Telemedicine and Neurology: A survey of Neurology patients in a Nigerian tertiary hospital

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Yakubu, Oluwakemi Eunice Olalude, Mayowa Sodiq Salami, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3956565/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract BACKGROUND Telemedicine has been recognized as a viable solution for addressing the shortage of medical professionals in developing countries such as Nigeria. Tele-neurology has the potential to provide remote consultations and care for patients with neurological conditions, thereby reducing the burden of travel and improving access to medical care. Despite its growing popularity, there is a lack of research on patient’s view on this mode of care delivery in Nigeria. This study was conducted to investigate patient's perspective on the use of tele-neurology in Nigeria. METHODOLOGY A descriptive cross-sectional study was conducted among 398 neurology patients at Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria. The data obtained were analyzed using descriptive statistics and a chi-square test using p < 0.05 RESULTS Only 3% of our respondents had previously used telemedicine, with 78.1% of the respondents open to using telemedicine as a means of consultation. The disadvantages of telemedicine noted include limitations in assessing neurological status (94.7%), difficulty in explaining health conditions (84.4%), and lack of technical support (14.6%). The majority of respondents (96.5%) believe telemedicine will help in saving time. There was a statistically significant association between propensity to use telemedicine and time spent in the hospital (0.045), and time off work (<0.001). The propensity to use telemedicine was statistically significant to the use of email (0.001) and type of email address (0.001). CONCLUSION The findings suggest that there is a need for healthcare providers and policymakers to invest in developing telemedicine to improve access to care. Teleneurology developing country remote consultation telemedicine telecommunications. INTRODUCTION The field of Telemedicine is one that has become increasingly explored as a means of healthcare delivery particularly since the advent of the COVID-19 pandemic. Due to the lockdown and the need for social distancing, it was imperative for other means of healthcare delivery to be implemented, whilst maintaining and prioritizing patient’s health. Following the onset of the pandemic, a rapid rise in the use of telemedicine was noted, especially in developed countries. Up to 95% of health centers reported using telemedicine as compared with 43% which previously reported capability of providing telemedicine prior to the pandemic [ 1 , 2 ]. The American Academy of Family Physicians (AAFP) defines Telemedicine as the practice of medicine using technology to deliver care at a distance, over a telecommunications infrastructure, between a patient at an originating (spoke) site and a physician, or other practitioner licensed to practice medicine, at a distant (hub) site [ 3 ]. It refers to healthcare delivery or the exchange of health information across distances, and is neither a branch of medicine nor a technology in itself [ 4 ]. Telemedicine as it pertains to neurological diseases was defined by Chirra et al. as an interface in a virtual patient–physician relationship to provide primary and secondary care in neurodegenerative, cerebrovascular, neuro-oncological, and neuroinflammatory disorders; assist the remote management of deep brain stimulation (DBS), transcranial direct current stimulation (tDCS), and infusion pumps; deliver highly specialized visits (telegenetics), diagnostic consultations (teleradiology and telepathology), or rehabilitative programs (telerehabilitation); and monitor motor and nonmotor functions in an ecologically valid environment (telemetry)[ 5 ]. Three main types of telemedicine have been identified which include store and forward telemedicine, remote monitoring and interactive services in real time [ 6 ]. The advent of this method of healthcare delivery opened the door to other possibilities and has persisted even beyond the pandemic as a result of its many benefits to both the healthcare provider and patient. Telemedicine has been found to be particularly useful in providing care to patients who live a far distance from the hospital, in the setting of disasters, and in public health emergencies [ 7 , 8 ]. Physicians have even reported that telemedicine offered much better quality of healthcare as compared with in-person hospital visits [ 8 ]. For patients with chronic diseases who may require long term followup including those with neurological disease which is our focus, telemedicine is believed to provide great benefit leading to improved outcomes [ 9 ]. This method is however still budding in developing countries and needs to be explored even further, as it has great potential for benefit across healthcare delivery in such countries, particularly in decreasing the wide healthcare gap. In this study, we have focused on neurological patients, as neurological conditions contribute significantly to the global burden of disease, and were found to be responsible for almost 10 million deaths and about 349 million disability adjusted life years (DALYs) in 2019[ 10 ].With the poor neurologist to population ratio in Nigeria [ 11 , 12 ] understanding the physician as well as patient view on telemedicine as a resource, especially in the setting of neurological disorders, would help in tailoring its use to their needs, as these patients often require long term care, and this could improve the success of this practice. Although studies on telemedicine and the physician’s perspective abound, there appears to be a paucity of data on the patient’s perspective and experience, particularly in developing countries and in sub-saharan Africa. This study aims to explore the patient’s perspective on the use of telemedicine as it pertains to the field of neurology in Nigeria. We believe that understanding the perception of those receiving healthcare via this means would give better insight on how teleneurology in Nigeria can be structured to encourage its adoption and its benefits to both provider and patient. METHODOLOGY This was a descriptive cross-sectional study conducted among 398 Neurology patients at Olabisi Onabanjo University Teaching Hospital (OOUTH) between June 2023 to October, 2023. The OOUTH is a state owned tertiary institution, formerly Ogun State University Teaching Hospital (OSUTH) located at Sagamu, Ogun State, Southwest Nigeria. The hospital is a prominent tertiary healthcare institution situated in the south-western region of Nigeria, which offers specialized care. The study protocol was approved by the Ethical Committee of the Institute of Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria (Approval number-UI/UCH/23/0499). Data Collection A validated questionnaire developed by Landi D. et al. [ 13 ] was utilized in this study. The questionnaire consisted of 32 questions, categorized into five subsections: 1) Sociodemographic, 2) Access to the hospital, 3) Internet access and use, and 4) Knowledge about telemedicine. A written informed consent was obtained from each participant before administering the questionnaire. A research assistant was recruited to help with administering the questionnaire to the respondents at the neurology outpatient clinic. Data analysis The data was sorted with Microsoft Excel and exported into a Statistical Package for social science 22 for statistical analysis. The data were summarized and presented using frequencies and percentages. Chi-Square was used to determine the association between the variables. RESULTS A total of 398 patients participated in the survey with 100% response rate, with more than half (52.3%) of the respondent’s male, and the majority of them (73.1%), married and Christians (66.3%). 46.4% of respondents were within the 51-70 years’ age range, and 43.2% had completed tertiary education. 61.8% were employed, and a majority (96.5%) earned less than 215 USD. 84.4% of participants did not require assistance with mobility (Table 1).49.5% spent less than an hour to reach the hospital, while 45.2% spent between 5 to 6 hours within the facility during clinic visits. More than half of the participants (64.1%) required an accompanying person during their visits to the hospital. More than half of the participants (65.8%) do not require time off from work (Table 2). Table 1: Socio-demographic characteristics of participants Variables Frequency Percentage (100%) Age (years) 10 – 30 31 – 50 51 – 70 71 – 90 76 94 185 43 19.1 23.6 46.4 10.8 Gender Male Female 208 190 52.3 47.7 Education None Primary Secondary Tertiary Postgraduate 6 26 165 172 29 1.5 6.5 41.5 43.2 7.3 Religion Christianity Islam Traditionalist 264 133 1 66.3 33.4 0.3 Marital status Single Married Divorced Widow 68 291 16 23 17.1 73.1 4.0 5.8 Employment status Employed Retired Unemployed 246 55 97 61.8 13.8 24.4 Income bracket (₦) 0-215 >215 384 14 96.5 3.5 Require assistance No Yes, bilateral assistance Yes, I use wheelchair Yes, unilateral assistance 336 5 8 49 84.4 