept of telemedicine is still relatively new, and applications of this technology are still limited [
To date, some of the well-established telemedicine programs in Jordan include the Hakeem Portal, which provides patients with the service of booking outpatient follow-up consultations within public health institutions [
Hence, the primary aim of this study was to investigate the knowledge, attitudes, and perceptions of the Jordanian public toward telemedicine. The secondary aims of this study were to identify key predictive factors of telemedicine usage and the potential obstacles for implementation.
This cross-sectional study was conducted in The Hashemite Kingdom of Jordan, an upper-middle-income country located in the Middle East. Jordan has a population of 10.3 million and a median age of 23.8 years as of 2022. We designed and distributed an online, self-administered questionnaire executed in Google Forms and distributed through social media. We adopted a convenience sampling technique in order to approach the target group of the study, which aimed to represent the adult general population (≥18 years old) across all genders, governorates, and nationalities of those living in Jordan. The questionnaire was distributed among the target population during January 2022 through multiple popular social media platforms (eg, Facebook, Twitter, and WhatsApp). Participants were encouraged to share the questionnaire among their friends and relatives for maximum reach and generalizability of results. Simultaneously, a printed self-administered version of the questionnaire was utilized and distributed in places where different groups of the target population, especially those who are less likely to be active on the aforementioned social media platforms, could be found, thus reducing biases introduced by online surveys. These locations included the Jordan University Hospital, King Abdullah University Hospital, Al-Bashir public hospital, and the Royal Medical Services, as these locations provide medical care to the greater majority of individuals in Jordan. Moreover, in-person data collection was initiated in public spaces including malls, shopping districts, and entertainment districts. It should be noted that the Jordan University Hospital is the largest academic center in Jordan and is the largest referral center for all of central Jordan serving over 4 million patients. Participants included in the study were those who gave informed consent, completed the whole questionnaire, and were ≥18 years of age.
The questionnaire was constructed after conducting an extensive literature review [
During pilot testing, the Cronbach alpha for the attitudes and perceptions scores were 0.82 and 0.74, respectively, thus ensuring proper internal consistency. The questionnaire’s content validity was ensured by a panel of experts in global and public health. Meanwhile, face validity was ensured through respondents’ feedback during pilot testing. Construct validity was examined using factor analysis. The Barret test for sphericity was significant at
The questionnaire was translated to Arabic to ensure comprehensibility, and it was translated back to English, all through the help of an expert translator. The final questionnaire included a total of 36 items (including demographics), with an approximate time of completion of 4 minutes.
Statistical analysis was conducted using SPSS version 24 (IBM Corp, Armonk, NY). Data were reported as frequencies (n) and percentages (%) or means (SDs) wherever applicable. Normality of data was tested using the Shapiro-Wilk and Kolmogorov Smirnov tests. Mean differences were examined using the independent sample
Considering that there are no comparable studies from Jordan that can be used to calculate the appropriate sample size, the estimated sample size was calculated using GPower 3.1 and EpiInfo. At a power of 95%, α margin of error of 5%, and effect size of 30%, a sample of 580 participants was needed to demonstrate statistical differences of appropriate power.
This study was approved by the University of Jordan Scientific Committee.
A total of 1201 participants fully completed the questionnaire. Participants were characterized by a mean age of 36.3 (SD 14.4) years and a male-to-female ratio of nearly 1:1. Most participants had at least a university degree (ie, bachelor’s; 758/1201, 63.1%), lived in the capital of Jordan (743/1201, 61.9%), and resided within urban cities (1056/1201, 87.9%). Nearly 58% (690/1201, 57.5%) of all participants were married, of which 70.7% (488/1201) had at least 3 children. Furthermore, 28.6% (344/1201) held office-based occupations, 26.2% (315/1201) were unemployed, 26.0% (312/1201) were students, 19.2% (230/1201) held field occupations, 4.4% (53, 1201) were housewives, and 3.9% (47/1201) were retired.
In terms of electronic competency, 54.3% (652/1201) perceived that they were highly competent in dealing with computers or electronic tablets. The most common internet connection types reported were 4G standard routers (386/1201, 30.6%), followed by fiber optic internet (522/1201, 23.5%). The sociodemographic characteristics of the cohort are described in
Demographics of the recruited participants (n=1201).
