Original Paper
People’s Experiences and Satisfaction With Telehealth During
the COVID-19 Pandemic in Australia: Cross-Sectional Survey
Study
Jennifer MJ Isautier
1
, MSc; Tessa Copp
1
, PhD; Julie Ayre
1
, PhD; Erin Cvejic
1
, PhD; Gideon Meyerowitz-Katz
2,3
,
MPH; Carys Batcup
1
, MSc; Carissa Bonner
1
, PhD; Rachael Dodd
1
, PhD; Brooke Nickel
1
, PhD; Kristen Pickles
1
, PhD;
Samuel Cornell
1
, MSc; Thomas Dakin
1
, MPH; Kirsten J McCaffery
1
, PhD
1
Faculty of Medicine and Health, Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Sydney, Australia
2
Population Wellbeing and Environment Research Lab, School of Health and Society, University of Wollongong, Wollongong, Australia
3
Western Sydney Diabetes, Western Sydney Local Health District, Sydney, Australia
Corresponding Author:
Jennifer MJ Isautier, MSc
Faculty of Medicine and Health
Sydney Health Literacy Lab, School of Public Health
The University of Sydney
Edward Ford Building
A27 Fisher Rd
Sydney, 2006
Australia
Phone: 61 02 9114 2199
Email: jennifer.isautier@sydney.edu.au
Abstract
Background: In response to the COVID-19 pandemic, telehealth has rapidly been adopted to deliver health care services around
the world. To date, studies have not compared people’s experiences with telehealth services during the pandemic in Australia to
their experiences with traditional in-person visits.
Objective: This study aimed to compare participants’ perceptions of telehealth consults to their perceptions of traditional
in-person visits and investigate whether people believe that telehealth services would be useful after the pandemic.
Methods: A national, cross-sectional, community survey was conducted between June 5 and June 12, 2020 in Australia. In
total, 1369 participants who were aged ≥18 years and lived in Australia were recruited via targeted advertisements on social
media (ie, Facebook and Instagram). Participants responded to survey questions about their telehealth experience, which included
a free-text response option. A generalized linear model was used to estimate the adjusted relative risks of having a poorer telehealth
experience than a traditional in-person visit experience. Content analysis was performed to determine the reasons why telehealth
experiences were worse than traditional in-person visit experiences.
Results: Of the 596 telehealth users, the majority of respondents (n=369, 61.9%) stated that their telehealth experience was
“just as good as” or “better than” their traditional in-person medical appointment experience. On average, respondents perceived
that telehealth would be moderately useful to very useful for medical appointments after the COVID-19 pandemic ends (mean
3.67, SD 1.1). Being male (P=.007), having a history of both depression and anxiety (P=.016), and lower patient activation scores
(ie, individuals’ willingness to take on the role of managing their health/health care) (P=.036) were significantly associated with
a poor telehealth experience. In total, 6 overarching themes were identified from free-text responses for why participants’telehealth
experiences were poorer than their traditional in-person medical appointment experiences, as follows: communication is not as
effective, limitations with technology, issues with obtaining prescriptions and pathology results, reduced confidence in their
doctor, additional burden for complex care, and inability to be physically examined.
Conclusions: Based on our sample’s responses, telehealth appointment experiences were comparable to traditional in-person
medical appointment experiences. Telehealth may be worthwhile as a mode of health care delivery while the pandemic continues,
and it may continue to be worthwhile after the pandemic.
J Med Internet Res 2020 | vol. 22 | iss. 12 | e24531 | p. 1http://www.jmir.org/2020/12/e24531/
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(J Med Internet Res 2020;22(12):e24531) doi: 10.2196/24531
KEYWORDS
COVID-19; patient experience; telehealth; experience; satisfaction; telemedicine; Australia; usability; cross-sectional; survey
Introduction
The COVID-19 outbreak was officially declared a pandemic
by the World Health Organization on March 11, 2020. To help
minimize the spread of COVID-19, health care systems have
rapidly adopted alternative models for health care delivery,
including telehealth services [1]. This type of health care
delivery minimizes the spread of the virus by providing health
care services without the need for close contact, thereby
reducing the risk of exposure to COVID-19 for both patients
and clinicians.
In response to the COVID-19 pandemic, the Australian
Government introduced a temporary telehealth scheme on March
30, 2020 to enable subsidized access to health care services that
are provided via telephone or videoconferencing [2]. Prior to
the pandemic, telehealth consultations were restricted to rural
and remote communities. This new scheme has allowed all
medical appointments with a variety of health professionals to
be conducted via telehealth, regardless of rurality. As a result
of this scheme, telehealth consults have accounted for 36% of
all services provided in April 2020, whereas telehealth consults
conducted before the pandemic only accounted for 1.3% [3,4].
