Evaluating perceived technology self-efficacy and telehealth acceptance in optometry students

Figures & data

Table 1. Learning objectives of telehealth curriculum.

Course learning outcomes

Explain and discuss the purpose and function of telehealth, including its growing role within various local, national, and international contexts. Compare and contrast telehealth infrastructure and critically select telehealth platforms and technologies that support delivery of quality, safe, and effective communications, and practices. Manage and interpret client data and information ethically obtained through telehealth to deliver and improve health outcomes and services.

Table 2. Telehealth curriculum – telehealth foundations for entry to practice health professional students: a suite of core elements.

Module	Content
Introduction of telehealth	Introduction/welcome to the course Overview of course aims, outline, course structure, course and module learning outcomes, and assessments’ Introduction to digital health + defining Telehealth Telehealth local/international strategic points – why it is becoming more important in healthcare
Foundation of telehealth	Overview of telehealth – what is involved? How can telehealth be delivered? (video consults, phone + remote monitoring) Where/what/when of telehealth Components of a telehealth intervention (minimum requirements – tools and methods) Strengths, weakness, opportunities, and threats of telehealth (general pros/cons/barriers/facilitators) Platforms and tools for telehealth (with examples) Architecture of various platforms for telehealth (e.g. video platforms, mobile apps, virtual reality, games, etc) Standards for telehealth
Telehealth modalities and architectures	Platforms and tools for telehealth (with examples) Architecture of various platforms for telehealth (e.g. video platforms, mobile apps, virtual reality, games, etc) Standards for telehealth
Ethics and governance	Ethics and telehealth (including culture) Clinical and technology governance (including privacy, confidentiality, cybersecurity aspects) Professional obligations/responsibility (i.e. Australian Health Practitioner Regulation Agency guidelines)
Regulation/funding	Major policy issues (Government/Dept of Health level) Regulation of telehealth (legalities) Funding models/reimbursement (private vs public) Business models/administration matters

Table 3. Technology self-efficacy survey; questions, score, and response distribution. Instructions for participants: The following questions relate to your PERCEPTIONS ABOUT USING TELEHEALTH as part of health professional practice. Please select the most appropriate rating on the scale from Strongly disagree (SD), Somewhat disagree (SWD), Neither agree or disagree (NAD), Somewhat agree (SWA) to Strongly Agree (SA). Note: some questions may be difficult to answer if you haven’t used telehealth or, based on future expectations – that’s ok – do your best to answer them based on how you feel at this time.

