1 

 

 

 
 

The feasibility of telemedicine based consultation in 
the primary healthcare sector in Johannesburg 

 

  

 

 

 

 

Karishma Jivan Mistry 

WITS Business School 

 

 

 

 

 

Research report presented in partial fulfilment for the degree of 
Master of Business Administration to the Faculty of Commerce, Law, 

and Management, University of the Witwatersrand 
 

April 2021 

 

 

 

 



 2 

DECLARATION 
 
I Karishma Jivan Mistry declare that this research report entitled ‘The feasibility of telemedicine-

based consultation in the primary healthcare sector in Johannesburg’ is my own unaided work. I 

have acknowledged, attributed, and referenced all ideas sourced elsewhere. I am hereby submitting 

it in partial fulfilment of the requirements of the degree of Master of Business Administration at 

the University of the Witwatersrand, Johannesburg. I have not submitted this report before for 

any other degree or examination to any other institution. 

 

             

Karishma Jivan Mistry  

Signed at Johannesburg on 30 April 2021  

 
 

Name of candidate Karishma Jivan Mistry 

Student number 451825 

Telephone numbers 071 048 9009 

Email address karishmajivan@yahoo.com 

First year of registration 2019 

Date of proposal submission 16 November 2020 

Date of report submission 30 April 2021 

Name of supervisor Patrick Zhuwao and Kambidima Wotela 

 



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ABSTRACT 
 

Author: Karishma Mistry Supervisor Patrick Zhuwao 

Thesis title: The feasibility of telemedicine based consultation in the primary healthcare 
sector in Johannesburg 

 

Healthcare system in South Africa is overburdened and telemedicine is considered a useful tool to 

make quality healthcare more accessible. In South Africa, regulations imposed by Health 

Professional Council of South Africa (HPCSA) and restricted access to technological, educational, 

economic and sociocultural factors has limited the ease of accessing and using telemedicine. In 

order for telemedicine to gain prominence, it needs to be integrated into everyday practice and be 

seen as an alternative to face-to-face consultation. Hence, the purpose of this study was to evaluate 

a combination of factors, in the context of Covid-19 pandemic, namely telemedicine as an engaging 

platform, seeking written or verbal informed consent for clinical procedures and using information 

and communication technology (ICT) and availability and knowledge of electronic resources to 

conduct virtual consultation. In addition, the method used to store patient information was 

examined to understand the prominence it has in the context of telemedicine.  

 

A quantitative, cross-sectional research strategy was used to collect data from 80 family physicians 

practicing in either private, state or both sectors. This study reported that a large number of 

participants have used some form of telemedicine, although only one third use it daily. On average 

the study population reported to agree that telemedicine is an engaging platform, but half the 

respondents found that the explanation concerning the disease or treatment is not better.  

 

Verbal consent is used more than written consent for activities relating to clinical examination or 

when using ICT. While, majority of the respondents indicated that they do have an electronic 

device to implement telemedicine consultation, only half the respondents had access to quality 

broadband network. The study also reported that about two-thirds of the respondents reported to 

stored patient information manually.  

 

Overall, more attention is required to make the functionality of telemedicine more noticeable. 

Telemedicine may not be valued so much when there is good health infrastructure, however, when 

health infrastructure is poor, telemedicine is unable to stand on its own. Hence, associated 

economic, education and socio cultural factors needs to be evaluated further so that behavioural 

barriers are reduced and telemedicine is used more frequently.  



 4 

TABLE OF CONTENTS 
 
DECLARATION ....................................................................................................................................... 2 

Abstract  .......................................................................................................................................... 3 

Table of contents ........................................................................................................................................ 4 

List of tables  .......................................................................................................................................... 6 

List of figures  .......................................................................................................................................... 7 

ACKNOWLEDGEMENTS .................................................................................................................... 8 

Definition of key terms and concepts ..................................................................................................... 9 

Introduction to the research ................................................................................................................... 10 

1.1 Background and context ..................................................................................................... 10 

1.1.1 Defining telemedicine ........................................................................................... 13 

1.2 Research conceptualisation ................................................................................................. 13 

1.2.1 The research problem statement ......................................................................... 13 

1.2.2 The research purpose (aim and objectives) statement ..................................... 15 

1.2.3 Research questions ................................................................................................ 16 

1.3 Significance of the research study ...................................................................................... 16 

1.4 Delimitations and assumptions of the research study .................................................... 17 

1.5 Limitations ............................................................................................................................. 18 

1.6 Preface to the research report ............................................................................................ 18 

2 Literature review............................................................................................................................... 19 

2.1 Research problem analysis .................................................................................................. 19 

2.1.1 Introducing telemedicine ...................................................................................... 20 

2.1.2 Challenges to implement telemedicine in South Africa .................................. 21 

2.2 Research knowledge gap analysis ....................................................................................... 24 

2.2.1 Performance expectancy: Engaging platform ................................................... 25 

2.2.2 Social influence: Written informed consent ...................................................... 26 

2.2.3 Facilitating condition: Availability & knowledge of resources to conduct telemedicine
 .................................................................................................................................. 27 

2.2.4 Effort expectancy: Storing patient information ................................................ 28 

2.3 Unified Theory of Acceptance and Use of Technology (UTAUT) ............................. 29 

2.4 Summary and conclusion .................................................................................................... 32 

2.4.1 Summary of literature reviewed .......................................................................... 32 

3 Research strategy, design, procedure and methods .................................................................... 33 

3.1 Research strategy .................................................................................................................. 33 

3.2 Research design .................................................................................................................... 34 

3.3 Research procedure and methods...................................................................................... 34 

3.3.1 Research data and information collection instrument(s) ................................ 34 

3.3.2 Research target population and selection of respondents .............................. 36 

3.3.3 Ethical considerations when collecting research data ...................................... 38 

3.3.4 Research data and information collection process ........................................... 38 

3.3.5 Research data and information processing and analysis ................................. 39 

3.4 Research strengthens—reliability measures applied ....................................................... 40 

3.5 Research weaknesses—technical and administrative limitations .................................. 41 

4 Presentation of research results ..................................................................................................... 42 



 5 

4.1 Socio-Demographic Characteristics of Participants ....................................................... 42 

4.2 Telemedicine usage .............................................................................................................. 43 

4.3 Telemedicine as an engaging platform .............................................................................. 46 

4.4 Informed consent preference (written or verbal) to perform a clinical examination or when 
using ICT ............................................................................................................................... 48 

4.5 Availability and quality of essential resources to conduct telemedicine ...................... 51 

4.6 Modalities used to store patient information ................................................................... 53 

4.7 Associations - one way Analysis of Variance (ANOVA)............................................... 54 

4.7.1 Differences of engagement means between age groups ................................. 54 

4.7.2 Differences of engagement means between gender groups ........................... 56 

4.7.3 Contingency Analysis of gender by ease of use ................................................ 58 

4.7.4 Contingency Analysis of age by ease of use ...................................................... 59 

5 Discussion of reserch findings ....................................................................................................... 61 

5.1 Introduction .......................................................................................................................... 61 

5.2 Socio-Demographic Characteristics of Participants ....................................................... 61 

5.3 Telemedicine as an engaging platform .............................................................................. 63 

5.4 Informed consent preference (written or verbal) to perform a clinical examination or when 
using ICT ............................................................................................................................... 65 

5.5 Availability and quality of essential resources to conduct telemedicine ...................... 67 

5.6 Modalities used to store patient information ................................................................... 70 

6 Summary, conclusions, limitations, and recommendations ...................................................... 73 

Introduction ...................................................................................................................................... 73 

6.1 Conclusions ........................................................................................................................... 73 

6.2 Limitations ............................................................................................................................. 74 

6.3 Recommendations (action plan) ........................................................................................ 75 

6.4 Areas for future research ..................................................................................................... 76 

References  ........................................................................................................................................ 78 

Appendix 1: Questionnaire ..................................................................................................................... 80 

Appendix 2: Letter to participate ........................................................................................................... 85 

Appendix 3: Ethics approval ................................................................................................................... 86 

Appendix 4: Histograms: Differences of engagement means between age groups ....................... 87 

Appendix 5: Histograms - Differences of engagement means between gender groups ............... 90 

Appendix 6: Knowledgeability of telemedicine amongst age groups ............................................... 92 

Appendix 7: Bio  ........................................................................................................................................ 93 



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 LIST OF TABLES 
  

Table 1: Socio-demographic representation of the study population Page 42 

Table 2: Telemedicine usage of the study population Page 43 

Table 3: Telemedicine as an engaging platform Page 46 

Table 4: Information exchange during a telemedicine consultation Page 47 

Table 5: Summary Statistics on written number of procedure Page 49 

Table 6: Summary Statistics on verbal number of procedure Page 50 

Table 7: The efficiency of telemedicine software Page 51 

Table 8: Preference for ease of using telemedicine, learning to operate and usefulness Page 52 

Table 9: Storage of patient information  Page 53 

Table 10: Efficiency of storing patient information Page 53 

Table 11: Tests that the Variances are Equal Page 54 

Table 12: Oneway Anova Summary of Fit for Engaging platform and age Page 55 

Table 13: Means for Oneway Anova Page 55 

Table 14: Means and Standard Deviation Page 55 

Table 15: Analysis of Variance  Page 55 

Table 16: Connecting Letters Report Page 56 

Table 17: Tests that the Variances are equal Page 56 

Table 18: Pooled t Test  Page 57 

Table 19: Contingency Table measuring ease of use and gender  Page 58 

Table 20: Pearson correlation test Page 58 

Table 21: Contingency Table measuring ease of use and age Page 59 

Table 22: Pearson Correlation Tests Page 60 
 

  

   

 



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LIST OF FIGURES 
 

Figure 1: Root causes to deteriorating health care system in South Africa Page 12 

Figure 2: UTAUT model Page 30 

Figure 3: How often telemedicine is used Page 44 

Figure 4: Modalities used by study population Page 44 

Figure 5: Usefulness of telemedicine as per the study population Page 45 

Figure 6: Study population knowledge about telemedicine Page 45 

Figure 7: Percentage of respondents that find telemedicine to be an engaging platform Page 47 

Figure 8: Study population preference on informed consent Page 48 

Figure 9: Written number of Procedures  Page 49 

Figure 10: Verbal number of Procedures Page 49 

Figure 11: Study population representation on tools used by doctors for telemedicine Page 51 

Figure 12: Study population representation on tools used by patients for telemedicine  Page 52 

Figure 13: Test to determine if variances are Equal Page 54 

Figure 14: Oneway Analysis of Engaging platform by Age Page 55 

Figure 15: Test to determine if variances are equal Page 56 

Figure 16: Mosaic Plot measuring ease of use and gender Page 58 

Figure 17: Mosaic Plot measuring ease of use and age Page 59 

 

 

 

 

 

 

 

 

 



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ACKNOWLEDGEMENTS 
 

A special thanks goes out to all medical doctors who participated in the survey. When the survey 

was launched (January 2021), South Africa was experiencing its second-wave of the Covid-19 

pandemic, putting doctors under immense pressure in treating patients. While this was a 

challenging period, my heartfelt gratitude goes to each and every participant for taking time out to 

answer the survey. 