At the end of April 2020, a nationally representative survey of
1022 people conducted by the Australian Bureau of Statistics
reported that 1 in 6 people (17%) used a telehealth service,
women were almost twice as likely as men to use telehealth
services (22% vs 12%), and persons with a chronic or mental
health condition were twice as likely to have used a telehealth
service compared to those without such conditions (25% vs
13%). However, 1 in 10 people (10%) reported to have a general
practitioner or health professional appointment cancelled or
postponed in the last 4 weeks because of the COVID-19
pandemic [5].
Cancelling or postponing appointments is concerning because
reduced health care during pandemics has been associated with
poor health outcomes, as observed during the Ebola virus
outbreak and Severe acute respiratory syndrome epidemic [6,7].
The increased uptake of telehealth services and increased
number of people cancelling or postponing medical
appointments warrants further investigation to better understand
people’s experiences and satisfaction with accessing telehealth
services during the COVID-19 pandemic. This is particularly
necessary, given the long-term outlook of the COVID-19
pandemic; although several health services have returned to
normal, continuing outbreaks may deter patients from accessing
in-person care for some time [8].
Despite the growth of telehealth, no studies have compared
people’s experiences with telehealth services during the
COVID-19 pandemic in Australia to people’s experiences with
traditional in-person visits. We investigated a sample of
Australians and their experiences with telehealth during the
COVID-19 pandemic. Our aims were to compare participants’
perceptions of telehealth consults to their perceptions of
traditional in-person visits and investigate whether people
believe that telehealth services would be useful after the
pandemic. Furthermore, we investigated the sociodemographic
and health-related factors associated with negative telehealth
experiences.
Methods
Recruitment
The data used in this study are from a prospective, longitudinal,
national survey that launched in April 2020 and explored
variations in people’s understanding of, attitude toward, and
uptake of COVID-19 health advice during the 2020 pandemic
[9]. Herein, we report on data from a survey wave conducted
over a 1-week period (ie, June 5 to June 12, 2020) in Australia.
Data were obtained using the Qualtrics online platform.
Participants who were aged ≥18 years, could read and
understand English, and resided in Australia were recruited via
paid targeted advertisements on social media (ie, Facebook and
Instagram). More details on recruitment are provided in the
McCaffery et al study [9]. Participants were given the
opportunity to enter a prize draw for the chance to win 1 of 10
Aus $20 (US $14.62) gift cards upon completion of the survey.
This study was approved by The University of Sydney Human
Research Ethics Committee (2020/212).
Measures
Sociodemographic variables, including age, gender, and
educational status, were collected, along with data on
self-reported chronic diseases and overall health. We assessed
health literacy using the Newest Vital Sign [10] and digital
health literacy using the eHealth Literacy Scale [11]. The
Consumer Health Activation Index [12] was used to determine
patient activation (ie, individuals’ willingness to take on the
role of managing their health and health care). The remoteness
and socioeconomic status of participants’ places of residence
were derived from participants’ postcodes [13]. Participants
were asked to indicate whether they had used telehealth services.
If so, they were then asked how telehealth services compared
to traditional in-person visits, whether they experienced any
barriers to using telehealth services, and whether they cancelled
or postponed an appointment with a health professional (Textbox
1).
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Textbox 1. Survey items and scoring scale on telehealth.
