Report

Perception and Use of Telemedicine on Healthcare Utilization

among Khulna University Students

Course No.: Econ 2204

Course Title: Rural Development Issues - Fieldwork and Studio

Submitted to
Dr. Khan Mehedi Hasan
Professor
Economics Discipline
&
Faijan Bin Halim Submitted by
Associated Professor Group D
Student No.: 211501,
Economics Discipline
211504, 211506,
Khulna University
211513, 211515
Year: 2nd; Term: 2nd
Economics Discipline
Khulna University

Submission Date:ii October 08, 2023

 Abstract

Understanding the perception and utilization of telemedicine in the digital health era is critical to
improving healthcare accessibility and efficiency. This study examines the perspectives and
behaviors of Khulna University students regarding telemedicine, revealing critical aspects of its
awareness and utilization within this demographic. The primary goal of the study is to determine
how Khulna University students perceive and use telemedicine in their healthcare utilization.
Khulna University was chosen through purposive sampling, followed by a stratified
disproportional sampling approach to select 106 student participants. The major findings
emphasize that respondents' acceptance and use of telemedicine is significantly influenced by
awareness, internet connection, and privacy and security concerns. Despite a reasonable level of
awareness, certain barriers, particularly those related to reliable internet connectivity and privacy
assurances, were prominent among participants. Furthermore, there was a visible fear of security,
particularly in the context of confidential health information. To close the identified gaps and
increase telemedicine adoption, strategies such as improving internet connectivity, raising
awareness, strengthening privacy and security, and cultivating a welcoming environment for
telemedicine use are critical. Considering these factors, it allows for a more efficient adaptation
to technological advances in the medical sector, but it also enhances decision-making and policy
formulation more appropriately and contextually relevant.

Keyword: Perception; telemedicine; healthcare utilization; relative important index

iii
 Table of Contents
Particulars Page No.
Abstract ii
Table of Contents iii
List of Tables v
List of Figures v
Acronyms vi
Abbreviations vi
Chapter One: Introduction 1
1.1 Background of the study 1
1.2 Objective of the study 2
1.3 Research question 2
1.4 Rationale of The Study 2
1.5 Scope of The Study 3
1.6 Limitations of the study 3
Chapter Two: Literature Review 4
2.1. Conceptual Framework 4
2.1.1 Telemedicine 4
2.1.2 Perception and Use of Telemedicine 4
2.1.3 Healthcare Utilization through the Use of Telemedicine 4
2.2 Review of Related Empirical Studies 5
2.3 Research Gap 6
Chapter Three: Methodology 7
3.1 Study Area 7
3.2 Sampling Unit 7
3.3 Sampling Technique 7
3.4 Sample Size 8
3.5 Major Variables of the Study 8
3.6 Estimation Technique 9
Chapter Four: Data Analysis 10
4.1 Respondent of Telemedicine User by Gender 10

iv
4.2 Telemedicine usage frequency against family income 11
4.3 Knowledge about telemedicine 12
4.4 Device for using telemedicine 13
4.4 Telemedicine Awareness Index 13
4.5 Relative Importance Index (RII) 15
4.6 Telemedicine Utilization 16
4.7 Impact on Healthcare Utilization 17
4.8 Technological Difficulties of Telemedicine 28
4.9 Legal and Regulatory Barriers 29
4.10 Future Preferences of Telemedicine 20
Chapter Five: Findings and Recommendations 21
5.1 Findings 21
5.2 Recommendations 22
5.3 Conclusion 22
References iv
Appendix: Questionnaire vi

v
 List of Tables

Table No. 3.1: Variable List 8

Table No. 4.1: Device for using telemedicine 13
Table No. 4.2: Telemedicine Awareness Index 13
Table No. 4.3: Relative Importance Index (RII) 15
Table No. 4.4: Telemedicine Utilization 16
Table No. 4.5: Impact on Healthcare Utilization 17

List of Figures

Figure No. 4.1: Respondent of Telemedicine User by Gender 10

Figure No. 4.2: Telemedicine usage frequency against family income 11
Figure No. 4.3: Knowledge about telemedicine 12
Figure No. 4.4: Legal and Regulatory Barriers 18
Figure No. 4.5: Technological Difficulties of Telemedicine 19
Figure No. 4.6: Future Preferences of Telemedicine 20

vi
 Acronyms
WHO World Health Organization
ICT Information and Communication Technology
CRP Cambodian Rehabilitation and Development Board
DUTP Dhaka University Telemedicine Programmed
RII Relative Importance Index

Abbreviations
E-Health Electronic Health

vii
ii
 Chapter One

Introduction

1.1 Background of the Study

The present digital revolution welcomes in a new era for healthcare delivery (Eysenbach and
Jadad, 2001). Patient empowerment and related structural and ideological shifts are currently
transforming conventional, hierarchical face-to-face healthcare by telemedicine (Cabieses et al.,
2013). Telemedicine is the use of electronic information to communicate technologies to provide
and support healthcare when distance separates the participants (Brown, 1995). It allows
healthcare professionals to diagnose, treat, and monitor patients at a distance, typically through
video calls, phone consultations, secure messaging platforms, or other digital communication
tools. According to World Health Organization, 2011 telemedicine is defined as healing at a
distance along with the use of electronic information and telecommunication technology to
enhance patient outcomes by facilitating better access to care and medical information specific to
an individual's requirements.

