For the purpose of this study, telemedicine is defined as the “. . .use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health, and health administration. Technologies include video-conferencing, the internet, store-and-forward imaging, streaming media, and wireless communications.”1 Tele-medicine is the integration of technology into health care delivery through a variety of methods with resulting benefits to both providers and patients.2 Telemedicine can be used to improve efficiency and cost in many functions of the modern health care system.3,4 It can be used to monitor chronic injury and illness3 or provide rehabilitation,5 health education,6 and the necessary self-care instructions after receiving outpatient care.7 It can also be used to allow patients to network with different health care providers and specialists as a means of performing remote postoperative follow-up for minor conditions and performing general health and wellness screenings.5,8 Telemedicine can occur as videos, web-based interactions, telephone calls, email exchanges, and short- and multi-media messages.8,9 Typically, the use of telemedicine leads to high satisfaction for both the provider and the patient receiving the services, with no reported negative impact on clinical outcomes.2,10
Athletic trainers provide primary care to active patient populations in a variety of settings and serve valuable roles in reducing health care costs to organizations and patients, improving population health through wellness education and chronic injury management. Telemedicine could be integrated during primary care evaluation, diagnosis, treatment, and rehabilitation to improve patient access, adherence, and outcomes while maximizing investment in onsite health care providers. With the already evident benefits and possibilities, there is a need to understand the knowledge and use of tele-medicine as an athletic trainer.
The knowledge other health care providers have of telemedicine is lacking.10,11 An examination of 532 clinicians including nurses, general physicians, specialty physicians, and dentists working for hospitals and clinics revealed that 96.1% had limited knowledge of telemedicine.11 When specialist physicians in the United States were asked about their telemedicine knowledge, 18.59% of users and 58.93% of non-users reported not knowing enough about telemedicine and how to apply it in their clinical practice.10 The study also found clinician exposure to telemedicine led to behaviors closely associated with properly integrating telemedicine into their practice.10 Identifying the relationship among exposure to technology, perceived knowledge, perceived benefits, and threats to telemedicine integration can help health care executives and leaders develop educational content aimed at enhancing telemedicine delivery. As a result of enhanced telemedicine delivery, the overall health care may improve. Additionally, creating exposure opportunities for future clinicians may improve behaviors associated with their adoption and integration of telemedicine into clinical practice.10 Therefore, this study aimed to examine the perspectives athletic trainers have of telemedicine and compare these results to their self-identified status as a user or non-user of telemedicine.
Study Design and Participants
We used a cross-sectional survey design through a web-based platform (Qualtrics, Inc). We recruited 5,666 members of the National Athletic Trainers' Association (NATA) who were identified as credentialed athletic trainers. From the 5,666 email addresses, 628 individuals (11.08% access rate) opened the link to the survey, with 569 of those responding to at least one item in the survey (90% completion rate). We excluded responses from those participants who did not consent to participate (n = 16) and who were not credentialed athletic trainers (n = 7). For the purposes of the study, we also excluded participant responses if less than 50% of the entire survey was completed (n = 34). The final sample size was 512 participants (mean age = 37.5 ± 11.3 years) for the data analysis. We identified approximate groups for telemedicine users (n = 214; 41.8%) and non-users (n = 298; 58.2%). Participant demographics are provided in Table 1.
The research team adopted a valid and reliable tool to examine health care providers' knowledge and agreement with concepts relative to telemedicine.11 The tool verbiage was adapted to reflect athletic trainers exclusively; as such, provider descriptors such as “physician” were replaced with “athletic trainer.” The tool contained 39 prompts split into six domain subscales, including the perceived advantages (7 prompts) and disadvantages (7 prompts), current knowledge level (7 prompts), perceived necessity (6 prompts), perceived security (6 prompts), and perceived ease-of-use of tele-medicine (6 prompts). The domains for advantages, disadvantages, perceived security, and ease-of-use used a 5-point Likert-style scale measuring agreement (5 = strong agree; 4 = somewhat agree; 3 = neither agree or disagree; 2 = somewhat disagree; 1 = strongly disagree) and the domains for knowledge and necessity used a separate 5-point Likert-style scale measuring intensity (5 = a great deal; 4 = a lot; 3 = a moderate amount; 2 = a little; 1 = none at all).
