Exploring the Feasibility and Acceptability of a Telehealth Platform for Older Adults with Noncommunicable Diseases and Chronic Viral Hepatitis

Abstract

Background

: Telehealth improves access to health care and potentially leads to better clinical outcomes. However, digital competence could be an essential factor in ensuring its adoption, particularly among older adults. This study evaluated the acceptability and perception of a mobile application platform among Thai older patients with chronic diseases according to their demographics and digital skills.

Methods

: The demographic information and internet usage profiles of patients with nonmalignant chronic diseases, including chronic viral hepatitis, were collected. Participants were grouped based on their self-perceived digital familiarity. The chi-square test was used to evaluate the associations between the parameters.

Results:

Among 710 participants (61.7% women, mean age: 66.2 years), digital familiarity was significantly higher among individuals aged <70 years, men, those with a bachelor’s degree or higher, those with higher incomes, and Bangkok residents (p < 0.001). In this study, regular use of smartphones and the internet, but not messaging applications, was associated with self-perceived digital familiarity. Of these, 100 participants completed a survey evaluating their satisfaction with and perceptions of telehealth. Participants with greater digital familiarity demonstrated significantly higher satisfaction with telemedicine compared with those with limited ability or relied on caretakers (χ² = 70.145, p < 0.001).

Conclusion

: Our data indicated that a user-friendly mobile application is feasible and acceptable for the management of chronic diseases in older patients. Digital familiarity is an important factor associated with satisfaction with the platform, underscoring the need to bridge digital skill gaps and ensure equitable health care delivery.

Introduction

Noncommunicable diseases (NCDs) are a major global public health challenge, and Thailand is no exception. The prevalence of chronic diseases in Thailand is alarmingly high, with citizens having a 14% risk of premature death from one of the four main chronic diseases, including cardiovascular diseases (CVD) and type 2 diabetes (T2DM).¹ In addition, Thailand is an endemic area of chronic infectious disease, particularly chronic viral hepatitis B and C, which can lead to the development of cirrhosis and liver cancer.²

Older adults, who typically have chronic diseases and multimorbidity, require frequent medical follow-ups, typically with multiple specialists. In Thailand, patients face an average waiting time of ∼3 h during medical visits.^3,4 Several patients with multiple comorbidities cannot manage all necessary appointments in one day, resulting in multiple hospital trips.⁴ This situation is further complicated by the time-consuming nature of appointments, impacting both patients and caregivers, thereby leading to discontinuous care and poor compliance. Additionally, the COVID-19 pandemic has exacerbated these issues, causing older patients to miss appointments because of fear of infection or transportation issues.^5
–7

This inefficiency adds to the administrative burden on health care providers, intensifying the challenges faced in the caring of Thailand’s rapidly aging population, which is projected to reach a superaged status by 2024.⁸ The geriatric clinic’s current appointment system is inefficient, as it relies on a paper-based method that complicates rescheduling and lacks patient reminders.

Telemedicine has been reported to improve medical access.⁹ However, digital competence is a significant factor in ensuring the adoption of telemedicine.¹⁰ People with low technology familiarity, especially older adults, are at risk of digital exclusion.¹¹ Adults aged >60 years are less likely to use online services as they get older, and feelings of inadequacy with the use of computers and the internet could discourage patients from using digital health services.¹¹ Hence, telemedicine might exacerbate disparities in this particular population.

To address these challenges, “TeleCU,” a telemedicine platform for older patients with chronic diseases focusing on nonmalignant NCDs and chronic viral hepatitis, was developed and implemented at King Chulalongkorn Memorial Hospital (KCMH). This study aimed to assess the acceptability and feasibility of this platform for managing chronic diseases in older adults while exploring demographic differences and satisfaction with the platform among patients with different levels of technological familiarity.