Around the world, it can be difficult for residents in rural and isolated places to get timely, high-
quality specialist medical treatment. Since specialist doctors are more likely to be found in
densely populated urban regions, residents of these places frequently have poor access to
specialty healthcare. Telemedicine offers the ability to reduce this gap and improve access to
healthcare in these situation (Al-Sofiani and Alyusuf, 2021).

Utilizing the Internet and associated technology, telemedicine combines the comfort, cheap cost,
and simple accessibility to health-related information and communication (Vidal-Alaball et al,
2020). Telemedicine has several benefits, including the provision of intra- and inter-hospital
communication, a reduction in the cost of delivering high-quality healthcare, and the elimination
of the need to build new hospital buildings, which are typically lacking in poor nations (Wootton
et al., 2011). Despite the advantages of using telemedicine, responsiveness to medical
development is typically a crucial precondition for continued telemedicine usage (Kirsten et al.,
2019). The character that telemedicine will take will likely be influenced by people's knowledge,

1
perceptions, and attitudes toward it. This will be a key factor in deciding the success of
telemedicine in the long run (Kirsten et al., 2019).

According to national ICT policy, 2000 Bangladesh has officially implemented a telemedicine
program in its basic healthcare institutions. CRP did this with assistance from the UK's Swinfen
Charitable Trust since 1999. Bangladeshis encountered telemedicine during the start of the
COVID-19 epidemic and benefited greatly, like those in other developing nations (Chowdhury et
al.). However, the telemedicine service whether official or informal has yet to be in use statewide
in nations like Bangladesh despite its seeming promise. Even though the number of people using
telemedicine services has grown due to the epidemic, little is known about how satisfied,
accepting, and generally happy they are with it (Rahman et al., 2021). One of the country's first
telemedicine programs, the Dhaka University Telemedicine Programmed (DUTP) aims to
comprehend the prior knowledge and patient response of the patients or care recipients of this
hotline-based telemedicine program, such as experience, satisfaction level, and acceptance.

1.2 Objective of the Study

The objective of the study is to find out perception and use of telemedicine on healthcare
utilization among Khulna University students.

1.3 Research Question

 How does telemedicine impact patient satisfaction with healthcare services?
 How does the use of telemedicine impact the frequency, type, and cost of healthcare
services that patients receive?

1.4 Rationale of the Study

Telemedicine is increasingly gaining popularity as a healthcare delivery method, particularly
amid the COVID-19 pandemic, underscoring the importance of comprehending its perception
and utilization among university students. University students frequently encounter distinctive
health challenges like academic stress, restricted healthcare facility access, and mental health
concerns, making telemedicine a potentially convenient solution for addressing these issues.
Previous research on telemedicine utilization and perception has mainly centered on broader

2
demographics or specific patient populations, highlighting the need to fill a knowledge gap by
investigating Khulna University students to understand their unique attitudes and practices.

1.5 Scope of the Study

This study has focused on understanding how students at Khulna University in Bangladesh use
and think about telemedicine. The authors have chosen this university because it has a diverse
group of students and easy access to telemedicine services. The authors have talked to different
students from various departments.

The authors have collected information from 106 students using a method that helps us choose
participants in a thoughtful way. This number was chosen to make sure our study is practical and
gives reliable results.

The authors have looked at the information we have collected using basic math methods like
averages (mean), middle numbers (median), and most common numbers (mode). The authors
have also looked at how spread out the numbers are (standard deviation). Additionally, the
authors have compared groups and seen if things are related (correlation).

Our main focus has been on two things. First, the authors have wanted to know how students at
Khulna University use and think about telemedicine. Second, the authors have wanted to see if
using telemedicine affects their health and well-being positively.

1.6 Limitations of the Study:

 The study's sample size has been too small to accurately represent the entire student
population, which has potentially impacted the generalizability of the findings.
 Data collection through self-reporting has been susceptible to response bias, as
participants may not have accurately represented their telemedicine usage and
perceptions.
 The findings have been specific to the Khulna University environment and may not
necessarily apply to other student populations or broader demographics.

3
  External factors like socio-economic status or access to healthcare facilities have not been
thoroughly explored, which may have impacted the study's conclusions.

Chapter Two

Literature Review

2.1. Conceptual Framework

2.1.1 Telemedicine
The use of telecommunications technologies to deliver medical information and services is
known as telemedicine. It may be as straightforward as a phone call between two medical
professionals discussing a patient's issue, or it might be as complex as employing satellite
technology to broadcast a whole nation using video conferencing equipment. Telemedicine is the
term for the use of telecommunications technology to diagnose and treat patients at a distance
(Stanberry, 2000; Chen et al., 2013; Sims, 2018). The context for health management and
communication is created by this technological instrument (Gustke et al., 2000; Munos et al.,
2016).