 

I would also like to take the opportunity to thank Mr Hennie Gerber for his assistance and 

guidance in analysing the data. 

 

Lastly, I would like to express my sincere gratitude and appreciation to my supervisor, Mr Patrick 

Zhuwao for his valued advice, guidance and support. 

 

 

DEDICATION  

I dedicate this work to my late father who always believed in me and supported me in every 

milestone achieved.  

 

 

 

 

 

 

 

 

 

 



 9 

DEFINITION OF KEY TERMS AND CONCEPTS 
 

1. Telemedicine: the practice of medicine using electronic communications, information 

technology or other electronic means between a health care practitioner in one location 

and a patient in another location (Chifamba, 2018). 

 

2. Informed consent: According to the Health Professions Council of South Africa 

Guidelines For Good Practice In The Health Care Professions Seeking Patients’ Informed 

Consent: The Ethical Considerations (Book 4, page 14), informed consent is an exercise 

of an informed choice by a patient who has the capacity to give consent: in instances where 

there are multiple options or alternatives to treatment; or in making a decision whether to 

withhold or disclose information or allow someone else to disclose information on their 

medical condition to a defined third party; or in making a decision for purposes of 

reimbursement by a Medical Scheme.  

 

 

 



 10 

INTRODUCTION TO THE RESEARCH 
 

1.1 Background and context 

The healthcare system in South Africa is overburdened due to underlying factors associated from 

the apartheid period between 1948 and 1993 (Delobelle, 2013). To date, majority of the South 

African population rely on public health facilities and unfortunately access to quality service is 

scarce for this population (Delobelle, 2013).  

 

As part of the National Development Plan aimed to achieve equity, efficiency, effectiveness and 

quality of healthcare provision by 2030; the Department of Health released a National Digital 

Health Strategy for South Africa in 2019 (page 8) that sets out a vision of ‘better health for all 

South Africans enabled by digital health’ (National Digital Health Strategy for South Africa 2019 

- 2024, 2019) 

 

One technique of digital health, called telemedicine, a form of information and communication 

technology used to deliver a health care service virtually, can be considered a useful tool to make 

quality health care more accessible (Cilliers & Flowerday, 2013) and an effective solution to 

alleviate the issues faced by the current health care system in South Africa.  

 

There is a prospect that telemedicine can, insofar, open the door to healthcare service delivery that 

is of better quality, highly accessible, and more efficient (van Dyk, 2014) to South African 

communities, particularly the rural and underserved areas. This can be supported by Jack and Mars 

(2013) research that stated that telemedicine is considered to be a cost-effective and efficient tool 

to deliver health care to under-resourced areas.  

 

However, implementing telemedicine does come with diverse challenges (Cilliers & Flowerday, 

2011). The literature review (chapter 2) conducted for this study identified the root causes for the 

deteriorating healthcare system that are shown in Figure 1 (page 13). According to Cilliers and 

Flowerday (2011), limited access to technology can be attributed to the costs associated with 

required ICT infrastructure such as internet connectivity, high-end videoconferencing systems and 

sophisticated medical devices. Cilliers and Flowerday (2011) further mentions that the current state 

of infrastructure often leads to frequent interruptions of electricity supply, poor connectivity and 

low bandwidth, making telemedicine unreliable.  

 



 11 

Another factor to low use of telemedicine is inequality (Petersen, Brown, Pather, & William, 2019) 

resulting from the South African history that still mirrors the South African population. Inequality 

had developed a socio-economic divide (Delobelle, 2013) leading to a ripple effect on survival 

needs, such as quality healthcare and lack of basic computer literacy. Petersen et al (2019) research 

stated that economic factors (such as the digital divide between the rich and poor), educational 

factors (such as lack of technology literacy) and sociocultural factors (such as lack of support from 

family and peers) are contributors to low use of telemedicine. 

 

Moreover, guidelines developed by the Health Professional Council of South Africa (HPCSA) 

namely seeking written informed consent, quality of care, data protection and prior doctor-patient 

relationship, is a barrier towards the implementation of telemedicine, especially in an asynchronous 

or telephonic format (Townsend, Scott and Mars, 2019).  

  



 12 

 

 

 

 

 

 

 

 

 

 

 
 
 
 
 
 
 
 
 
 
 

 

 
 
Figure 1: Root causes to deteriorating healthcare system in South Africa  

 

 



 13 

From the onset of Covid-19, this research aimed to evaluate a combination of factors that limit 

the ease of accessing and use of digital health namely: telemedicine consultation as an engaging 

platform, seeking written informed consent for clinical procedures and using ICT, and availability 

and knowledge of resources to conduct virtual consultation. In addition, the method used to store 

patient information was introduced into the research to examine availability and sharing of patient 

information in the context of telemedicine. 

 

Concepts from the Unified Theory of Acceptance and Use of Technology (UTAUT) model was 

used as a guide in developing the research questions to examine the factors that limit the use of 

telemedicine.  

 

 The following section expands on the research problem statement, research purpose statement 

and research propositions.  

 

1.1.1 Defining telemedicine 

According to the American Telemedicine Association, telemedicine is a form of information and 

communication technology in which medical information between a doctor and patient is 

exchanged remotely (Chifamba, 2018). Telemedicine is divided into two categories namely 

asynchronous and synchronous. Asynchronous, also called store and forward telemedicine, is 

when information is shared between two parties, independent of time and at their own 

convenience (Chifamba, 2018). For example, images are stored and emailed to a referred medical 

professional. Synchronous or real-time telemedicine is when communication between a doctor and 

patient is live and interactive. This form of communication is usually undertaken on a 

videoconference call (Chifamba, 2018). 

 

1.2 Research conceptualisation 

1.2.1 The research problem statement 

Jack & Mars (2013) point that in order for telemedicine to gain prominence, it needs to be 

integrated into everyday practice and be seen as an alternative to face-to-face consultation. Hence, 

the importance to look into the factors that contribute to the low use of telemedicine.  

Whilst, there has been research done to examine the factors affecting healthcare workers’ 

acceptance and use of telemedicine, there has been minimal academic research on measuring a 

combination of the key contributors of accessibility and usefulness of telemedicine during Covid-



 14 

19. Hence, Section 1.2 will cover the following factors and its weaknesses that limit the accessibility 

and use of telemedicine (a) written informed consent, (b) if telemedicine provides an engaging 

platform, and (c) availability of resources and knowledge to implement telemedicine. The fourth 

factor is the method used to store patient information and how this influences the use of 

telemedicine.    

1.2.1.1 Written informed consent 

In the event of a telemedicine consultation, the HPCSA General Ethical Guidelines For Good 

Practice in Telemedicine (Booklet 10, page 12) stipulates that healthcare practitioners are required 

to seek consent in writing from patients to conduct clinical procedures virtually, such as diagnosis 

and treatment (Human Rights, 2014).  

 

This becomes a challenge for patients because of required paperwork and e-signatures; and a 

challenge for doctors in the need of asynchronous or telephone consultations. Thus, the need to 

examine from family physicians if written or verbal informed consent is routinely obtained from 

patients during clinical examination or when using ICT, before and during Covid-19.  

 

1.2.1.2 Engaging platform 

As per the HPCSA General Ethical Guidelines For Good Practice in Telemedicine (Booklet 10, 

page 18), the level of engagement during a telemedicine consultation, between a medical doctor 

and patient, is highly important to ensure that the patient is provided with sufficient information 

and fully understands the diagnosis and treatment provided (Human Rights, 2014). 

 

In their research, Jack and Mars (2013), indicated that there is sufficient evidence that a patient 

would obtain the same level of quality in a virtual consultation (be it synchronous or asynchronous) 

and a face-to-face consultation. However, there is not sufficient theory to justify the doctor-patient 

relationship as technology and telemedicine practice evolve. 

 

 
1.2.1.3 Availability of resources and knowledge to implement telemedicine 

Restricted access to resources such as electronic devices and good internet connection as well as 

lack of knowledge needed to operate the telemedicine system is another mechanism that makes 

the implementation of telemedicine unsuccessful. This is a resultant from the South African 

history, which still mirrors some parts of the population, in that inequality led to a socio-economic 

divide (Cilliers & Flowerday, 2011). Hence, the need to investigate if electronic resources and 

digital literacy is still an implication to low use of telemedicine.  