Methods

Using a user-centered codesign approach,^12,13 key stakeholders, including physicians, nurses, and 13 older patients (average age = 70 years), who had been receiving care in the clinic were involved in decision-making throughout the design process to identify challenges in clinical workflow and patient experiences. Based on these insights, we developed a prototype for “TeleCU,” a telemedicine platform consisting of a web application for providers and a mobile app for patients. After the prototype underwent internal testing and group-based discussions with all stakeholders, the design was finalized. We then implemented the platform in the KCMH’s geriatric clinics. Patients whose health conditions were deemed stable and appropriate for virtual consultations were recruited for follow-up visits using a telehealth platform. Before their virtual visit, patients completed a digital skills questionnaire and downloaded a mobile application. They received reminders via the application and attended appointments on the platform. After these visits, an online questionnaire was distributed via an in-app chat feature.

This prospective, self-controlled study was conducted at the KCMH in 2020, following approval from the Ethics Committee of the Institutional Review Board of the Faculty of Medicine, Chulalongkorn University (IRB No. 375/63). The research was conducted in accordance with the Declaration of Helsinki, revised in 2013 (Fig. 1).

Fig. 1.

Overview of telemedicine platform development.

USER RESEARCH

Focus group discussions with three nurses and a clinic administrator revealed several challenges. For example, an overwhelming nurse-to-patient ratio of ∼1:700 has worsened owing to the lack of a systematic patient-tracking system and the reliance on manual scheduling and rescheduling of appointments. Additionally, there was no automated reminder system in place, with reminders sent only to patients whose appointments were rescheduled by a physician, which contributed to an ∼50% loss of patient follow-up.

Interviews with older patients revealed that none of them had received reminders about their appointments, and some had missed appointments in the past. The available telehealth platform is a third-party web-based videoconferencing platform, which is difficult to use. Patients were unaware of their current position in the queue to consult physicians and typically faced long wait times when they called the hospital for confirmation. In addition, they lacked a point of contact between visits or before and after visits when encountering appointments or technical issues. Furthermore, ∼15% knew about online health education videos and group activities hosted by the hospital, and only 30% were open to telemedicine, revealing a greater preference for face-to-face consultations.

Based on these insights, we developed a telehealth platform with the following objectives: integration of patients’ personal information, allowing digital appointment scheduling with automated reminders, enabling in-app video consultation and providing communication between health care providers and patients for rescheduling, queue status updates, technical troubleshooting, and announcements of health education activities hosted by hospitals. Moreover, online health educational resources were tailored to each patient’s medical history.

PLATFORM DEVELOPMENT

The telemedicine platform was developed according to Thailand’s Personal Data Protection Act. Only authorized users had access to the data, which were stored on the Tencent Cloud server and compliant with several International Organization for Standardization standards. Data transfer across networks was encrypted following the Transport Layer Security 1.2 (TLS1.2) protocol.

We developed an HTML-5 web-based platform for health care providers, integrating it with the KCMH’s information system to allow access to patient records, contact information, previous visits, laboratory results, and medications. Providers can edit schedules, reschedule appointments within the application, and view each visit’s calendar. Physicians can tag patients using keywords/medical conditions, enabling them to receive health-related educational videos and event notifications specific to their medical conditions (Fig. 2 ).

Fig. 2.

User interface for administrators and providers.

For patients, we developed a smartphone application available in iOS and Android application stores. The application facilitates in-app video consultations, appointment reminders, and direct in-app messaging with providers. In addition, it alerts users to group activities and health education videos tailored to their medical histories (Fig. 3).

Fig. 3.

User interface for general users.

PARTICIPANTS, DATA COLLECTION, AND ANALYSES

Data were collected between September 2020 and March 2022, focusing on patients with chronic diseases, including T2DM, hypertension (HT), CVD, and chronic viral hepatitis. Participants were recruited from the geriatric clinic at KCMH’s Center of Excellence in Hepatitis and Liver Cancer, Faculty of Medicine, Chulalongkorn University. Patients who were evaluated and found suitable for virtual follow-up by any of the physicians, consisting of two geriatricians, two gastroenterologists, and one internal medicine physician, were invited to participate. A team of nurse administrators ensured that all information was disclosed and confirmed that the patients fully understood the decision-making process, with an emphasis on the voluntary aspect of their participation. Informed consent was obtained from all the patients. Nurse administrators then assisted patients in downloading and setting up the TeleCU application. Patients completed questionnaires on their demographic and health information, which were cross-verified using the hospital’s electronic health records. In addition, participants were asked to report their experiences using digital devices and the internet and to self-categorize their digital skills, placing themselves into one of three groups:

Patients who could proficiently navigate the internet and social media (Group 1)

Patients who could navigate the internet and social media to a limited extent (Group 2)

Patients who relied on caretakers for internet and social media use (Group 3).