Variable | Results, n (%) | ||
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Male | 615 (51.2) | |
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Female | 586 (48.8) | |
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18-30 | 515 (42.9) | |
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31-40 | 232 (19.3) | |
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41-50 | 227 (18.9) | |
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51-60 | 165 (13.7) | |
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61-85 | 62 (5.2) | |
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Primary | 29 (2.4) | |
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High school | 209 (17.4) | |
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University | 758 (63.1) | |
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Postgraduate (ie, master’s) | 205 (17.1) | |
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Capital (Amman) | 743 (61.9) | |
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Central | 210 (17.5) | |
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North | 198 (16.5) | |
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South | 50 (4.2) | |
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Urban | 1056 (87.9) | |
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Rural | 145 (12.1) | |
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Married | 690 (57.5) | |
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Single | 511 (42.5) | |
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0 | 57 (8.3) | |
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1 | 51 (7.4) | |
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2 | 94 (13.6) | |
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≥3 | 488 (70.7) | |
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Office | 344 (28.6) | |
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Field | 230 (19.2) | |
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Retired | 47 (3.9) | |
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Student | 312 (26.0) | |
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Housewife | 53 (4.4) | |
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Unemployed | 215 (17.9) | |
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Fiber | 522 (23.5) | |
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4G router | 368 (30.6) | |
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ADSL | 45 (3.7) | |
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Phone packets | 184 (15.3) | |
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Router and phone packets | 81 (6.7) | |
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None | 1 (0.1) | |
Comorbidities (yes) | 280 (23.3) | ||
Medications (yes) | 359 (29.9) | ||
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High (8-10) | 652 (54.3) | |
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Low (0-7) | 549 (45.7) |
Participants’ responses on the telemedicine knowledge items.
Knowledge items | Agree, n (%) | Disagree, n (%) |
Have you heard of telemedicine before? | 619 (51.5) | 582 (48.5) |
Have you observed a telemedicine process previously? | 299 (24.9) | 902 (75.1) |
Have you ever used telemedicine before? | 170 (14.2) | 1031 (85.8) |
Telemedicine reduces the number of needed medical staff. | 755 (62.9) | 446 (37.1) |
Telemedicine reduces transportation costs and time. | 1127 (93.8) | 74 (6.2) |
Telemedicine facilitates care for older adult patients. | 948 (78.9) | 253 (21.1) |
With telemedicine, you can remotely acquire a prescription, refill, or admission orders | 1018 (84.8) | 183 (15.2) |
With telemedicine, you can closely follow up with your ongoing/chronic illnesses remotely. | 824 (68.6) | 377 (31.4) |
With regards to participants’ attitudes, our cohort displayed mostly favorable attitudes toward telemedicine. The majority of participants believed that telemedicine is useful during a pandemic (1001/1201, 83.3%), is able to decrease the number of outpatient visits (1033/1201, 86.0%), can increase the speed of performing health care services (893/1201, 74.4%), mitigates health care costs (897/1201, 74.7%), and is able to provide specialized health care to underserved areas (841/1201, 70.0%). Overall, 67.8% (814/1201) of all participants were willing to use telemedicine for diagnosis or follow up.
On the other hand, a significant number of participants believed that telemedicine cannot provide accurate diagnoses (810/1201, 67.4%) or comprehensive health care (757/1201, 63.0%). Moreover, the greater majority of participants believed that telemedicine is unable to reduce medical errors (889/1201, 74.0%). Most importantly, 43.5% (522/1201) of all participants believed that telemedicine may pose a threat to their information privacy. In terms of perceptions, most participants believed that Jordan does not have the capacity to implement telemedicine (626/1201, 60.4%); however, more than one-half (654/1201, 54.5%) of the cohort perceived telemedicine as the future of health care.
Attitudes and perceptions of respondents toward telemedicine.