After approval from the Institutional Review Board at Indiana State University, recruitment emails were sent to credentialed members of the NATA that contained information about the study and a link to the survey instrument, which was housed in a secure web-based survey system. After electronically signing the informed consent, participants entered the survey, which consisted of demographic information, self-identification as a user or non-user of telemedicine based on a provided definition in Table 2, and the valid and reliable tele-medicine knowledge tool. A reminder email was sent to all participants every week for 5 weeks after the initial invitation between July and August 2019.
User and Non-user Values for All Items
The data were analyzed for both individual items (descriptive statistics) and subscale scores (descriptive and interferential statistics). Measures of central tendency (mean, mode, standard deviation, and frequencies) were calculated, when appropriate, for participant demographics, user/non-user status, and then individually for the 39 prompts from the instrument and the six summary subscales. Next, we completed six univariate analyses of variance (ANOVA) tests to examine the six subscale mean scores (subscales: advantages, disadvantages, knowledge, necessity, security, and ease-of-use) compared to one factor (self-identified users and non-users of telemedicine). The Levene statistic for homogeneity identified that the groups (telemedicine user status) were approximately equal for each of the six sub-scales, meaning non-parametric analysis was not warranted. The univariate ANOVA tests were completed for participants who answered all questions within each subscale. Data analysis was completed using SPSS software (version 26; IBM Corporation) with an a priori significance level set at an alpha value of 0.05 or less.
Most participants agreed with the advantages and disagreed with the disadvantages of telemedicine. Athletic trainers responded that they lacked knowledge and familiarity with telemedicine, yet were able to identify a necessity and ease-of-use for the technology delivery system. Finally, participants strongly agreed with the need for a framework including policy and legal clarifications on the security scale items. The means and standard deviation for all 39 prompts organized by subscale are provided in Table 2 for the total sample of respondents and by group status (user and non-user).
Perceived Advantages and Disadvantages
Overall, most participants responded they agreed with the seven prompts related to the advantage sub-scale. The highest agreement was that telemedicine would benefit health care practices (mean = 4.37 ± 0.69) and the lowest agreement was that telemedicine provided fast and better medical care (mean = 3.30 ± 0.95). On the disadvantage domain subscale, the athletic trainers reported an overall disagreement with the presented barriers in the statement, meaning they did not feel the statement was an issue for them. We identified that regardless of previous telemedicine use, participants disagreed that telemedicine causes psychological harm to patients (mean = 1.90 ± 0.85).
Current Knowledge and Perceived Ease-of-Use
Participants lacked familiarity with telemedicine tools (mean = 2.08 ± 0.67) and had very little knowledge about telemedicine application in other countries (mean = 1.30 ± 0.64). However, athletic trainers reported that continuous training was moderately necessary in athletic training (mean = 3.03 ± 1.18). Overall, clinicians agreed ease-of-use related to technology and efficiency was important for telemedicine implementation (mean = 3.99 ± 0.81). Most agreed an easy-to-use software program was important (mean = 4.04 ± 0.79). There was moderate agreement that ease-of-use of telemedicine increased a clinician's skills (mean = 3.24 ± 0.99).
Perceived Necessity and Security
Overall, perceived necessity of telemedicine in clinical practice was moderate to strong. Most participants agreed with the necessity of implementing national standards as an essential component of telemedicine practice (mean = 3.92 ± 1.05); however, several participants noted telemedicine was not necessary for patient care (mean = 2.69 ± 0.95). The perceived importance of security was very high with a strong mutual agreement that a framework to prevent breaking data confidentiality when using telemedicine was necessary (mean = 4.85 + 0.44) and policies relative to clinical practice guidelines are key for athletic trainers (mean = 4.78 + 0.50).
