Abstract
Introduction:
Telehealth has emerged as a transformative tool in healthcare delivery, particularly during and after the COVID-19 pandemic. In the field of plastic and reconstructive surgery, telehealth facilitates patient consultations, follow-up visits, and postoperative care, especially for those in remote areas. However, evaluating its usability and patient satisfaction remains essential to guide future implementation. This study aimed to assess the usability of telehealth services and measure patient perceptions in plastic surgery clinics at a tertiary healthcare center in Riyadh, Saudi Arabia.
Methods:
A cross-sectional study was conducted between September 2024 and May 2025 at King Abdulaziz Medical City. After receiving ethical approval (IRB: NRC23R/515/09), eligible patients who had attended at least one online plastic surgery clinic consultation were contacted by phone and invited to participate. A self-administered questionnaire was distributed via Google Forms. The survey included demographic questions and the validated Telehealth Usability Questionnaire (TUQ), which covers seven domains. Responses were rated on a 7-point Likert scale. Data were analyzed using RStudio; nonparametric tests and multivariable linear regression were performed to identify predictors of usability.
Results:
A total of 93 participants completed the survey. Most respondents were female (67.7%), aged between 29–39 and 51–61 years. Overall, TUQ scores indicated high usability, with the highest medians in usefulness, ease of use, and interface quality (median = 7.0). Lower scores were observed in the reliability subscale (median = 6.0). Educational level significantly influenced ease-of-use and reliability scores, while visit type (e.g., craniofacial vs. breast reconstruction) impacted interaction quality. No significant predictors were identified for the overall TUQ score.
Conclusion:
Telehealth services in plastic surgery were perceived positively across all domains of usability. While demographic factors such as education influenced specific subscales, the overall experience was favorable. Telehealth presents a viable, efficient, and patient-satisfying alternative for surgical follow-up, with potential for broader integration in clinical practice.
Introduction
Telehealth uses information and communication technology to connect patients with healthcare providers remotely, facilitating a range of interactions from simple image exchanges to high-quality audio-visual consultations. 1 It has rapidly evolved to overcome geographical barriers, particularly addressing healthcare access inequalities in rural areas where resources and specialized care are often limited. 2
Telehealth has become vital in healthcare delivery, especially during the COVID-19 pandemic when in-person services were limited. 3 Ensuring ongoing access to telehealth postpandemic is essential for patients in various locations.3,4 A systematic review by Khoshrounejad et al. analyzed 64 studies from 18 countries, mainly China and the United States, focusing on telehealth for COVID-19 screening, diagnosis, treatment, and follow-up. Most studies reported positive outcomes, particularly in-patient follow-up, using synchronous communication methods such as video calls and phone consultations. However, challenges remain, including technological issues, legal concerns, and user acceptance. 5
The development and use of telehealth have varied significantly between rural and urban areas, especially during the COVID-19 pandemic. 6 Telehealth has enhanced healthcare access and outcomes for patients, particularly older individuals in rural communities, many of whom prefer these services. This delivery method is cost-effective, reducing travel expenses and enabling care without long-distance travel, thus improving health management and facilitating timely interventions. However, some older adults face challenges related to digital literacy, potentially affecting their satisfaction. 7 Despite increased telehealth use among older individuals, rural residents utilized it at a much lower rate than their urban counterparts, particularly for video chats and messaging. Research by Johannes et al. using data from over 3,000 Medicare recipients aged 70 years and older indicated that telehealth use was linked to postponements of in-person care, with this trend more pronounced in rural areas, highlighting the need for governmental efforts to improve telehealth access. 4
Several key factors influence telehealth adoption in Saudi Arabia, including infrastructure, culture, and technology. Technological advancements have improved healthcare access, especially in remote areas, but poor infrastructure and high costs impede widespread implementation. Cultural attitudes toward technology and healthcare can affect acceptance, with traditional preferences for in-person consultations and concerns about privacy often hindering adoption. The COVID-19 pandemic has increased demand for telehealth, showcasing its potential to enhance healthcare delivery. However, challenges such as inadequate training for healthcare providers and insufficient legislation limit the full benefits of telehealth in the Saudi system. 8 The Sehhaty app, launched by the Saudi Ministry of Health, aims to improve healthcare access and promote healthy living. While it offers convenience, user satisfaction remains moderate, with many preferring in-person visits due to perceived limitations in the app’s efficiency. 3
Telehealth is becoming a transformative tool in plastic surgery, providing timely access to specialized consultations for patients in remote areas. This technology enables real-time videoconferencing, allowing clinicians to conduct follow-ups, examine wounds, and give postoperative care advice without requiring extensive travel. Telehealth has improved patient compliance, reduced travel-related costs, and enhanced collaboration among healthcare personnel. 9 While in-person visits traditionally offer thorough examinations and foster trust, telehealth provides increased accessibility and convenience, allowing patients to consult specialists from home.2,10 Research indicates that telehealth visits, mainly in pediatric plastic surgery, yield patient satisfaction levels equal to or higher than in-person consultations. 10
Telehealth has proven effective for follow-up visits and initial consultations, ensuring continuity of care without compromising perceived quality, despite challenges in conducting thorough remote examinations. As telehealth evolves, it is expected to enhance patient access and satisfaction in plastic surgery. This study aims to assess the telehealth experience of patients in plastic surgery clinics and gauge their views on telehealth services, anticipating that patients will appreciate the time and travel cost savings it offers.