2.1.2 Perception and Use of Telemedicine

The usage of telemedicine shows that patient and healthcare provider health communication has
been sped up and made more effective. However, they would hope and anticipate that
telemedicine will be more readily accepted as a tool by all medical professionals who want to
learn about and determine its full potential and utility. In actuality, telemedicine provides the
healthcare system as a whole and practitioners who use its services with a variety of advantages
in terms of health communication. From the patient to the community to the doctors and other
practitioners, telemedicine may help everyone. With this possibility in mind, Jonathan and
Gerald-Mark (2007) addressed and investigated the effects of telemedicine applications, such as
digitize health communication via Web-based services, transcend geographic boundaries,
transcend temporal boundaries, reduce costs, and increase patient comfort, security, and
satisfaction.

4
2.1.3 Healthcare Utilization through the Use of Telemedicine
Telemedicine can enhance access to medical services that are frequently inconsistently provided
in far-off rural communities by removing constraints caused by distance. The development of
information and communication technology (ICT) has increased access to healthcare services
and practitioners' interactions with patients in developed nations. Healthcare professionals can
now use telemedicine services to effectively consult with medical professionals inside and
outside of their geographic location, deliver healthcare services, and establish ongoing
communication with their patients without distance acting as a barrier (Matawalli and Ibrahim,
2014).

E-Health, according to the World Health Organization (2009), is the secure and cost-effective
use of information and communication technologies (ICT) in support of the health and fields
closely related to it, such as healthcare services, health surveillance, health literature, and health
education, knowledge, and research.

2.2 Review of Related Empirical Studies

The expense of telemedicine equipment, user acceptance, patient data privacy and
confidentiality, and a lack of established norms and regulations for telemedicine are all
mentioned as hurdles for adopting telemedicine services in Bangladesh by Nessa et al. (2010).
They additionally disclosed that the incorporation of telemedicine in already-established health
centers can make it simpler and less expensive to deliver healthcare to people in rural places, as
well as create new employment opportunities for them.

Given the lack of solid evidence, Ahmed et al. (2014) noted in their research that it is still
unclear how eHealth and mHealth will be incorporated into the current healthcare system.
Additionally, they warned that involving the public sector would aid in gathering data on the best
ways to incorporate mHealth and eHealth into healthcare systems. They also showed that there
are very few people in Bangladesh who have received training in eHealth, and that there is a high
need for capacity building and experience exchange, particularly for implementation and policy
making.

Khatun and Sima (2015) noted a development in the provision of ICT health services at Sadar
Hospital. Additionally, they noted in their study that Sadar Hospital and other institutions

5
struggle to provide e-health services because of a shortage of experienced workers, patients who
are unaware of how to use these services, and insufficient central government oversight.
A study was conducted in 2008 by Banjoko and Omoleke to evaluate knowledge and perception
of telemedicine and e-health. 200 healthcare professionals, including doctors, nurses,
pharmacists, laboratory scientists, medical records officers, radiographers, senior nursing and
senior medical students, participated in this study. Interviews and a semi-structured questionnaire
were used to assess their knowledge and perception. Only 42 (21%) of the respondents were
aware of the nation's intended telehealth program, and 83 (41.5%) had poor awareness about
telehealth. 138 people (69%) will advise others to use telehealth services, while 141 (70.5%) will
use them themselves. Due to the current lack of information, this outcome highlighted the
necessity for extensive stakeholder participation and public education prior to the creation of
government policy on telemedicine.

2.3 Research Gap

Undoubtedly, the majority of the existing research on telemedicine services in Bangladesh has
focused on evaluating the general state of the sector, its sustainability, and potential future
improvements. Despite the fact that these studies have offered insightful information, they
frequently ignored an important factor: the influence of people's views on the availability and use
of telemedicine services in the nation. Particularly, there is a substantial gap in the research when
it comes to the viewpoints of important parties, such as patients, medical professionals, and
doctors. By concentrating on the perception and use of telemedicine for Khulna university
students in Bangladesh, this study aims to close this gap. By doing this, it hopes to offer insight
on how this group's attitudes and beliefs may affect how widely and successfully telemedicine is
used across the nation, helping us gain a more complete picture of the country's telemedicine
environment.

6
 Chapter Three

Methodology

3.1 Study Area

The study has conducted at Khulna University, which is located in Khulna, Bangladesh's third-
largest city. For in-depth research and advanced studies in the field, this university is very
significant. It's a great place to examine how students view and utilize telemedicine services
because they come from a variety of backgrounds and are in various financial situations.
Telemedicine is similar to in-person doctor visits, but over a video call. This study is worth
mentioning because it provides insight into the attitudes of young people toward using digital
health services, who are instrumental in popularizing technology in healthcare.

3.2 Sampling Unit

The population for this study comprises all students currently enrolled at Khulna University. This
includes students from all levels (undergraduate, postgraduate, etc.) and from all schools and
disciplines. Students must be enrolled in the study, have some engagement with telemedicine, be
willing to participate, and be at least 18 years old in order to take part. To ensure precise and
relevant findings about students' perceptions of and use of telemedicine, the study will not take
into account non-students, people who are unaware of telemedicine, unwilling participants, or
anyone outside the student community.

3.3 Sampling Technique

In this study, the authors aim to investigate how Khulna University students view and utilize
telemedicine for their healthcare requirements. In order to accomplish this successfully,
they selected their participants using a multistage sampling technique. First, because they were
particularly interested in comprehending the behaviors and perceptions of Khulna University
students, they chose purposive sampling technique method. Next, they chose 106 students from
all 29 university disciplines using a method known as stratified disproportional sampling to
ensure that all disciplines, regardless of size, were represented in the study.