User and Non-User Subscale Comparisons
The means for user and non-user subscale scores are explored in Table 3. Both telemedicine users (mean = 2.37 ± 0.64) and non-users (mean = 1.86 ± 0.60) self-identified knowledge of telemedicine as their lowest subscale. Although it may appear that perceived disadvantages lacked agreement for telemedicine users, a lower mean for the subscale denoted that the users disagreed with the disadvantages. The users of telemedicine agreed more strongly with the advantages of telemedicine (F1,501 = 29.307, P ≤ .001, η2 = 0.055), strongly disagreed about disadvantages (F1,490 = 41.542, P ≤ .001, η2 = 0.078), had higher knowledge (F1,485 = 78.903, P ≤ .001, η2 = 0.140), found telemedicine simple to use (F1,453 = 23.919, P ≤ .001, η2 = 0.050), and identified a greater necessity for telemedicine (F1,472 = 20.600, P ≤ .001, η2 = 0.042). We did not identify a significant difference between groups for perceived importance of security (F1,463 = 0.064, P ≤ .801, η2 = 0.000), with users and non-users both strongly agreeing about the importance of security.
Subscale Means and Standard Deviations for Users and Non-Users
The results of our study demonstrated athletic trainers who self-identified as users of telemedicine had higher agreement about advantages, had stronger disagreement about disadvantages, had higher knowledge, saw a greater need for telemedicine in practice, and more strongly believed that easy-to-use technology is essential to implementing telemedicine. Those who self-identified as users of telemedicine had overall more positive perspectives of using technology in clinical practice. Athletic trainers with exposure to telemedicine better appreciate the efficiency, necessity, drawbacks, and benefits, while also having greater knowledge about implementing technology into practice. We believe these differences between users and non-users were a result of clinicians overcoming barriers to use, which in turn improved intention to use and positively influenced perceptions in favor of telemedicine. The two primary barriers to tele-medicine use are technical challenges and a resistance to change12 that may be overcome through training and exposure. Similar to development with technical skills, such as taking blood pressure and working effectively on a health care team, experiential repetition allows clinicians to be more successful with implementation, which results in a greater intention to use in clinical practice.12 Repetition improves skill performance, which, in the context of telemedicine, may be exposure and use. Athletic trainers garnering exposure in telemedicine could improve skill development and learn to appreciate the advantages and necessity offered to clinical practice.
Telemedicine Experiences in Other Professions
The results of this study are in line with a similar study examining self-reported knowledge and acceptance of telemedicine benefits in user and non-user specialty physicians.10 Physicians who identified as users were “somewhat knowledgeable” (mean = 2.53/4.00; P < .0001) and non-users were “not at all knowledgeable” (mean = 1.84/4.00; P < .0001), which aligns closely with our results in Table 3 demonstrating athletic trainers who used telemedicine were somewhat knowledgeable contrasted to non-user counterparts.10 Physicians reported current technology use habits as the primary factor related to implementing telemedicine, emphasizing a need to focus on changing habits to incorporate technology.10 According to our results and the study by Barton et al,10 exposure to telemedicine leads to a higher perceived ease-of-use and greater necessity for implementation, which are key predictors for implementing technology in clinical practice.13 Our results demonstrate a mutual agreement between users and non-users that ease-of-use improved clinician skill in delivery of health care that aligns with user and non-user agreement in clinicians from the study our tool was adopted from.11 As a result, effort should be directed toward making telemedicine technology simpler use to maximize outcomes. Our results also align with a previous study by Ayatollahi et al11 that demonstrated the greatest agreement among all clinicians, including users and non-users of telemedicine, was around the importance of security and confidentiality in telemedicine. We believe that this is because security concerns may impede adoption or be a continuous factor for all clinicians when considering telemedicine. Therefore, security and confidentiality are important topics for all and should be discussed to encourage adoption and instilled during training for telemedicine.