After discharge from the clinic, patients were scheduled for follow-up appointments at 3- or 6-month intervals, with separate clinic visits arranged for any necessary laboratory work or imaging. Automated reminders were sent to patients before their virtual visits, and a postsession satisfaction and perception survey using a 5-point Likert scale was distributed via the TeleCU application. We hypothesized that participants in Group 1 would report the highest levels of satisfaction with the TeleCU platform and possess the most favorable perceptions of telemedicine. In contrast, participants in Groups 2 and 3 were expected to reveal progressively lower satisfaction and less positive perceptions as they were less comfortable using the internet and digital devices.

Statistical weighting was used to ensure that the survey results were representative of the entire population. The weighted data were subjected to chi-square tests to assess the significance of the observed differences across various satisfaction and perception metrics related to telemedicine usage. All statistical analyses were performed using SPSS version 29.0 (IBM Co., Chicago, IL, USA), with a p < 0.05 considered significant.

Results

DEMOGRAPHIC CHARACTERISTICS

Demographic data were analyzed for all 710 patients who participated in the study. There were 75 (10.6%) participants who could use the internet skillfully (Group 1). Over half of the participants (385, 54.2%) felt that they could maneuver the internet and social media to a certain extent (Group 2), and 250 (35.2%) participants required support from caretakers to navigate the internet and social media (Group 3). Factors that are statistically associated with higher technological literacy included sex (male) (χ² = 7.915, p = 0.019), having at least a bachelor’s degree (χ² = 42.188, p < 0.001), having income over 20,000 Thai Baht (equivalent to ∼540 USD at 1 THB = 0.027 USD) (χ² = 23.695, p < 0.0001), and residing in the capital city, Bangkok (χ² = 19.485, p < 0.001) (Table 1).

Table 1.

Demographic Characteristics of the Participants

VARIABLES	ALL (n = 710)	GROUP 1^a (n = 75)	GROUP 2^b (n = 385)	GROUP 3^c (n = 250)	CHI-SQUARE
Sex					χ² = 7.915 p = 0.019
Male	272 (38.3)	39 (52.0)	148 (38.4)	85 (34.0)
Female	438 (61.7)	36 (48.0)	237 (61.6)	165 (66.0)
Age					χ² = 43.033 p = <0.001
<70 years old	485 (68.3)	59 (78.7)	294 (76.4)	132 (52.8)
≥70 years old	225 (31.7)	16 (21.3)	91 (23.6)	118 (47.2)
Education					χ² = 42.188 p = <0.001
Bachelor’s degree	437 (61.5)	34 (45.3)	210 (54.5)	193 (77.2)
≥Bachelor’s degree	273 (38.5)	41 (54.7)	175 (45.5)	57 (22.8)
Income/month					χ² = 23.695 p = <0.001
<20,000 Baht	451 (63.5)	37 (49.3)	227 (59.0)	187 (74.8)
≥20,000 Baht	259 (36.5)	38 (50.7)	158 (41.0)	63 (25.2)
Registered address					χ² = 19.485 p = <0.001
Bangkok	457 (64.4)	48 (64.0)	274 (71.2)	135 (54.0)
Other provinces	253 (35.6)	27 (36.0)	111 (28.8)	115 (46.0)

Individuals who can proficiently navigate the internet and social media.

Individuals with limited ability to navigate the internet and social media.

Individuals who rely on caretakers for internet and social media use.