7
3.4 Sample Size
A total of 106 students from Khulna University are chosen as the sample for this study. This
sample size is carefully chosen to be both practical for data collection and analysis and to
accurately reflect the diverse student population.

3.5 Major Variables of the Study

The authors find out various type of variables to study this paper. There are various types of
variables such as socio-demographic, household information, perception and usage of
telemedicine, impact of healthcare utilization, telemedicine utilization, challenges and future
preferences related. And these variables are divided into different categories such as dummy,
categorical, continuous, and like art scale.

Table No. 3.1: Variable List

Variable Measurement Unit
Age In years
Gender Male=1, Female=0
Marital status Yes=1, No=0
Education level Hons 1st year=1, Hons 2nd year=2, Hons
3rd year=3, Hons 4th year=4
Credit access Yes=1, No=0
Income In BDT
Expenditure In BDT
Family size In numbers
Number of Earning Members In numbers
House ownership Own=1, Rent= 0
Number of Educated Family Members In numbers
Family size In numbers
Number of Earning Members In numbers
Awareness source Peer group=1, Parents=2, Friends=3, Online
platform=4
Device used Phone=1, Laptop=2, Smart Watch=3, Other

8
 Digital Devices=4
Frequency of Use In numbers
Perception and Usage of Telemedicine Likert Scale
Strongly Agree=5, Agree=4, Neutral=3,
Disagree=2, Strongly Disagree=1
Impact of Healthcare Utilization Likert Scale
Strongly Agree=5, Agree=4, Neutral=3,
Disagree=2, Strongly Disagree=1
Telemedicine Utilization Audio call=1, Videocall=2, Apps=3,
SMS=4
Future Preferences Likert Scale
Strongly Agree=5, Agree=4, Neutral=3,
Disagree=2, Strongly Disagree=1

3.6 Estimation Technique

The following estimation techniques have been used to assess the real scenario of this study:
Research Question 1: To measure the level of awareness of telemedicine of Khulna University
students, the authors have created telemedicine awareness index. It indicates the respondents
whether they are aware or unaware based on his score. The score of a particular respondent has
been evaluated against the mean of all combined score. If the respondent has a score greater than
the mean, he is considered as well-aware or if his score is less, he will be regarded as unaware.

Research Question 2: The obstacles and challenges of telemedicine have been measured with the
help of a histogram and line graph. The authors have plotted histogram and line graph based on
the information collected from the students to locate the major obstacles and difficulties.

9
 Chapter Five

Data Analysis

4.1 Respondent of Telemedicine User by Gender

Telemedicine as a method of delivering healthcare is gaining popularity these days. Everyone
uses this facility heavily, regardless of gender. The authors want to determine the gender-specific
percentage of telemedicine users. The goal is to determine how frequently people of different
genders use this facility. A pie chart has been made using the sample data. Figure 4.1, which is
shown below, shows how telemedicine use differs by gender in a clear and understandable way.

Figure No. 4.1: Respondent of Telemedicine User by Gender

Respondent of Telemedicine User by

Gender

Male
42% Female
58%

(Source: Authors’ compilation, 2023)

The percentage of responders who use telemedicine for both genders is displayed in a pie chart.
Males make up 58% of telemedicine users, while females make up 42%. This indicates that men
are more likely than women to use telemedicine services. This pie chart offers an insightful
overview of the present gender distribution of telemedicine use.
Affordable healthcare is available through telemedicine. By paying a fair price, people of all
income levels can use this amenity. The authors compared the respondents' household income to

10
how frequently they used telemedicine. In figure 4.2, which is provided below, a scatter diagram
is used to measure this relationship.

4.2 Telemedicine Usage Frequency against Family Income

Usage Frequency
The scatter plot shows different income ranges starting from 0 to 100000 BDT. Respondents
whose family income is up to 20000 use telemedicine 36 times in the last six months. When the
respondent’s family income is between 20000 to 40000, use of telemedicine is 40 times.

Telemedicine
5

0
Figure No. 4.2: Telemedicine Usage Frequency against Family Income

Telemedicine Usage Frequency vs. Family Income

0 20000 40000 60000 80000 100000

Family Income

(Source: Authors’ compilation, 2023)

Again, respondent’s family lies between 40000 to 60000, 60000 to 80000 and 80000 to 100000
have the frequency of using telemedicine are 32, 5 and 2 times respectively during the last six
months. Healthcare facilities through the use of telecommunication is the outcome of modern
technology. The idea of giving medical treatment by ignoring the distance is an innovative one.
People came to know about this facility through various sources. The respondents for this
research work have given multiple answers for the question of their first idea about the existence
of telemedicine.

11
4.3 Knowledge about Telemedicine
According to this histogram, 4 out of 106 have come to know about telemedicine from their peer
group. The frequencies of students being introduced with this facility by their parents, friends
and online platform are 9, 28 and 65 respectively. So, majority of the students came to know
about telemedicine from online platform.