Telehealth usage
•
Since the COVID-19 restrictions started, have you had a telemedicine/telehealth appointment (appointment with your health provider by video
or phone instead of an in-person appointment)? (Response options: Yes/No)
•
How many telehealth appointments have you had? (Response: Numerical [free-text])
•
Was/were your telemedicine/telehealth visit(s) done by: (Response options: Telephone/Videoconference/Both)
Comparison between telehealth and traditional in-person visits
•
How did your telemedicine/telehealth visit compare to a traditional in-person medical visit? (Response options: Better than a traditional visit/Just
as good as a traditional visit/Worse than a traditional visit/Not sure)
•
If, telemedicine/telehealth was worse, please tell us why. (Response: Free text)
Interest in telehealth after COVID-19
•
How useful do you think it will be to have medical appointments with telemedicine/telehealth after the COVID-19 emergency is over? (Response
scale: 1-5, indicating not at all to extremely)
Cancellation of in-person appointments
•
Have you cancelled or postponed an appointment with a health professional in the last 4 weeks because of COVID-19? (Response options:
Yes/No)
•
Why? (Response options: Concerned about the cost/I am isolating due to COVID-19 symptoms or risk/I was worried about travelling on public
transport because of the COVID-19 risk/I did not want to go to a health or hospital clinic because of concerns about catching COVID-19 there/Too
busy Other [please tell us])
•
Did you feel you needed to see a health professional in person in the last 4 weeks but chose not to go? (Response options: Yes/No)
•
Why? (Response options: Concerned about the cost/I am isolating due to COVID-19 symptoms or risk/I was worried about travelling on public
transport because of the COVID-19 risk/I did not want to go to a health or hospital clinic because of concerns about catching COVID-19 there/Too
busy/Other [please tell us])
Barriers to telehealth
•
Have you needed to access a telehealth service in the last 4 weeks but could not? (Response options: Yes/No)
•
What was the main reason that you could not access a telehealth service in the last 4 weeks? (Response options: Telehealth not available from
general practitioner or other health professional/Do not have internet/I am not able to use the internet/Dislike or fear of the service/Appointment
not available when required/Other [please detail])
Statistical Analysis
Quantitative data were analyzed using Stata/IC v16 (StataCorp
LLC). Descriptive statistics were analyzed to obtain sample
characteristics and summarize participants’ telehealth
experiences since COVID-19 restrictions commenced. A
generalized linear model using a modified Poisson approach
(ie, log link function with robust standard errors) was used to
estimate adjusted relative risks with 95% confidence intervals
for having a poorer telehealth experience than a traditional
in-person medical visit experience based on various
sociodemographic and health-related factors. A 2-tailed
independent samples t test was used to compare the perceived
usefulness of telehealth medical appointments once the
COVID-19 emergency ends between participants who rated
their telehealth experience as worse than their in-person medical
visit experience and those who rated their telehealth experience
as the same as or better than their in-person medical visit
experience. The statistical significance for these exploratory
analyses was set at P<.05 (2-tailed).
Qualitative data were analyzed using content analysis [14],
which combines both qualitative and quantitative methods and
allows for both the frequency of categories and the content to
be reported. JI and TC familiarized themselves with the content
and generated a list of recurring themes; these were discussed
with and checked by an additional researcher (JA). JI and TC
then applied the final coding framework to all the data. The
level of agreement was tested using the Cohen kappa, which
indicated substantial agreement (κ=0.76) [15]. Discrepancies
were discussed until a consensus was obtained. Descriptive
statistics were provided to summarize the frequency of each
code.
Results
Of the 1369 respondents who completed the June survey, 596
(43.5%) reported using telehealth services since the start of the
pandemic. Respondents who used telehealth services were
slightly older; more likely to be female; had higher levels of
education; had a greater prevalence of chronic health conditions,
including a history of mental health conditions; and had poorer
self-reported general health compared to those who did not use
telehealth services. Sample characteristics are summarized in
Table 1.
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Table 1. Descriptive characteristics of our sample sorted by participants’use of telehealth services during the COVID-19 lockdown period.
Overall (N=1369)Did not access telehealth services
(n=773)
Accessed telehealth services
(n=596)
Variable
44.7 (16.7)43.6 (17.0)46.2 (16.1)Age in years, mean (SD)
Age group (years), n (%)
232 (16.9)156 (20.2)76 (12.8)18-25
372 (27.2)206 (26.6)166 (27.9)26-40
344 (25.1)192 (24.8)152 (25.5)41-55
421 (30.8)219 (28.3)202 (33.9)56-90
Gender, n (%)
433 (31.6)287 (37.1)146 (24.5)Male
911 (66.5)478 (61.8)433 (72.7)Female
25 (1.8)8 (1)17 (2.9)Other/prefer not to say
Highest level of education completed, n (%)
198 (14.5)130 (16.8)68 (11.4)High school or less
140 (10.2)73 (9.4)67 (11.2)Certificate I-IV
1031 (75.3)570 (73.7)461 (77.3)University education
Number of chronic health conditions
a
, n (%)
675 (49.3)436 (56.4)239 (40.1)0
408 (29.8)220 (28.5)188 (31.5)1
286 (20.9)117 (15.1)169 (28.4)≥2
Mental health history, n (%)
471 (34.4)193 (25.0)278 (46.6)Depression
534 (39)232 (30)302 (50.7)Anxiety
Self-reported general health, n (%)
46 (3.4)9 (1.2)37 (6.2)Poor
187 (13.7)76 (9.8)111 (18.6)Fair
463 (33.8)237 (30.7)226 (37.9)Good
493 (36)321 (41.5)172 (28.9)Very Good
180 (13.1)130 (16.8)50 (8.4)Excellent
3.7 (1.4)3.7 (1.4)3.7 (1.4)
Socioeconomic status, mean IRSAD
b
quintile
(SD)
Remoteness, n (%)
1027 (75)589 (76.2)438 (73.5)Major cities
342 (25)184 (23.8)158 (26.5)Other
1170 (91.1)665 (91.7)505 (90.3)
Adequate health literacy
c
, n (%)
4.2 (0.7)4.1 (0.7)4.2 (0.7)
eHealth literacy
d
, mean (SD)
74.9 (13.3)75.0 (13.4)74.7 (13.2)
Patient activation
e
, mean (SD)
272 (19.9)125 (16.2)147 (24.7)
Cancelled/postponed an appointment
f
, n (%)
219 (16)104 (13.5)115 (19.3)
Chose not to see a health professional
g
, n (%)
19 (1.4)7 (0.9)12 (2)
Could not access telehealth services
h
, n (%)
a
Chronic health conditions included respiratory disease, asthma, chronic obstructive pulmonary disease, hypertension, cancer, heart disease, stroke, and
diabetes.