DISTRIBUTION OF CHRONIC CONDITIONS AMONG PARTICIPANTS

T2DM prevalence varied significantly across the groups (χ² = 10.346, p = 0.006), suggesting an association with digital familiarity. The condition was most prevalent in Group 3 (25.2%), followed by Groups 2 (15.8%) and 1 (13.3%). CVD was less prevalent across the sample (5.1%), with a statistically significant difference among groups (χ² = 7.854, p = 0.020). It was most prevalent in Group 1 (8.0%), whereas Group 3 had the lowest prevalence (2.0%). Chronic viral hepatitis was present in 47.9% of the participants, with significant differences across groups (χ² = 6.097, p = 0.047). Group 3 had the highest proportion of patients with chronic viral hepatitis (52.8%), whereas Group 1 had the lowest proportion (53.3%). These results suggest that self-perceived digital familiarity is significantly associated with the prevalence of T2DM, CVD, and chronic viral hepatitis (Table 2).

Table 2.

Distribution of Chronic Conditions Among Participants

VARIABLES	ALL (n = 710)	GROUP 1^a (n = 75)	GROUP 2^b (n = 385)	GROUP 3^c (n = 250)	CHI-SQUARE
HISTORY OF ILLNESS
Type 2 diabetes					χ² = 10.346 p = 0.006
Yes	134 (18.9)	10 (13.3)	61 (15.8)	63 (25.2)
No	576 (81.1)	65 (86.7)	324 (84.2)	187 (74.8)
Hypertension					χ² = 3.285 p = 0.194
Yes	259 (36.5)	24 (32.0)	133 (34.5)	102 (40.8)
No	451 (63.5)	51 (68.0)	252 (65.5)	148 (59.2)
Cardiovascular disease					χ² = 7.854 p = 0.020
Yes	36 (5.1)	6 (8.0)	25 (6.5)	5 (2.0)
No	674 (94.9)	69 (92.0)	360 (93.5)	245 (98.0)
Chronic viral hepatitis					χ² = 6.097 p = 0.047
Yes	340 (47.9)	40 (53.3)	168 (43.6)	132 (52.8)
No	370 (52.1)	35 (46.7)	217 (56.4)	118 (47.2)

Individuals who can proficiently navigate the internet and social media.

Individuals with limited ability to navigate the internet and social media.

Individuals who rely on caretakers for internet and social media use.

DIGITAL FAMILIARITY AND INTERNET USE

The internet and social media usage profiles of the participants were assessed. A significant difference was observed in years of internet experience across the three groups (χ² = 304.931, p < 0.001). Most Group 1 participants (78.7%) had over a decade of internet and social media experience, compared with the majority of Group 2 participants (43.9%) having 5–10 years’ experience, whereas only 4.4% of those dependent on caregivers exceeded 10 years of internet use. The use of the internet for communication was reported by 88.9% of the total cohort, with significant differences among the groups (χ² = 46.723, p < 0.001). Notably, 97.3% of Group 1 participants used the internet for communication compared with 78.0% in Group 3. The overall smartphone usage was high (92.7%), with significant differences among the groups (χ² = 18.247, p < 0.001). Group 1 had the highest smartphone use (98.7%), whereas Group 3 had the lowest (87.2%). Notably, the LINE (Line Corporation, Tokyo, Japan) application was the most used platform among all groups, with no significant difference observed among the groups (χ² = 2.867, p = 0.238) (Table 3).

Table 3.