Methods
Ethical approval for this study was obtained from the Institutional Review Board of the King Abdullah International Medical Research Center (IRB number: NRC23R/515/09). This cross-sectional study was conducted among patients who had appointments in the plastic surgery online clinic at King Abdulaziz Medical City in Riyadh. Data collection took place between September 2024 and May 2025. Following ethical approval, eligible patients were contacted by phone and invited to participate. Those who agreed received a link to complete a self-administered questionnaire. The study population included Saudi men and women between the ages of 18 and more than 61 years who had attended at least one online consultation in the plastic surgery clinic during the study period. Individuals were excluded if they declined to complete the questionnaire, were younger than 18 years old.
DATA COLLECTION
Data were collected through a self-administered online questionnaire using Google Forms. The questionnaire consisted of two sections: (1) the first section gathered demographic data including age, sex, region of residence, educational status, marital status, and the reason for follow-up and (2) the second section incorporated the validated Telehealth Usability Questionnaire (TUQ), 11 which includes 21 items covering seven domains (1) Usefulness, (2) Ease-of-Use and Learnability, (3) Interface Quality, (4) Ease-of-Use Scale Summary, (5) Interaction Quality, (6) Reliability, and (7) Satisfaction and Future Use. Each item followed a 5-point Likert scale format ranging from “strongly agree” to “strongly disagree.” The TUQ was chosen based on its validity and relevance to the study objectives, particularly in assessing patient experience and usability of telehealth services. Informed consent was obtained from all the patients/participants involved in this study.
TUQ SCORING
As mentioned earlier, the TUQ consisted of 21 items grouped into seven subscales. Each item was rated on a 7-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree), with higher scores indicating more favorable perceptions of telehealth usability. Subscale scores were calculated by averaging the responses of items within each domain, while the overall TUQ score was obtained by averaging all 21 items.
QUESTIONNAIRE
The questionnaire was translated into Arabic to ensure clarity and comprehension among participants, and the collected responses were subsequently translated back into English for statistical analysis. To prevent duplicate entries, the survey required IP addresses, which were used solely to identify repeat submissions without compromising anonymity. Neither respondents nor data collectors received any financial incentives for participation. The online survey was distributed via Google Forms, which offered a secure and anonymous platform for data collection while maintaining the confidentiality of all participants.
STATISTICAL ANALYSIS
Data were analyzed using RStudio (version 2024.9.1.394, Boston, MA, USA) with R version 4.4.2. Categorical variables were summarized as frequencies and percentages, while continuous variables derived from the TUQ were described using median and interquartile range (IQR). Internal consistency for each TUQ subscale was assessed using Cronbach’s alpha. Differences in TUQ subscale scores across sociodemographic and telehealth-related characteristics were assessed using the Wilcoxon rank-sum test or Kruskal–Wallis rank-sum test, as appropriate. All the sociodemographic and telehealth-related characteristics were further entered in multivariable linear regression models to identify independent predictors of usability outcomes. A p value of less than 0.05 was considered statistically significant.
Results
DEMOGRAPHIC AND TELEHEALTH-RELATED CHARACTERISTICS
Data from 93 participants were analyzed in the current study. The majority were female (67.7%) and resided within Riyadh (86.0%). The most common age groups were 29–39 years and 51–61 years, each comprising 25.8% of the sample. Most participants held either a bachelor’s degree (30.1%) or had completed primary or secondary school (29.0% each). Regarding marital status, 67.7% were married. The largest proportion of participants was unemployed (50.5%), followed by employed individuals (28.0%). Most telehealth visits were conducted for follow-up purposes (80.6%), and slightly over half had used telehealth multiple times (52.7%). The most frequent reasons for visits were cosmetic surgery (40.9%) and hand surgery (31.2%, Table 1).