1.3 2.0 12.3 Table 2: Access to the hospital Variables Frequency Percentage (%) Time required to get to the health facility 6 hours 20 153 180 45 5.0 38.4 45.2 11.3 Employer permission for health facility visit/Time off work No Not working Yes, a day Yes, less than a day Yes, more than a day 262 2 119 11 4 65.8 0.5 29.9 2.8 1.0 Accompanying person Yes No Sometimes 255 90 53 64.1 22.6 13.3 Means of transportation Motorcycle Private car Public buses 77 69 252 19.4 17.3 63.3 Majority (87.7%) of the participants have used the internet, and 42.7% utilized it for medical purposes. The majority (95.7%) had smartphones, and 84.4% had personal email addresses. Video/social media platforms popular among the participants were WhatsApp (91.2%), followed by Zoom (21.9%) and Google Meet (16.3%) Table 3. Only 3% of the respondents had previous experience with telemedicine, and only 5% have heard about it before. Majority of the respondents (78.1%) were open to using telemedicine as a means of consultation. More than half of the respondents (56.5%) preferred teleconsultation to telephone calls. Disadvantages of telemedicine noted include limitations in assessing neurological status (94.7%), difficulty in explaining health problems (84.4%), and lack of technical support (14.6%). Majority (96.5%) believed that telemedicine will help save time. Most participants (76.4%) are open to upload their personal information on the Internet. Only 13.8% believed telemedicine is complete. Situation in which telemedicine could replace hospital visitation include living far from hospital (96.5%), patient with mobility issues (93%), medication change (27.1%) and emergency situation (16.8%). (Table 4) Table 3: Internet access and use Variables Frequency Percentage (%) Use the internet Yes No 349 49 87.7 12.3 Use a digital device (preference) None Personal computer Smart phone Tablet 6 5 381 6 1.5 1.2 95.7 1.6 Use the internet for medical reasons No Yes 228 170 57.3 42.7 Use the email Yes No 306 92 76.9 23.1 Type of email address Friends Personal Relative Work None 5 336 21 7 29 1.3 84.4 5.3 1.8 7.2 Video/social media platform (Multiple entries) WhatsApp Zoom Google meet Teams FaceTime skype None 363 87 65 42 7 13 36 91.2 21.9 16.3 10.6 1.8 3.3 9.0 Table 4: Knowledge about telemedicine Variables Frequency Percentage (100%) Heard of telemedicine Yes No 20 378 5.0 95.0 Previous telemedicine experience Yes No 12 386 3.0 97.0 Evaluation of previous telemedicine experience if any Some connection problems but solved No connection problems Assistance needed 8 2 2 66.8 16.6 16.6 Open to using telemedicine No, not interested Yes, I would like to 87 311 21.9 78.1 Advantages of telemedicine (multiple entry) No accompanying person needed Saves money Saves time 101 311 384 25.4 78.1 96.5 Disadvantages of telemedicine (Multiple entry) Difficult to explain medical/health problems No possibility of assessing neurological status Difficult to use Unreliable Lack of technological support It is expensive 336 377 20 44 58 1 84.4 94.7 5.0 11.1 14.6 0.3 Telemedicine is complete Agree Disagree Neutral 55 78 265 13.8 19.6 66.6 Telemedicine is preferable over the telephone Yes No/not sure 225 173 56.5 43.5 Situations where telemedicine can replace center visit (Multiple entry) Evaluation of medication change Multidisciplinary counselling Patients with mobility issue Patients from far places Evaluation of new symptoms In emergency situations 108 41 370 384 8 67 27.1 10.3 93.0 96.5 2.0 16.8 Open to having your personal information on the internet Yes No Not sure 304 52 42 76.4 13.1 10.5 There was a statistically significant association between propensity to use telemedicine and time off work (<0.001). Average time spent in the hospital had a statistically significant association with propensity to use telemedicine (P-0.045) Table 5. The propensity to use telemedicine was statistically significant to the use of email (0.001) and type of email address (0.001). Table 6 Table 5: Association between Access to the hospital and open to use telemedicine Variables Open to use telemedicine n (%) NO Open to use telemedicine n (%) YES p value Time required to get to the health facility 6 hours 4 (20.0) 29 (19.0) 37 (20.6) 17 (37.8) 16 (80.0) 124 (81.0) 143 (79.4%) 28 (62.2%) 0.045 Employer permission for health facility visit/Time off work No Not working Yes, a day Yes, less than a day Yes, more than a day 74 (28.2) 0 (0.0) 13 (10.9) 0 (0.0) 0 (0.0) 188 (71.8) 2 (100.0) 106 (89.1) 11 (100.0) 4 (100.0) <0.001 Accompanying person Yes No Sometimes 62 (24.3) 17 (18.9) 8 (15.1) 193 (75.7) 73 (81.1) 45 (84.9) 