 15 

1.2.1.4 Patient information 

The South African Public healthcare system still follows the traditional method of record keeping 

that has negative consequences such as patients’ folders being misplaced and incorrect patient 

diagnosis. Hence, the National Digital Health Strategy (2019 – 2024) has prioritised to establish an 

integrated platform and architecture for the health sector information system, which will ensure 

interoperability and linkage of existing patient-based information systems. This will have a positive 

implication on telemedicine because instant accessibility of patient information will improve the 

quality and continuity of care. Additionally, the transmission of documents between different 

venues poses a health risk because viruses can easily be transmitted, a learning from the Covid-19 

pandemic.  

 

In consequence, the examination of the method used by family physicians to store patient 

information, its success rate on National Digital Health Strategy and influence it will have on 

telemedicine.  

 

1.2.2 The research purpose (aim and objectives) statement 

Following the weaknesses to gain maximum value of telemedicine as discussed in section 1.2.1, 

the aim of this research was to study a combination of key factors that limit the ease of accessing 

and using telemedicine by medical doctors specialising as Family Physicians in Johannesburg, in 

the context of Covid-19.  The four factors examined in this research study included:  

 

a) If telemedicine results in an engaging platform in a doctor-patient relationship, especially as 

technology and telemedicine practice evolve; 

b) If written or verbal informed consent is routinely obtained from patients during clinical 

examination or when using ICT, before and during Covid-19; 

c) If electronic resources and digital literacy is still an implication of low use of telemedicine;  

d) Over and above and as a contribution to new literature, the research study examined a factor 

that influences the ease of using telemedicine, the method used to store patient information. 

This factor links to the National Digital Health Strategy for South Africa’s prioritization to 

establish an integrated information architecture for interoperability and safe sharing of health 

information across health systems and services. Electronic record keeping, especially for 

telemedicine consultations, will be beneficial to both medical practitioner and patient because 

patient information is easier to access and eliminates health risks.  

 



 16 

Overall, the results obtained in this research will assist stakeholders in the South African healthcare 

sector in developing frameworks that will make telemedicine more user friendly and strengthen 

the current South African health ecosystem.  

 

1.2.3 Research questions 

As per the factors and weaknesses identified in section 1.2.1 that influences a low intake of 

telemedicine and research objectives stipulated in section 1.2.2, the following section represents 

the research questions established to research the objectives of this study:   

 
1.2.3.1 Question 1: Does consultation using a telemedicine format provide the same level of 

engagement and satisfaction as face-to-face consultation?  

  

1.2.3.2 Questions 2: Which method of informed consent is used, written or verbal, for the 

following activities – namely taking history, examinations, ordering a special 

investigation such as an X-ray or blood test, referring the patient to a specialist, email 

patient information, prescriptions and virtual consultation?  

 
1.2.3.3 Question 3: How crucial is access to the right resources, such as electronic devices and 

skills to navigate the technology, to achieving the desired outcome of telemedicine?  

 
1.2.3.4 Questions 4: Which method, manual or electronic, is used to store patient information? 

If patient information is stored electronically, is patient information protected through 

encryption? 

 

1.3 Significance of the research study 

Telemedicine is an innovative digital solution that has the potential to provide better healthcare 

services including access to healthcare services in remote areas, thereby minimizing the effect of 

shortages of healthcare professionals and accessibility. Telemedicine enables a patient to engage 

with their healthcare providers more frequently, minimising the risk to health deterioration. It may 

also provide an opportunity to reduce healthcare spending and increase productivity levels of 

medical practitioners.  

 

Determination of the underlying factors and findings from the study will assist in developing a 

suitable framework to enable telemedicine to be accessible to the broader population and offer a 

sufficient number of healthcare workers to treat increasing number of patients. Additionally, 



 17 

examining the underlying factors will help address what the resource constraints are and develop 

a model whereby allocation to required infrastructure and equipment is made easily available and 

is reliable. The frameworks lead to indirect benefits whereby the need to travel long distances to 

access adequate healthcare will be eliminated.  

 

Hence, in order for telemedicine to gain prominence and integrated into everyday practice, there 

are key underlying factors that need to be evaluated.  

 

South Africans, especially those that depend on state facilities will continue to be underserved 

(Delobelle, 2013). Moreover, the number of health care workers needed to meet the increasing 

number of patients will continue to decelerate as more and more health workers will prefer to 

work for the private sector, patients will have to travel long distances to access adequate healthcare, 

and there will be restricted resources to treat patients (Delobelle, 2013).  

 

1.4 Delimitations and assumptions of the research study 

The research focused mainly on the factors that influence the ease of accessing and using 

telemedicine in the primary healthcare sector. Hence, the following section discusses the 

delimitations and assumptions of the research study.  

 

For the study, family physicians were approached because their specialist is in primary care. The 

study did not include medical doctors who specialised in other medical specialities because this 

would impact the objective of the study.  

 

Similar to previous research studies, the sample encompassed only medical doctors and not 

patients, as research factors (namely, seeking verbal verses written consent, regulations imposed 

by the HPCSA, storage of patient information, resource availability and knowledge to conduct 

telemedicine consultation and whether telemedicine is an engaging platform for doctors) was 

appropriate for this study population.   

 

Furthermore, the research used a quantitative method of research in order to measure the 

objectives of this study numerically. The intended study population used was from Johannesburg 

that represents the population. This region was used for the researcher’s proximity and familiarity 

of location.  

 



 18 

1.5 Limitations 

The following section identifies the limitations experienced during data collection for this research 

study. 

 

Due to the second wave of the Covid-19 pandemic, between December 2020 and January 2021, 

the acquisition of the targeted number (120) was a challenge to achieve because doctors especially 

those that focus on primary healthcare under immense pressure. Furthermore, respondents based 

their answers in the context of Covid-19 whilst the HPCSA was forced to ease guidelines on the 

use of telemedicine.  

 

Also, the aim of the present study was to collect data from a sample based in Johannesburg, 

however, due to the above-mentioned challenge, the sample was stretched to family physicians 

practicing in other metropolitan areas in of South Africa. 

 

When the study population was approached to participate in the research, it was assumed that they 

were potential users of telemedicine and could be considered a volunteer sample. 

 

1.6 Preface to the research report 

To this end, the report has six chapters. Following Chapter 1 on introduction, Chapter 2 provides 

a literature review covering the underlying issues of telemedicine using past studies, the four 

attributes the study focused on and the UTAUT framework. Chapter 3 discusses the research 

strategy, design, procedures used in this study as well as the, validity measures and research 

limitations. A quantitative, cross-sectional research strategy was used to collect data from 80 

medical doctors who specialize as a family practice physician in Johannesburg.  

 

Chapter 4 provides a presentation of the findings and Chapter 5 is an interpretation of the findings. 

Chapter 6 concludes the study with limitations of the present research study and recommendations 

for future research.  



 19 

2 LITERATURE REVIEW 
 

In the following chapter, four themes namely research problem analysis, research knowledge gap 

analysis, UTAUT model and key attributes that affect telemedicine implementation will be 

discussed. Chapter 2 forms the foundation used to develop a framework for interpreting the 

research findings.  

2.1 Research problem analysis  

The root cause of the deteriorating health care system in South Africa is primarily due to its history 

that can be traced back to the apartheid period between 1948 and 1993 (Maphumulo, 2019). 

During that period, there was a build-up of economic and social inequality as a result of racial 

segregation, resulting in a highly fragmented and poorly organized healthcare system (Maphumulo, 

2019).   

 

Post 1994, even though all citizens became eligible to access quality healthcare services, including 

private healthcare, a major part of the population is still restricted to access to basic healthcare 

needs and rely on the state hospitals for treatment.  

 

To date, state hospitals rely on government funding, such as tax revenues, to fund for required 

skills and equipment to treat patients (Delobelle, 2013). Every year, government would allocate a 

certain percentage of its budget to state healthcare facilities in the nine provinces. (Delobelle, 

2013). Even though the government contributes about 40% of all expenditure on health, the public 

health sector is under pressure to deliver services to about 80% of the population (Mvelase, 

Dlamini, & Dludla, 2015).  

 

On the other hand, the private healthcare sector offered world-class facilities for the smaller 

population who either had medical insurance or could afford care on an out-of-pocket basis. 

(Delobelle, 2013). Here, the facilities were independent and did not rely on government for 

funding (Delobelle, 2013).  

 

Post-apartheid, socio-economic inequality still remains a concern in South Africa and the 

requirement to build a healthcare system for all is far from complete (Delobelle, 2013). Currently, 

there are several factors causing the unequitable provision of healthcare in the public sector 

(Delobelle, 2013). These include the public sector being under-resourced and overused and the 

highly uneven skills distribution due to the migration of healthcare workers from public sector to 



 20 

private sector, loss of staff due to illness, absenteeism, low staff morale, and an increased patient 

load (Delobelle, 2013).  

 

Delobelle (2013) stated in their study that the primary factors, of under-resourced and overused, 

faced by the public healthcare sector results in additional challenges. These include longer than 

average waiting period which may increase the health risk of patients, accommodate a certain 

number of patients for treatment while others in need of medical treatment are either put on a 

waiting list or turned away and poor hygiene (Delobelle, 2013). Being under-resourced, it further 

cannot cope with the increased burden of non-communicable & communicable diseases and 

injuries caused by violence, road traffic and other accidents (Delobelle, 2013).  

 

2.1.1 Introducing telemedicine  

A potential solution to improve the public healthcare system that is overwhelmed is through 

telemedicine (Chifamba, 2018). In the HPCSA General Ethical Guidelines for Good Practice in 

Telemedicine (Booklet 10, page 6), Telemedicine is a digital platform used to provide virtual 

medical consultation between a healthcare practitioner in one location and patient in a difference 

location through various modes namely video conference, email, and instant messaging, and SMS 

(Human Rights, 2014). 

 

The HPCSA General Ethical Guidelines for Good Practice in Telemedicine (Booklet 10, page 6) 

further notes that the practice of telemedicine should involve secure videoconferencing or similar 

forms of technology to “replicate the interaction of traditional face-to-face consultations between 

healthcare practitioners and the patient. Telemedicine as defined refers to where information is 

exchanged electronically either on or off-line, formally, informally or as a need for a second 

opinion  (Human Rights, 2014).” 