Frequency
60

40

20

0
Figure No. 4.3: Knowledge about Telemedicine

Peer group Parents Friends Online Platform

Knowledge about telemedicine

(Source: Authors’ compilation, 2023)

To get the benefit of telemedicine one must have modern devices. These devices can be of
various types. When the students of Khulna University were asked about their medium of using
telemedicine, they gave more or less same answer. On the basis of their answers, table 4.1 has
been created which is given below.

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4.4 Device for Using Telemedicine
From Table 4.4, it is clear that most of the students use phone as the medium of using
telemedicine which is 87 out of 106 respondents and the percentage is 82.08%.

Table No. 4.1: Device for Using Telemedicine

Device for using Frequency Percent
telemedicine
Phone 87 82.08%
Laptop 16 15.09%
Other Digital Devices 3 2.83%
Total 106 100%
(Source: Authors’ compilation, 2023)

Another 15.09% use laptop and the frequency for this is 16. Only three students use other digital
devices for taking medical treatment through telemedicine.

4.4 Telemedicine Awareness Index

This analysis evaluates the telemedicine awareness index. In table no. 4.2, it indicates the
respondents whether he is aware or unaware based on his score. The authors calculate this to
measure the awareness level of telemedicine among the students.

Table No. 4.2: Telemedicine Awareness Index

Respondents Score Stats Respondents Score Stats
1 30 Unaware 54 36 Well Aware
2 34 Well Aware 55 34 Well Aware
3 24 Unaware 56 34 Well Aware
4 32 Unaware 57 35 Well Aware
5 26 Unaware 58 40 Well Aware
6 16 Unaware 59 40 Well Aware
7 40 Well Aware 60 36 Well Aware
8 36 Well Aware 61 13 Unaware
9 36 Well Aware 62 36 Well Aware
10 36 Well Aware 63 37 Well Aware
11 36 Well Aware 64 37 Well Aware
12 32 Unaware 65 34 Well Aware
13 25 Unaware 66 37 Well Aware
14 32 Unaware 67 31 Unaware
15 37 Well Aware 68 14 Unaware

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 16 36 Well Aware 69 36 Well Aware
17 40 Well Aware 70 36 Well Aware
18 34 Well Aware 71 36 Well Aware
19 32 Unaware 72 36 Well Aware
20 38 Well Aware 73 40 Well Aware
21 26 Unaware 74 41 Well Aware
22 32 Unaware 75 39 Well Aware
23 36 Well Aware 76 36 Well Aware
24 36 Well Aware 77 41 Well Aware
25 32 Unaware 78 41 Well Aware
26 37 Well Aware 79 28 Unaware
27 33 Unaware 80 36 Well Aware
28 36 Well Aware 81 24 Unaware
29 36 Well Aware 82 37 Well Aware
30 16 Unaware 83 14 Unaware
31 40 Well Aware 84 34 Well Aware
32 36 Well Aware 85 40 Well Aware
33 36 Well Aware 86 36 Well Aware
34 39 Well Aware 87 36 Well Aware
35 32 Unaware 88 34 Well Aware
36 36 Well Aware 89 36 Well Aware
37 36 Well Aware 90 36 Well Aware
38 36 Well Aware 91 37 Well Aware
39 36 Well Aware 92 36 Well Aware
40 35 Well Aware 93 34 Well Aware
41 32 Unaware 94 36 Well Aware
42 15 Unaware 95 45 Well Aware
43 36 Well Aware 96 36 Well Aware
44 33 Unaware 97 36 Well Aware
45 32 Unaware 98 36 Well Aware
46 34 Well Aware 99 28 Unaware
47 17 Unaware 100 40 Well Aware
48 13 Unaware 101 39 Well Aware
49 36 Well Aware 102 36 Well Aware
50 36 Well Aware 103 40 Well Aware
51 36 Well Aware 104 36 Well Aware
52 34 Well Aware 105 40 Well Aware
53 37 Well Aware 106 34 Well Aware
(Source: Authors’ compilation, 2023)

Total Score = 3581

Mean = 33.7830
The analysis ascertained that 78 students out 106 are well aware of telemedicine which is around
74%. Rest of the 29 are unaware as their score lies below the average level and it is around 26%.

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4.5 Relative Importance Index (RII)
The Relative Importance Index (RII) is a numerical representation of the importance of different
factors related to the perception and usage of telemedicine. In this specific dataset, factors such
as comfort in using telemedicine, concerns about quality, trust in diagnosing accuracy, security
and privacy confidence, patient-doctor relationships, and others have been evaluated. The RII
values have been calculated in table 4.4 based on the importance ratings assigned by
respondent’s responses. A higher RII value indicates greater perceived importance. The formula
for calculating relative importance index along with its value for the concerned variables are
given below:
…………………………………………. (1)
ΣW
RII =
( A∗N )
Where,
RII = Relative Importance Index
W = Is the Weight given to each factor by the respondent and ranges from 1 to 5.
A = Is the highest weight
N = Is the total number of respondents

Table No. 4.3: Relative Importance Index (RII)