Demographic and Telehealth-Related Characteristics
Data expressed as n (%).
DESCRIPTION OF THE TUQ SCALE AND SUBSCALES
The median scores for all TUQ subscales were high, with a maximum value of 7.0 across all the domains. The highest median (Q1–Q3) was observed in the usefulness, ease of use and learnability, interface quality, and ease-of-use scale summary subscales, each with a median of 7.0 (5.7–7.0 or higher). The interaction quality subscale had a slightly lower median of 6.5 (5.5–7.0), while reliability was the lowest at 6.0 (5.0–7.0). The overall TUQ score had a median of 6.3 (5.5–7.0) and a mean of 5.9 ± 1.5, with a strong internal consistency across subscales, evidenced by Cronbach’s alpha ranging from 0.813 to 0.969 (Table 2).
Description of the TUQ Scale and Subscales
N: Number; NA: The reliability analysis was nonavailable because the subscale constituted one item; TUQ, Telehealth Usability Questionnaire.
PARTICIPANT RESPONSES ON TUQ SUBSCALES
The majority of participants expressed agreement with the statements, indicating favorable perceptions of telehealth services. In the usefulness subscale, 81.7% agreed that telehealth improves access to healthcare, 89.2% agreed that it saves time traveling, and 85.0% believed it meets their healthcare needs. For the ease of use and learnability subscale, 86.0% found the system simple to use, 86.1% found it easy to learn, and 79.6% believed they could become productive quickly using it. In the interface quality subscale, 80.6% reported that their interaction with the system was pleasant, 85.0% liked using the system, and 87.1% found it simple and easy to understand. Finally, under the ease-of-use scale summary, 79.6% of participants agreed that the system was capable of performing all the tasks they desired. These findings reflect a consistently high level of perceived usability across all evaluated aspects of the telehealth system (Fig. 1).
Description of four subscales of the TUQ survey, including usefulness, ease of use and learnability, interface quality, and ease of use scale summary. TUQ, Telehealth Usability Questionnaire.
In the interaction quality subscale, high levels of agreement were noted, with 86.0% of participants reporting they could easily talk to the clinician, 89.3% stating they could hear the clinician clearly, and 82.8% feeling they were able to express themselves effectively. However, only 69.9% agreed that they could see the clinician as well as in an in-person visit. For the reliability subscale, 70.0% of participants agreed that telehealth visits were equivalent to in-person visits, 73.1% felt they could recover easily after making mistakes while using the system, and 73.2% found the error messages helpful in resolving problems. Regarding satisfaction and future use, 83.8% of participants felt comfortable communicating with the clinician via telehealth, 86.0% accepted telehealth as a valid mode of healthcare delivery, 84.4% stated they would use telehealth services again, and 82.8% expressed overall satisfaction with the system (Fig. 2).
Description of three subscales of the TUQ survey, including interaction quality, reliability and satisfaction, and future use. TUQ, Telehealth Usability Questionnaire.
PREDICTORS OF THE OVERALL TUQ SCORE
No significant predictors of the overall TUQ score were identified in the multivariable regression analysis. None of the sociodemographic or telehealth-related variables—including gender (p = 0.898), place of residence (p = 0.427), age (all p > 0.400), educational level (p = 0.921 for bachelor’s degree vs. reference), marital status (p = 0.633 for married vs. single), employment status (p = 0.104 for unemployed vs. student), reason for the telehealth visit (p = 0.225 for cosmetic surgery vs. reference), number of telehealth sessions (p = 0.801), or visit type (p = 0.794 for follow-up vs. consultation)—were significantly associated with the overall TUQ score. All corresponding p-values exceeded the significance threshold of 0.05 (Table 3).
Predictors of the Overall TUQ Domain
Median (Q1, Q3).
Wilcoxon rank-sum test; Kruskal–Wallis rank-sum test.
CI, confidence interval; IQR, interquartile range; TUQ, Telehealth Usability Questionnaire.
PREDICTORS OF TUQ SUBSCALES
A significant association was observed only in the inferential analysis of the ease of use subscale with educational level (p = 0.035). Specifically, participants with intermediate school education reported lower ease-of-use scores compared with those with primary education (median = 4.7 vs. 6.0 or more for other categories). Having an intermediate education was also a significant predictor of lower ease-of-use (beta = –2.31, 95% CI, –4.27 to –0.35, p = 0.021, Table 4).