 

There are two primary methods that can be used namely synchronous and asynchronous, provided 

the patient has access to an electronic device (Chifamba, 2018). Both methods can be used in 

numerous settings such as doctor rooms, clinics and hospitals (Chifamba, 2018).  Synchronous is 

when the consultation between the patient and doctor happens in real time while asynchronous is 

when the exchange of information happens at no given time (Chifamba, 2018). 

 



 21 

Consultation through telemedicine involves the participation of various stakeholders in order for 

it to be effective and successful. These stakeholders include healthcare workers, information and 

communication technologists, economists, managers and policy makers (van Dyk, 2014).  

 

2.1.2 Challenges to implement telemedicine in South Africa 

Majority of the South African population depend on public healthcare facilities which is currently 

understaffed, with inadequate resources, especially in rural areas (Delobelle, 2013). Studies have 

indicated that digital health mediums such as telemedicine can act as a tool to provide improved 

access to health care to those in need (Adeyelure & Kalema, 2019). However, the implementation 

of telemedicine has its own unique challenges (Cilliers & Flowerday, 2013).  

 

Telemedicine is a listed health solution strategy in the e-health plan (National Digital Health 

Strategy for South Africa 2019 - 2024, 2019) executed by the Department of Health of South 

Africa, and is seen as a cost effective and efficient means of delivering health care needs to 

communities that are under-resourced. The e-health plan constitutes other sectors such as health 

informatics (Cilliers & Flowerday, 2013).  

 

Prior to Covid-19 pandemic, the use of telemedicine in South Africa was low due to regulations 

imposed by the HPCSA. Regulators consider this innovative digital health solution as unproven 

and risky, thus the need for set regulation in order to protect both participating parties namely 

patients and doctors and to establish mutual trust (Jack & Mars, 2013).  

 

A regulation posed by the HPCSA General Ethical Guidelines for Good Practice in Telemedicine 

(Booklet 10, Page 5) is that “all Telemedicine services should involve a healthcare provider where 

there is an actual face-to-face consultation and physical examination of the patient in a clinical 

setting. The consulting practitioner will communicate the information to the servicing practitioner, 

who will then provide the necessary assistance” (Human Rights, 2014). Jack and Mars (2013) 

reported that this would be an impediment to telemedicine because it is unlikely that patients from 

underserved areas or rural areas will have had a prior doctor-patient relationship with the distant 

doctor being consulted. 

 

Section 2.1.2.1 to 2.1.2.4 will further discuss the key contributors of accessibility and usefulness of 

telemedicine.  

 



 22 

2.1.2.1 Written informed consent 

An imposing factor to Telemedicine is the requirement of a written informed consent. The HPCSA 

General Ethical Guidelines for Good Practice in Telemedicine (Booklet 10 page 12) states that 

“informed consent for the use of telemedicine technologies must be obtained in writing” (Human 

Rights, 2014).  

 

However, this regulation was relaxed during the pandemic to “formal (preferably written) consent 

for among other things, specific services, including diagnosis and prescriptions and Information 

Communication Technology equipment to be used must always be secured from the patient” 

(Guidelines on telemedicine in South Africa, 2020).  

 

The HPCSA General Ethical Guidelines for Good Practice in Telemedicine (Booklet 10, page 16) 

further states that in an emergency situation “The practitioner must provide the patient with 

emergency instructions when the care provided by telemedicine indicates that a referral to an acute 

care or emergency facility is necessary for the immediate treatment of the patient. Furthermore, 

the emergency instructions should be in writing and appropriate to the services being rendered via 

telemedicine” (Human Rights, 2014). 

 

Notably, the requirement of written consent and especially obtaining the signature of patient, the 

patient’s parent, the patient’s guardian or the patient’s caregiver and signature of the witness will 

make the implementation of telemedicine more difficult because of inaccessibility and cost to meet 

this requirement.  

 

2.1.2.2 Engaging platform 

The HPCSA General Ethical Guidelines for Good Practice in Telemedicine (Booklet 10, page 17) 

states that during a patient & practitioner consultation, “the quality and quantity of patient 

information received should be sufficient and relevant for the patient’s clinical condition in order 

to ensure that accurate medical decisions and recommendations are made for the benefit of the 

patient” (Human Rights, 2014).  

 

Tates et al (2017) identified that the three main pillars of communication namely information 

exchange, interpersonal relationship building, and shared decision making is more successful and 

of better quality during offline consultations. 

 



 23 

Thus, the quality of virtual consultation verses face-to-face consultation poses a challenge to the 

implementation of telemedicine (Nordal, D, Kvammen, & Løchen, 2001). However, Cilliers and 

Flowerday (2013) research study presented a different view for the reason that the quality of a 

physical consultation is similar to a virtual consultation. Although Jack and Mars (2013) found that 

there are underlying factors that restrain the efficiency of telemedicine, which include poor internet 

connection that contribute to the low use of telemedicine. Thus, this study considered that further 

evaluation of effectiveness of telemedicine is needed. 

 

2.1.2.3 Availability of resources and knowledge to implement telemedicine  

Petersen el al (2019) addressed that lack of awareness about the kinds of technology available, skills 

needed to apply the technology and its significance are other barriers to telemedicine remaining 

unsuccessful. Cilliers and Flowerday (2013) indicated in their study that only 54.4% of respondents 

thought they did have the resources necessary to make use of telemedicine.  

 

Prinsloo (2017), research depicted that fifty-six percent of study population agreed that they did 

have the knowledge needed to operate the system. Similarly, Cilliers and Flowerday (2011) study 

on whether computer literacy affect telemedicine acceptance among healthcare workers, pointed 

that less than fifty percent of the participants considered themselves confident about their 

knowledge of telemedicine.  

 

However, is there an opportunity to continue with telemedicine in South Africa and will it be the 

go-to platform in future. Will digital health be able to fix the challenges the healthcare system faces 

by narrowing the inequality gap through improving access to quality, accessibility and efficiency of 

healthcare in South Africa.  

 

Public healthcare facilities will become far less under pressured and patients will benefit with 

accessing a wide range of specialists (Jack & Mars, 2013). There is hope that telemedicine will grant 

access to healthcare that is more affordable (Chifamba, 2018). Most importantly, patients don’t 

need to travel long distances for treatment (Jack & Mars, 2013). 

 

2.1.2.4 Patient information 

Maphumulo and Bhengu (2019) points out that poor record keeping can lead to other problems 

such as unnecessary delays for patients. The research further points that using the traditional 

method of storing patient information, patients’ folders can be misplaced. Nevertheless, healthcare 



 24 

workers are then forced to look for these files, causing patients to wait extra longer. In worst 

scenarios, the medical history of the patient is lost, which can create further complications leading 

to incorrect diagnosis and in some cases death of the patient (Maphumulo & Bhengu, 2019).  

 

In 2019, the Department of Health of South Africa published a white paper, titled  National Digital 

Health Strategy for South Africa2019 – 2024 (page 11), which aims to develop a platform to store 

patient information electronically that will become easily accessible to stakeholders (such as 

medical doctors) in the healthcare industry and in preparation for the National Healthcare 

Insurance (NHI) (National Digital Health Strategy for South Africa 2019 - 2024, 2019).  

 

Yet, the HPCSA is concerned about security of patient information and states that “healthcare 

practitioners using telemedicine should provide safe procedures to avoid any alteration or 

elimination of patient data; and patient information should only be transmitted from one site to 

the other and stored, with the full knowledge and approval of the patient, in line with the informed 

consent guidelines” (Human Rights, 2014).  

 

2.2 Research knowledge gap analysis  

Section 2.2 discusses the following attributes – namely telemedicine as an engaging platform, 

seeking written informed consent for clinical procedures and using ICT, availability and knowledge 

of resources to conduct virtual consultation, and method used to store patient information – and 

why it contributes towards the accessibility, usefulness and low uptake of telemedicine and an 

individual’s readiness to opt for telemedicine, taking into consideration the following studies by 

Prinsloo (2017) and Adeyelure and Kalema (2019).  

 

Adeyelure and Kalema (2019) examined factors that influenced a user’s readiness to accept 

telemedicine in the context of the South African public healthcare sector. Using a quantitative 

research strategy, Adeyelure and Kalema (2019) examined environmental and socio-economic 

factors that influence the use of telemedicine namely organization and environment, technology 

compatibility, perceived usefulness and perceived ease of use.  

 

The findings reveal that organization, environment, technology, perceived usefulness and 

perceived ease of use are factors that influence the implementation of telemedicine in South Africa. 

The study also revealed that external factors such as government regulations and tariffs will have 

an influence on user readiness to accept telemedicine (Adeyelure & Kalema, 2019).  



 25 

Prinsloo (2017) also did a study on the factors affecting healthcare workers’ acceptance and use of 

telemedicine in hospitals in Kwa-Zulu Natal. Here the factors explored were technology 

acceptance; the influence of socio-demographic factors (age, experience, profession, qualification) 

and acceptance factors on use and behavioural intention to use telemedicine. There were high 

levels of agreement amongst respondents regarding the value of telemedicine (performance 

expectancy, and ease of use (effort expectancy), but less so for the role of social influence on use 

and the presence of facilitating conditions (such as support and assistance).  

 

Examples of factors are trust, demographic features (age and race), personal factors (personal 

experience), and workplace factors (computer skills, perceived enjoyment, management support). 

 

2.2.1 Performance expectancy: Engaging platform 

Satisfaction is defined when an individual’s expectations are met and can be achieved through 

quality, trust and empathy. In telemedicine, satisfaction occurs when there is effective 

communication between the medical professional and patient and accessibility to the resources 

needed to implement a virtual consultation and self-care efficacy. This factor links to UTAUT’s 

performance expectancy because the telemedicine user is confident that the system will enable 

them to meet their expectations. 

