Healthcare Providers and Patients Perception on Telehealth Services Adoption for Post-Operative Follow-Ups at the Korle Bu Teaching Hospital (Ghana)

Abstract

Introduction:

Telehealth is revolutionizing healthcare, particularly in post-operative care accessibility. However, technological limitations, costs, and communication barriers hinder its full implementation. This study examines healthcare providers’ and patients’ perception on telehealth services adoption for post-operative follow-ups at Korle Bu Teaching Hospital (KBTH), Ghana.

Methodology:

A descriptive cross-sectional study design was employed to collect data involving 350 participants, (doctors (29), nurses (96), and patients (225)) at KBTH’s surgical department using the priori power calculation method. Participants were selected via purposive and convenience sampling. There was a pilot-tested electronic and paper questionnaire administered by trained research assistants. The instrument captured multidimensional perception indices (eg, clinical efficacy, convenience, economic burden) on validated Likert scales alongside socio-demographic and telehealth utilization covariates. Data were managed in REDCap with mandatory fields to minimize missing responses and anonymized identifiers to reduce bias. Analyses comprised descriptive statistics and proportions in IBM SPSS v26 and R v4.2.1.

Results:

A substantial 76.6% of stakeholders agree or strongly agree that telehealth reliably monitors minor postoperative conditions. Convenience and efficiency are paramount, with 82.9% of participants finding virtual follow-ups more convenient and 86.6% reporting significant time savings relative to in-person visits. Infection-control benefits are widely recognized (85.2%), and patient-provider rapport remains strong, with only 10.9% expressing discomfort. Major barriers include unstable broadband (83.4%), limited on-site technical support (66.0%), poor audiovisual quality (81.7%), and prohibitive data/device costs (61.4%). Key facilitators encompass robust security measures trusted by 73.8% of users, regulatory confidence (59.7%), perceived clinical equivalence (76.5%), and enhanced access for underserved populations (82.6%).

Conclusion:

Telehealth improves accessibility and efficiency in minor post-operative care. However, addressing technological barriers, insurance issues, and communication challenges is crucial. A hybrid approach integrating telehealth with in-person visits is recommended to enhance care quality and patient satisfaction.

Keywords

telehealth post-operative care patient satisfaction teaching hospital healthcare accessibility

Introduction

Background

Healthcare is continually evolving, driven by technological advancements and increasing patient needs. Telehealth, or the use of telecommunications technologies to deliver healthcare services, has emerged as an important component of this change.¹ Telehealth tackles several critical difficulties in modern healthcare, including improved accessibility, cost savings, and increased patient comfort.² Post-operative care is a vital component of the surgical procedure, particularly for small procedures. Traditionally, this follow-up care has involved in-person visits, which can be unpleasant and costly for patients due to travel time, scheduling issues, and associated costs.³ According to Smith et al,⁴ patients with small procedures may fail to do the follow-ups which can in turn lead to worsening of their conditions. The incorporation of telehealth is key to mitigating missed appointments and speeding up recovery, therefore enhancing follow-ups and promoting remote care plans.⁴

Telehealth is transforming healthcare delivery by improving efficiency, accessibility, and affordability for both patients and healthcare systems. It reduces healthcare expenditures by minimizing in-person visits and optimizing resources, with studies demonstrating comparable patient outcomes and satisfaction in post-operative care,^4,5 Telehealth has also proven more efficient for follow-ups, addressing logistical barriers, reducing health disparities, and improving attendance.⁶ In Ghana, telehealth is set to bridge urban-rural healthcare gaps, increasing access to services in underserved areas while reducing patient costs.⁷ By eliminating indirect expenses like transportation, lost wages, and childcare, it benefits low-income populations.²

Additionally, telehealth lowers healthcare system costs by reducing reliance on physical infrastructure and optimizing resource use, making it a cost-effective solution for equitable healthcare delivery. Communication barriers have also been limited or reduced through the application of telehealth.⁸ However, for these digital services to be fully effective, both patients and healthcare providers must possess a certain level of digital literacy, the ability to use, understand, and engage with digital platforms for healthcare purposes. In contexts like Ghana, where digital divides persist, limited digital literacy can hinder the proper utilization of telehealth services, particularly in rural and underserved populations. Enhancing digital health literacy empowers patients to better navigate telehealth platforms, adhere to care plans, and participate actively in their own care, which is crucial for achieving the desired outcomes of remote post-operative care.

Telehealth components used across various platforms allow frequent interactions between patients and healthcare practitioners, leading to continuity of care. The essence of using these platforms has been demonstrated by Günther⁸ to aid in early detection of complications as well as resolving possible concerns that may arise from the procedure, hence improving overall comfort and care quality. At Ghana’s Korle-Bu Teaching Hospital, using telehealth for post-operative follow-up could dramatically lessen the load on both the healthcare professionals and patients. With multiple simultaneous access to these platforms, telehealth closes healthcare access gaps, particularly for patients in distant locations who have difficulties in pursuing follow-up care. Atiwoto et al⁹ reported that telehealth services in Ghana have the potential to alter healthcare delivery, making it more inclusive and accessible, particularly in underprivileged areas.

Despite these benefits, it is critical to acknowledge and address the obstacles that come with telehealth adoption. To guarantee successful adoption, technological challenges, legislative limitations, and concerns about distant care quality must be addressed in a methodical manner. Telehealth adoption requires a complete approach that includes stakeholder participation, training, and strong infrastructure.¹ Training healthcare practitioners to properly use telehealth platforms is critical for maintaining high-quality care. Equally important is equipping patients with the health literacy needed to understand medical instructions, follow through with digital consultations, and make informed decisions about their care. Without adequate health or digital literacy, even the most advanced telehealth solutions risk being underutilized or misinterpreted. Addressing concerns about data privacy and security is also critical to fostering trust between patients and providers.¹⁰ The regulatory environment must evolve to enable telehealth, including clear criteria for licensing, payment, and cross-border consultations.^3,11,12 Nonetheless, telehealth presents an appealing alternative for modern healthcare systems by enhancing post-operative care, improving patient outcomes, and reducing healthcare costs.