0.097 Means of transportation Motorcycle Private car Public buses 6 (7.8) 18 (26.1) 63 (25.0) 71 (92.2) 51 (73.9) 189 (75.0) 0.433 Table 6: Association between Access to the internet and open to use telemedicine Variables Open to use telemedicine n (%) NO Yes, Open to use telemedicine n (%) YES p value Use the internet Yes No 76 (20.7) 11 (35.5) 291 (79.3) 20 (64.5) 0.056 Use a digital device (preference) None Personal computer Smart phone Tablet 3 (50.0) 2 (40.0) 81 (21.3) 1 (17.0) 3 (50.0) 3 (60.0) 300 (78.7) 5 (83.0) 0.083 Use the internet for medical reasons Yes No 21 (12.4) 66 (28.9) 149 (87.6) 162 (71.1) 0.739 Use the mail Yes No 49 (16.0) 38 (41.3) 257 (84.0) 54 (58.7) <0.001 Type of email address Friends Personal Relatives Work Personal and work None 0 (0.0) 61 (18.2) 3 (14.3) 0 (0.0) 0 (0.0) 23 (79.3) 5 (100.0) 275 (81.8) 18 (85.7) 6 (100.0) 1 (100.0) 6 (20.7) <0.001 DISCUSSION Telemedicine refers to healthcare delivery that entails the exchange of health information across distances and it is neither a branch of medicine nor a technology in itself [ 14 ].It is an emerging means of the practice of medicine with a lot of potential in decreasing the healthcare gap in neglected areas. In this study, we have focused on neurological patients as it is important to assess their perceptions and identify potential factors that may impact the utilization of telemedicine. Nearly all participants (98.5%) have at least primary school education. The level of education has been shown to influence the use of telemedicine as patients with tertiary education are likely to use telemedicine, [ 15 ], with more than half of our participants (50.5%) having tertiary education, this must have influenced their high level of openness to adopt telemedicine, as noted in our study. More than 90% of our respondents earned less than 215 USD monthly, this is in contrast to a study in which 50.1% of respondents were high-medium income-earners with no association with adoption of telemedicine [ 15 ]. This might have accounted for many of our respondents who were open to the use of telemedicine as a means of consultation. Although it takes the majority of respondents (94.7%) two hours or less to get to the hospital for their health visit, 95% spent 3 hours or more in the hospital on average during each health visit. This large amount of time spent at each visit could easily lead to fatigue, impede a patient's work and productivity, and could discourage attendance at future visits. This cascade could be a determining factor for considering telemedicine usage. Only about 29.9% of patients were given a day off work for health visits compared to 65.8% who weren’t granted permission off duty for hospital visits. It is not surprising that the majority of patients (98.5%) believe that telemedicine would help in saving time spent accessing healthcare. Our study found an association between openness to use telemedicine and hours spent in the hospital, and time off at work. This is in contrast with a study among patients with multiple sclerosis in that those factors do not influence propensity to use telemedicine. Patients in other countries who have utilized telemedicine have attested to its cost-effectiveness, time saving and convenience [ 13 , 16 , 17 ]. It is also helpful in reaching patients in rural areas who may not have access to medical care and ultimately reducing rural-urban health disparities [ 18 ].Patients can save valuable time, while healthcare providers can optimize their schedules, a lot specific time slots for patients, and enhance overall efficiency in patient care delivery. Our study showed that 84.4% of patients do not require mobility aids but more than half of the participants do require an accompanying person. These findings are consistent with a previous study among patients with multiple sclerosis in which 75% of the patients did not require mobility assistance [ 13 ]. Although telemedicine is believed to assist healthcare delivery, especially for patients with varying degrees of mobility impairment [ 16 ], both studies didn't find any significant correlation between the propensity to use telemedicine and the patient's level of disability. More than half of our participants use public transport, and though our study did not find an association between openness to telemedicine and means to transport, telehealth has been shown to address transport barriers. In a study in the US, 41% of respondent’s experience transport problems that led to missed and rescheduling appointments, and 78.3% of telehealth users find it easier to access medical care without