Internet and Social Media Usage Profiles Across Participant Groups

VARIABLES	ALL (n = 710)	GROUP 1^a (n = 75)	GROUP 2^b (n = 385)	GROUP 3^c (n = 250)	CHI-SQUARE
YEARS OF INTERNET EXPERIENCE					χ ²= 304.931 p = <0.001
>10 years	178 (25.1)	59 (78.7)	108 (28.1)	11 (4.4)
5–10 years	226 (31.8)	14 (18.7)	169 (43.9)	43 (17.2)
1–5 years	216 (30.4)	1 (1.3)	91 (23.6)	124 (49.6)
<1 year	90 (12.7)	1 (1.3)	17 (4.4)	72 (28.8)
Duration of using the internet and/or social media on weekdays					χ² = 82.698 p = <0.001
>4 h	175 (24.6)	29 (38.7)	114 (29.6)	32 (12.8)
2–4 h	305 (43.0)	37 (49.3)	182 (47.3)	86 (34.4)
<2 h	230 (32.4)	9 (12.0)	89 (23.1)	132 (52.8)
Use the internet for communication					χ² = 46.723 p = <0.001
Yes	631 (88.9)	73 (97.3)	363 (94.3)	195 (78.0)
No	79 (11.1)	2 (2.7)	22 (5.7)	55 (22.0)
Use smartphone					χ² =18.247 p = <0.001
Yes	658 (92.7)	74 (98.7)	366 (95.1)	218 (87.2)
No	52 (7.3)	1 (1.3)	19 (4.9)	32 (12.8)
Use LINE (Line Corporation, Tokyo, Japan)					χ² = 2.867 p = 0.238
Yes	706 (99.4)	75 (100.0)	384 (99.7)	247 (98.8)
No	4 (0.6)	0 (0.0)	1 (0.3)	3 (1.2)

Individuals who can proficiently navigate the internet and social media.

Individuals with limited ability to navigate the internet and social media.

Individuals who rely on caretakers for internet and social media use.

TELEMEDICINE SATISFACTION

Of the 710 participants, 14.1% responded to the questionnaire. Comparative analyses were performed to investigate the association between technology literacy and satisfaction in using telemedicine platforms, and their opinions on the benefits of telehealth. The degree of satisfaction was evaluated on a 5-point rating scale. Additionally, participants’ perceptions of telemedicine usability were assessed, and the degree of agreement was scored on a 5-point rating scale (1= strongly disagree, 2 = disagree, 3 = neutral/uncertain, 4 = agree, 5 = strongly agree). A chi-square test was used to determine the relationship between participants’ technological competency and their satisfaction with telemedicine services (Table 4).

Table 4.

Telemedicine Satisfaction Assessment Across Different Technology Literacy Groups

VARIABLES	ALL (n = 710)	GROUP 1^a (n = 75)	GROUP 2^b (n = 385)	GROUP 3^c (n = 250)	CHI-SQUARE
OVERALL SATISFACTION (1 = EXTREMELY NOT SATISFIED, 5 = EXTREMELY SATISFIED)					χ² = 70.145 p = <0.001
1–3 points	201 (28.3)	0 (0.0)	123 (31.9)	78 (31.2)
4 points	324 (45.6)	33 (44.0)	196 (50.9)	95 (38.0)
5 points	185 (26.1)	42 (56.0)	66 (17.1)	77 (30.8)
Satisfaction in receiving a medical consultation					χ² = 123.937 p = <0.001
1–3 points	259 (36.5)	0 (0.0)	161 (41.8)	98 (39.2)
4 points	278 (39.2)	21 (28.0)	170 (44.2)	87 (34.8)
5 points	173 (24.4)	54 (72.0)	54 (14.0)	65 (26.0)
Satisfaction in the application’s security					χ² = 84.322 p = <0.001
1–3 points	294 (41.4)	0 (0.0)	174 (45.2)	120 (48.0)
4 points	271 (38.2)	37 (49.3)	158 (41.0)	76 (30.4)
5 points	145 (20.4)	38 (50.7)	53 (13.8)	54 (21.6)
Telemedicine offers better access to health care					χ² = 53.859 p = <0.001
1–3 points	250 (35.2)	8 (10.7)	161 (41.8)	81 (32.4)
4 points	267 (37.6)	23 (30.7)	140 (36.4)	104 (41.6)
5 points	193 (27.2)	44 (58.7)	84 (21.8)	65 (26.0)
Telemedicine offers better continuity of care					χ² = 64.841 p = <0.001
1–3 points	226 (31.8)	15 (20.0)	171 (44.4)	40 (16.0)
4 points	287 (40.4)	30 (40.0)	128 (33.2)	129 (51.6)
5 points	197 (27.7)	30 (40.0)	86 (22.3)	81 (32.4)

Individuals who can proficiently navigate the internet and social media.

Individuals with limited ability to navigate the internet and social media.

Individuals who rely on caretakers for internet and social media use.