Incorporating telehealth into post-operative treatment at Korle-Bu Teaching Hospital has the potential to yield various benefits. It can greatly minimize the hospital’s resource utilization. Reducing traditional follow-up treatment frequently, staffing levels, and physical space. By transitioning to telehealth, these resources can be optimized and reallocated to other vital areas of patient care. This increased efficiency is especially useful in a high-volume hospital setting like Korle-Bu, where resource constraints are widespread.⁹ Telehealth services used in the hospital has made several benefits to both patients and the hospital. The number of cases managed through telehealth has steadily increased over the years from 42,783 in 2021 to 50,101 in 2022, and 52,297 in 2023 indicating growing adoption and capacity. These trends reflect the positive impact of telehealth on post-operative follow-up care.

While there are hurdles to implementing telehealth, the potential benefits make it an important complement to current healthcare systems. The adoption of telehealth for post-operative follow-up care provides numerous benefits to Korle-Bu Teaching Hospital, including improved accessibility, cost savings, increased patient engagement, better patient outcomes, greater efficiency, more equitable access to healthcare services, and reduced healthcare disparities. While there are difficulties to solve, the potential for improved patient outcomes and healthcare efficiency makes telehealth an appealing alternative for modernizing post-operative treatment at Korle-Bu Teaching Hospital. By embracing this innovative strategy, the hospital can pave the way for the transformation of healthcare delivery in Ghana, ensuring that all patients receive the high-quality care they require, regardless of geography, digital skill level, or financial status. These multiple benefits have motivated the necessity to adopt telehealth for post-operative care at Korle-Bu, as well as this research to investigate its use.

This study aims to assess healthcare providers’ and patients’ perceptions of telehealth service adoption for post-operative follow-ups at Korle-Bu Teaching Hospital, Ghana.

Study Objectives

The study aims to:

Determine the level of acceptance and perceived benefits of telehealth for minor post-operative care among doctors, nurses and patients at Korle-Bu Teaching Hospital.

Identify the key barriers that hinder the successful adoption of telehealth in post-operative follow-ups.

Evaluate the facilitators and contributing factors that promote telehealth uptake in the surgical department.

Methods

Study Design

This study employed a descriptive cross-sectional survey to evaluate the use of telehealth for post-operative surgical follow-ups among staff and patients in the Surgical Department of Korle-Bu Teaching Hospital, Ghana. Data was collected through a structured electronic and hard copy questionnaire. Participants were selected using purposive and convenience sampling methods, enabling the researchers to focus on specific sub-populations within the department that were most relevant to the study’s objectives.

Study Setting

The study was conducted at the Surgical Department of Korle-Bu Teaching Hospital, a premier tertiary healthcare facility in Ghana. Established on October 9, 1923. Korle-Bu Teaching Hospital houses multiple clinical and diagnostic departments. The Department of Surgery, occupies the main six-story surgery block, which includes various specialized units such as the National Cardiothoracic Centre, National Reconstructive Plastics Surgery and Burns Centre, Trauma and Orthopedics Centre, and the New Allied Surgery Sub-BMC. The department has expanded into several sub-units, including General Surgery, Plastic Surgery, Trauma and Orthopedic Surgery, Urology, Neurosurgery, Cardiothoracic Surgery, Pediatric Surgery, Ophthalmology, Ear, Nose, and Throat Surgery, and Dental Surgery.

Participants

Eligible participants comprised staff members and patients physically present in the Surgical Department during the data collection period who were willing and able to provide informed consent. Those unwilling or unavailable were excluded. Ward In-Charges across Surgical Wards 1 to 6 and the Genito-Urinary Ward facilitated participant identification, with all respondents invited to self-complete the instrument or to receive assistance from research personnel.

Variables

In this investigation, a comprehensive framework of both endogenous and exogenous variables was delineated to elucidate factors shaping telehealth adoption in post-operative contexts. Dependent constructs comprised multidimensional perception indices, each operationalized through validated Likert-type scales: clinical efficacy (eg, ability to effectively monitor healing trajectory), user convenience (eg, time savings, travel reduction), economic burden (eg, device and data costs), and advocacy propensity (ie, willingness to recommend the service). These latent constructs were quantified by aggregating several constituent items to yield composite scores for robust interpretability. Independent covariates encompassed a suite of demographic and utilization attributes. Socio-demographic covariates included age brackets (<21, 21-30, 31-40, 41-50, 51-60, >61 years), binary gender, professional role (patient, nurse, medical doctor), and educational attainment strata (certificate, diploma, bachelor’s degree, postgraduate degree, professional qualification). Telehealth utilization attributes comprised consultation modality (direct video, store-and-forward, direct conversation), usage frequency (always, very often, seldom, rarely), and application domain (general consultation, patient education, surgical consultation). Together, these variables permitted nuanced exploration of subgroup differentials and interaction effects on telehealth perceptions.

Data Sources and Management

Data sources included a pilot-tested instrument adapted from validated literature tools, refined through feedback from 30 preliminary participants to optimize clarity, cultural relevance, and linguistic appropriateness. Finalized questions were delivered via REDCap software or paper, leveraging mandatory fields to minimize missing data, and were administered by trained research assistants who provided uniform instructions and ethical justifications for participant engagement.

Bias

To mitigate bias, we acknowledged that non-probability sampling could introduce selection effects favoring telehealth-enthusiastic subgroups and that social-desirability responses might affect self-reported attitudes. These were addressed through pilot testing, anonymized unique identifiers, and explicit assurances of voluntary participation and confidentiality.

Study Size

The sample size was determined by the number of participants available and willing to participate during the study period (June 2023 to December 2023). A minimum of nine participants per day was targeted until the total sample size was achieved.

The sample size determination for this study was determined based on an a priori power calculation.^13,14 A minimum sample of 194 respondents was determined. This was expected to provide enough statistical power (0.80) to detect small-sized correlation coefficients (0.20).¹⁴ We made room for a larger sample size because it would increase the statistical power for detecting smaller effects and strengthen the robustness of the findings.

A priori power sample size calculation is denoted by:

N = {[\frac{(Z_{α} + Z_{β})}{C}]}^{2} + 3

Where,

N = sample size

α (two-tailed) = 0.05 (Threshold probability for rejecting the null hypothesis. Type I error rate).