the need to travel [ 19 ]. As it is a digital age, it is unsurprising that almost all participants in this study (98.5%) possessed a mobile device or personal computer, with nearly 90% having internet access. These figures align with a separate study indicating that 97% of African American parents own cell phones, and 80% have internet access [ 20 ]. Given the rising use of mobile health technologies in Nigeria, 21 the widespread availability of mobile devices, internet connectivity, and familiarity with online platforms are pivotal for advancing and embracing teleneurology in the region. Notably, our study revealed no significant association between internet access and a willingness to explore telemedicine. Our findings demonstrated that over three-quarters of respondents were acquainted with electronic mails, and 84.4% had personal email addresses. Our results also show that the use of email and type of email address were associated with higher propensity to use telemedicine. Email address has been shown to be helpful in providing access to medical treatment, improving follow up and adherence to treatment [ 22 ]. Email addresses are used as a primary means of consultation and tele-diagnosis in successful telemedicine projects [ 23 ]. Our findings suggest that the majority of our participants are familiar with digital platforms such as WhatsApp, Zoom, Google Meet and FaceTime. These platforms are suitable platforms for telemedicine and means of communications. Despite the fact that only 3% of the respondents had prior experience with telemedicine, and only about 5% had heard about it before the study, the majority (78.1%) expressed openness to televisitations This emphasizes the existing user gap, and highlights the potential for its adoption among patients. This study serves as a crucial step in addressing the understanding of tele-neurology and acceptance rates among patients in Nigeria. Our finding is similar to another study in India, where 82.6% of participants were initially unaware of telemedicine, but their attitude shifted positively once they gained a better understanding of the technology [ 24 ]. Another study in Italy reported a slightly lower percentage (54%) of Multiple Sclerosis patients being open to telemedicine visits. Importantly, a larger percentage of their patients (43%) were already aware of telemedicine even before the COVID-19 pandemic. This disparity shows the knowledge gap and health disparity between low-middle income countries and high-income countries [ 13 ]. The consensus among nearly all participants in our study regarding the benefits of telemedicine use was centered on its time and cost-saving advantages. Of the participants with prior experience, more than 80% reported encountering connection issues and assistance during usage, although these were deemed resolvable. The remaining participants were evenly divided between those requiring assistance to address the problems and those who encountered no connection issues at all. Our study also identified concerns about the limitation of telemedicine in assessing neurological status as a significant drawback. Other challenges included difficulty in articulating health problems and a lack of technical support. These findings align with a multi-country study highlighting technical challenges and the absence of physical examination as major hurdles to virtual visits [ 17 ]. Physicians have also acknowledged these limitations, particularly the absence of physical examination, as a challenge to reaching an accurate diagnosis with telemedicine [ 25 ]. These limitations stress the need for ongoing modification and adaptation of telemedicine strategies. Furthermore, the study explored potential applications of telemedicine, with a substantial number of respondents recognizing its effectiveness for individuals facing mobility challenges, such as those living with disabilities and the elderly. Telemedicine, by offering virtual consultations, addresses this obstacle. Respondents also identified additional scenarios where telemedicine could be beneficial, particularly for individuals residing at long distances who endure extensive journeys to access healthcare. This suggests that individuals facing such challenges would be open to considering telemedicine if it becomes readily available. CONCLUSION Teleneurology presents a feasible means of healthcare delivery which should be explored in low-middle income countries. These should be complementary tools to traditional hospital visits, rather than a complete replacement. Telemedicine has the potential to save time