Attitudes and perceptions | Response categories, n (%) | Score, mean (SD) | ||||||||||
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Strongly disagree | Disagree | Agree | Strongly agree |
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Is telemedicine useful during a pandemic (eg, COVID-19)? | 71 (5.9) | 129 (10.7) | 401 (33.4) | 600 (50.0) | 3.3 (0.9) | ||||||
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Can telemedicine accurately facilitate the diagnosis of people? | 332 (27.6) | 478 (39.8) | 278 (23.1) | 113 (9.4) | 2.1 (0.9) | ||||||
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Does telemedicine improve the communication between patient and physician? | 177 (14.7) | 325 (27.1) | 420 (35.0) | 279 (23.2) | 2.7 (0.9) | ||||||
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Does telemedicine decrease visits to outpatient clinics? | 69 (5.7) | 99 (8.2) | 454 (37.8) | 579 (48.2) | 3.3 (0.8) | ||||||
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Does telemedicine help increase the speed of performing medical care? | 105 (8.7) | 203 (16.9) | 492 (41.0) | 401 (33.4) | 2.9 (0.9) | ||||||
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Does telemedicine reduce medical errors? | 415 (34.6) | 474 (39.5) | 204 (17.0) | 108 (9.0) | 2.0 (0.9) | ||||||
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Is telemedicine able to provide patients with comprehensive health care? | 271 (22.5) | 486 (40.5) | 302 (25.1) | 142 (11.8) | 2.3 (0.9) | ||||||
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Does telemedicine threaten information privacy? | 270 (22.5) | 409 (34.1) | 331 (27.6) | 191 (15.9) | 2.4 (1.0) | ||||||
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Does telemedicine reduce the costs of providing health care? | 87 (7.2) | 217 (18.1) | 510 (42.5) | 387 (32.2) | 2.9 (0.9) | ||||||
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Are you willing to use telemedicine for your medical diagnosis or follow-up? | 189 (15.7) | 198 (16.5) | 456 (38.0) | 358 (29.8) | 2.8 (1.0) | ||||||
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Telemedicine will improve access to specialized health care for people who live in rural and suburban areas. | 153 (12.7) | 207 (17.2) | 455 (37.9) | 386 (32.1) | 2.9 (0.9) | ||||||
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Do you believe that Jordan has the capacity to adopt and implement telemedicine services? | 338 (28.1) | 288 (32.3) | 306 (25.5) | 169 (14.1) | 2.3 (1.0) | ||||||
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Telemedicine can be integrated within the existing system. | 177 (14.7) | 319 (26.6) | 457 (38.1) | 248 (20.6) | 2.6 (0.9) | ||||||
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Telemedicine is the future of clinical practice. | 187 (15.6) | 360 (30.0) | 427 (35.6) | 227 (18.9) | 2.6 (0.9) |
Univariate analysis demonstrated that having higher educational degrees (
On another note, it appears that being married (odds ratio [OR] 1.426, 95% CI 1.017 to 1.998;
Differences in knowledge, attitude, and perception scores across different sociodemographic variables.
Variables | Knowledge score, mean (SD) | Attitudes score, mean (SD) | Perception score, mean (SD) | ||||||||||
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Male | 4.8 (1.5) | .96 | 30.2 (6.6) | .25 | 7.3 (2.5) | .007 | ||||||
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Female | 4.8 (1.5) | 29.7 (5.9) | 7.6 (2.2) | |||||||||
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18-30 | 4.8 (1.5) | .41 | 30.3 (5.7) | .05 | 7.5 (2.3) | .80 | ||||||
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31-40 | 4.7 (1.6) | 29.7 (6.5) | 7.4 (2.4) | |||||||||
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41-50 | 4.9 (1.6) | 29.8 (6.5) | 7.4 (2.4) | |||||||||
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51-60 | 4.8 (1.6) | 30.0 (7.1) | 7.4 (2.6) | |||||||||
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61-85 | 4.6 (1.5) | 27.8 (6.5) | 7.2 (2.5) | |||||||||
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Primary | 4.4 (1.4) | <.001 | 29.0 (6.6) | .006 | 7.8 (3.0) | .39 | ||||||
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High school | 4.3 (1.5) | 28.9 (7.5) | 7.4 (2.7) | |||||||||
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University | 4.8 (1.5) | 29.9 (5.8) | 7.4 (2.3) | |||||||||
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Postgraduate (ie, masters) | 5.2 (1.4) | 31.1 (6.5) | 7.7 (2.3) | |||||||||