Our results suggest both users and non-users have moderate agreement about the necessity for continuous training related to technology in health care. Previous literature suggests medical trainees are familiar with technology, but lack the ability to apply it to patient care and telemedicine,14 which is not ideal for the current health care landscape aimed at molding clinicians to meet the National Academy of Medicine's (NAM) core competencies in health care. Specifically, because athletic training aims to align with the NAM's core competencies, attention should be given to telemedicine as a tool to enhance health care informatics and interprofessional practice.
Our study revealed that users of telemedicine had, on average, 27% greater knowledge of telemedicine as compared to non-users. Based on the findings, we propose integrating telemedicine education during formal professional and post-professional education in conjunction with continuing education. Previous research in a nursing education program that implemented a 1-year faculty development program aimed at improving health care informatics and telemedicine led to an 11% improvement in competency for this domain.15 This demonstrates that exposure to education aimed at health care informatics and telemedicine may allow clinicians with minimal technological experiences to adapt and learn the necessary skills and knowledge to inform other health care providers. Our data support the framework that athletic trainers do have exposure to telemedicine based on the provided definition, but the experiences with telemedicine are inconsistent and ill-defined. As a result, we need to examine how to implement learning that closely aligns with how athletic trainers are accustomed to interacting with technology in today's society.16
To do so, clinicians should have experiential learning opportunities that allow them to gain knowledge or skills through experience.17 These types of opportunities allow learners to engage in telemedicine encounters that may enhance competency and proficiency with the technology, assessment skills, and overall acceptance of telemedicine.17 Experiential learning may occur in the form of observation or hands-on skill development. Through implementation of experiential learning, such as simulations or problem-based discussions, we believe athletic trainers may better appreciate and learn to integrate telemedicine effectively into clinical practice, resulting in more skillful clinicians and a greater quality of health care delivery. We can improve learners' intention to use technology by tailoring education to address perceived usefulness, ease-of-use, and subjective norms by actively integrating technology with learning.13,18 Through interactivity, practice exercises, repetition, and immediate feedback, learners can better achieve learning outcomes19 and enhance perceptions of telemedicine.
Based on our results indicating use improves acceptance of telemedicine, we propose professional and post-professional curricular education focus on experiential learning and high-fidelity simulations for learners to maximize ease-of-use through improved familiarity and use of technology as a compliment to standards of practice. We propose professional and post-professional athletic training programs create opportunities for students to engage in purposeful clinical experiences or shadowing opportunities involving telemedicine. We also suggest programs expose students to telemedicine tools that may be available in clinical practice. Engaging in these active learning environments with low-stakes situations will improve learner attitudes about perceived usefulness and ease-of-use, resulting in a greater likelihood of acceptance in clinical practice.20 We suggest that continuing professional development programs emphasize these learning strategies to necessitate skill development and expand acceptance through more positive attitudes and greater perceived usefulness.
Telemedicine Operating Standards
Both users and non-users in our study indicated a strong mutual agreement for having national standards for telemedicine delivery in place. Specifically, our results indicated no significant difference between users and non-users (P < .801), which demonstrates both groups perceived a necessity for security standards focused around establishing security policies and frameworks to prevent confidentiality breaches. To complement national standards of practice, we suggest tailoring current national educational standards for athletic trainers to incorporate telemedicine. The two areas of focus for our educational recommendations, curricular and continuing education, both currently have national requirements. Additionally, as reflected in Table 2, both users and non-users equally reported a necessity to address security that aligns closely with the American Medical Association, which claims the greatest barrier to implementation is the lack of legal framework between and within states.21 This is supported by our study's data indicating a need for a framework aimed at preventing breaches in data confidentiality. Data confidentiality and technology management are topics that may be covered in both curricular and continuing education as means of learning and applying information related to the Health Information Technology for Economic and Clinical Health Act22 and the Health Insurance Portability and Accountability Act,23 which both have substantial national implications for practicing health care providers.
