Study reveals what makes telemedicine work in SA

A recent doctoral study from Stellenbosch University has identified two crucial factors that drive the success of app-based telemedicine in South Africa’s strained public healthcare environment: perceived privacy and perceived care.

Dr Grethe van Tonder, who completed her doctorate in Business Management, conducted the research using the Kena Health app - a digital platform offering virtual consultations with nurses, doctors, and mental health professionals.

The app was launched in 2022 and provides diagnoses, prescriptions, sick notes, and counselling via text, audio, or video, without appointments.

“In a country where public clinics are often overcrowded and under-resourced, telemedicine offers a vital alternative for accessing primary healthcare,” said Dr van Tonder.

“It is, therefore, important to tailor primary care telemedicine services in a way that builds and maintains patients’ trust - especially given the sensitivity around health-related needs. Providers have the significant opportunity to receive and treat patients when they’re often at their most vulnerable and should always do so with the utmost care and respect,” said Dr van Tonder.

Her study found that patients were more likely to accept and continue using the app-based service when they felt their privacy was protected - often more so than in-person clinic visits.

Participants reported feeling less exposed and more anonymous during text or voice consultations, which they saw as a safer, more respectful experience compared to the lack of privacy in public facilities.

“During data collection, participants explained that app-based consultations allow for ‘anonymity’ where they don’t have to be seen - such as when text or voice calls are used instead of video."

"Even more significant, however, was the perception of care. Patients overwhelmingly said they felt listened to, respected, and treated with kindness by professionals on the app - a stark contrast to experiences in clinics where rushed, impersonal service and even verbal abuse were common.

Furthermore, others can’t overhear their conversations with the healthcare professional, unlike in many under-resourced public healthcare facilities. Participants regard these circumstances as key to their acceptance of the app-based telemedicine service.”

“Many participants said they felt judged or disrespected in public clinics,” Dr Van Tonder noted. “By contrast, the app-based service left them feeling genuinely cared for, which directly influenced their willingness to trust and continue using the platform.”

Dr van Tonder said that participants also described being shouted at or scolded by medical staff, which often left them feeling judged and ashamed of the healthcare need that brought them to the public facility in the first place.

“In contrast to such experiences, participants said their interactions with healthcare professionals on the Kena Health app were the exact opposite - highlighting how their highly positive perceptions of care shaped their acceptance of, their satisfaction with, and their willingness to continue using the app-based telemedicine service.”

Dr van Tonder said her study could help app-based telemedicine service providers of primary care to tailor their services according to patient-specific needs, considering patients’ unique contexts and frames of reference to address the factors that would most significantly influence their acceptance of such a service.

The insights could also benefit other healthcare providers looking to add app-based telemedicine services to their existing offerings.

She said that even though a digital platform is used, the human ability to show empathy, kindness, and genuine care is what primary healthcare providers should focus on to build patient trust and satisfaction during app-based digital consultations.

She recommends that digital health providers focus on empathy and compassion during virtual consultations, as these human elements are central to patient trust and satisfaction - even in a digital environment.

Dr van Tonder also suggested that integrating pharmacy services into the app could significantly improve access to medication, particularly for patients who struggle to collect prescriptions through the public system.

“We need to understand the driving factors in patients’ unique contexts causing them to continue using (app-based) primary care telemedicine services to make sure this kind of service delivery can continue to benefit South Africa’s healthcare system in the long run,” said Dr van Tonder.