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Capital (Amman) | 4.8 (1.5) | .23 | 30.1 (3.1) | <.001 | 7.5 (2.4) | <.001 | ||||||
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Central | 4.7 (1.3) | 29.7 (6.7) | 7.4 (2.3) | |||||||||
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North | 4.8 (1.6) | 30.6 (6.3) | 7.7 (2.2) | |||||||||
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South | 4.4 (2.3) | 27.1 (7.4) | 6.1 (2.6) | |||||||||
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Urban | 4.8 (1.5) | .002 | 30.1 (3.2) | .14 | 7.5 (2.3) | .05 | ||||||
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Rural | 4.4 (1.7) | 29.2 (7.1) | 7.1 (2.6) | |||||||||
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Married | 4.8 (1.6) | .74 | 29.7 (6.7) | .09 | 7.5 (2.3) | .36 | ||||||
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Single | 4.8 (1.5) | 30.3 (5.7) | 7.4 (2.5) | |||||||||
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0 | 4.7 (1.5) | .83 | 30.1 (6.0) | .64 | 7.6 (2.3) | .38 | ||||||
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1 | 4.8 (1.7) | 30.5 (6.9) | 7.4 (2.4) | |||||||||
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2 | 4.8 (1.6) | 29.5 (6.3) | 7.2 (2.1) | |||||||||
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≥3 | 4.8 (1.6) | 29.7 (6.6) | 7.4 (2.5) | |||||||||
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4G | 4.7 (1.5) | .11 | 30.2 (6.3) | .004 | 7.5 (2.3) | .72 | ||||||
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Fiber | 4.9 (1.5) | 30.4 (3.2) | 7.5 (2.4) | |||||||||
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Phone packets, others | 4.7 (1.7) | 28.9 (6.5) | 7.4 (2.5) | |||||||||
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High (8-10) | 4.9 (1.5) | <.001 | 30.7 (6.0) | <.001 | 7.6 (2.3) | .11 | ||||||
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Low (0-7) | 4.6 (1.6) | 29.0 (6.5) | 7.4 (2.4) |
The multivariate linear regression analysis demonstrated that the perceived ability of using electronics was associated with positive attitudes (
Factors predicting favorable attitudes toward telemedicine.
Factors | Linear regression model for attitudes | |||
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B |
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Lower and upper 95% CIs for B | |
Age | .74 | –0.007 | 0.022 | –0.051 to 0.036 |
Gender (female) | .59 | –0.199 | 0.369 | –0.922 to 0.525 |
Number of children | .83 | 0.026 | 0.122 | –0.214 to 0.266 |
Ability to deal with computers and tablets | <.001 | 0.394 | 0.086 | 0.224 to 0.563 |
Presence of comorbidities | .87 | –0.110 | 0.671 | –1.427 to 1.207 |
Taking regular medications | .64 | 0.294 | 0.620 | –0.922 to 1.510 |
Being Married | .95 | –0.034 | 0.612 | –1.234 to 1.165 |
High school education | .49 | –0.871 | 1.272 | –3.367 to 1.624 |
University education | .57 | –0.699 | 1.243 | –3.137 to 1.740 |
Postgraduate education | .88 | 0.188 | 1.304 | –2.370 to 2.746 |
4G internet | .08 | 0.859 | 0.495 | –0.111 to 1.829 |
Fiber internet | .07 | 0.897 | 0.491 | –0.067 to 1.861 |
Living in Amman | .08 | –0.963 | 0.546 | –2.035 to 0.109 |
Living in Central Jordan | .09 | –1.064 | 0.629 | –2.298 to 0.170 |
Living in Southern Jordan | .004 | –2.896 | 1.008 | –4.873 to –0.919 |
In summary, we demonstrated that about one-half of our studied population were aware of the existence of telemedicine, while only a small minority declared having observed or ever used the technology. Furthermore, more than one-half of the population were willing to use telemedicine. Overall, attitudes toward telemedicine were positive. However, participants questioned its capacity to reduce errors, make accurate diagnoses, or provide comprehensive care. Moreover, telemedicine was perceived as a threat to privacy and impractical within Jordan’s current resource capacity. Attitudes and degree of knowledge were typically higher in those with higher education levels, who perceived themselves as competent electronics users, and who lived in metropolitan regions. Regression analysis showed that perceived competency with electronics was a positive predictor of favorable attitudes, while living in rural areas (Southern Jordan) was a negative predictor. Also, a higher likelihood of using telemedicine was associated with having children, being married, having previous comorbidities, or taking medications.