Telemedicine in Athletic Training
The athletic trainers who identified as users of tele-medicine more strongly agreed that use would lead to improved care, improved access to care for under-privileged and remote populations, and reduced costs associated with unnecessary transportation. These perceptions align closely with the currently identified benefits of telemedicine demonstrating no remarkable negative impacts on patient care outcomes,4 significant cost-effectiveness for patients,3 and reduced travel and increased access to care in rural areas.24 These benefits align with the function of athletic trainers as primary care providers in rural and underserved communities. As a result, we should improve accessibility to exposure opportunities for students and clinicians to overcome technical barriers, improve positive perceptions, and increase widespread intention to use telemedicine.
Limitations and Future Research
Limitations in our study included potentially limited or skewed response rates due to contextual factors because we did not collect information about where athletic trainers learned telemedicine, amount of time using telemedicine, and current level of technological acceptance. Future research may consider examining the perceived impact curricular and continuing education may have in athletic training students and credentialed professionals. This may provide valuable insight into effective strategies for disseminating information about telemedicine. Our study also supports the need to explore secure mechanisms for telemedicine delivery to better protect patient privacy.
Implications for Clinical Practice
Our study suggests athletic trainers with exposure to telemedicine are more likely to have positive perceptions and knowledge of telemedicine. Based on these findings, we suggest developing educational opportunities in both curricular and continuing education to help disseminate information to future and current clinicians about the advantages, disadvantages, and applications of telemedicine in athletic training. Topics covered should emphasize the rationale about why and how to engage in telemedicine with a specific focus on security and strategies for mitigating risks during the delivery of health care in the digital age. As technology develops and access increases, athletic trainers should be on the forefront of telemedicine to closely align with the core competencies of health care and solidify our roles in the modern health care system.
- Health Resources and Services AdministrationFederal Office of Rural Health Policy. 2017. https://www.hrsa.gov/rural-health/telehealth
- Currell R, Urquhart C, Wainwright P, Lewis R. Telemedicine versus face to face patient care: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2000(2). doi:10.1002/14651858.CD002098 [CrossRef]
- Darkins A, Ryan P, Kobb R, et al. Care Coordination/Home Telehealth: the systematic implementation of health informatics, home telehealth, and disease management to support the care of veteran patients with chronic conditions. Telemed J E Health. 2008;14(10):1118–1126. doi:10.1089/tmj.2008.0021 [CrossRef]
- Finkelstein SM, Speedie SM, Potthoff S. Home telehealth improves clinical outcomes at lower cost for home healthcare. Telemed J E Health. 2006;12(2):128–136. doi:10.1089/tmj.2006.12.128 [CrossRef]
- Tousignant M, Boissy P, Moffet H, et al. Patients' satisfaction of healthcare services and perception with in-home telerehabilitation and physiotherapists' satisfaction toward technology for post-knee arthroplasty: an embedded study in a randomized trial. Telemed J E Health. 2011;17(5):376–382. doi:10.1089/tmj.2010.0198 [CrossRef]
- Free C, Phillips G, Galli L, et al. The effectiveness of mobile-health technology-based health behaviour change or disease management interventions for health care consumers: a systematic review. PLoS Med. 2013;10(1):e1001362. doi:10.1371/journal.pmed.1001362 [CrossRef]
- Cugelman B, Thelwall M, Dawes P. Online interventions for social marketing health behavior change campaigns: a meta-analysis of psychological architectures and adherence factors. J Med Internet Res. 2011;13(1):e17. doi:10.2196/jmir.1367 [CrossRef]
- Flodgren G, Rachas A, Farmer AJ, Inzitari M, Shepperd S. Interactive telemedicine: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2015(9). doi:10.1002/14651858.CD002098.pub2 [CrossRef]
- Chi N-C, Demiris G. A systematic review of telehealth tools and interventions to support family caregivers. J Telemed Telecare. 2015;21(1):37–44. doi:10.1177/1357633X14562734 [CrossRef]
- Barton PL, Brega AG, Devore PA, et al. Specialist physicians' knowledge and beliefs about telemedicine: a comparison of users and non-users of the technology. Telemed J E Health. 2007;13(5):487–499. doi:10.1089/tmj.2006.0091 [CrossRef]
- Ayatollahi H, Sarabi FZP, Langarizadeh M. Clinicians' knowledge and perception of telemedicine technology. Perspect Health Inf Manag. 2015;12(Fall):1c.