β = 0.20 (Probability of failing to reject the null hypothesis under the alternative hypothesis. Type II error rate).

r = 0.20 (The expected correlation coefficient)

The standard normal deviation for α = Zα = 1.9600

The standard normal deviation for β = Zβ = 0.8416

C = 0.5 \times l n [\frac{(1 + r)}{(1 - r)}] = 0.2027

\begin{array}{l} T h e r e f o r e, T o t a l s a m p l e s i z e = N = {[\frac{(1.9600 + 0.8416)}{0.2027}]}^{2} \\ + 3 = 194 \end{array}

Therefore, the estimated number of respondents in the hospital during the period of the study was 540. The actual sample size used in this study was 350. The detail sample size for each classification of respondents is shown in Table 1.

Table 1.

Distribution of Estimated Number of Health Professionals, Expected Sample Size, and the Actual Sample Per Facility.

Classification of participants	Estimated number	Expected sample size	Actual sample
Patients	372	125	225
Nurses	105	55	96
Medical doctors	63	14	29

Quantitative Variables

The dataset integrated both continuous and categorical measurements to support diverse analytical strategies. Ordinal variables such as age strata and telehealth usage frequency were encoded numerically (1-6 for age; 1-4 for telehealth usage frequency), preserving rank order without assuming equal intervals. Likert-scale perception items were captured on a five-point continuum (1 = strongly disagree to 5 = strongly agree), with composite scores derived via summation of related items. Nominal variables, including gender, professional role, and consultation modality, were recorded as frequencies and their associated percentages. Economic burden items were further transformed into percentage scores representing the proportion of respondents endorsing each cost-related concern.

Statistical Methods

The analytical framework encompassed a multi-tiered approach to ensure robust inference and address the study’s complex variable structure. Initially, descriptive analytics summarized the distribution of all variables via frequencies and proportions. All statistical procedures were conducted in IBM SPSS Statistics v26.0 and R v4.2.1.

Ethics Approval and Consent to Participate

Approval for the study was obtained from the Administrative Review Board of Korle-Bu Teaching Hospital with clearance number KBTH-ADM/000156/23. Oral and written informed consent were sought from the participants. Each consent form provided comprehensive information regarding the study’s objectives, the advantages stemming from the research, the application of study findings, and the dissemination of results. Involvement in this research was entirely voluntary, and participants were explicitly informed that they had the liberty to withdraw from the study at any point without any coercion or intimidation, and they could opt not to respond to question(s). To guarantee the enduring confidentiality of the participants, all research records were securely disposed of through incineration following the compilation of the final study report. This study is not a clinical trial study and has no clinical trial number.

Results

Participants

This study surveyed 350 participants from the Surgical Department of Korle-Bu Teaching Hospital, comprising 225 patients, 96 nurses, and 29 medical doctors (see Table 2).

Table 2.

Demographic Characteristics of Respondents.

	Patients		Nurses		Medical doctor
Characteristics	Frequency	%	Frequency	%	Frequency	%
Age rank
<21	7	3.11	—	—	—	—
21-30	86	38.22	37	38.54	8	27.59
31-40	84	37.33	50	52.08	11	37.93
41-50	24	10.67	9	9.38	5	17.24
51-60	20	8.89	—		5	17.24
>61	4	1.78	—	—	—
Total	225	100	96	100	29	100
Education
Certificate (high school/technical colleges)	37	16.4	10	8.0
Diploma	68	30.2	43	34.4
Bachelor degree	92	40.9	44	35.2
Postgraduate degree (master/doctoral)	18	8.0	16	12.8
Professional qualification	5	2.2	12	9.6
Others (please specify)	5	2.2
Total	225	100.0	125	100.0

Source: Author Field Data (2023).

Descriptive Data

Demographic Characteristics of Respondents

Table 2 delineates the demographic profile of study participants, patients (N = 225), nurses (N = 96), and medical doctors (N = 29), presented as absolute frequencies and corresponding percentages. Patient age was distributed as follows: <21 years, 7 (3.1%); 21 to 30 years, 86 (38.2%); 31 to 40 years, 84 (37.3%); 41 to 50 years, 24 (10.7%); 51 to 60 years, 20 (8.9%); and >61 years, 4 (1.8%). Among nurses, no respondents were <21 years; 37 (38.5%) were aged 21 to 30 years; 50 (52.1%) were 31 to 40 years; 9 (9.4%) were 41 to 50 years; and none were older than 50 years. Medical doctors comprised no participants <21 years; 8 (27.6%) were 21 to 30 years; 11 (37.9%) were 31 to 40 years; 5 (17.2%) were 41 to 50 years; 5 (17.2%) were 51 to 60 years; and none exceeded 60 years. Educational attainment is reported for patients and nurses only: among patients, 37 (16.4%) held certificates, 68 (30.2%) diplomas, 92 (40.9%) bachelor’s degrees, 18 (8.0%) postgraduate degrees, 5 (2.2%) professional qualifications, and 5 (2.2%) other credentials; among nurses, 10 (8.0%) held certificates, 43 (34.4%) diplomas, 44 (35.2%) bachelor’s degrees, 16 (12.8%) postgraduate degrees, and 12 (9.6%) professional qualifications, with no additional categories reported; education data for medical doctors were not provided.

Outcome Data

Telehealth Services Used Within the Hospital

Table 3 presents a descriptive overview of telehealth (tele-consultation) utilization patterns within the study hospital. Three principal modalities of remote clinical interaction were identified: direct conversation (n = 270; 76.9%), store-and-forward video (n = 44; 12.5%), and synchronous video conferencing (n = 54; 15.4%). Direct, real-time verbal communication thus emerges as the overwhelmingly preferred method for remote consultation, accounting for more than three-quarters of all reported telehealth encounters. In terms of overall frequency, nearly half of respondents (n = 165; 47.0%) indicated that tele-consultation services are used “rarely,” whereas 22.5% (n = 79) and 20.8% (n = 73) reported “seldom” and “very often” usage, respectively; only 9.7% (n = 34) described telehealth engagement as “always” part of their practice. This distribution suggests that, despite availability, tele-consultation remains an infrequent adjunct to conventional care for most clinicians. When classifying the clinical applications of telehealth, patient education was marginally the most common use (n = 158; 45.0%), followed by general consultation (n = 147; 41.9%), with surgical consultation representing a smaller fraction of telehealth activity (n = 46; 13.1%). These findings highlight that educational outreach and routine consultative functions predominate in the hospital’s telehealth portfolio, while procedural or operative consultations are comparatively limited. Taken together, the data underscore both the underutilization of advanced video technologies and the concentration of telehealth services in non-procedural domains.