To the best of our knowledge, this study is the first of its kind in Jordan. We aimed to explore the levels of awareness, knowledge, and concerns of the general public toward telemedicine in an attempt to closely inspect the understanding of its potential recipients and providers of the concept of the technology and further evaluate the possibility of incorporating it into the current health system. Within the regional literature, studies conducted in Saudi Arabia and Egyptian populations showcased similar results to those of our study [
In terms of attitudes, our participants demonstrated positive perceptions toward telemedicine. They believed that it has the capacity to decrease transportation costs and the number of medical staff required. They also believed that telemedicine can smoothen health care logistics and facilitate better health care for older adults. Mutual economic benefits for patients and health care providers were evidently recognized in successful telemedicine projects in Jordan [
Moreover, Jordanian participants believed that telemedicine helps in reducing outpatient visits, increasing the speed of delivering health care services, and providing more comprehensive care to underserved regions. Also, they perceive it as a useful tool during a pandemic similar to that of COVID-19. Similar statements were also observed from residents of Saudi Arabia and Egypt [
On the other hand, our study participants expressed a multitude of concerns toward telemedicine. These concerns were mostly pertaining to accuracy of diagnosis, medical errors, and information privacy. Diagnostic accuracy through telemedicine services has been thoroughly evaluated in the literature. Most studies reported high accuracy in specialties where telemedicine is viable, although variations across literature are still evident. Most notably, those specialties were dermatology [
Although some studies associate the rapid expansion of telemedicine technology in COVID-19 with an increased incidence of medical errors [
Maintaining privacy and information security was a challenging conundrum that was threatened and prominently highlighted through the era of rapid expansion of telemedicine services during COVID-19. Such challenges were manifested as a lack of controls or limits on the collection, use, and disclosure of sensitive personal information, repeated cyberattacks, and rapid spread of ransomware and went as far as suspected death in patients [
In our study, higher rates of telemedicine use were significantly higher among patients with comorbidities and those taking chronic medications. Such results could be largely explained by the fact that, in 2020, due to COVID-19 restrictions, the Ministry of Health, along with the Royal Medical Services and university hospitals, offered primarily medication refill services through telemedicine programs [
Among the studied cohort, participants who were married and had children had a higher likelihood of telemedicine usage. The particular use of telemedicine services within the context of a marriage appears to be a solution for a myriad of obstacles that otherwise would prevent couples from seeking therapy such as childcare, scheduling difficulties, and stigma. Providing couples treatment via telemedicine services was reported to address these obstacles and improve accessibility to health care services [
More than one-half of the studied population believed that Jordan cannot successfully integrate telemedicine into the current health care system. This may be due to resource scarcity, as it remains a major hindrance for the implementation of telemedicine in Jordan. Considering its position as a country with limited resources and a high poverty rate of 24.1% [
Another reason for such negative perceptions of telemedicine is the misleading status of the technological infrastructure in Jordan. Although around 67% of the Jordanian population utilize the internet [
Our results should be considered with caution due to the following limitations: the cross-sectional study design and its implications, close-ended nature of the questionnaire that may miss certain participants’ responses, and sampling technique that may have missed certain groups of the Jordanian populace (eg, older adults and technologically illiterate individuals).
In light of these findings, Jordanians have favorable and positive perceptions of telemedicine that are similar to other populations within the same region. Nonetheless, concerns with regards to privacy, medical errors, and capacity for making accurate diagnoses are prevalent. Despite the generally positive perceptions toward and willingness to use telemedicine, Jordanians believed that telemedicine cannot be easily integrated within the current system nor do they have resources to adopt it.
odds ratio
None declared.