Perception and Usage of Telemedicine RII Importance
Comfortable of using telemedicine 0.745283 5
Concern about the quality 0.777358 3
Varying degrees of comfort of using telemedicine 0.79434 1
Trust on the accuracy of diagnosing 0.720755 8
Confidence on security and privacy 0.716981 9
Strong patient-doctor relationship 0.724528 6
Providing comparable level of care to in-person visits 0.722642 7
Suitable alternative for routine check-ups 0.769811 4
Reliable internet connectivity 0.784906 2
(Source: Authors’ compilation, 2023)

Here in table no. 4.3, "Varying degrees of comfort of using telemedicine" received the highest

15
RII and is ranked as the most important factor, suggesting that respondents prioritize comfort
when using telemedicine. Conversely, "Confidence on security and privacy" received the lowest
RII, indicating it is considered less crucial. These RII values and rankings provide valuable
insights into how individuals perceive and prioritize aspects of perception and usage of
telemedicine, which can inform healthcare providers and policymakers when implementing and
improving telemedicine services.

4.6 Telemedicine Utilization

The facilities of telemedicine are given using various medium. The common services of
telemedicine are appointment, test, report sharing, doctor’s consultation etc. and these services
are generally given through audio call, video call, apps and SMS. A table has been generated on
the basis of student’s responses regarding this. It is given below in table 4.4:

Table No. 4.4: Telemedicine Utilization

Medium Audio Call Video Call Apps SMS
Service
Type
Appointment 54 (42.86%) 8 (6.35%) 22 (17.46%) 42 (33.33%)
Test 7 (10.14%) 27 (39.13%) 25 (36.23%) 10 (14.49%)
Report Sharing 9 (9.47%) 23 (24.21%) 33 (34.74%) 30 (31.58%)
Doctor Consultation 36 (26.28%) 50 (36.50%) 27 (19.71%) 24 (17.52%)
(Source: Authors’ compilation, 2023)

This table provides a quantitative breakdown of healthcare service types distributed across
different communication mediums, offering insights into how healthcare services are delivered
and preferred by patients. Notably, "Appointment" services are prevalent across all mediums,
with audio calls (42.86%) and SMS (33.33%) being the primary channels for such appointments.
"Doctor Consultation" is another commonly provided service, especially through video calls
(36.50%), highlighting the increasing use of video communication in healthcare. "Report
Sharing" finds a substantial presence through apps (34.74%) and SMS (31.58%). Meanwhile,
"Test" services are frequently conducted via video calls (39.13%) and apps (36.23%). This data

16
underscores the diverse ways in which healthcare services are accessed, with varying preferences
for communication mediums across different service types, potentially reflecting patient needs
and technological capabilities in the healthcare sector.

4.7 Impact on Healthcare Utilization

This table presents quantitative data on the impact of various factors on healthcare utilization,
along with their weighted mean values and descriptive values. The weighted mean values
represent the average ratings given to each factor, with higher values indicating a more positive
impact. The formula for calculating weighted mean is given below in table 4.5:

…………………………………………. (2)

Where, W = weighted average

n = number of terms to be averaged
wi = weights applied to x values
Xi = data values to be averaged

Table No. 4.5: Impact on Healthcare Utilization

Impact on Healthcare Utilization Weighted Mean Descriptive Value
Reliable information 3.698113208 Agree
Consume less time in consultation 3.933962264 Agree
Cost effective 3.858490566 Agree
Immediate response of specialist 3.650943396 Agree
Convenient follow up and procedure 3.773584906 Agree
Opinion of more than one doctor 3.91509434 Agree
24/7 access specialist 3.641509434 Agree
Reducing unnecessary visits to hospital 3.943396226 Agree
Easy scheduling and talking 3.877358491 Agree
Patient satisfaction 3.688679245 Agree
Composite mean 3.798113208 Agree
(Source: Authors’ compilation, 2023)
Here in this table, "Reducing unnecessary visits to the hospital" has a high weighted mean of
3.943, suggesting that respondents consider it highly beneficial for healthcare utilization. The
17
descriptive values indicate a general agreement among respondents, with all factors receiving an
"agree" rating. This collective agreement signifies that respondents perceive these factors as
positively influencing healthcare utilization. The composite mean, which averages all the factors,
is 3.798, further emphasizing the overall positive perception of these factors in relation to the
impact of healthcare utilization. In summary, this table provides a quantitative assessment of the
perceived impact of specific factors, indicating that respondents believe these factors are
beneficial and contribute positively to healthcare utilization.

4.8 Technological Difficulties of Telemedicine

Telemedicine is a rapidly growing field of healthcare that allows patients to receive care from
their providers remotely, using video conferencing and other technologies. While telemedicine
offers many benefits, it also faces a number of challenges, including technological difficulties.
The respondents were asked about the difficulties that they face while using telemedicine. On the
basis of their responses a histogram has been plotted. It is in figure 4.4 which is given below:

Figure No. 4.4: Technological Difficulties of Telemedicine

Technological Difficulties of Telemedicine

60
50
Frequency

40
30
20
10
0

(Source: Authors’ compilation, 2023)

It can be seen from the histogram, the most common technological difficulty for telemedicine is
internet connection which is faced by 55 students. Another common technological difficulty for
telemedicine is the complexity of the devices and platforms used. About 17 students face this
difficulty. Additionally, some students may not have the digital literacy skills necessary to use

18
telemedicine devices and the number of this student is around 8. Finally, 26 students do not have
access to the necessary devices for telemedicine, such as smartphones, tablets, or computers.
Technological difficulties can have a significant impact on the quality and effectiveness of
telemedicine care.