Table 3.

Telehealth Services Used Within the Hospital.

Factor	Measuring items	Frequency	%
Telehealth (tele-consultation) methods used in this hospital	Direct video conferencing.	54	15.4
	Store and forward video method.	44	12.5
	Direct conversation	270	76.9
Frequency of telehealth (tele-consultation) services use in this hospital	Always	34	9.7
	Very often	73	20.8
	Seldom	79	22.5
	Rarely	165	47.0
Areas of telehealth (teleconsultation) services application	General consultation	147	41.9
	Patient education	158	45.0
	Surgical consultation	46	13.1

Source: Author Field Data (2023).

Advantages of In-Person Visits Over Telehealth

Table 4 presents respondents’ Likert-scale responses to six statements contrasting in-person visits with telehealth. For the assertion that “telehealth decreases the care received from the healthcare provider more than in-person visits,” 154 (43.9%) strongly disagreed, 107 (30.5%) disagreed, 25 (7.1%) were uncertain, 50 (14.2%) agreed, and 15 (4.3%) strongly agreed. On whether “telehealth consultations save more time to do other activities than traveling to a hospital or specialist clinic to interact with your doctor,” 4 (1.1%) strongly disagreed, 19 (5.4%) disagreed, 24 (6.8%) were uncertain, 236 (67.2%) agreed, and 68 (19.4%) strongly agreed. In relation to “telehealth consultations waste more time than in-person consultations,” 58 (16.5%) strongly disagreed, 124 (35.3%) disagreed, 39 (11.1%) were uncertain, 122 (34.8%) agreed, and 8 (2.3%) strongly agreed. For “telehealth minimizes the spread of infectious diseases,” 12 (3.4%) strongly disagreed, 16 (4.6%) disagreed, 24 (6.8%) were uncertain, 204 (58.1%) agreed, and 95 (27.1%) strongly agreed. Regarding “it is impossible to conduct a physical examination virtually after post-operative surgery,” 26 (7.4%) strongly disagreed, 102 (29.1%) disagreed, 54 (15.4%) were uncertain, 147 (41.9%) agreed, and 22 (6.3%) strongly agreed. Finally, on “telehealth reduces unnecessary visits to the health facility,” 14 (4.0%) strongly disagreed, 25 (7.1%) disagreed, 16 (4.6%) were uncertain, 220 (62.7%) agreed, and 76 (21.7%) strongly agreed.

Table 4.

Advantages of In-Person Visits Over Telehealth.

Measuring items	Strongly disagree	Disagree	Uncertain	Agree	Strongly agree
Measuring items	Frequency (%)	Frequency (%)	Frequency (%)	Frequency (%)	Frequency (%)
Telehealth decreases the care received from the healthcare provider more than in-person visits	154 (43.9)	107 (30.5)	25 (7.1)	50 (14.2)	15 (4.3)
Telehealth consultations save more time to do other activities than traveling to a hospital or specialist clinic to interact with your doctor	4 (1.1)	19 (5.4)	24 (6.8)	236 (67.2)	68 (19.4)
Telehealth consultations waste more time than in-person consultations	58 (16.5)	124 (35.3)	39 (11.1)	122 (34.8)	8 (2.3)
Telehealth minimize the spread of infectious diseases	12 (3.4)	16 (4.6)	24 (6.8)	204 (58.1)	95 (27.1)
It is impossible to conduct a physical examination virtually after post-operative surgery	26 (7.4)	102 (29.1	54 (15.4)	147 (41.9)	22 (6.3)
Telehealth reduces unnecessary visits to the health facility	14 (4.00	25 (7.1)	16 (4.6)	220 (62.7	76 (21.7)

Source: Author Field Data (2023).

Providers and Patients Acceptance of Telehealth Adoption in Post-Operative Service

Table 5 summarizes providers’ and patients’ acceptance of telehealth adoption in post-operative services across six statements, with responses on a five-point Likert scale (Strongly Disagree, Disagree, Uncertain, Agree, Strongly Agree). For “Telehealth is effective to monitor patients with minor conditions after surgery,” respondents reported 4 (1.1%) strongly disagreeing, 54 (15.4%) disagreeing, 24 (6.9%) uncertain, 232 (66.3%) agreeing, and 36 (10.3%) strongly agreeing; for “Telehealth is a convenient way for patients to follow up,” the counts were 2 (0.6%), 22 (6.3%), 36 (10.3%), 227 (64.9%), and 63 (18.0%), respectively; for “Telehealth allows providers to consult from anywhere (home, office) without compromising on care,” frequencies were 3 (0.9%), 23 (6.6%), 25 (7.1%), 236 (67.4%), and 63 (18.0%); regarding “Cost of telehealth technology or devices is an issue in accepting the service,” responses were 11 (3.1%), 43 (12.3%), 64 (18.3%), 192 (54.9%), and 40 (11.4%); for “The level of pocket expenses (eg, purchase of internet bundle) is a concern in accepting telehealth,” counts were 7 (2.0%), 49 (14.0%), 40 (11.4%), 215 (61.4%), and 39 (11.1%); and for “Use telehealth and recommend to others,” respondents indicated 3 (0.9%) strongly disagree, 49 (14.0%) disagree, 88 (25.1%) uncertain, 148 (42.3%) agree, and 62 (17.7%) strongly agree.

Table 5.

Providers and Patients Acceptance of Telehealth Adoption in Post-Operative Service.