Predictors of the Ease-of-Use Subscale
IQR, interquartile range.
Notably, the reason for the telehealth visit was significantly associated with the interaction quality subscale (p = 0.034). The highest median score was reported among participants whose visits were related to craniofacial surgery (median = 7.0, IQR = 6.8–7.0) and cosmetic surgery (median = 7.0, IQR = 6.0–7.0), while the lowest scores were seen in visits related to breast reconstruction (median = 5.4, IQR = 4.3–7.0) and other procedures (median = 5.5, IQR = 1.8–6.3). In the multivariable analysis, participants who visited for craniofacial surgery had higher interaction quality scores compared with those who visited for breast reconstruction (beta = 2.54, 95% CI, 0.02–5.07, p = 0.049, Table 5).
Predictors of the Interaction Quality Subscale
IQR, interquartile range.
A significant difference in reliability scores was observed by educational level in the inferential analysis (p = 0.031). Participants with a bachelor’s degree and those with diploma/postgraduate education reported higher reliability scores (median = 7.0, IQR = 5.3–7.0 and 7.0–7.0, respectively), compared with those with only primary (median = 5.7, IQR = 4.7–7.0) or intermediate education (median = 5.3, IQR = 2.3–6.0). In the multivariable regression analysis, no variables were significantly associated with the reliability subscale, as all p values exceeded 0.05 (Table 6).
Predictors of the Reliability Subscale
IQR, interquartile range.
No other sociodemographic or telehealth-related factors showed significant associations across the remaining TUQ subscales, including usefulness (Table 7), interface quality (Table 8), ease-of-use scale summary (Table 9), and satisfaction and future use (Table 10).
Predictors of the Usefulness Subscale
IQR, interquartile range.
Predictors of the Interface Quality Subscale
Predictors of the Ease-of-Use Scale Summary Subscale
IQR, interquartile range.
Predictors of the Satisfaction and Future Use Subscale
IQR, interquartile range.
Discussion
In recent years, telehealth has become a well-known tool used across various specialties. This became especially apparent during the COVID-19 pandemic, as it allowed the maintenance of social distancing while connecting providers with their patients. This study aimed to evaluate the usability of telehealth services in plastic and reconstructive surgery among a sample with diverse sociodemographic statuses in a tertiary hospital located in Riyadh, Saudi Arabia. The findings demonstrated high levels of satisfaction, perceived usability, and quality of care. Key objectives included identifying predictors of usefulness, satisfaction, and reliability, as well as assessing the perceived quality of telehealth compared with in-person visits. The majority of participants were female, predominantly aged 29–39 and 51–61 years, and held higher education degrees. This reflects the inclination of younger and middle-aged adults to utilize telehealth. Similarly, studies conducted by Almalki et al. 12 revealed comparable parameters to those found in the current study. A cross-sectional analysis showed that male participants had significantly decreased use of telehealth during the pandemic. This difference may be attributed to the fact that women frequently seek cosmetic procedures, in addition to addressing reconstructive needs, leading to higher attendance at plastic surgery clinics. 13 This trend likely explains the predominance of female participants in our study, as their engagement with both aesthetic and medical concerns enhances their likelihood of utilizing telehealth services.
Median scores across all TUQ subscales were highest in areas of usefulness, ease of use, and interface quality. The majority of participants found telehealth reliable and effective for accessing healthcare, reporting positive experiences with technology and a high likelihood of future use. However, the number of patients finding it difficult to use or unwilling to use it in the future is a concern. Despite the continuous efforts of the Saudi Ministry of Health to accelerate the empowerment and revolution of digital health by creating and maintaining high-quality telehealth services, the differences in findings could be attributed to technical issues associated with mobile applications or network usage, which significantly affect user satisfaction and usability. 14
The lack of significant predictors for the overall TUQ suggests that perceptions of usability result from a complex interplay of multiple factors. However, educational level was identified as a significant predictor for the ease of use subscales, where participants with lower educational levels reported lower scores on both scales. Alshorby et al. 15 reflected that telehealth was generally utilized by individuals with higher education levels, which correlates with the observed statistics. Furthermore, the reliability subscale of telehealth was reported to be higher among participants with a bachelor’s degree, diploma, or postgraduate education compared with those with only intermediate or primary education. Although Syed et al. 16 reported low reliability in nearly half of their participants, this study found that two-thirds or more agreed that telehealth was equivalent to in-person visits, that mistakes were easily recoverable, and that error messages effectively guided them.