4.9 Legal and Regulatory Barriers

There are some barriers for the further development of telemedicine. These barriers can be in
various forms. The authors have gathered data related the barriers from the students focusing on
four common difficulties. It can be seen in the figure 4.5 given below:

Figure No. 4.5: Legal and Regulatory Barriers

Legal and Regulatory Barriers

48
Frequency

24
19
15

(Source: Authors’ compilation, 2023)

This graph shows the frequency of legal and regulatory barriers of telemedicine. The most
common legal and regulatory barriers to telemedicine are licensing and credentialing. About 48
students identify this as the major barrier. Other barriers are public perception and acceptance
(24), medical malpractice (19), and privacy and security (15).This graph suggests that legal and
regulatory barriers are a significant barrier to the use of telemedicine. Addressing these barriers
will be essential to making telemedicine more accessible and effective.
4.10 Future Preferences of Telemedicine
Telemedicine will become more popular medium of taking healthcare services in coming times.
Students are very optimistic about the future prospects of telemedicine. By minimizing the
19
current difficulties of using telemedicine, it has the potential for further growth. The students
have expressed their views on the future preferences of telemedicine. It can be seen in figure 4.6.

Figure4.6: Future Preferences of Telemedicine

Future Preferences of Telemedicine

Tool in disaster response
Sum of Strongly
Disagree
Primary mode of consultation
Sum of Disagree

Government support Sum of Neutral

Reduce healthcare disparities Sum of Agree

Sum of Strongly
Medical records agree

0% 50% 100%

(Source: Authors’ compilation, 2023)

This graph shows the future preferences of telemedicine, according to the number of people who
are willing to use it. About 74% of the respondents believe that telemedicine will become a
primary tool in disaster response. 81% of the students have agreed with the concept of
telemedicine being primary mode of consultation. Again 72% of the respondents believe that
telemedicine will get support from the government for further development. Telemedicine will
reduce healthcare disparities and will help to keep a good medical record, 72% and 69% students
have agreed with this idea. Overall, the graph suggests that there is a strong preference for
telemedicine in the future.

Chapter Five

Findings and Recommendations

20
5.1 Findings
This study focuses on Khulna University’s students’ perception and use of telemedicine on
healthcare utilization. The main finding of this study is that the telemedicine platform is
acceptable and usable to students, proved with the minimum and slight difference between the
average scores of each students and the combined mean. About 78 students out of 106 are well
aware of telemedicine facility. Meanwhile, comfort of using telemedicine is given the most
priority by the students when it comes to measure the awareness regarding telemedicine.
Uses of various medium can be seen for different services of telemedicine. Audio call has been
used most of the times for appointment. On the other, video call has been used most of the times
for both test and doctor’s consultation. Most of the reports have been shared through the use of
apps. The weighted mean is calculated for variables like reliable information, consume less time
in consultation, cost effectiveness and patient satisfaction under the impact on healthcare
utilization. Now, the composite mean of impact on healthcare utilization is 3.798. Descriptive
value against this composite is “agree”. It emphasizes an overall general positive perception of
the students regarding the impact. Among various difficulties “internet connection” is the most
important one. Because most of the students face problems related to internet connectivity while
using telemedicine. It has been seen that “privacy and security” is considered as the most
common barrier for the further development of telemedicine.
For future preferences, students are very optimistic about the future of telemedicine. The
percentages of “agree” for variables like key tool in disaster response, primary mode of
consultation, government support are very high. Since these variables are the determinants of the
future preferences of telemedicine, it gives a positive scenario. Today, most students considered
telemedicine platforms as an accessible and convenient way to receive healthcare services.

5.2 Recommendations
Based on the findings from this study, the following recommendations are made:
1. There is need for basic telecommunication devices and a strong internet communication
system in order to facilitate the use of telemedicine application and system.

21
2. Students need to be acquainted with the existence of this healthcare facility through modern
technology.
3. Health communication professionals should devise methods of approaching educational
institution to encourage them to integrate basic knowledge about telemedicine into their
programs that instruct the students on the most commonly used forms of telemedicine and the
forms likely to be used in the future.
4. Privacy and security of telemedicine needs to be increased for future development.
5. The surveyed Khulna University should embark on drastic development of telemedicine in
line with global trend in order to promote effective utilization of telemedicine services.

5.3 Conclusion
This study aimed to analyze the perception and utilization of telemedicine among Khulna
University students, with a focus on its impact on healthcare utilization patterns. The study found
that the telemedicine platform is acceptable and usable to students, and that they are well aware
of the telemedicine facility. A total of 106 students from Khulna University were chosen as the
sample for this study. The author collected sample through purposive sampling method and
sampling unit is all students currently enrolled at Khulna University. The study recommends
improving internet connectivity, addressing privacy and security concerns, providing financial
incentives to healthcare providers, and increasing awareness of telemedicine to promote its use.
These policies would make telemedicine more accessible and affordable, leading to increased
utilization and a number of benefits, including reduced costs, improved access, and reduced
travel time and inconvenience for patients. Telemedicine has the potential to revolutionize
healthcare delivery. By implementing the recommended policies, governments and other
stakeholders can help to ensure that everyone has access to high-quality healthcare services.