Measuring items	Strongly disagree	Disagree	Uncertain	Agree	Strongly agree
Measuring items	Frequency (%)	Frequency (%)	Frequency (%)	Frequency (%)	Frequency (%)
Telehealth is effective to monitor patients with minor conditions after surgery	4 (1.1)	54 (15.4	24 (6.9)	232 (66.3)	36 (10.3)
Telehealth is a convenient way for patients to follow up	2 (0.6),	22 (6.3)	36 (10.3)	227 (64.9)	63 (18.0)
Telehealth allows providers to consult from anywhere (home, office) without compromising on care	3 (0.9)	23 (6.6)	25 (7.1)	236 (67.4)	63 (18.0)
Cost of telehealth technology or devices is an issue in accepting the service	11 (3.1)	43 (12.3)	64 (18.3)	192 (54.9)	40 (11.4)
The level of pocket expenses (eg, purchase of internet bundle) is a concern in accepting telehealth	7 (2.0)	49 (14.0)	40 (11.4)	215 (61.4)	39 (11.1)
Use telehealth and recommend to others	3 (0.9)	49 (14.0)	88 (25.1)	148 (42.3)	62 (17.7)

Source: Author Field Data (2023).

Barriers Preventing the Successful Adoption of Telehealth Operative Follow-Up for Monitoring of the Patients

Table 6 presents respondents’ Likert-scale ratings of seven potential barriers to telehealth adoption in operative follow-up, with frequencies and column percentages for Strongly Disagree, Disagree, Uncertain, Agree, and Strongly Agree. For “Telehealth services lack insurance coverage,” 4 (1.1%) strongly disagreed, 33 (9.4%) disagreed, 53 (15.1%) were uncertain, 221 (63.1%) agreed, and 39 (11.1%) strongly agreed; for “Internet is needed to access telehealth services,” the counts were 3 (0.9%), 23 (6.6%), 32 (9.1%), 246 (70.3%), and 46 (13.1%), respectively. Regarding data security, “Medical information or records are secure when using telehealth to access healthcare” elicited 6 (1.7%) strongly disagree, 24 (6.9%) disagree, 195 (55.7%) uncertain, 84 (24.0%) agree, and 41 (11.7%) strongly agree. On support requirements, “IT personnel are required to teach how telehealth systems are used” recorded 12 (3.4%) strongly disagree, 52 (14.9%) disagree, 53 (15.1%) uncertain, 205 (58.6%) agree, and 28 (8.0%) strongly agree. For connectivity issues, “Could not talk and hear the clinician while using the telehealth system” showed 2 (0.6%) strongly disagree, 31 (8.9%) disagree, 31 (8.9%) uncertain, 258 (73.7%) agree, and 28 (8.0%) strongly agree. Concerning user comfort, “It is uncomfortable communicating with the clinician using the telehealth system” yielded 20 (5.7%) strongly disagree, 163 (46.6%) disagree, 42 (12.0%) uncertain, 106 (30.3%) agree, and 19 (5.4%) strongly agree. Finally, for cost perceptions, “Telehealth consultations are much more expensive than going to the hospital to access care” elicited 17 (4.9%) strongly disagree, 76 (21.7%) disagree, 42 (12.0%) uncertain, 187 (53.4%) agree, and 28 (8.0%) strongly agree (Author Field Data, 2023).

Table 6.

Barriers to Telehealth Adoption in Operative Follow-Up.

Measuring items	Strongly disagree	Disagree	Uncertain	Agree	Strongly agree
Measuring items	Frequency (%)	Frequency (%)	Frequency (%)	Frequency (%)	Frequency (%)
Telehealth services lack insurance coverage	4 (1.1)	33 (9.4)	53 (15.1)	221 (63.1)	39 (11.1)
Internet is needed to access telehealth services	3 (0.9)	23 (6.6)	32 (9.1)	246 (70.3)	46 (13.1)
Medical information or records are secure when using telehealth to access healthcare	6 (1.7)	24 (6.9)	195 (55.7)	84 (24.0)	41 (11.7)
IT personnel are required to teach how telehealth systems are used	12 (3.4	52 (14.9)	53 (15.1)	205 (58.6)	28 (8.0)
Could not talk and hear the clinician whiles using the telehealth system	2 (0.6)	31 (8.9)	31 (8.9)	258 (73.7)	28 (8.0)
It is uncomfortable communicating with the clinician using the telehealth system, for example, video call	20 (5.7)	163 (46.6)	42 (12.0)	106 (30.3)	19 (5.4)
Telehealth consultations are much more expensive than going to the hospital to access care	17 (4.9)	76 (21.7)	42 (12.0)	187 (53.4)	28 (8.0)

Source: Author Field Data (2023).

Factors Contributing to the Adoption of Telehealth in Post-Operative Service

Table 7 reports respondents’ five-point Likert-scale ratings (Strongly Disagree, Disagree, Uncertain, Agree, Strongly Agree) for ten factors contributing to telehealth adoption in post-operative service, with both absolute frequencies and column percentages. For “Privacy is protected during telehealth consultations,” responses were 1 (0.3%) strongly disagree, 27 (7.7%) disagree, 64 (18.3%) uncertain, 220 (62.9%) agree, and 38 (10.9%) strongly agree; for “Telehealth visits are conducted over systems that provide ‘end-to-end’ electronic security,” the counts were 1 (0.3%), 21 (6.0%), 116 (33.1%), 177 (50.6%), and 35 (10.0%), respectively; “Telehealth treatment, prescribing, and documentation comply with health policy and standards” elicited 2 (0.6%), 22 (6.3%), 117 (33.4%), 179 (51.1%), and 30 (8.6%); “Understanding of security and privacy requirements (eg, HIPAA) associated with telehealth” showed 2 (0.6%), 32 (9.1%), 139 (39.7%), 140 (40.0%), and 37 (10.6%); for “Telehealth services ensure the same quality of care or better service compared with an office visit,” frequencies were 6 (1.7%), 60 (17.1%), 81 (23.1%), 183 (52.3%), and 20 (5.7%); “Telehealth reduces the time to diagnosis and treatment for those who can’t be at the hospital” had 0 (0.0%), 36 (10.3%), 46 (13.1%), 236 (67.4%), and 32 (9.1%); for “Telehealth improves access to healthcare services,” counts were 0 (0.0%), 24 (6.9%), 37 (10.6%), 238 (68.3%), and 50 (14.3%); “Telehealth is an acceptable way to provide healthcare needs” elicited 2 (0.6%), 18 (5.1%), 56 (16.0%), 238 (68.0%), and 36 (10.3%); “Telehealth saves time traveling to a hospital for minor post-operative patient review” recorded 0 (0.0%), 22 (6.3%), 33 (9.4%), 239 (68.3%), and 56 (16.0%); and “Telehealth helps to avoid overcrowding at the hospital when a minor postoperative review patient uses telehealth for a consultation” showed 0 (0.0%), 11 (3.1%), 29 (8.3%), 236 (67.4%), and 74 (21.1%).