Overall Results	Perceived Telehealth Self-efficacy	<50%	50–64%	65–69%	70–74%	75–79%	80–100%
	Pre-learning	0.00	0.00	6.90	6.90	15.52	70.69
	Post-learning	0.00	0.00	0.00	4.08	6.12	89.80
	Difference post-pre learning	0.00	0.00	−6.90	−2.81	−9.39	19.11
	Perceived Telehealth Self-efficacy	SD	SWD	NAD	SWA	SA	Total (Average (SD))
	Pre-learning (α = 0.85)	2.43	6.82	8.86	32.99	48.90	83.8 (8.2)
	Post-learning (α = 0.89)	0.46	2.41	7.33	37.11	52.69	87.8 (7.1)
	Difference post-pre learning	−1.97	−4.41	−1.53	4.11	3.79	4
Domain 1- Internet	Domain 1- Internet	SD	SWD	NAD	SWA	SA	Total (Average (SD))
1. Use an Internet search engine (e.g., Google) to find web pages related to my subject matter interests 2. Create my own web page 3. Find primary sources of information on the Internet that I can use in my role as a health professional	Pre-learning (α = 0.13)	7.47	13.79	1.72	27.59	49.43	79.54 (10.66)
	Post-learning (α = 0.41)	2.04	6.80	9.52	31.97	49.66	84.08 (9.70)
	Difference post-pre learning	−5.43	−6.99	7.80	4.39	0.23	4.54
Domain 2- Integrated applications	Domain 2- Integrated Applications	SD	SWD	NAD	SWA	SA	Total (Average (SD))
4. Use a spreadsheet to create a bar graph (e.g. to show the proportions of different colours of M&Ms in a bag) 5. Create a newsletter with graphics 6. Save documents in formats so that others can read them if they have different word processing programs (eg. saving Word, pdf, RTF, or text) 7. Use the computer to create a slideshow presentation 8. Create a database of information (e.g. about important authors in a subject matter field)	Pre-learning (α = 0.67)	0.69	6.55	11.38	32.41	48.97	84.48 (10.65)
	Post-learning (α = 0.61)	0.00	1.63	6.12	35.51	56.73	89.47 (7.42)
	Difference post-pre learning	−0.69	−4.92	−5.26	3.10	7.77	4.99
Domain 3- Working with technology	Domain 3- Working with technology	SD	SWD	NAD	SWA	SA	Total (Average (SD))
9. Use technology to collaborate with other people who are distant from where I am 10. Describe 5 software programs or apps that I would use in my role as health professional 11. Write a plan with a budget to buy technology that would support me in my role as health professional	Pre-learning (α = 0.54)	4.02	11.49	16.67	34.48	33.33	76.32 (13.86)
	Post-learning (α = 0.58)	0.68	3.40	14.97	43.54	37.41	82.72 (10.96)
	Difference post-pre learning	−3.34	−8.09	−1.70	9.05	4.08	6.40
Domain 4- Emerging technology	Domain 4- Emerging Technology	SD	SWD	NAD	SWA	SA	Total (Average (SD))
12. Integrate mobile technologies into my role as health professional 13. Use social media tools as part of my role as health professional (e.g. Facebook or Twitter, etc) 14. Create a wiki or blog to have peers collaborate 15. Use online tools to communicate from a distance in my role as health professional (e.g. video-based platforms like Zoom) 16. Communicate with someone in a one-to-one environment in which the other person has their own device 17. Find a way to use a smartphone in my role as a health professional to collect people’s responses 18. Use mobile devices to connect to others for my professional development 19. Download and listen to podcasts/audio books	Pre-learning ((α = 0.79)	1.72	5.17	10.59	40.89	41.63	83.10 (11.05)
	Post-learning (α = 0.82)	0.29	2.04	7.29	44.02	46.36	86.82 (9.40)
	Difference post-pre learning	−1.43	−3.13	−3.30	3.14	4.73	3.72
Domain 5- Emerging technology skills	Domain 5- Emerging Technology Skills	SD	SWD	NAD	SWA	SA	Total (Average (SD))
20. Download and view streaming movies/video clips 21. Send/transfer photos or other data via a smartphone 22. Save and retrieve files in a cloud-based en vironment	Pre-learning (α = 0.74)	0.86	1.29	2.16	22.84	72.84	93.10 (9.90)
	Post-learning (α = 0.82)	0.00	0.00	1.53	26.02	72.45	94.18 (7.80)
	Difference post-pre learning	−0.86	−1.29	−0.62	3.18	−0.40	1.08

This survey was administered pre- and post-learning. Participants remain anonymous. Numbers expressed as a percentage.

SD = Strongly disagree, SWD = Somewhat disagree, NAD = Neither agree or disagree, SWA = Somewhat agree, SA = Strongly agree.

Table 4. Telehealth acceptance survey questions, score, and response distribution. Instructions for participants: The following questions relate to your PERCEPTIONS ABOUT USING TELEHEALTH as part of health professional practice. Please select the most appropriate rating on the scale from Strongly disagree (SD), Somewhat disagree (SWD), Neither agree or disagree (NAD), Somewhat agree (SWA) to Strongly Agree (SA). some questions may be difficult to answer if you haven’t used telehealth or, based on future expectations – that’s ok – do your best to answer them based on how you feel at this time.