and reach patients who reside far from healthcare facilities, especially those in rural areas who may lack access to specialized care. This is particularly relevant considering the limited ratio of neurologists-to-the-population in countries such as Nigeria. Telemedicine should prioritize the needs of both healthcare providers and patients and implement a feedback mechanism that helps to identify and address the challenges, allowing for necessary adjustment and improvement. Also, a regulatory body dedicated to overseeing telemedicine usage is crucial to maintaining high standards of care and maximizing its benefits. While there are challenges such as technological barriers, lack of supportive policies, and biases among patients and healthcare personnel in sub-Saharan Africa, we remain confident that these challenges can be overcome and with the right strategies and implementation, telemedicine can thrive in Nigeria and the entire African continent. Declarations Ethics approval and consent to participate – The study protocol was approved by the Ethical Committee of the Institute of Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria (Approval number-UI/UCH/23/0499). A written informed consent was obtained from each participant before administering the questionnaire. Consent for publication - Not applicable Availability of data and materials - The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request. Competing interests -The author declared no competing interests. Funding - Research was self-funded by the authors Authors' contributions - All authors was involved in the writing and review of the final manuscript. A.Y was involved in conceiving of the project, design of the research proposal, data analysis, supervision of the projects. OO- was involved in the design of the research proposal and supervision of the projects. MS - was involved in the design of the research proposal and supervision of the projects. AA- was involved in the design of the research proposal and supervision of the projects. AA, HS and AA were involved in data collection and supervision of the project Acknowledgements- Not applicable References Demeke HB, Pao LZ, Clark H, Romero L, Neri A, Shah R, et al. Telehealth practice among health centers during the COVID-19 pandemic - United States, July 11-17, 2020. MMWR Morb Mortal Wkly Rep [Internet]. 2020;69(50):1902–5. 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Awareness and attitudes to telemedicine among doctors and patients in India. J Telemed Telecare [Internet]. 2009;15(3):139–41. Available from: http://dx.doi.org/10.1258/jtt.2009.003011 Mubaraki AA, Alrabie AD, Sibyani AK, Aljuaid RS, Bajaber AS, Mubaraki MA. Advantages and disadvantages of telemedicine during the COVID-19 pandemic era among physicians in Taif, Saudi Arabia. Saudi Med J [Internet]. 2021;42(1):110–5. Available from: http://dx.doi.org/10.15537/smj.2021.1.25610 Additional Declarations No competing interests reported. Supplementary Files data.xlsx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Yakubu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7UlEQVRIiWNgGAWjYFACNgZmICnDxsDYcOADiM9OpBYeIHXw4AwQn5lYLUBG8mEekAAhLQbHj6VJF7bZ8fBJ5Bgctvm1TZ6PmYHxw8ccPFrOpB2TntmWzMMG0pLbd9uwjZmBWXLmNjxaDqS3SfO2MUO19NxmBGphY+bFp+X8c5CWeogWy57b9oS13AA6jLftMFBLWsJhhh+3EwlqkbzxLNl6xrnjPGw8jw8c7G24ndzGzNiM1y9859MMbxeUVcvJtyc2f/jx57bt/Pbmgx8+4tGicACZx9gGJhtwqwcCeVTpP3gVj4JRMApGwQgFAOYcTuaN+Wr9AAAAAElFTkSuQmCC","orcid":"","institution":"College of Medicine, University of Ibadan","correspondingAuthor":true,"prefix":"","firstName":"Aliu","middleName":"O.","lastName":"Yakubu","suffix":""},{"id":273030741,"identity":"14a30020-3090-4892-8d67-8b1896fd213a","order_by":1,"name":"Oluwakemi Eunice Olalude","email":"","orcid":"","institution":"Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos","correspondingAuthor":false,"prefix":"","firstName":"Oluwakemi","middleName":"Eunice","lastName":"Olalude","suffix":""},{"id":273030742,"identity":"da9350a2-decc-4e98-9d9e-c6fa6b80c636","order_by":2,"name":"Mayowa Sodiq Salami","email":"","orcid":"","institution":"Department of Pediatrics, Princess Royale Maternity Hospital, Glasgow","correspondingAuthor":false,"prefix":"","firstName":"Mayowa","middleName":"Sodiq","lastName":"Salami","suffix":""},{"id":273030743,"identity":"f69b10e7-2f6d-4dd2-aa79-7388a0759716","order_by":3,"name":"Augustine Chijioke Amuta","email":"","orcid":"","institution":"Prince George’s County Health Department, Largo MD","correspondingAuthor":false,"prefix":"","firstName":"Augustine","middleName":"Chijioke","lastName":"Amuta","suffix":""},{"id":273030744,"identity":"02019e61-75b1-472e-8719-516af2923715","order_by":4,"name":"Abeedat