Table 7.

Factors Contributing to the Adoption of Telehealth in Post-Operative Service.

Measuring items	Strongly disagree	Disagree	Uncertain	Agree	Strongly agree
Measuring items	Frequency (%)	Frequency (%)	Frequency (%)	Frequency (%)	Frequency (%)
Privacy is protected during telehealth consultations	1 (0.3)	27 (7.7)	64 (18.3)	220 (62.9)	38 (10.9)
Telehealth visits are conducted over systems that provide “end-to-end” electronic security, such as encryption	1 (0.3)	21 (6.0)	116 (33.1)	177 (50.6)	35 (10.0)
Telehealth treatment, prescribing, and documentation comply with health policy and standards	2 (0.6)	22 (6.3)	117 (33.4)	179 (51.1)	30 (8.6)
Understand of the security and privacy requirements (eg, HIPAA) associated with telehealth	2 (0.6)	32 (9.1),	139 (39.7)	140 (40.0)	37 (10.6)
Telehealth services ensure the same quality of care or better service compared with an office visit	6 (1.7)	60 (17.1)	81 (23.1)	183 (52.3)	20 (5.7)
Telehealth reduces the time to diagnosis and treatment for those who can’t be at the hospital regularly	0	36 (10.3)	46 (13.1)	236 (67.4)	32 (9.1)
Telehealth improve access to healthcare services	0	24 (6.9)	37 (10.6)	23 (68.3)	50 (14.3)
Telehealth is an acceptable way to provide healthcare needs and services	2 (0.6)	18 (5.1)	56 (16.0)	238 (68.0)	36 (10.3)
Telehealth saves time traveling to a hospital for minor post-operative follow-ups	0	22 (6.3),	33 (9.4)	239 (68.3)	56 (16.0)
Telehealth helps to avoid being overcrowded at the hospital when a minor postoperative review patient uses telehealth for a consultation	0	11 (3.1)	29 (8.3)	236 (67.4)	74 (21.1)

Source: Author Field Data (2023).

Discussion

Acceptance and Perceived Benefits of Telehealth for Minor Post-Operative Care

Telehealth for minor post-operative follow-up at Korle-Bu Teaching Hospital commands endorsement from clinicians and patients alike. As illustrated in Table 5, a combined 76.6% of respondents (66.3% “agree”; 10.3% “strongly agree”) attest to telehealth’s efficacy in monitoring minor surgical conditions. Such consensus underscores the perceived diagnostic reliability of remote visual inspection and structured patient inquiry, which together obviate the need for routine in-person visits. These findings corroborate extant evidence affirming telehealth’s validity in uncomplicated postoperative surveillance,⁶ positioning it as a clinically acceptable modality for wound assessment and functional evaluation.

Convenience emerges as a critical driver of stakeholder acceptance. Table 5 further reveals that 82.9% of participants (64.9% “agree”; 18.0% “strongly agree”) regard telehealth as inherently more convenient than traditional follow-up appointments. By mitigating travel burdens, scheduling constraints, and attendant socio-economic costs, virtual consultations appreciably enhance patient adherence and satisfaction. For healthcare providers, streamlined appointment management reduces clinic congestion and optimizes personnel deployment. Thus, convenience not only elevates patient-centeredness but also augments operational efficiency within high-volume surgical services.⁶

Time efficiency constitutes another salient benefit. According to Table 5, 86.6% of respondents (67.2% “agree”; 19.4% “strongly agree”) report that telehealth confers significant temporal savings relative to face-to-face encounters. The elimination of transit and waiting-room delays enables abbreviated yet comprehensive consultations, thereby increasing provider throughput without compromising quality. This temporal economy is particularly valuable in resource-constrained settings, where surgeon and nursing capacity is often stretched. Consequently, time savings serve as a potent incentive for the adoption of telemedicine in postoperative care.

The perception of enhanced infection control further strengthens telehealth’s appeal. As Table 5 indicates, 85.2% of participants (58.1% “agree”; 27.1% “strongly agree”) perceive virtual follow-up as reducing nosocomial transmission risk. Post-operative patients, who are inherently susceptible to hospital-acquired infections, benefit from minimized in-person contact, an advantage that assumes heightened importance during periods of endemic or epidemic outbreaks. By curtailing potential exposure pathways, telehealth contributes to a safer postoperative environment, aligning with global infection-prevention imperatives.¹⁵

Moreover, the integrity of patient-provider rapport appears largely preserved in virtual contexts. Only 10.9% of respondents (7.1% “agree”; 3.8% “strongly agree”) expressed discomfort with telehealth modalities, indicating that trust, empathy, and effective communication endure despite physical separation. Through the deployment of high-resolution video, structured communication protocols, and consistent follow-up schedules, clinicians sustain therapeutic alliances and deliver psychosocial reassurance during the critical convalescent phase. This maintenance of relational continuity underscores telehealth’s capacity to uphold core tenets of patient-centered care.