- Scott Kruse C, Karem P, Shifflett K, Vegi L, Ravi K, Brooks M. Evaluating barriers to adopting telemedicine worldwide: a systematic review. J Telemed Telecare. 2018;24(1):4–12. doi:10.1177/1357633X16674087 [CrossRef]
- Chau PY, Hu PJ-H. Investigating healthcare professionals' decisions to accept telemedicine technology: an empirical test of competing theories. Inf Manage. 2002;39(4):297–311. doi:10.1016/S0378-7206(01)00098-2 [CrossRef]
- Pathipati AS, Azad TD, Jethwani K. Telemedical education: training digital natives in telemedicine. J Med Internet Res. 2016;18(7):e193. doi:10.2196/jmir.5534 [CrossRef]
- Gallagher-Lepak S, Scheibel P, Gibson C. Integrating telehealth in nursing curricula: can you hear me now. Online J Nurs Inform. 2009;13(2):2.
- Rothman D. ATsunami of learners called Generation Z. Public Safety: A State of Mind Online Journal. 2014;1(1). http://www.mdle.net/JoumaFA_Tsunami_of_Learners_Called_Generation_Zpdf
- Henning JM, Weidner TG, Jones J. Peer-assisted learning in the athletic training clinical setting. J Athl Train. 2006;41(1):102–108.
- Ketikidis P, Dimitrovski T, Lazuras L, Bath PA. Acceptance of health information technology in health professionals: an application of the revised technology acceptance model. Health Informatics J. 2012;18(2):124–134. doi:10.1177/1460458211435425 [CrossRef]
- Cook DA, Levinson AJ, Garside S, Dupras DM, Erwin PJ, Montori VM. Instructional design variations in internet-based learning for health professions education: a systematic review and meta-analysis. Acad Med. 2010;85(5):909–922. doi:10.1097/ACM.0b013e3181d6c319 [CrossRef]
- Holden RJ, Karsh B-T. The technology acceptance model: its past and its future in health care. J Biomed Inform. 2010;43(1):159–172. doi:10.1016/j.jbi.2009.07.002 [CrossRef]
- Hjelm NM. Benefits and drawbacks of telemedicine. J Telemed Telecare. 2005;11(2):60–70. doi:10.1258/1357633053499886 [CrossRef]
- Adler-Milstein J, Jha AK. HITECH Act drove large gains in hospital electronic health record adoption. Health Aff (Millwood). 2017;36(8):1416–1422. doi:10.1377/hlthaff.2016.1651 [CrossRef]
- Luxton DD, Kayl RA, Mishkind MC. mHealth data security: the need for HIPAA-compliant standardization. Telemed J E Health. 2012;18(4):284–288. doi:10.1089/tmj.2011.0180 [CrossRef]
- Nesbitt TS, Marcin JP, Daschbach MM, Cole SL. Perceptions of local health care quality in 7 rural communities with telemedicine. J Rural Health. 2005;21(1):79–85. doi:10.1111/j.1748-0361.2005.tb00066.x [CrossRef]
| Secondary schools||166||32.5|
| Professional sports||17||3.3|
| Performing arts||4||0.8|
| Military/law enforcement/government||14||2.7|
| Health/fitness/performance enhancement clinic/clubs||8||1.6|
| Occupational health/industrial||15||2.9|
| Independent contractor||10||2.0|
| Non-binary/third gender||1||0.2|
| Preferred no response||1||0.2|
|Age||37.5 ± 11.3 years|
User and Non-user Values for All Items
|Prompt||Total (n)||Total (Mean ± SD)||User (n)||User (Mean ± SD)||Non-user (n)||Non-user (Mean ± SD)|
