Assessing Telehealth Readiness and Contributing Factors Among Nurses and Nurse Managers in Saudi Arabia: A Cross-Sectional Study
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Date
2025
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Alzarqa University
Abstract
Abstract
Background: Telehealth is increasingly essential in modern healthcare, improving
access and quality, particularly in rural regions like Aljouf, kingdom of Saudi
Arabia (KSA). Therefore, understanding the factors influencing telehealth
readiness is crucial for its successful implementation.
Aim: This study aims to assess telehealth readiness among nurses and managers at
Aljouf Hospitals, KSA and identify key predictors that influence telehealth
readiness.
Methodology: A descriptive cross-sectional correlational study was conducted
with 153 nurses and managers from Aljouf Hospitals. Data were collected using
the Telehealth Readiness Assessment Tool (TRAT).
Results: A total of 163 nurses and managers participated. The mean total
telehealth readiness score was 4.17 (SD = 0.90), indicating a high level of overall
readiness. Among the subscales, structural readiness scored the highest (M = 4.20,
xv
SD = 0.90), followed by engagement (M = 4.19, SD = 0.95) and core readiness (M
= 4.10, SD = 0.99).. Readiness scores significantly differed by variables including
marital status, education, telehealth training, usage frequency, and organizational
support (p < .05). Correlation analysis revealed strong positive relationships among
readiness subscales with age. Multiple regression identified age, experience, and
income as significant predictors of telehealth readiness (p < .05), explaining up to
93.5% of the variance in total readiness.
Conclusion: The findings reveal a high level of telehealth readiness among nurses
and managers in Aljouf hospitals, with structural factors and engagement emerging
as key strengths. Organizational support, individual experience, and prior training
significantly influenced readiness. These insights highlight the importance of
targeted training, supportive infrastructure, and policy alignment to optimize
telehealth implementation in similar healthcare settings.
Keywords: Telehealth readiness, nurses, managers, Saudi Arabia, healthcare
technology, cross-sectional study, predictors.
Description
The field of medicine has traditionally relied on conventional methods of
delivering care, characterized by face-to-face interactions between healthcare
providers and patients (Guo et al., 2023; Wubante et al., 2022). Nurses, who are
integral to healthcare systems, engage in a systematic approach (nursing process)
that includes assessment, diagnosis, planning, implementation, and evaluation,
ensuring that patient care is delivered effectively and efficiently (Shiferaw et al.,
2020). However, with the rapid advancement of technology, the process of
healthcare delivery has undergone a significant transformation, leading to the
emergence of telehealth as a modern approach to medical care (Mantaleon, 2023).
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Telehealth, defined as the use of digital information and communication
technologies to access and manage healthcare services remotely, has evolved
significantly over the past few decades (WHO, 2021; Kruse et al., 2018). Initially
conceived as a means to provide care in remote areas, telehealth has expanded its
scope and capabilities, integrating into various healthcare systems worldwide,
particularly in response to the global challenges posed by the COVID-19 pandemic
(Scott Kruse et al., 2018; Gagnon et al., 2016). It enables the provision of medical
care, health education, and information exchange between healthcare providers and
patients, regardless of their physical location. Telehealth facilitates real-time
consultations, diagnostics, and treatment, particularly for those in remote or
underserved areas, improving access to healthcare services (WHO, 2021; Kruse et
al., 2018).
Globally, the telehealth market is expected to reach 559.52$ billion by 2027,
growing at a compound annual growth rate (CAGR) of 25.5% from 2020 to 2027
(GrandViewResearch, 2021). In high-income countries such as the United States,
telehealth usage increased from less than 1% of outpatient visits in 2019 to nearly
38% during the peak of the pandemic in 2020 (Shaver., 2022). Similarly, in
Europe, telehealth consultations in Germany rose significantly in 2020, particularly
in rural areas where healthcare access is limited (Wong et al., 2021). Regionally, in
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the Middle East, countries like the United Arab Emirates and Saudi Arabia have
adopted telehealth as part of national healthcare strategies, with the telehealth
market in the Gulf Cooperation Council (GCC) countries projected to grow at a
CAGR of 29% between 2021 and 2027 (GrandViewResearch., 2022). In Saudi
Arabia, telehealth services have been integrated through initiatives such as the 937
Virtual Medical Call Center and Seha Virtual Hospital. The 937 Call Center
provides round-the-clock consultations, having serviced more than 3 million calls
during the COVID-19 pandemic alone (Al-Wathinani et al., 2024). Locally in
Aljouf, the process of adopting telehealth is still pretty new and it is at the
beginning phases. and the digital infrastructure which isn’t really developed
enough yet. Additionally, Many healthcare providers still lack full readiness and
training in using the technology. While initiatives under Saudi Vision 2030 are
promoting modernization and improved access, significant progress is still needed.
telehealth helps improve access to medical services especially for people
who live far away from big hospitals or who can’t easily travel to see a doctor
(Scott Kruse et al., 2018; Gagnon et al., 2016), and also it saves money when
budgets are tight and healthcare costs are rising (Al-Wathinani et al., 2024), and it
actually improves patient outcomes especially when there is shortage of doctors
and nurses in rural areas or small clinics (May et al., 2021; Almuqati et al., 2023).