Key Barriers to Telehealth Adoption in Post-Operative Follow-Ups

Notwithstanding high acceptance, unstable internet connectivity represents the most formidable barrier to telehealth integration. Table 6 demonstrates that 83.4% of stakeholders (70.3% “agree”; 13.1% “strongly agree”) identify reliable broadband as indispensable for effective teleconsultations. In regions beset by infrastructural deficits or overreliance on mobile data, video interruptions and audio dropouts can erode user confidence and undermine clinical assessments. Addressing these network shortcomings through targeted public-private partnerships and the expansion of broadband infrastructures is therefore imperative.¹⁶

A concomitant challenge is the dearth of on-site technical support. Sixty-six percent of respondents (58.6% “agree”; 8.0% “strongly agree”) reported that the absence of dedicated IT personnel hinders telehealth utilization. Clinicians and patients with limited digital literacy frequently encounter login difficulties, image-sharing errors, and audiovisual malfunctions. Establishing help-desk services, delivering hands-on training modules, and embedding technical staff within surgical clinics can substantially mitigate these obstacles.¹⁷ Such capacity-building measures foster end-user proficiency and bolster telehealth uptake.

Suboptimal communication quality constitutes a third impediment. As Table 6 shows, 81.7% of participants (73.7% “agree”; 8.0% “strongly agree”) have experienced difficulties in hearing or conversing during telehealth sessions. Poor audiovisual fidelity compromises the nuanced exchange of clinical information such as assessments of swelling, erythema, and pain severity, potentially delaying interventions. Optimizing telehealth platforms for low-bandwidth scenarios and prioritizing audio clarity through codec enhancements and performance monitoring are critical to sustaining high-quality remote consultations.

Financial constraints further circumscribe telehealth adoption. Table 6 reflects that 61.4% of respondents (53.4% “agree”; 8.0% “strongly agree”) consider the cost of data bundles and requisite devices prohibitive, while 74.2% lament inadequate reimbursement for telehealth services. In the absence of subsidized connectivity schemes and parity in remuneration for virtual versus in-person visits, economic disincentives deter both patients and providers. Policymakers and payers may collaborate to institute supportive financing mechanisms such as reimbursable telehealth codes and subsidized broadband packages to alleviate these monetary barriers.¹⁶

Finally, ambivalence regarding data security undermines stakeholder trust. Only 35.7% of participants (24.0% “agree”; 11.7% “strongly agree”) felt confident in the protection of their medical data during teleconsultations. Concerns surrounding potential breaches, unauthorized access, and opaque privacy policies diminish willingness to engage fully with telehealth. The implementation of end-to-end encryption, multi-factor authentication, and transparent privacy disclosures, and their clear communication to users are essential to fortifying perceptions of data security and fostering telehealth’s long-term viability.

Facilitators and Contributing Factors Promoting Telehealth Uptake

Robust privacy and security assurances emerge as primary facilitators of telehealth engagement. Table 7 reveals that 73.8% of stakeholders (62.9% “agree”; 10.9% “strongly agree”) trust in the safeguarding of their personal health information, while 60.6% (50.6% “agree”; 10.0% “strongly agree”) specifically endorse platforms utilizing end-to-end encryption. These findings highlight the pivotal role of transparent security protocols and stringent compliance with data-protection standards in cultivating user confidence.¹⁸

Alignment with regulatory and professional frameworks constitutes another enabling factor. Nearly 59.7% of respondents believe that telehealth prescribing, documentation, and treatment modalities adhere to extant healthcare policies, and 50.6% demonstrate familiarity with privacy regulations such as HIPAA. Explicit articulation of legal guidelines and professional standards alleviates liability concerns for providers and reassures patients of telehealth’s legitimacy, thereby facilitating its integration into routine practice.¹⁹

Perceived equivalence of clinical quality further underpins telehealth acceptance. A substantial 76.5% of participants concur that telehealth can deliver care outcomes comparable to, or surpassing those of in-person visits, particularly for patients constrained by geographic or mobility barriers. This perception aligns with systematic reviews demonstrating equivalent diagnostic accuracy and patient satisfaction when telehealth is incorporated into standardized care pathways.¹⁸ Emphasizing evidence-based protocols and rigorous outcome monitoring can reinforce clinician confidence in virtual modalities.

Enhanced accessibility remains a potent driver of telehealth uptake. According to Table 7, 82.6% of respondents (68.3% “agree”; 14.3% “strongly agree”) recognize telehealth’s capacity to expand service reach, while 84.3% (67.4% “agree”; 16.0% “strongly agree”) note its value in reducing travel time for minor reviews. An even greater majority (88.5%) appreciate its role in alleviating hospital overcrowding. In underserved and rural settings, these accessibility gains are transformative, enabling timely follow-up care without geographic constraints.^20,21

Finally, continuous platform refinement and user-centered design foster sustained telehealth engagement. Regular software updates, intuitive interfaces, clear user instructions, and responsive support services incrementally build digital literacy and trust among users. When coupled with equitable reimbursement structures and transparent communication regarding clinical efficacy and security measures, this iterative, client-focused approach cultivates a resilient telehealth ecosystem, transforming telemedicine from an adjunctive offering into a core component of postoperative care delivery.^6,18-20

Recommendations

To ensure the sustainable integration of telehealth for minor post-operative care, targeted investments in digital infrastructure are paramount. National and regional health authorities should prioritize the expansion of high-speed broadband networks, particularly in peri-urban and rural catchment areas where connectivity deficits are most pronounced.¹⁶ Public-private partnerships can mobilize resources for fiber-optic deployment and mobile network enhancements, while universal service obligations could subsidize last-mile connectivity for underserved clinics. By establishing robust and resilient network backbones, healthcare providers can reliably deliver teleconsultations without disruptive latency or dropout events.

Complementary to infrastructural development is the establishment of comprehensive technical support frameworks. Hospitals should institute dedicated telehealth help-desks staffed by trained IT personnel, available during clinical hours to troubleshoot audiovisual and platform-access issues.¹⁷ Concurrently, rolling training programs for clinicians and patients must be deployed, incorporating hands-on workshops, e-learning modules, and readily accessible user guides. Such capacity-building interventions will enhance digital literacy, streamline system adoption, and reduce appointment cancellations, ultimately fostering confidence in telehealth modalities.