Overall Results	Telehealth acceptance	<50%	50–64%	65–69%	70–74%	75–79%	80–100%
	Pre-learning	3.45	43.10	17.24	17.24	8.62	10.3
	Post-learning	4.08	10.20	18.37	24.49	10.20	32.7
	Difference post-pre learning	0.63	−32.90	1.13	7.25	1.58	22.3
	Telehealth acceptance	SD	SWD	NAD	SWA	SA	Total (Average (SD))
	Pre-learning (α = 0.92)	6.80	11.21	39.60	30.43	11.97	66.1 (9.59)
	Post-learning (α = 0.94)	3.66	8.46	25.69	40.70	21.49	73.98 (9.92)
	Difference post-pre learning	−3.13	−2.74	−13.91	10.27	9.52	7.88
Domain 1- Performance expectancy (The degree to which using telehealth will provide benefits to practitioners and patients)	Domain 1- Performance expectancy	SD	SWD	NAD	SWA	SA	Total (Average (SD))
1. Using telehealth will support critical aspects of my role as a health professional 2. Using telehealth will enhance my effectiveness in managing my patients/clients 3. Overall, telehealth will be useful in my role as a health professional	Pre-learning (α = 0.78)	0.00	4.02	17.24	47.70	31.03	81.15 (13.40)
	Post-learning (α = 0.90)	0.00	4.76	7.48	40.14	47.62	86.12 (14.77)
	Difference post-pre learning	0.00	0.74	−9.76	−7.56	16.59	4.97
Domain 2- Effort expectancy (The degree of ease related to using telehealth)	Domain 2- Effort expectancy	SD	SWD	NAD	SWA	SA	Total (Average (SD))
4. Learning how to use telehealth is easy for me 5. My interactions with telehealth are clear and understandable 6. I find telehealth easy to use 7. It is easy for me to become skilful at using telehealth	Pre-learning (α = 0.81)	0.43	8.19	38.79	41.81	10.78	70.86 (12.95)
	Post-learning (α = 0.86)	0.00	2.55	20.92	54.59	21.94	79.18 (11.96)
	Difference post-pre learning	−0.43	−5.64	−17.87	12.78	11.16	8.32
Domain 3- Social influence (The degree that others who are important to respondents believe they should use telehealth)	Domain 3 - Social influence	SD	SWD	NAD	SWA	SA	Total (Average (SD))
8. People who are important to me think that I should use telehealth 9. People who influence my behaviour think that I should use telehealth 10. People whose opinions that I value prefer that I use telehealth	Pre-learning (α = 0.88)	1.15	11.49	62.64	20.11	4.60	63.10 (12.99)
	Post-learning (α = 0.82)	2.04	3.40	52.38	28.57	13.61	69.66 (14.97)
	Difference post-pre learning	0.89	−8.09	−10.26	8.46	9.01	6.56
Domain 4- Facilitating conditions (The degree that support is available for using telehealth)	Domain 4. Facilitating conditions	SD	SWD	NAD	SWA	SA	Total (Average (SD))
11. I have the resources necessary to use telehealth 12. I have the knowledge necessary to use telehealth 13. Telehealth is compatible with other technologies I use 14. I can get help from others when I have difficulties using telehealth	Pre-learning (α = 0.80)	2.16	16.38	26.29	39.66	15.52	70.00 (15.76)
	Post-learning (α = 0.82)	1.02	4.59	8.16	51.53	34.69	82.86 (13.35)
	Difference post-pre learning	−1.13	−11.79	−18.13	11.88	19.18	12.86
Domain 5- Hedonic motivation (The degree of intrinsic motivation in using telehealth)	Domain 5. Hedonic motivation	SD	SWD	NAD	SWA	SA	Total (Average (SD))
15. Using telehealth is fun 16. Using telehealth is enjoyable 17. Using telehealth is very entertaining	Pre-learning (α = 0.95)	1.72	4.60	66.67	21.26	5.75	64.94 (13.54)
	Post-learning (α = 0.95)	1.36	8.16	40.14	34.01	16.33	71.16 (17.29)
	Difference post-pre learning	−0.36	3.56	−26.53	12.75	10.58	6.22
Domain 6- Price value (The degree that monetary cost value is assigned to telehealth)	Domain 6- Price value	SD	SWD	NAD	SWA	SA	Total (Average (SD))
18. Telehealth care is reasonably priced as a service 19. Telehealth care is good value for money to patients/clients 20. Telehealth care is good value for money to me as a health professional	Pre-learning (α = 0.73)	0.57	6.90	53.45	26.44	12.64	68.74 (13.23)