 

There have been numerous debates (Nordal, D, Kvammen, & Løchen, 2001) around the 

satisfaction received when using an online platform. Some of the elements include discomfort, 

embarrassment, nervousness and difficulty in hearing the doctor. Nevertheless, previous studies 

have reported that there may be a quality difference between a face-to-face consultation and 

telemedicine (Nordal, D, Kvammen, & Løchen, 2001).  

 

Nordal, et al (2001) evaluated teledermatology in a comparative study of video conferences versus 

face-to-face consultations and found that there was no significant difference on patients’ 

satisfaction between teleconsultation and of face-to-face consultation. The only exception was for 

patients’ feelings of contact with the dermatologist. 

 

While Mirzaei and Kashian (2020) did a study to determine if there were any differences in patients' 

perceptions of communication effectiveness with their physicians through different modes of 

communication. Here, it was noted that there was no significant difference in satisfaction 



 26 

perceived, information exchange or interpersonal relationship building between face-to-face or 

digital consultation.  

 

Additionally, Tates K, Antheunis ML and et al (2017) study on the “Effect of Screen-to-Screen 

Versus Face-to-Face Consultation on Doctor-Patient Communication” revealed that there was no 

significant difference between face-to-face and virtual consultation in terms of information 

exchange, interpersonal relationship building, and shared decision making. The research design 

used in their study was  experimental, quantitative and the setting was in Netherlands (Tates, 

Antheunis, Kanters, Nieboer, & Gerritse, 2017). The hypothesis was tested using Preacher and 

Hayes' procedure (Tates, Antheunis, Kanters, Nieboer, & Gerritse, 2017) and a regression method 

was used to determine the association between medium of consultation and perceived information 

exchange, perceived interpersonal relationship building, and perceived shared decision making 

(Tates, Antheunis, Kanters, Nieboer, & Gerritse, 2017).  

 

Taking into consideration the previous studies, this study examined the following factors that 

contribute to performance expectancy namely satisfaction and confidence, especially in the context 

of Covid-19. This study also measured the level of communication and information exchange 

where participants were asked if explanation concerning the disease and treatment was better in 

telemedicine.  

 

2.2.2 Social influence: Written informed consent  

An informed consent is providing permission or access to personal information in order to make 

an informed decision (Townsend, Scott, & Mars, 2019) through methods such as verbal or written.  

 

Townsend, Scott, & Mars (2019) explains that an informed consent encompasses detailed 

information about the treatment process and potential risks and benefits provided by the doctor 

to the patient in a language that they understand. The study also explains the importance of an 

explanation of how the virtual consultation will occur such as the role and responsibility of the 

provider and the patient during the telemedicine interaction. 

 

Prior to Covid-19 pandemic, the HPCSA’s regulation on telemedicine was that written informed 

consent for all aspects of telemedicine is important because it implies that when an individual seeks 

help from a medical professional knowing that there might be some degree of risk/harm involved, 

they are not able to bring a claim against the consulting party (Jack & M, 2013).  



 27 

 

The regulation links to the UTAUT social influence construct because rules and regulations can 

inhibit one from pursuing telemedicine. 

 

In South Africa, there is debate (Jack & Mars, 2013) on whether informed consent for all forms 

of telemedicine is needed and whether it has to be in writing. According to Jack and Mars (2013) 

the riskier the medical intervention, the greater the requirement for written informed consent in a 

traditional consultation. While the World Medical Association (WMA’s) guidelines on the Use of 

Telemedicine for the Provision of Health Care indicates that that the requirement for written 

consent is not compulsory, but medical professionals are required to follow relevant protocols for 

verbal, written or recorded consent and, where appropriate (Jack & Mars, 2013).  

 

Using a quantitative, descriptive, cross-sectional survey, Jack and Mars (2013) measured how often 

doctors (general practitioners and all specialists) and nurses sought informed consent to take 

patient history; examine patient; order special investigation; refer patient; email patient 

information, and whether the consent was written or verbal. The overall findings saw that written 

consent is not regularly obtained from patients during a clinical examination or when using a digital 

platform. 

 

Taking into consideration the Covid-19 pandemic resulting in surge of telemedicine consultations 

and relaxation of HPCSA regulation on informed consent, this research measured how often 

family physicians sought written and verbal informed consent for the following procedures: patient 

history, examine a patient, email patient information, refer patient, prescription, and virtual 

consultation. 

 

2.2.3 Facilitating condition: Availability & knowledge of resources to 
conduct telemedicine  

Venkatesh et al (2003) stated that facilitating conditions play an important role in the acceptance 

of telemedicine and included the following elements: technical assistance, knowledge of the system 

and compatibility with other systems already in use.  

 

Cilliers and Flowerday (2013) study on the factors that influence the user acceptance of 

telemedicine found that there was no significant difference for qualification and knowledge of 

telemedicine. Findings in their research study reported that forty percentage of the study 



 28 

population found that telemedicine is not suitable for the systems in place at their workplace; and 

fifty percent of the study population assumed that they had the required resources in place to make 

use of telemedicine (Cilliers & Flowerday, Health information systems to improve health care: A 

telemedicine case study, 2013).  

 

Research by Cilliers and Flowerday (2013) did not make specification on the availability of 

resources. Whilst in this research, availability of resources namely electronic devices, ease of use 

and learning to operate the telemedicine system was measured to stipulate their preference of 

telemedicine. 

 

2.2.4 Effort expectancy: Storing patient information  

Jack and Mars (2013) indicated that even though electronic record keeping can have a security 

concern, information on 'who, what, when, and why' is easier to access within a national eHealth 

ecosystem, less time consuming and treatment can be provided soonest. Storing patient health 

information manually will make the sharing of this data challenging between medical professionals 

and between hospitals (Coleman, 2013). In the context of telemedicine, availability of patient 

information will improve the quality and continuity of care of patients.  

 

The 4IR has improved ways to store and safeguard information. Personal data navigates within 

the health ecosystem leading to extensive sharing and transference and a possible threat to the 

misuse of such data (Townsend, R E Scott, & Mars, The development of ethical guidelines for 

telemedicine in South Africa). While, Jack and Mars (2013) pointed that emails and other patient 

information that is confidential can be encrypted and password protected. 

 

In the South African context, record keeping/data protection requires more consideration as the 

current frameworks is insufficient to determine the reliance of data protection electronically 

(Townsend, Scott, & Mars, 2019). Townsend, Scott, and Mars (2019) suggest that the guidelines 

by the HPCSA called ‘Confidentiality: Protecting and providing information’, and ‘General ethical 

guidelines for good practice in telemedicine’ need to be more aligned with the provisions stipulated 

in South African legislative law, particularly with regard to data collection, security, storage and 

transfer, within the national eHealth ecosystem. 

 

Since limited research is available on how patient information is stored, this study, measured the 

procedure used to store patient information and its link to National Digital Health Strategy for 



 29 

South Africa.  If patient information was stored electronically, how patient information is 

protected was also studied to identify its alignment with the HPCSA regulation.  

 

In conclusion and from the studies discussed in this section, this research study examined a 

combination of previously researched and new components in the following categories that 

maximises the value of telemedicine, especially in the context of the Covid-19 pandemic: quality 

of information exchange; access and knowledge to the required resources for the consultation to 

be effective; regulations imposed by HPCSA such as the requirements of written informed consent 

and method used to store patient information.  

 

2.3 Unified Theory of Acceptance and Use of Technology 
(UTAUT) 

Adeyelure and Kalem (2019) stated that ICT can become a vital solution to alleviate some of the 

challenges faced in public health sectors in South Africa. However, the benefits of this technology 

can only be seen if healthcare workers have access to the necessary resources, are knowledgeable 

about navigating required platforms and if they find it useful (Cilliers & Flowerday, 2013). 

 

There are various psychological factors, such as understanding and trust, that make the acceptance 

of technology challenging. Venkatesh et al (2003), deployed eight theories/models of technology 

to develop the Unified Theory of Acceptance and Use of Technology (UTAUT). The theories 

used to study the behavioural intention to use a technology included: Theory of Reasoned Action 

(TRA), the Technology Acceptance Model (TAM), the Motivational Model (MM), the Theory of 

Planned Behaviour (TPB), a combined Theory of Planned Behaviour/Technology Acceptance 

Model (C-TPBTAM), the Model of PC Utilization (MPCU), Innovation Diffusion Theory (IDT), 

and Social Cognitive Theory (SCT) (Venkatesh, Thong, & Xin, 2012). 

 

The model consists of four constructs namely performance expectancy, effort expectancy, social 

influence, and facilitating conditions as well as key moderators including gender, age, voluntariness 

and experience (Figure 2). 

 

This study used the definitions of the four constructs to develop the questions in section 1.2.3. 

 



 30 

 

Figure 2: UTAUT model (Prinsloo, 2017) 

 

Performance expectancy is defined as the extent to which an employee enjoys certain benefits 

when using technology for an activity (Venkatesh, Thong, & Xin, 2012). Cohen, Bancilhon, and 

Jones (2013) explain that performance expectancy is achieved when an individual perceives that a 

technology works to their advantage, as well as improve productivity and effectiveness.  

 

Effort expectancy is the degree of ease associated with consumers’ use of technology (Venkatesh, 

Thong, & Xin, 2012). In other words, it is about how user friendly a certain technology is and 

whether it needs a lot of effort to be operational (Cohen, Bancilhon, & Jones, 2013). Petersen et 

al (2019) observed that if using a technology device is slow and cumbersome, this will likely 

influence an individual to use it less frequently. Additional studies denote that effort expectancy 

to be the most important factor influencing health professional satisfaction with an electronic 

health system (Cohen, Bancilhon, & Jones, 2013).  

 

Social influence is defined by the individuals’ decision to use digital health based on the perception 

of peers on the usefulness of this technology (Venkatesh, Thong, & Xin, 2012).  