Financial incentives and regulatory reforms are critical to overcome economic barriers hindering telehealth uptake. Health ministries and insurance payers should enact parity-of-payment policies, ensuring that telehealth consultations receive reimbursement rates equivalent to in-person visits.¹⁶ Moreover, subsidized data-bundle schemes, negotiated through collaborations with telecommunications operators, can alleviate the out-of-pocket costs borne by patients. Regulatory bodies must promulgate clear telemedicine guidelines covering licensure, clinical documentation, and quality assurance, thereby legitimizing virtual care pathways and reducing provider liability concerns.¹⁹

To build and maintain user trust, robust data-protection measures must be universally applied and transparently communicated. Telehealth platforms should integrate end-to-end encryption, multi-factor authentication, and rigorous audit-trail capabilities as standard features.¹⁸ Institutions must also develop and disseminate concise privacy policies, detailing data-handling practices, retention periods, and breach-notification procedures. By foregrounding patient confidentiality and security, providers can mitigate apprehensions regarding information misuse and strengthen long-term engagement with telehealth services.

Finally, a user-centered approach underpinned by continuous performance evaluation will ensure telehealth remains responsive to stakeholder needs. Health systems should implement routine satisfaction surveys and clinical-outcome audits to monitor teleconsultation quality, accessibility, and safety.^20,21 Insights gleaned from these evaluations can inform iterative platform refinements, optimizing user interfaces, streamlining workflows, and tailoring support services. Embedding telehealth within broader quality-improvement cycles will transform it from an ancillary offering into an integral component of postoperative care delivery.

Limitations

This study may not fully capture the variations in telehealth adoption for post-operative follow-ups at the Korle Bu Teaching Hospital, which could result in differences in access and benefits among patients. The rapid evolution of digital healthcare technologies may also render the findings obsolete over time, potentially limiting the long-term relevance of the study’s conclusions and recommendations. Furthermore, disparities in technological proficiency among healthcare providers and patients may impact the effectiveness of telehealth services, which this study may not comprehensively address. Additionally, constraints related to technological infrastructure, financial resources, and human capacity could hinder the successful implementation and sustainability of telehealth solutions in post-operative care. Lastly, the use of purposive and convenience sampling may introduce sampling bias, limiting the generalizability of the findings.

Conclusion

This study demonstrates that telehealth for minor post-operative care at Korle-Bu Teaching Hospital is both highly acceptable and practically beneficial. A substantial majority of stakeholders endorse its diagnostic reliability (76.6%), convenience (82.9%), time efficiency (86.6%), and infection-control advantages (85.2%), while maintaining strong patient-provider rapport with minimal reported discomfort (10.9%). However, persistent barriers, namely; unreliable broadband connectivity (83.4%), insufficient on-site technical support (66.0%), suboptimal audiovisual quality (81.7%), prohibitive data and device costs (61.4%), and concerns regarding data security (64.3% expressing insecurity) undermine broader implementation. Addressing these impediments through strategic investments in internet infrastructure, dedicated IT staffing, optimized low-bandwidth telehealth platforms, and supportive financing and reimbursement policies is essential. Moreover, reinforcing transparent privacy and security protocols (trusted by 73.8% of users), regulatory alignment (59.7% confidence), perceived clinical quality equivalence (76.5%), and enhanced accessibility (82.6% agreement) will catalyze further uptake. By integrating these facilitators into a user-centered design framework, telehealth can transition from an adjunctive service to a core component of postoperative care delivery, ultimately improving patient outcomes, optimizing resource utilization, and enhancing health system resilience. To consolidate telehealth’s integration into routine postoperative workflows, it is imperative that health authorities and institutional stakeholders orchestrate targeted investments in digital infrastructure. Specifically, the deployment of resilient, high-capacity broadband networks, achieved through strategic public-private partnerships and the imposition of universal service mandates, will attenuate connectivity fluctuations and ensure the seamless delivery of remote consultations. Such infrastructural fortification must be complemented by the institution of dedicated telehealth support units, staffed by specialized IT personnel, alongside structured training curricula for clinicians and patients to augment digital literacy and platform proficiency. Collectively, these measures will establish the technical and human-resource foundations requisite for the reliable, secure, and equitable provision of telemedicine in post-operative care. The cross-sectional nature of the current study precludes causal inference and fails to capture temporal shifts in telehealth perceptions. The use of purposive and convenience sampling within a single surgical department may have introduced selection bias, thereby limiting the representativeness of the broader patient and staff populations. Reliance on self-administered questionnaires carries inherent risk of social-desirability and recall biases despite the implementation of anonymity safeguards. Moreover, the confinement of data collection to 350 participants at one tertiary hospital, coupled with the heterogeneity of telehealth modalities and absence of longitudinal follow-up, constrains the extrapolation of results to other institutional settings and the evaluation of sustained telehealth adoption.

Footnotes

Acknowledgements

The authors wish to thank all study participants for the valuable time they shared during the study. The authors are also grateful to the Head and staff of the Surgical Department of Korle-Bu Teaching Hospital for their support and permission to conduct the study and patients who made themselves available at the surgical department during the study period. Finally, we would also want to thank the Research Assistants (HIMSA SANDWICH 2023 batch) for supporting us during data collection.

ORCID iDs

Jonathan Kissi

Godwin Adzakpah

Ethical Considerations

An administrative approval for the study was obtained from the review board of Korle-Bu Teaching Hospital with clearance number KBTH-ADM/000156/23. Oral and written informed consent were sought from the participants. Each consent form provided comprehensive information regarding the study’s objectives, the advantages stemming from the research, the application of study findings, and the dissemination of results. Involvement in this research was entirely voluntary, and participants were explicitly informed that they had the liberty to withdraw from the study at any point without any coercion or intimidation, and they could opt not to respond to question(s). To guarantee the enduring confidentiality of the participants, all research records were securely disposed of through incineration following the compilation of the final study report.

Author Contributions

Conceptualization, JK; formal analysis, investigation, and data curation, JK, VA, GA and CA; formal data analysis and results interpretation, JK, VK, VA, GA, CA and JOM; writing and original draft preparation, JK, VK, DKKQ, SYA, VA, KJO and DO; and writing, review, and editing, JK, VA, GA, CA, DKKQ, SYA, VA, KJO, DO, and JOM. All authors have read and agreed to the published version of the manuscript.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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