title: Are people with chronic diseases interested in using telehealth? A cross-sectional postal survey.
abstract: BACKGROUND
  There is growing interest in telehealth-the use of technology to support the remote delivery of health care and promote self-management-as a potential alternative to face-to-face care for patients with chronic diseases. However, little is known about what precipitates interest in the use of telehealth among these patients.
  
  
  OBJECTIVE
  This survey forms part of a research program to develop and evaluate a telehealth intervention for patients with two exemplar chronic diseases: depression and raised cardiovascular disease (CVD) risk. The survey was designed to explore the key factors that influence interest in using telehealth in these patient groups.
  
  
  METHODS
  Thirty-four general practices were recruited from two different regions within England. Practice records were searched for patients with (1) depression (aged 18+ years) or (2) 10-year risk of CVD ≥20% and at least one modifiable risk factor (aged 40-74 years). Within each general practice, 54 patients in each chronic disease group were randomly selected to receive a postal questionnaire. Questions assessed five key constructs: sociodemographics, health needs, difficulties accessing health care, technology-related factors (availability, confidence using technology, perceived benefits and drawbacks of telehealth), and satisfaction with prior use of telehealth. Respondents also rated their interest in using different technologies for telehealth (phone, email and Internet, or social media). Relationships between the key constructs and interest in using the three mediums of telehealth were examined using multivariable regression models.
  
  
  RESULTS
  Of the 3329 patients who were sent a study questionnaire, 44.40% completed it (872/1740, 50.11% CVD risk; 606/1589, 38.14% depression). Overall, there was moderate interest in using phone-based (854/1423, 60.01%) and email/Internet-based (816/1425, 57.26%) telehealth, but very little interest in social media (243/1430, 16.99%). After adjusting for health needs, access difficulties, technology-related factors, and prior use of telehealth, interest in telehealth had largely no association with sociodemographic variables. For both patient groups and for each of the three technology mediums, the most important constructs related to interest in telehealth were having the confidence to use the associated technology, as well as perceiving greater advantages and fewer disadvantages from using telehealth. To illustrate, greater confidence using phone technologies (b=.16, 95% CI 0.002-0.33), while also perceiving more benefits (b=.31, 95% CI 0.21-0.40) and fewer drawbacks (b=-.23, 95% CI -0.28 to -0.17) to using telehealth were associated with more interest in using phone-based telehealth technologies for patients with depression.
  
  
  CONCLUSIONS
  There is widespread interest in using phone-based and email/Internet-based telehealth among patients with chronic diseases, regardless of their health status, access difficulties, age, or many other sociodemographic factors. This interest could be increased by helping patients gain confidence using technologies and through highlighting benefits and addressing concerns about telehealth. While the same pattern exists for social media telehealth, interest in using these technologies is minimal.
authors.affiliation: Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom. Louisa.Edwards@bristol.ac.uk.
authors.forename: Louisa
authors.initials: L
authors.lastname: Edwards
authors.forename: Clare
authors.initials: C
authors.lastname: Thomas
authors.forename: Alison
authors.initials: A
authors.lastname: Gregory
authors.forename: Lucy
authors.initials: L
authors.lastname: Yardley
authors.forename: Alicia
authors.initials: A
authors.lastname: O'Cathain
authors.forename: Alan A
authors.initials: AA
authors.lastname: Montgomery
authors.forename: Chris
authors.initials: C
authors.lastname: Salisbury
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001292:Attitude to Computers; D001294:Attitude to Health; D002318:Cardiovascular Diseases / Q000628:therapy; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000628:therapy; D004739:England; D005260:Female; D058006:General Practice; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012648:Self Care; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Internet; cardiovascular diseases; chronic disease; depression; mental health; patient acceptance of health care; survey methodology; technology; telehealth