Regarding overall satisfaction, a higher proportion of Group 1 participants rated their satisfaction at 4 or 5 points (100%) than Groups 2 and 3. Notably, 56.0% of Group 1 participants reported extreme satisfaction (5 points), in stark contrast to 17.1% in Group 2 and 30.8% in Group 3. Moreover, none of the Group 1 participants rated their satisfaction as below 4 points, compared with 31.9% of Group 2 and 31.2% of Group 3, who rated their satisfaction between 1 and 3 points (χ² = 70.145, p < 0.001). A pronounced trend was observed in the satisfaction with receiving medical consultations. Group 1 demonstrated an inverted pattern relative to Groups 2 and 3, with 72.0% expressing extreme satisfaction (5 points), while this sentiment was shared by only 14.0% and 26.0% of Groups 2 and 3, respectively (χ² = 123.937, p < 0.001).

Group 1 had the highest proportion of participants who strongly agreed that telemedicine offered better access (58.7%) and continuity of health care (40.0%). In contrast, these perceptions declined with decreasing digital literacy, as demonstrated by Groups 2 and 3. The data indicated that participants with higher digital literacy (Group 1) were significantly more satisfied with various aspects of telemedicine than those with limited (Group 2) or assisted digital use (Group 3).

Furthermore, most participants with limited digital skills (Group 2) reported less favorable perceptions of telemedicine than those least proficient but received assistance from caretakers (Group 3). Specifically, 58.2% of Group 2 participants rated their agreement at 4 or 5 (agree and strongly agree) that telemedicine offers better access to health care, compared with 64.8% of Group 3. Similarly, for the statement regarding telemedicine offering better continuity of care, 73.3% of Group 2 participants rated their agreement as 4 or 5, compared with 83.8% of Group 3. These results suggest that despite their limited familiarity with technology, Group 3 participants perceived telemedicine as a valuable tool for improving health care access and continuity, possibly because of the support they received in utilizing these services.

Discussion

The telemedicine platform “TeleCU” was well accepted by the older patients, with 71.7% of participants rating their overall satisfaction as 4 or higher. However, those with greater digital familiarity reported significantly higher satisfaction with receiving medical consultation and the application’s security, as well as having more positive perceptions of telemedicine. These results highlight a significant challenge. While telemedicine has the potential to enhance health care access, its effectiveness is heavily dependent on users’ digital literacy. This suggests that digital literacy influences the ability to use such technologies and affects perceived quality and trust in the services provided. These findings align with the existing literature suggesting a positive correlation between digital literacy and user satisfaction in e-Health services.^14,15 This may be attributed to several factors, such as ease of navigation, a sense of control over the technology, and the ability to understand and utilize security features effectively.¹⁶ Hence, the implementation of user-friendly design and educational initiatives such as manuals and troubleshooting resources may help older patients feel more comfortable and better engage with telehealth services.¹⁷

Interestingly, older patients who were dependent on caretakers for digital tasks had a more optimistic perception of telehealth use than those with limited digital proficiency. This positive outlook could be attributed to the assistance of caregivers. With assistance, telehealth felt more accessible, and virtual visits were more convenient than traditional visits requiring travel to a hospital. Older adults prefer in-person or on-demand support to handle the technical aspects of telemedicine platforms.¹⁵ They would participate more actively in telemedicine services after receiving training from volunteers.¹⁶ Our results suggest that support with technological aspects is essential in encouraging telemedicine use among older adults and can improve their perception of telemedicine benefits.

Our study also highlights the notable disparities in digital proficiency attributed to sex, age, education, income, and geographical location. The higher digital proficiency observed among men and younger individuals is consistent with the findings of previous studies.^18
–20 For instance, Helsper et al. observed that men were more likely to engage in internet-based activities than women¹⁵ and that gender differences in digital proficiency could be influenced by educational background, as older men tend to have higher levels of education than their female counterparts.²¹ Moreover, the urban–rural divide is evident in our study, with participants from Bangkok demonstrating higher digital proficiency, probably owing to better access to education and technology in urban areas.¹⁹