Notable differences in the interaction quality subscale were observed among participants based on the reason for the telehealth visit, specifically, patients seeking breast reconstruction. These patients reported lower interaction quality scores compared with those seeking craniofacial or cosmetic surgeries. Effective communication may be hindered by the complexity and sensitive nature of the subject, requiring in-depth discussions from history-taking to treatment options, as well as the associated psychological and emotional burden.
The high levels of satisfaction reported by participants suggest that telehealth could serve as a viable alternative to in-person visits, particularly for follow-up consultations. According to Funderburk et al. 13 while most patients preferred in-person visits preoperatively, nearly 100% expressed satisfaction postvisit, with all their questions answered. Therefore, healthcare providers should consider integrating telehealth into their practices to enhance access and convenience for patients, particularly in follow-up appointments.
Research into patient requirements can guide improvements in telehealth platforms, ensuring they meet the diverse needs of patients, particularly older individuals who are most likely to benefit from such technology regarding clinical visits and many appointments. Edwards et al. 17 found that older individuals showed comparable interest in using telehealth when accounting for factors like confidence in technology. This highlights the need to adjust technologies to suit this demographic group and enhance their experience, allowing healthcare to be provided effectively. Additionally, the experience from the Western Australian pediatric burn unit in the McWilliams et al. 18 study demonstrates that telehealth not only provides convenience and enhances patient satisfaction but can also be significantly implemented in burn care within plastic surgery. Telehealth can substantially reduce unnecessary transfers and inpatient bed days.
Resources in such specialized fields need to be optimized, especially when ongoing consultations and follow-up care are frequent. For instance, telehealth has allowed burn units to avoid 4,905 inpatient bed days and 364 transfers. This highlights the substantial value of telehealth in resource-intensive specialties.
Despite promising results, this study has limitations, such as a limited sample size and demographic homogeneity, which may affect the applicability of the findings. Previous research has highlighted that diverse samples are crucial for understanding the multifaceted nature of telehealth usability; therefore, future studies should strive for more representative samples to enhance generalizability. Future research should explore the long-term effects of telehealth on patient satisfaction and health outcomes, specifically in plastic surgery. Investigating the specific barriers faced by less educated individuals could inform strategies to improve telehealth accessibility. Additionally, further studies are needed to assess the efficacy of implementing an integrated platform between tertiary centers and less specialized rural hospitals in terms of plastic surgery emergencies.
Conclusions
This study highlights the potential of telehealth services to enhance patient access and satisfaction, particularly in the field of plastic and reconstructive surgery. The evidence suggests that telehealth can be effectively utilized across various settings, including burn care and other specialized areas, to improve patient outcomes. While the findings are promising, ongoing evaluation and adaptation are necessary to address the diverse needs of patients and ensure that telehealth continues to evolve as a viable healthcare delivery option in multiple contexts.
Authors’ Contributions
I.A.S.A.: Concept, design, definition of intellectual content, literature search, clinical studies, data acquisition, data analysis, statistical analysis literature search, IRB writing, methodology writing, abstract writing, questionnaire, and article editing and article review. N.Z.A.: Concept, design, definition of intellectual content, literature search, clinical studies, data acquisition, data analysis, statistical analysis, literature search, ethical approval, institutional coordination, data curation and management, and questionnaire article review. N.A.S.: Concept, design, definition of intellectual content, literature search, clinical studies, data acquisition, data analysis, statistical analysis, dissection writing, and article review. J.S.A.: Concept, design, definition of intellectual content, literature search, clinical studies, data acquisition, data analysis, statistical analysis, literature search, introduction writing, and article review. A.F.A.: Concept, design, definition of intellectual content, literature search, clinical studies, data acquisition, data analysis, statistical analysis, literature search, data curation, and article review. Y.N.A.: Concept, design, definition of intellectual content, literature search, clinical studies, data acquisition, data analysis, statistical analysis, literature search, data curation, and article review. B.A.: Literature search, clinical studies, article preparation, and article editing and article review. M.A.: Literature search, clinical studies, article preparation, and article editing and article review.
Footnotes
Acknowledgments
The authors express our sincere gratitude to the King Abdullah International Medical Research Center for their valuable support and collaboration throughout this study. The authors deeply appreciate their assistance in facilitating access to the data and their ongoing cooperation.
Funding Information
The authors do not have any conflicts of funding to declare.
Disclosure Statement
No competing financial interests exist.