 



 31 

Facilitating conditions encompass the environmental factors, resources and support available to 

make it easier to perform a task (Venkatesh, Thong, & Xin, 2012). These include financial and 

technical resources, support and training.  

 

Based on the UTAUT model, Venkatesh, Thong, & Xin (2012) research identified that factors that 

influence behavioural intention to use technology are performance expectancy, effort expectancy, 

and social influence. Facilitating condition is a factor that influences the determination to use a 

technology (Venkatesh, Thong, & Xin, 2012).  

 

Since the inception of the model, UTAUT serves as a baseline model in technology adoption and 

has been tested widely including the health sector, both organisational and non-organisational 

settings (Venkatesh, Thong, & Xin, 2012). The theory was found to explain 70% of the variance 

in behavioural intention to use a technology and about 50% of the variance in technology use 

(Cilliers & Flowerday, 2013). The benefit of this model is that it provides for managerial decisions 

and to determine the effectiveness and value of a technology product is to be implemented.  

 

Hennington and Janz (2007) were the first researchers to study the UTAUT model in the 

acceptance of technology in the health sector. While  (Chang, Hwang, Hung, & Li, 2007) recently 

suggested that UTAUT is a useful framework to use in research related to electronic health 

adoption; other studies have shown that the UTAUT model can be modified to gain maximum 

usefulness across different countries. Elsewhere, the UTAUT framework was used to examine 

physicians’ acceptance of a pharmacokinetics-based clinical decision support system in Taiwan and 

acceptance of telemedicine in South Africa’s public healthcare system (Cohen, Bancilhon, & Jones, 

2013). 

 

Some of the limitations of UTAUT Petersen et al (2019) include community, culture, country, 

organisation, agency, department, person, use of students to explore workplace issues, no use of 

moderating variables, and lack of exogenous factors. It does not include external factors that can 

affect the performance of the behaviour. It also does not take into consideration factors such as 

contexts and situations that may impact usage (Petersen et al, 2019).  

 



 32 

2.4 Summary and conclusion 

2.4.1 Summary of literature reviewed 

This chapter explored telemedicine and factors that reduce the use of this technology. 

Telemedicine is a form of information and communication technology used to provide healthcare 

service virtually and is likely to fix the challenges the healthcare system faces by narrowing the 

inequality gap through improving access to quality, accessibility and efficiency of healthcare. 

 

However, in South Africa economic factors (the digital divide between the rich and poor), 

educational factors (such as lack of technology literacy) and sociocultural factors (such as lack of 

support from family and peers) hinder the accessibility and usefulness of telemedicine (Petersen et 

al, 2019). 

 

Hence, the purpose of this study was to use a quantitative, cross-sectional research strategy to 

evaluate the following factors: written informed consent (social influence), record keeping (effort 

expectancy), if telemedicine is engaging (performance expectancy) and availability & quality of 

resources to conduct telemedicine (facilitating condition). 

 
 



 33 

3 RESEARCH STRATEGY, DESIGN, PROCEDURE AND 
METHODS 

 
This chapter looks into the research strategy, the research design as well as the procedure and 

methods undertaken in this study based on the four questions (section 1.2.3) that this research 

report examined - that is, is telemedicine an engaging platform; method used to seek informed 

consent to perform a clinical examination or when using ICT; availability and knowledge of 

resources to implement telemedicine successfully; and the method is used to store patient 

information. 

 

3.1 Research strategy 

A research strategy (Research methodology: Research Starters Topic, 2018) is the method 

undertaken in order to pursue information to meet the objectives of this study. The strategy builds 

a foundation by developing a consensus on what problems need to be investigated, how will the 

investigation take place and how will the findings help resolve a current societal issue (Research 

methodology: Research Starters Topic, 2018). It constitutes of three elements namely qualitative, 

quantitative, and mixed (Goertzen, 2017).   

 

In order to measure the objectives of this study, a quantitative research strategy was implemented. 

The purpose of using this research strategy, was to study human behaviour by collecting numerical 

data from the sample representing a population. It involved obtaining numerical data across a 

certain time (i.e. Covid-19 pandemic) and profession (for the purpose of this study) through 

statistical inference procedures. Also, questions used in the survey were direct and quantifiable – 

such as percentage, what proportion, what extent and how much – so that the data could be 

analysed using statistical models and to gain an understanding about needs of the targeted sample. 

(Goertzen, 2017).  In order to test for reliability, a sample size of 50 or more was needed.  

 

Cilliers and Flowerday (2013) used a positivistic, quantitative research methodology to investigate 

if user acceptance is a factor for the poor uptake of telemedicine in the Eastern Cape using the 

four major constructs of the UTAUT model as a baseline. The study comprised of hypothesis per 

construct and required statistical models to prove the hypothesis.  

 

Hence, for this study, the UTAUT constructs was used as a foundation to establish the factors 

that influence the ease of accessing and use of telemedicine leading to the research questions.  



 34 

3.2 Research design 

A research design is a framework used to collect and analyse data (Goertzen, 2017). The motive 

of the research design is to find evidence for each research question and for a certain set of criteria 

namely validity, replication, trustworthiness and authenticity. There is more than one type of 

research design namely: cross-sectional; longitudinal; quasi-experimental; case study; comparative 

design.  

 

More specifically, a cross-sectional design involves the collection of data at one specific time with 

one specific sample. It can be used in both qualitative and quantitative research. It is like a status 

report or even a ‘snapshot’ of reality in a very focused and specified manner (Merriam & Tisdell, 

2016).  

 

Thus, for this study, the cross-sectional design was leveraged to understand the prevalence of a 

behaviour in the usage of telemedicine by family physicians during Covid-19 pandemic (single 

point in time). This research design was highly useful in collecting data in connection with two or 

more variables. Additionally, the design was used to identify the association of the causes of low 

use of telemedicine and outcome of interest. 

 

Adeyelure and Kalema (2019) research study on examining factors that influence the use of 

telemedicine used a cross-sectional research design to study the association between dependent 

and independent variables quantitatively. The motive for the design was to also gather data from 

participants at one specific point in time (Tope Samuel Adeyelure & Kalema, 2019).   

 

3.3 Research procedure and methods 

This section documents the actual procedure and methods employed in this research to collect, 

collate, process, and analyse empirical evidence.  

3.3.1 Research data and information collection instrument(s) 

Research data collection instrument are tools used to collect data from a specified sample to ensure 

the seamless translation from raw data captured to interpretation (Merriam & Tisdell, 2016).  

 

Types of data collection methods include primary data where information is collected by the 

researcher from scratch and secondary data is using information collected by others such as 

government publications, websites, ethno-statistics and journal articles. (Merriam & Tisdell, 2016). 



 35 

For this study, a primary data collection method was used so that the findings are most current, 

taking into consideration preface of Covid-19.  

 

According to Merriam and Tisdell (2016), in a primary data collection method, there are various 

tools used to collect information. Common tools (Merriam & Tisdell, 2016) include 

questionnaires/surveys (mailed, online, group/collective, individual, panel); interviews (structured, 

semi-structured, unstructured); observations (participant, non-participant); experiments 

(experimental, semi-/quasi-experimental).  

 

Since this research focused on a quantitative research strategy, the type of instrument structure 

used was an online questionnaire encompassing close ended questions. The aim of this instrument 

structure was to minimize differences in responses and to keep it as standard as possible so that 

true variation is achieved. 

 

This research study was associated with the structure of the data collection instrument 

implemented by Prinsloo (2017) due to its relevance and to generalise findings of the specified 

sample. Prinsloo (2017) research on factors affecting healthcare workers’ acceptance and use of 

telehealth in hospitals in KwaZulu-Natal (KZN), used a structured and close ended questionnaire 

so that the responses can be analysed using relevant statistical models such as t-tests and regression 

models. The research by Prinsloo (2017) further used a questionnaire that covered demographic 

variables (gender, age), behavioural intention, performance expectancy, effort expectancy, social 

influence, and facilitating conditions. Different formats of questions and responses were included 

in the questionnaire such as yes/no, and degree of agreement or disagreement in Likert scale 

questions which will be used as a guide for the current research study. 

 

Additionally, questions for this study were sourced from previous research studies that investigated 

the questions stated in Section 1.2.3 to understand the factors affecting low use of telemedicine. 

The questionnaire was introduced with questions on demographics such as geographic area, gender 

and age. This was followed by questions based on the four overarching research propositions in 

section 1.2.3. Each research question comprised sub-questions for the purposes of obtaining more 

data and statistical models relevant to this research study.   

 

While collecting data, each question had a multi-item scale allocated for statistical analysis 

purposes. Various measurement tools were used to assist with interpreting the data. This included 



 36 

categorial data to interpret gender, geographic area of practice, work place description, 

telemedicine modalities, profession and how informed consent is taken; ordinal data to interpret 

age; Likert scale to interpret if telemedicine is engaging, factors that cause low use of telemedicine 

and how patient information is stored.  

 

3.3.2 Research target population and selection of respondents 

3.3.2.1 Research target population 

When conducting the research, it is important to decide which section of the population is suitable 

to represent the research proposition and add value to the study.  

 

For this study purposes, a population of South African medical doctors was used. Furthermore, 

the population included medical doctors practicing in state, private or both facilities; male or 

female; and all age groups.  

 

The categories were taken into consideration in order to determine if telemedicine usage is 

common in males or females, which age category finds it most useful and to ensure that the 

participants were based in the region and profession as per the objective of this study. Factors 

such as income level served least importance.  

 

The initial sampling strategy was to focus on the Johannesburg region, however, due to a low 

response rate, the survey was expanded to the rest of South Africa.  