|Advantage Subscale: Please rate your level of agreement with the following statements related to telemedicinea|
| Telemedicine offers benefits to health care practices||512||4.37 ± 0.69||214||4.55 ± 0.64||297||4.23 ± 0.71|
| Telemedicine is effective in reducing unnecessary transportation costs||509||4.24 ± 0.82||212||4.35 ± 0.78||296||4.15 ± 0.83|
| Telemedicine is effective in reducing costs of patient care in hospitals||509||4.06 ± 0.82||213||4.16 ± 0.82||295||3.98 ± 0.82|
| Telemedicine influences users' satisfaction||510||3.71 ± 0.77||213||3.87 ± 0.78||296||3.60 ± 0.75|
| Telemedicine saves clinicians' time||510||3.70 ± 0.94||213||3.88 ± 1.03||296||3.58 ± 0.86|
| Telemedicine provides faster and better medical care||506||3.30 ± 0.95||211||3.50 ± 1.00||294||3.17 ± 0.89|
| Telemedicine improves patient care||509||3.56 ± 0.95||213||3.83 ± 0.97||295||3.36 ± 0.89|
|Disadvantages Subscale: Please rate your level of agreement with the following statements related to telemedicinea|
| Telemedicine technology will disrupt athletic trainer-patient relationships||496||2.70 ± 1.03||210||2.40 ± 1.02||285||2.92 ± 0.99|
| Telemedicine technology reduces the effectiveness of patient care||495||2.76 ± 1.00||209||2.44 ± 1.00||285||3.00 ± 0.94|
| Telemedicine technology causes psychological harm to the patient||495||1.90 ± 0.85||209||1.75 ± 0.84||285||2.01 ± 0.84|
| Telemedicine technology endangers patient privacy||495||2.68 ± 1.05||209||2.58 ± 1.04||285||2.74 ± 1.06|
| Telemedicine technology reduces the efficiency of patient care||493||2.45 ± 0.95||209||2.18 ± 0.90||283||2.64 ± 0.94|
| Telemedicine technology increases expenses at hospitals||495||2.30 ± 0.84||209||2.12 ± 0.85||285||2.42 ± 0.81|
| Telemedicine technology increases malpractice in health care||493||2.77 ± 0.90||209||2.62 ± 0.90||283||2.89 ± 0.88|
|Knowledge Subscale: Please rate your educational experience related to the following statements on telemedicinea|
| To what extent are you familiar with telemedicine technology?||491||2.55 ± 0.89||208||2.91 ± 0.80||282||2.29 ± 0.86|
| To what extent are you familiar with medical applications of telemedicine technology?||491||2.33 ± 0.94||208||2.71 ± 0.86||282||2.04 ± 0.89|
| Are conferences, speeches, or meetings held in our workplace regarding telemedicine technology?||489||1.55 ± 0.89||208||1.77 ± 1.03||280||1.39 ± 0.74|
| To what extent are you familiar with telemedicine tools?||491||2.08 ± 0.92||208||2.41 ± 0.89||282||1.83 ± 0.88|
| To what extent are you familiar with telemedicine guidelines?||490||1.71 ± 0.89||207||2.07 ± 0.95||282||1.45 ± 0.74|
| To what extent are you familiar with the use of telemedicine in other countries?||490||1.30 ± 0.64||207||1.36 ± 0.70||282||1.25 ± 0.59|
| To what extent is continuous training in the use of telemedicine necessary in athletic training?||489||3.03 ± 1.18||208||3.33 ± 1.06||280||2.81 ± 1.22|
|Necessity Subscale: Please rate your level of necessity with the following statements related to telemedicinea|
| To what extent is telemedicine technology necessary for patient care?||478||2.69 ± 0.95||200||2.93 ± 0.95||277||2.52 ± 0.92|