22
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 Appendix
Questionnaire for Survey
Group: D
(211501, 211504, 211506, 211513, 211515)
Perception and Use of Telemedicine on Healthcare Utilization
among Khulna University Students
(Your responses will be kept confidential and will only be used for research purposes)

Sample No.: __________ Location: ______________________________ Date:

Section A: Respondent’s Personal Profile

A.1. Age (in Years) : ______________________________
A.2. Gender : ☐ Male ☐ Female
A.3. Marital Status : ☐ Married ☐ Unmarried
A.4. Highest Level of Education : ______________________________
A.5. Credit Access : ☐ Yes ☐ No
A.6. Income (BDT per month) : ______________________________
A.7. Expenditure (BDT per month) : ______________________________

Section B: Household Information

B.1. Number of Family Members : ______________________________
B.2. Number of Earning Members : ______________________________
B.3. House Ownership : ☐ Own ☐ Rent
B.4. Number of Educated Persons in Family : ______________________________
Section C: Study-related Questions

C.1 Basic Questions Regarding Telemedicine

C.1.1. How did you come to know about telemedicine?

a) Peer group
b) Parents
c) Friends
d) Online platform
C.1.2. Your device for using telemedicine?
a) Phone
b) Laptop
c) Smart Watch
d) Other Digital Devices
C.1.3. Your frequency of using telemedicine in last six
months______________________________

vi
C.1.4. You prefer to use telemedicine to consult.
a) When you are diagnosed with severe health issues
b) When you were diagnosed with mild health issues
c) For regular check up
d) For psychological assistances

C.2 Perception and Usage of Telemedicine

Questions Measurement
1 2 3 4 5
C.2.1. I am comfortable with the idea of using telemedicine for my
healthcare needs.
C.2.2. I have concerns about the quality of care provided through
telemedicine.
C.2.3. Different age groups might have varying degrees of comfort with
using telemedicine.
C.2.4. I trust that healthcare professionals can accurately diagnose
medical issues through telemedicine.
C.2.5. How confident are you in the security and privacy of your medical
information when using telemedicine platforms?
C.2.6. A strong patient-doctor relationship can be established via
telemedicine.
C.2.7. I believe telemedicine can provide a comparable level of care to in-
person visits.
C.2.8. Telemedicine can be a suitable alternative for routine check-ups
and minor health concerns.
C.2.9. Lack of reliable internet connectivity might limit the effectiveness
of telemedicine.
Total Score (Out of 75)
NB: (1=Strongly Disagree, 2=Disagree, 3=Neutral, 4=Agree, 5=Strongly Agree)

C.3 Impact of Healthcare Utilization

Measurement
Questions
1 2 3 4 5
C.3.1. Information provided by doctors is reliable
C.3.2. Consume less time in medical consultation and treatment
C.3.3. Cost effective
C.3.4. Immediate response from specialist
C.3.5. Follow up and procedure become more convenient
C.3.6. Opinion of more than one doctor is possible
C.3.7. Providing 24/7 access to specialist
C.3.8. Telemedicine helps in reducing unnecessary visits to

vii
 hospitals
C.3.9. Scheduling appointments and talking to healthcare
providers become easy
C.3.10. Patient satisfaction
Total Score (Out of 50)
NB: (1=Strongly Disagree, 2=Disagree, 3=Neutral, 4=Agree, 5=Strongly Agree)
C.4 Telemedicine Utilization
Types of Appointment Test Report Sharing Doctor Consultation
Services
C.4.1. Audio Call
C.4.2. Video Call
C.4.3. Apps
C.4.4. SMS

C.5 Challenges regarding the uses of telemedicine

C.5.1. The technological difficulties you face:
a) Internet connection
b) Complex functions of device
c) Unavailability of necessary devices
d) Digital illiteracy
C.5.2. What legal and regulatory barriers exist for the uptake of telemedicine?
a) Medical malpractice
b) Licensing and credentialing
c) Privacy and security
d) Public perception and acceptance
C.5.3. Do you think there is a risk of misdiagnoses in telemedicine consultation?
a) Yes
b) No
C.5.3.1. If yes, what are the risks risk of misdiagnoses in telemedicine consultation?
a) Limited physical examination
b) Technology limitations
c) Diagnostic accuracy
d) Medication prescription challenges

C.6 Future Preferences

viii
 Questions 1 2 3 4 5
C.6.1. Telemedicine will become the primary mode of initial
medical consultations in the coming years.

C.6.2. Telemedicine will play a significant role in reducing

healthcare disparities between urban and rural areas.
C.6.3. Telemedicine will become a vital tool in disaster response
and remote medical assistance.
C.6.4. Telemedicine will enable patients to have more control
over managing their health and medical records.
C.6.5. I believe telemedicine will receive increased government
support and investment in the coming years.
Total Score (Out of 25)

(Thank you for participating in this survey. Your feedback is very valuable in helping us better
understand the effects of telemedicine on healthcare utilization.)

Surveyor Signature
Date

ix