Germany they started doing video calls instead of regular visits for nursing homes
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which helped with keeping communication going and continuing care even with
limited number of physicians (May et al., 2021). Similarly in the united states
(U.S.) during COVID telehealth was used in many places in managing chronic
diseases like heart failure and diabetes (Birkhoff et al., 2021). Moreover, in
Ethiopia health care providers used telehealth to get over the barriers that stop
people from getting proper medical help despite poor internet and low digital
literacy (Wubante et al., 2022; Butta et al., 2023).
Now, nurses are the ones who do so much of the actual work when it comes
to using telehealth in a real-life healthcare setting.they assess the patients, teach
them what to do, monitor progress, and make sure everything gets coordinated
properly which makes them a big part of why any telehealth program succeeds or
fails (Al-Wathinani et al., 2024; Godfrey et al., 2021), like in the Philippines
nurses were asked about using the online medication system used in a telehealth
hospital and they gave really important feedback about how user-friendly it was
and what could be better, proving how essential their opinions are when designing
these tech systems (Floresca et al., 2022), and even in U.S. schools nurses had a
big role in helping students with asthma through a school telehealth program and it
was their views that helped shape how the program worked and whether it was
seen as useful or not (MacGeorge et al., 2022)
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Readiness, as we defined it in the context of this study and as explained in
earlier research, is not just about knowing how to click buttons on a screen, it’s
about whether or not the healthcare worker is mentally, emotionally, and
professionally prepared to actually implement telehealth in their day-to-day job
and that includes their attitudes engagement , and whether or not the systems they
work in actually have the tools and infrastructure needed to support it (Jennett et
al., 2003), and if that readiness isn’t there then you’re going to see a lot of
problems in delivering care or keeping up quality standards (Ranjbar et al., 2021;
Chang et al., 2021).
Nurse readiness for telehealth is all over the place and varies a lot depending
on the country or even the city or hospital. which influenced by tech infrastructure
kind of training the nurses got, and whether their organization is actually
supporting them in this shift or just expecting them to figure it out on their own
(Alshammari et al., 2024; Bartosiewicz et al., 2021). As well as in China there was
a study that looked at how ready clinical nurses were to use telehealth and it
showed that while they were kind of ready in a general sense, there were still major
gaps in areas like structural readiness like policies, leadership, and system design
and those gaps were especially big among nurses with less experience or lower
professional rank (Yu-Tong et al., 2022) so clearly there’s still work to be done.
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Similarly, in Poland, nurses' attitudes towards e-health solutions and selfassessment of information technology (IT) competence have highlighted the need
for additional training to enhance digital skills, particularly among older nurses and
those in primary healthcare settings (Bartosiewicz et al., 2021). In the United
Kingdom, the readiness of general practice staff for digital technologies, including
telehealth, has been found to be higher among younger staff and those in larger
urban practices, emphasizing the role of demographic and organizational factors in
telehealth readiness (Hammerton et al., 2022).
In Saudi Arabia, nurses are staring actually implement and engage with
telehealth systems, it really depends on factors like how familiar they are with
technology in generalwhich ties into digital literacy,and whether or not the hospital
or health center they work at is giving them the support they need, both in terms of
leadership encouragement and also having the actual tech infrastructure in place to
let them use telehealth tools properly (Alzahrani et al., 2022; Alqurashi et al.,
2023), and for instance there was this study done during the height of the COVID19 pandemic that showed healthcare providers were ready, like their scores were
moderate to high in terms of readiness, but still there were some big problems,
mostly related to not having enough digital tools or facing financial barriers that
made it hard to move forward smoothly (Moussa et al., 2023). In contrast , during
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COVID 19 , The health care run around 937 Virtual Medical Call Center which
has been running successfully in Saudi Arabia and has apparently made a real
difference in terms of making healthcare more accessible and keeping patients
happier with the services they receive (Al-Wathinani et al., 2024). In Aljouf where
the infrastructure isn’t as strong and training opportunities are limited, there is a
need to investigate the readiness for telehealth
Keywords
Telehealth readiness, nurses, managers, Saudi Arabia, healthcare technology, cross-sectional study, predictors.