Although only 87.2% of participants in Group 3 own smartphones, 98.8% have access to the LINE application, the most widely used messaging application in Thailand, Japan, and Taiwan.²² This trend, where the use of LINE outnumbers smartphone ownership, is consistent across Groups 1 and 2. Some older individuals were observed accessing LINE via tablets or using the application on their caretakers’ devices to communicate with their family members. Therefore, a messaging application (e.g., LINE) could have significant potential as a platform for delivering digital health services. A previous study reported that messaging applications could help patients quit smoking and take medication regularly.²³

Telemedicine has been introduced to bridge the gap for vulnerable populations such as low-income individuals, rural residents, older adults, and minorities, helping them overcome barriers such as financial and transportation challenges, time off work, and long distances from specialty care.²⁴ However, if implemented without adequate training or support, telemedicine could unintentionally exacerbate existing disparities.²⁵ Individuals in these communities may develop negative perceptions of telehealth, experience lower satisfaction, and ultimately opt out of follow-up care.

To effectively leverage telemedicine as a tool for addressing inequities, it is crucial to adopt user-centered and codesign approaches, particularly when working with vulnerable populations.²⁶ Actively involving stakeholders in the design process can empower them and help address the specific challenges faced by these communities.¹³ Key strategies include conducting user research to identify demographic characteristics, assess digital literacy, and evaluate user experiences. This approach led us to choose a mobile application over a web-based platform. Stakeholders were invited to focus groups and workshops to test and provide feedback before the platform’s official release, which was the key to ensuring that the platform was relevant and beneficial to the target group. Additionally, during the implementation phase, providing support systems, such as assigning dedicated personnel to assist with installation and setup, offering video tutorials or instructional sessions to guide elderly patients, and involving caregivers in the process can help bridge these gaps. By incorporating these considerations into the design and implementation process, digital health solutions can become more inclusive and effective in reducing health care disparities.²⁷

LIMITATIONS

Our study’s interpretations are subject to several limitations. First, a nonvalidated questionnaire was used to evaluate patient perceptions of and satisfaction with telemedicine. While this custom questionnaire yielded relevant data, established tools such as the Telehealth Usability Questionnaire or Telemedicine Satisfaction Questionnaire could have offered more standardized and reliable assessments. Second, the cross-sectional design constrained our ability to infer causal relationships or track changes over time. Future longitudinal studies are required to better understand how digital familiarity influences telemedicine use and its long-term effects on digital literacy and telemedicine outcomes. Finally, our study mainly assessed patient perceptions and satisfaction without examining specific clinical outcomes. Future studies should integrate objective clinical metrics for a more holistic evaluation of the effects of telemedicine on health outcomes and treatment adherence.

Conclusions

Our research indicates that patient satisfaction with telemedicine and their perception of its benefits are significantly influenced by digital familiarity, which is associated with sex, income, educational level, and geographical region, highlighting disparities in access to digital devices and services. Caretaker support and on-demand assistance can help bridge this divide among elderly patients. Additionally, the widespread use of LINE among older adults offers a promising channel for widely accessible digital health services in Thailand. Involving stakeholders in the platform design, providing technical support, and establishing on-demand systems are key strategies for ensuring equitable telemedicine access.

Footnotes

Acknowledgments

The authors thank the staff of the geriatric clinic at King Chulalongkorn Memorial Hospital. The authors would like to thank the Center of Excellence in Hepatitis and Liver Cancer, Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Korea.

Authors’ Contributions

P.C. was involved in conceptualization, data curation, formal analysis, methodology, visualization, writing of the original draft, and editing. Z.N. was involved in conceptualization, supervision, and validation. A.P. and K.P. were involved in the project administration, resources, and supervision. P.T. was involved in conceptualization, funding acquisition, project administration, resources, supervision, validation, writing, review, and editing.

Disclosure Statement

All authors declare that they have no conflicts of interest.

Funding Information

The authors received financial support from the National Research Council of Thailand (NRCT) (grant number 253/2563 and the NSRF via the Program Management Unit for Human Resources & Institutional Development, Research and Innovation (PMU-B, grant number B38G670012).

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