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b
IRSAD: Index of Relative Socio-Economic Advantage and Disadvantage. In the IRSAD quintile [13], a score of 1 represents most disadvantaged and
a score of 5 represents most advantaged.
c
Health literacy was assessed using the Newest Vital Sign [10]. Data were missing for 85 (6.2%) participants percent due to technical errors with the
Qualtrics online platform.
d
eHealth [11] literacy was measured on a 5-point Likert scale. A higher score reflects a higher level of eHealth literacy.
e
Results are based on the Consumer Health Activation Index [12]. A score of 0-79 indicates low activation, 80-94 indicates moderate activation, and
95-100 indicates high activation.
f
Respondents who cancelled/postponed an appointment in the last 4 weeks because of COVID-19.
g
Respondents who felt the need to see a health professional in the last 4 weeks, but chose not to.
h
Respondents who needed access to a telehealth service in the last 4 weeks, but could not.
Cancellation of In-Person Appointments
Of the 1369 total respondents, 272 (19.9%) cancelled or
postponed an in-person appointment with a health professional.
The reasons for cancelling appointments were as following:
concerns about catching COVID-19 at a clinic or hospital (n=85,
31.3%), isolating due to COVID-19 symptoms or risks (n=31,
11.4%), concerns about travelling via public transport (n=21,
7.7%), feeling too busy (n=20, 7.4%), cost (n=9, 3.3%), and
other reasons (n=106, 39%). Less common reasons for
cancelling or postponing an in-person appointment included
the following: border closures, postponed elective surgery, and
the appointment seemed nonessential. Furthermore, 219 (16%)
respondents felt that they needed to see a health professional
in-person in the last 4 weeks, but chose not to go due to the
following reasons: concerns about catching COVID-19 at a
clinic or hospital (n=72, 32.9%), feeling too busy (n=37, 16.9%),
isolating due to COVID-19 symptoms or risks (n=18, 8.2%),
concerns about travelling via public transport (n=13, 5.9%),
other reasons (n=67, 30.6%). Less common reasons listed for
choosing not to see a health professional included the following:
only telehealth services were available, limited in-person
appointment availability, and felt that seeing a health
professional was too complicated.
Telehealth Experiences
The characteristics of telehealth users’ experiences are shown
in Table 2. Of the 596 respondents who used telehealth services,
over half (n=326, 54.7%) reported having more than 1 telehealth
appointment, of which most were conducted by telephone
(n=427, 71.6%). The majority of respondents (n=369, 61.9%)
stated that their telehealth experience was “just as good as” or
“better than” their traditional in-person medical visit experience.
On average, respondents perceived telehealth as moderately
useful to very useful for medical appointments after the
COVID-19 pandemic ends (mean 3.67, SD 1.1). Individuals
who responded that their telehealth experience was worse than
their traditional in-person medical visit experience (n=205,
34.4%) also rated the usefulness of telehealth after the
COVID-19 emergency ends significantly lower than those whose
telehealth experience was “just as good as” or “better than” their
in-person visit experience (mean 2.86 vs mean 4.17; difference:
mean 1.31; 95% CI 1.14-1.47; t
572
=15.62; P<.001).
Table 2. Characteristics of telehealth users’ experience (n=596).
Summary value, n (%)Variable
Number of telehealth appointments
270 (45.3)1
157 (26.3)2
169 (28.4)≥3
Mode of telehealth delivery
427 (71.6)Telephone
84 (14.1)Videoconference
85 (14.3)Both
Telehealth visit compared to traditional in-person medical visit
49 (8.2)Better
320 (53.7)Just as good
205 (34.4)Worse
22 (3.7)Unsure
Factors Associated With a Poor Telehealth Experience
The results of the multivariable analysis that explored factors
associated with a poorer telehealth experience than an in-person
appointment experience are displayed in Table 3. Being male
(P=.007), having a history of both depression and anxiety
(P=.04), and having a low patient activation score (P=.04) were
associated with a poorer telehealth experience, after controlling
for all other variables in the model.
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