 

3.3.2.2 Sampling or selecting respondents from the target population 

Sample is usually drawn from a population and data gathered from the sample will lead to 

assumptions about the population (Bryman & Bell, 2014). A sample of medical doctors specialising 

as Family Physicians was used in this study. Family Physicians focus on primary healthcare by 

diagnosing and treating acute or chronic illnesses, hence its relevance to the study.  

 

According to Bryman and Bell (2014), there are a number of methods used to formulate a sample 

such as bias, sampling error, probability sample (simple random sample, systematic sample, 

stratified random sampling, multi-stage cluster sampling), non-probability sampling (convenience 

sampling, snowball sampling, quota sampling). 

 



 37 

In a research conducted by Prinsloo (2017) the sampling method used was convenience sampling 

where the researcher conducted face to face briefing sessions with staff at seven hospitals in Kwa-

Zulu Natal and obtained email addresses. Thereafter, the researcher approached participants 

individually via email. Each email contained an information sheet explaining the purpose of the 

study, an invitation to participate and informing the recipient that participation is voluntary and 

anonymous.  Through this method, a large number of people took part in the research.  

 

For this study, a non-probability convenience sampling was used so that the accuracy of data 

obtained is high. Initially, face-to-face briefing sessions with family physician was going to be 

conducted. However, due to Covid-19 pandemic and restrictions imposed at healthcare facilities, 

online communication was instrumented.  Hence, doctors’ (that specialised as family physicians) 

names and email address were sourced from the websites of hospital groups namely Netcare, Life 

Healthcare and Mediclinic.  

 

Thereafter, an email containing the research information, link to the online survey and ethics 

certificate was sent to each medical doctor, inviting them to participate in the research and 

informing them that participation is voluntary and that all information shared remained 

confidential by encrypting documents with a password. Contact details was also included in the 

email. Here, 50 Family Physicians based in Johannesburg was approached.  

 

Additionally, an organisation that collects and maintains the contact information of South African 

healthcare providers and complies with the Protection of Personal Information Act (POPIA), was 

approached to assist with accessing the contact information of Family Physicians, in both public 

and private practices. However, due to privacy concerns, the organisation preferred to share the 

invitation to 580 Family Physicians practicing in various parts of South Africa to participate in the 

research via email using their resources.  

 

Amidst the Covid-19 and medical doctors working longer than normal shifts, a challenge 

experienced during data collection was doctors’ unavailability to answer the survey shared, hence 

low response received. To try and alleviate the problem and improve the response rate, telephone 

conversations with medical doctors was conducted.  

 



 38 

3.3.3 Ethical considerations when collecting research data 

The role of ethics is to ensure sustainability and transparency of a study. Ethics or morals is a 

standard of conduct. When conducting research, participants are likely to share their personal 

information and experiences and would prefer that the researcher keeps all information shared 

confidential and not be shared externally by the data collector (Merriam & Tisdell, 2016).  

 

A researcher should seek consent from respondents prior to collecting data. Consent is defined as 

giving permission for something to happen. For research purposes, consent is willingness to 

participate in the interview/survey/focus group and should include the following characteristics 

for building trust: honesty, openness, carefulness, accountability and fairness (Merriam & Tisdell, 

2016). 

 

In this study, an email (appendix 2) containing the following information was sent to each Family 

Physician - the title and aim of the research undertaken; link to the online survey should the medical 

doctor be interested to participate with a claim that no personal costs is associated by participating; 

option to withdraw at any time; noting that information shared will remain confidential; all 

information that is obtained will be stored and protected; a summary of the research will be sent 

upon request; and contact details of the researcher, supervisor and University Human Research 

Ethics Committee.  

 

Prior to data collection, approval from School of Graduate School of Business Administration 

Ethics Committee was obtained. For authenticity, a signed ethics certificate (appendix 3) was 

shared with medical doctors who wished to participate.  

 

3.3.4 Research data and information collection process 

When collecting data, various elements should be taken into consideration to gain as much 

information as possible. These include: what data sources are most valued; what data collection 

methods is highly effective; what data collection methods will provide valid and reliable results; 

and any parameters that need to be considered (Merriam & Tisdell, 2016).  

 

Family Physicians who agreed to participate had to simply click on a link supplied on the email 

which took them to the survey. The survey was built on a user-friendly online platform called 

Survey Monkey. Each survey took an average of 5 minutes to complete.  

 



 39 

Data collected from participants was then automatically stored in an Excel spreadsheet which 

could easily be downloaded from Survey Monkey.  

 

In order to meet the objectives of the study and present a quality quantitative research, data 

captured on the Excel spreadsheet was then cleaned whereby respondents who did not specialise 

as family physicians was deleted and those who did not complete the survey was deleted.  

 

3.3.5 Research data and information processing and analysis 

3.3.5.1 Research data and information processing 

Research data processing is the steps used to filter information acquired to make it more 

meaningful and comprehensive. The benefits of data processing is that it becomes easy to handle 

large amounts of data and to reorder great quantities of information quickly. In quantitative 

research, data processing becomes much simpler and variability is reduced because interviewees 

are provided with answers to choose from (Merriam & Tisdell, 2016).  

 

For the current research, data was coded as per the code number on each completed questionnaire 

and imported to JMP software for analysis. Data was analysed by the researcher with the assistance 

of a statistician using both descriptive and analytic statistics. 

 

3.3.5.2 Research data and information analysis 

Data analysis is defined as interpreting data collected and how it relates to the study. It is about 

making meaning about the data collected by consolidating, reducing, and interpreting what people 

have said and what the researcher has seen and read. This is done using statistical models such as 

descriptive statistics, regressions analysis, cluster analysis, content analysis, Pearson’s correlation 

coefficient, t-test, statistical significance, univariate analysis and bivariate analysis (Merriam & 

Tisdell, 2016). 

 

The data collected from the study population was analysed using descriptive and analytic statistics.  

 

Descriptive statistics was used to summarise data collected from the sample for questions on 

demographics of the respondents, engaging platform, informed consent, resources and storage of 

patient information. Measures of central tendency (mean, median or mode) was used to understand 

common patterns in the use of telemedicine. While, measures of variability, was used to analyse 

how spread out the distribution of the data was.  



 40 

The types of analytic statistics used was: 

1. A Mosaic Plot to summarize the relationship between ease of use and gender (male & 

female) among several categorical variables 

2. A Oneway Analysis of engaging platform & age and engaging platform & gender was done 

to determine which age group (21-40; 41-60; 61+) and gender (male/female) agrees the 

most that telemedicine is an engaging platform  

3. A Pearson Correlation of family physicians & written informed consent and family 

physicians & verbal informed consent to determine its association 

 

3.4 Research strengthens—reliability measures applied 

Reliability 

Reliability is the degree to which findings are consistent when researchers repeat the process. An 

assessment cannot be valid unless it is reliable. Factors which stimulate reliability include stability, 

internal reliability and inter-observer consistency (Bryman, 2014).  

 

For this study, a Cronbach's alpha was used to measure internal reliability. The measurement was 

done using question 1 in appendix 1 on engaging platform as the Likert scale was consistent for 

all the sub-questions and the score was 0.83.  

 

The calculation of the alpha correlation coefficient varies between 0 (no correlation and therefore 

no internal consistency) and 1 (perfect correlation and therefore complete internal consistency). A 

result of 0.8 and above usually implies an acceptable level of internal reliability (Bryman, 2014).  

 

Validity 

Validity is an important research criterion that describes the integrity of research findings and 

consists of four main types namely, internal, external, measurement, and ecological (Bryman, 

2014). This section discusses three categories of validity for the current research study.  

 

Internal validity refers to whether the current research findings are aligned to the theoretical ideas 

proposed (Bryman, 2014). Bryman (2014) argued that internal validity tends to strengthen a 

qualitative research design strategy because of the consistency between concepts and observations 

through an experimental design. In the current research study, a survey as utilised, making internal 

reliability difficult to achieve because the research design strategy is quantitative and the outcome 

variable cannot be controlled by the researcher.  



 41 

External validity is if the research finding can be applied more broadly in external environments 

such as different location or population (Bryman, 2014). In the current research study, a non-

probability convenience sampling was used and respondents were family physicians. Thus, the 

results may not represent other medical specialities.  

 

Ecological validity is described when the research findings can be applied to natural setting such 

as people’s everyday lives (Bryman, 2014). Hence, the findings in the current research study will 

help determine the socio-economic conditions influencing daily life conditions and contribute 

towards future research studies and models to improve the usage of telemedicine in various 

geographical locations. 

 

3.5 Research weaknesses—technical and administrative 
limitations  

Limitations in a research is broad and certain environmental or social factors may hinder achieving 

the expected results. 

 

The targeted number of responses for this study was 120, but 80 responses was acquired. The 

acquisition of the targeted number was a challenge to achieve because between December 2020 

and January 2021, South Africa experienced the second wave of the Covid-19 pandemic, putting 

doctors especially those that focus on primary healthcare under immense pressure. Also, the aim 

of the present study was to collect data from a sample based in Johannesburg, however, due to the 

above mentioned challenge, the sample was stretched to family physicians practicing in other 

metropolitan areas in of South Africa.  

 

A difficulty in the research was extracting a sample that had some sort of telemedicine experience. 

When the study population was approached to participate in the research, it was assumed that they 

were potential users of telemedicine and could be considered a volunteer sample.  

 

The initial strategy for the research was to use the entire UTAUT model, including the set of 

questions developed for this specific model. However, the questionnaire and research propositions 

developed for this research study does not strongly correlate with the requirements of the UTAUT 

model and statistical analysis required. In a UTAUT model, all questions based on the four 

constructs has a consistent Likert scale of strongly agree, agree, disagree and strongly disagree. 

Hence the usage of some parts of the model was omitted in the present study.  



 42 

4 PRESENTATION OF RESEARCH RESULTS 
 
The purpose of this study was to determine if the following attributes namely engagement, written 

and verbal informed consent, method used to store patient information, and availability of 

resources - make access to telemedicine consultation less feasible. Five questions were drafted and 

researched to meet the objectives of the study. In this chapter, an analysis was done on the 

demographics of the sample approached and research questions portrayed as in section 1.2.3. 