| To what extent can telemedicine provide health care to patients in a timely manner?||479||3.52 ± 0.95||200||3.77 ± 0.87||278||3.36 ± 0.97|
| To what extent should new techniques be used along with the current technology?||479||3.51 ± 0.92||200||3.66 ± 0.88||278||3.41 ± 0.93|
| To what extent is telemedicine essential to provide health care to under-privileged and remote areas?||478||3.69 ± 1.00||200||3.80 ± 0.96||277||3.61 ± 1.03|
| To what extent can telemedicine technology provide athletic trainers with instant access to patient information?||475||3.64 ± 1.01||199||3.96 ± 0.91||275||3.41 ± 1.02|
| To what extent are national standards essential for telemedicine technology implementation?||475||3.92 ± 1.05||200||3.94 ± 0.96||274||3.90 ± 1.12|
|Security Subscale: Please rate your level of agreement with the following statements related to telemedicinea|
| Is authorized access necessary for the implementation of telemedicine?||468||4.57 ± 0.69||199||4.57 ± 0.68||268||4.57 ± 0.69|
| Are security policies and guidelines necessary for the use of telemedicine technology?||467||4.78 ± 0.50||199||4.80 ± 0.44||267||4.77 ± 0.55|
| Does telemedicine need to be supported by the medical community?||467||4.42 ± 0.73||198||4.49 ± 0.68||268||4.37 ± 0.77|
| Should a framework be created to prevent breaching data confidentiality when using telemedicine?||468||4.85 ± 0.44||199||4.83 ± 0.44||268||4.86 ± 0.44|
| Does telemedicine technology require legal clarification for patients?||468||4.60 ± 0.66||199||4.55 ± 0.69||268||4.63 ± 0.63|
| Does telemedicine technology require a formulated and clear framework for access to medical information?||466||4.67 ± 0.61||198||4.69 ± 0.53||267||4.66 ± 0.66|
|Ease-of-Use Subscale: Please rate your level of agreement with the following statements related to telemedicinea|
| Does the ease of use of telemedicine technology make it practical for the clinical staff?||454||3.87 ± 0.78||190||4.08 ± 0.74||263||3.72 ± 0.78|
| Do easy-to-understand software programs make it easy for clinicians to apply telemedicine technology?||455||4.04 ± 0.79||191||4.15 ± 0.79||263||3.96 ± 0.79|
| Does easy-to-use telemedicine technology increase the efficiency of clinical users?||455||3.99 ± 0.81||191||4.17 ± 0.76||263||3.87 ± 0.83|
| Does ease of use of telemedicine technology reduce clinicians' errors?||455||3.37 ± 0.97||191||3.55 ± 0.98||263||3.24 ± 0.95|
| Does ease of use of telemedicine technology facilitate its learning?||455||3.85 ± 0.80||191||4.01 ± 0.73||263||3.75 ± 0.84|
| Does ease of use of telemedicine technology increase clinician's skills?||455||3.24 ± 0.99||191||3.48 ± 1.00||263||3.07 ± 0.96|
Subscale Means and Standard Deviations for Users and Non-Users
|Perceived advantages||4.02 ± 0.63||3.72 ± 0.58||≤ .001a|
|Perceived disadvantages||2.30 ± 0.63||2.66 ± 0.62||≤ .001a|
|Current knowledge||2.37 ± 0.64||1.86 ± 0.60||≤ .001a|
|Perceived necessity||3.67 ± 0.66||3.37 ± 0.76||≤ .001a|
|Perceived security||4.65 ± 0.40||4.64 ± 0.47||.801|
|Perceived ease-of-use||3.90 ± 0.64||3.60 ± 0.66||≤ .001a|