	Post-learning (α = 0.83)	0.00	4.08	25.85	38.78	31.29	79.46 (14.65)
	Difference post-pre learning	−0.57	−2.82	−27.60	12.34	18.65	10.72
Domain 7- Habit (The degree that telehealth will be used automatically)	Domain 7- Habit	SD	SWD	NAD	SWA	SA	Total (Average (SD))
21. Use of telehealth has become a habit for me 22. I am addicted to using telehealth 23. I must use telehealth	Pre-learning (α = 0.87)	39.08	11.49	41.38	7.47	0.57	43.79 (18.78)
	Post-learning (α = 0.88)	29.25	17.69	46.26	6.80	0.00	46.12 (17.20)
	Difference post-pre learning	−9.83	6.20	4.88	−0.67	−0.57	2.33
Domain 8- Self-perception (The degree that they would use telehealth as part of their health belief model)	Domain 8- Self-perception	SD	SWD	NAD	SWA	SA	Total (Average (SD))
24. Telehealth suits my role as a health professional 25. Telehealth is a reputable delivery medium for healthcare 26. I could treat patients/clients via telehealth independently 27. I need more information about using telehealth	Pre-learning (α = 0.65)	8.19	14.22	21.12	37.50	18.97	68.97 (13.66)
	Post-learning (α = 0.55)	2.55	10.71	16.84	49.49	20.41	74.90 (12.23)
	Difference post-pre learning	−5.64	−3.51	−4.28	11.99	1.44	5.93
Domain 9- Behavioural intention (The degree of intention to use telehealth)	Domain 9 - Behavioural intention	SD	SWD	NAD	SWA	SA	Total (Average (SD))
28. I intend to use telehealth in my role as a health professional 29. I intend to use telehealth in the next few months in my studies 30. I plan to use telehealth frequently in my role as a health professional	Pre-learning (α = 0.84)	10.92	21.84	36.21	24.14	6.90	58.85 (17.58)
	Post-learning (α = 0.84)	2.72	21.77	27.89	34.01	13.61	66.80 (16.91)
	Difference post-pre learning	−8.20	−0.07	−8.32	9.87	6.71	7.95
Domain 10- Use behaviour (The degree of frequency in using telehealth) What do you think is appropriate frequency of use of the following telehealth features?	Domain 10- Use behaviour	Never	Infrequently	Sometimes	Frequently	Always	Total (Average (SD))
31. Conducting a live (SYNCHRONOUS) virtual consultation with a patient/client 32. Monitor/track a client’s health status remotely (ASYNCHRONOUS) 33. Reviewing a patient/clients health status before an appointment 34. Prescribing online resources to educate patients/clients 35. Please use this space if you have any other thoughts or comments about using telehealth. 35. Please use this space if you’d like to provide any constructive feedback regarding your experiences studying telehealth.	Pre-learning (α = 0.80)	6.90	11.21	42.24	29.31	10.34	65.00 (15.19)
	Post-learning (α = 0.70)	1.02	9.18	22.45	53.57	13.78	73.98 (11.77)
	Difference post-pre learning	−5.88	−2.02	−19.79	24.26	3.43	8.98

This survey was administered pre- and post-learning. Participants remain anonymous. Numbers expressed as a percentage. SD = Strongly disagree, SWD = Somewhat disagree, NAD = Neither agree or disagree, SWA = Somewhat agree, SA = Strongly agree.

Figure 1. A: Gender of participants. B: Age of participants.

Figure 2. A: Number and percentage of users per device. B: Frequency of online access.

Figure 3. Pre- and post-learning total and domain scores for A: Technology self-efficacy scores, and B: Telehealth acceptance scores.

Figure 4. Percentage of participants in each score range pre- and post- learning for A: Technology self-efficacy B: Telehealth acceptance.

Figure 5. Distribution of change in responses in A: Technology self-efficacy and B: Telehealth acceptance. Percentage change (post-learning score – pre-learning score) for each response category (strongly disagree- strongly agree) for each domain. Values below 0 indicate fewer respondents post-learning and values above 0 indicate more respondents post-learning.