 

In the study, a Cronbach's alpha was used to measure internal reliability and the score was 0.83. 

The measurement was done using question 1 on engaging platform as the Likert scale was 

consistent for all the sub-questions.  

 

The calculation of the alpha correlation coefficient varies between 0 (no correlation and therefore 

no internal consistency) and 1 (perfect correlation and therefore complete internal consistency). A 

result of 0.8 and above usually implies an acceptable level of internal reliability. 

 

4.1 Socio-Demographic Characteristics of Participants 

The study population included mixed genders with 65% males and 35% females (Table 1). The 

age group of participants was ranked into four groups and ranged from 21 – 61+ with majority 

been between 51+. In terms of practice of work, the study population practiced as family 

physicians in either a private facility, state facility or both.  

 
Table 1: Socio-demographic representation of the study population 

 

 N Percentage 

Gender 

Female 28 35% 

Male 51 65% 

Age 

21 – 30 4 5% 

31 – 40 10 13% 

41 – 50 18 22% 

51 – 60 30 38% 

61+ 18 22% 



 43 

Place of work 

Private 47 59% 

State 23 29% 

Both 8 10% 

Other 2 2% 

 

4.2 Telemedicine usage 

Study population reported that 35% used telemedicine daily, 29% weekly, 15% monthly and 21% 

never used it (Table 2 and Figure 3). For those that made use of telemedicine, 5% used it for 

diagnosis, 12% used it for treatment, 71% used it for both while 12% reported for other purposes 

with reasons being following up, consultation and scripts, referral letters and feedback (Table 2) 

 
Table 2: Telemedicine usage of the study population 
 

 N Percentage 

How often telemedicine is used 

Daily 28 35% 

Weekly 23 29% 

Monthly 12 15% 

Never 17 21% 

   

What purpose is telemedicine used 

Diagnosis 3 5% 

Treatment 8 12% 

Both 46 71% 

Other 8 12% 

 



 44 

 

Figure 3 How often telemedicine is used 

 

The study population also reported on the types of telemedicine modalities used from the options 

that were provided – SMS, telephonic conversation, video call, instant messaging and other with 

reasons being email. Even though participants could choose from more than one option, 

telephonic conversation was rated the highest telemedicine modality used by family physicians, 

followed by instant messaging (Figure 4).  

 
Figure 4: Modalities used by study population 
  

Daily Weekly Monthly Never

0

10

20

30

40

50

60

70

SMS Telephonic
conversation

Video call Instant
messaging

Other

Telemedicine modalities



 45 

More than 40% of the population study find telemedicine to be somewhat useful followed by 

30% who find it to be extremely useful (Figure 5). 

 

 
Figure 5: Usefulness of telemedicine as per the study population 

 
 

Nearly half (47.5%) of the participants are somewhat knowledgeable about telemedicine while 

37.5% indicated that they are knowledgeable, while only 7.5% very knowledgeable and 7.5% are 

not knowledgeable about telemedicine (Figure 6).  

 
Figure 6: Study population knowledge about telemedicine 

 

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Extremely
useless

Somewhat
useless

Slightly
useless

Slightly
useful

Somewhat
useful

Extremely
useful

Usefulness of telemedicine

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

45.00%

50.00%

Not knowledgeable Somewhat
knowledgeable

Knowledgeable Very knowledgeable

Knowledge of telemedicine



 46 

4.3 Telemedicine as an engaging platform 

Respondents were assigned scores (strongly disagree= 1; strongly agree= 4) and mean scores for 

the individual indicators and mean total scores as a whole was computed (Table 3). The mean total 

score was 10.7 out of 16 with individual means ranging from 2.56 to 2.85.  

 

Table 3: Telemedicine as an engaging platform 
 

 Min Max Mean Std Deviation 

1. Do you agree that telemedicine enables a 

doctor to be more productive? 
1 4 2.85 0.74 

2. Do you agree that telemedicine results in 

increased confidence in a doctor/patient 

relationship? 

1 4 2.61 0.77 

3. Do you agree that as a doctor, satisfaction 

is usually gained post telemedicine 

consultation? 

1 4 2.56 0.67 

4. Are questions answered profusely during a 

telemedicine consultation? 
1 4 2.68 0.65 

 



 47 

Overall, more than 50% of respondents agreed that telemedicine is an engaging platform with 

52.5% agreeing that telemedicine enables a doctor to be more productive (Q1), 55% agreeing that 

satisfaction is usually gained post telemedicine consultation (Q3); and 55% agreeing that questions 

answered profusely during a telemedicine consultation (Q4). However, the same percentage of 

respondents (41.25%) agreed and disagreed that telemedicine results in increased confidence in a 

doctor/patient relationship (Q2). A relatively low percentage of respondents strongly disagreed 

that telemedicine is an engaging platform (Figure 7). 

 

 

Figure 7: Percentage of respondents that find telemedicine to be an engaging platform  

 

In terms of information exchange during a telemedicine consultation more than half the 

respondents said that the explanation concerning the disease or treatment is not better (Table 4).  

 

Table 4: Information exchange during a telemedicine consultation  

 Yes No Sometimes 

1. In your experience, was the explanation concerning the disease 

better in telemedicine? 
2.5% 58.75% 38.75% 

2. In your experience, was the explanation concerning the 

treatment better in telemedicine? 
6.25% 50% 43.75% 

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

Q1 Q2 Q3 Q4

Strongly disagree Disagree Agree Strongly agree



 48 

4.4 Informed consent preference (written or verbal) to 
perform a clinical examination or when using ICT 

 
For this category, the study population scored according to elements from a list - take patient 

history, examine a patient, email patient information, refer patient, prescription, virtual 

consultation, none of the above, and other - for both written informed consent and verbal 

informed consent. Respondents were allowed to choose more than one option (Figure 8). Overall, 

more respondents (40%) took verbal consent to conduct virtual consultation compared to 14% 

that took written consent.  

 

Family physicians take an average of 2.61 (Figure 9 and Table 5) procedures relating to clinical 

examination or when using ICT using verbal format and an average of 1.08 (Figure 10 and Table 

6) procedures relating to clinical examination or when using ICT using a written format.  

 

Figure 8: Study population preference on informed consent 

 

 

 

 

0

10

20

30

40

50

60

Take patient
history

Examine a
patient

Email
patient

information

Refer
patient

Prescription Virtual
consultation

None of the
above

Other

Written Verbal



 49 

 
Figure 9: Written number of Procedures 
 
Table 5: Summary Statistics on written number of procedure 

Mean 1.0875 

Std Dev 1.6396492 

Std Err Mean 0.1833183 

Upper 95% Mean 1.452386 

Lower 95% Mean 0.722614 

N 80 

Skewness 1.9414634 

Kurtosis 3.4516841 

 
 

 
Figure 10: Verbal number of Procedures 



 50 

Table 6: Summary Statistics on verbal number of procedure 
 

 
 
 
 
 
 
 
 
 

 

A Pearson Correlation of family physicians and written informed consent was higher at 0.1174 

compared to the correlation of 0.0329 of family physicians and verbal informed consent, showing 

no real evidence of association.  

 
 
 
 

 

Mean 2.6125 

Std Dev 1.9967933 

Std Err Mean 0.2232483 

Upper 95% Mean 3.0568646 

Lower 95% Mean 2.1681354 

N 80 

Skewness 0.3878212 

Kurtosis  -1.126012 



 51 

4.5 Availability and quality of essential resources to conduct 
telemedicine  

 
As with the facilitating condition, the responses in this category was significant with 72 of the 

respondents indicating that they do have an electronic device to implement telemedicine 

consultation followed by 42 who also had access to quality broadband (Figure 11). On average 

family physicians had access to 1.61 resources to conduct telemedicine consultation.  

 

 
Figure 11: Study population representation on tools used by doctors for telemedicine 
 
Of the 17 respondents that use a telemedicine software, 76% said that the software is user friendly. 

Respondents also reported that 71% of their patients found the telemedicine software to be user 

friendly (Table 7).  

 

Table 7: The efficiency of telemedicine software  

 Yes No 

1. If you do use a telemedicine software, is it user friendly for 

you? 
76% 24% 

2. If you do use a telemedicine software, is it user friendly for 

your patient? 
71% 29% 

 

0

10

20

30

40

50

60

70

80

Electronic device Telemedicine Software Quality broadband None

Tools needed to facilitate a telemedicine consultation



 52 

The study population also reported that 59 of the medical doctor’s patients do have access to an 

electronic device, 20 have access to quality network while 18 have access to none (Figure 12).    

 

 

Figure 12: Study population representation on tools used by patients for telemedicine  

 

For those respondents that use telemedicine, preference for ease of using telemedicine, learning 

to operate and usefulness was measured (Table 8). 

 

On a scale of 1 = Never and 4= Always, the mean for telemedicine is easy to use was 2.65, which 

lies between rare and usually.  

 

On a scale of 1 = very difficult and 4 = very easy, the mean for learning to operate telemedicine 

systems was 2.81, leaning more towards easy. 

 

On a scale of 1 = never and 4 = always, the mean for telemedicine useful in your job was 2.73, 

leaning more towards usually.  

 

Table 8: Preference for ease of using telemedicine, learning to operate and usefulness 

 
Min Max Mean 

Std 

Deviation 

1. Easy to use (1 = Never; 4= Always)  1 4 2.65 0.70 

2. Learning to operate (1= Very difficult; 4= very 

easy) 
1 4 2.81 0.69 

3. Useful in your job (1= Never, 4= Always) 1 4 2.73 0.72 

0

10

20

30

40

50

60

70

Electronic device Quality network None

Tools needed by patients to conduct telemedicine consultation



 53 

4.6 Modalities used to store patient information  

The study population reported on how pat