Olaide Amusa","email":"","orcid":"","institution":"Olabisi Onabanjo University, Ago Iwoye, Ogun State","correspondingAuthor":false,"prefix":"","firstName":"Abeedat","middleName":"Olaide","lastName":"Amusa","suffix":""},{"id":273030745,"identity":"cd471a44-41fb-4da7-9054-f6a7cdd55ab4","order_by":5,"name":"Hasanat Adejoke Salaudeen","email":"","orcid":"","institution":"Olabisi Onabanjo University, Ago Iwoye, Ogun State","correspondingAuthor":false,"prefix":"","firstName":"Hasanat","middleName":"Adejoke","lastName":"Salaudeen","suffix":""},{"id":273030746,"identity":"1032da1b-708a-4285-b973-90cfc78da18b","order_by":6,"name":"Ayodeji John Awoyemi","email":"","orcid":"","institution":"Olabisi Onabanjo University, Ago Iwoye, Ogun State","correspondingAuthor":false,"prefix":"","firstName":"Ayodeji","middleName":"John","lastName":"Awoyemi","suffix":""}],"badges":[],"createdAt":"2024-02-14 16:16:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3956565/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3956565/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":51561522,"identity":"7173ffb2-1177-4e1d-9e9e-783c830ab1cc","added_by":"auto","created_at":"2024-02-23 18:24:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":521940,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3956565/v1/92957e98-f90a-4bf9-972f-d277680d8562.pdf"},{"id":51315325,"identity":"81ddf128-f3a2-48c4-8d1b-53db3cbb59e5","added_by":"auto","created_at":"2024-02-19 12:29:03","extension":"xlsx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":62782,"visible":true,"origin":"","legend":"","description":"","filename":"data.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-3956565/v1/faec3f693ab49e393dd9d57b.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Telemedicine and Neurology: A survey of Neurology patients in a Nigerian tertiary hospital","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eThe field of Telemedicine is one that has become increasingly explored as a means of healthcare delivery particularly since the advent of the COVID-19 pandemic. Due to the lockdown and the need for social distancing, it was imperative for other means of healthcare delivery to be implemented, whilst maintaining and prioritizing patient\u0026rsquo;s health. Following the onset of the pandemic, a rapid rise in the use of telemedicine was noted, especially in developed countries. Up to 95% of health centers reported using telemedicine as compared with 43% which previously reported capability of providing telemedicine prior to the pandemic [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe American Academy of Family Physicians (AAFP) defines Telemedicine as the practice of medicine using technology to deliver care at a distance, over a telecommunications infrastructure, between a patient at an originating (spoke) site and a physician, or other practitioner licensed to practice medicine, at a distant (hub) site [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. It refers to healthcare delivery or the exchange of health information across distances, and is neither a branch of medicine nor a technology in itself [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTelemedicine as it pertains to neurological diseases was defined by Chirra et al. as an interface in a virtual patient\u0026ndash;physician relationship to provide primary and secondary care in neurodegenerative, cerebrovascular, neuro-oncological, and neuroinflammatory disorders; assist the remote management of deep brain stimulation (DBS), transcranial direct current stimulation (tDCS), and infusion pumps; deliver highly specialized visits (telegenetics), diagnostic consultations (teleradiology and telepathology), or rehabilitative programs (telerehabilitation); and monitor motor and nonmotor functions in an ecologically valid environment (telemetry)[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Three main types of telemedicine have been identified which include store and forward telemedicine, remote monitoring and interactive services in real time [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe advent of this method of healthcare delivery opened the door to other possibilities and has persisted even beyond the pandemic as a result of its many benefits to both the healthcare provider and patient. Telemedicine has been found to be particularly useful in providing care to patients who live a far distance from the hospital, in the setting of disasters, and in public health emergencies [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Physicians have even reported that telemedicine offered much better quality of healthcare as compared with in-person hospital visits [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFor patients with chronic diseases who may require long term followup including those with neurological disease which is our focus, telemedicine is believed to provide great benefit leading to improved outcomes [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis method is however still budding in developing countries and needs to be explored even further, as it has great potential for benefit across healthcare delivery in such countries, particularly in decreasing the wide healthcare gap. In this study, we have focused on neurological patients, as neurological conditions contribute significantly to the global burden of disease, and were found to be responsible for almost 10\u0026nbsp;million deaths and about 349\u0026nbsp;million disability adjusted life years (DALYs) in 2019[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].With the poor neurologist to population ratio in Nigeria [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] understanding the physician as well as patient view on telemedicine as a resource, especially in the setting of neurological disorders, would help in tailoring its use to their needs, as these patients often require long term care, and this could improve the success of this practice.\u003c/p\u003e \u003cp\u003eAlthough studies on telemedicine and the physician\u0026rsquo;s perspective abound, there appears to be a paucity of data on the patient\u0026rsquo;s perspective and experience, particularly in developing countries and in sub-saharan Africa. This study aims to explore the patient\u0026rsquo;s perspective on the use of telemedicine as it pertains to the field of neurology in Nigeria. We believe that understanding the perception of those receiving healthcare via this means would give better insight on how teleneurology in Nigeria can be structured to encourage its adoption and its benefits to both provider and patient.\u003c/p\u003e"},{"header":"METHODOLOGY","content":"\u003cp\u003eThis was a descriptive cross-sectional study conducted among 398 Neurology patients at Olabisi Onabanjo University Teaching Hospital (OOUTH) between June 2023 to October, 2023. The OOUTH is a state owned tertiary institution, formerly Ogun State University Teaching Hospital (OSUTH) located at Sagamu, Ogun State, Southwest Nigeria. The hospital is a prominent tertiary healthcare institution situated in the south-western region of Nigeria, which offers specialized care. The study protocol was approved by the Ethical Committee of the Institute of Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria (Approval number-UI/UCH/23/0499).\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData Collection\u003c/h2\u003e \u003cp\u003eA validated questionnaire developed by Landi D. et al. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] was utilized in this study. The questionnaire consisted of 32 questions, categorized into five subsections:\u003c/p\u003e \u003cp\u003e1) Sociodemographic, 2) Access to the hospital, 3) Internet access and use, and 4) Knowledge about telemedicine. A written informed consent was obtained from each participant before administering the questionnaire. A research assistant was recruited to help with administering the questionnaire to the respondents at the neurology outpatient clinic.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eThe data was sorted with Microsoft Excel and exported into a Statistical Package for social science 22 for statistical analysis. The data were summarized and presented using frequencies and percentages. Chi-Square was used to determine the association between the variables.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 398 patients participated in the survey with 100% response rate, with more than half (52.3%) of the respondent\u0026rsquo;s male, and the majority of them (73.1%), married and Christians (66.3%). \u0026nbsp;46.4% of respondents were within the 51-70 years\u0026rsquo; age range, and 43.2% had completed tertiary education. 61.8% were employed, and a majority (96.5%) earned less than 215 USD. 84.4% of participants did not require assistance with mobility (Table 1).49.5% spent less than an hour to reach the hospital, while 45.2% spent between 5 to 6 hours within the facility during clinic visits. More than half of the participants (64.1%) required an accompanying person during their visits to the hospital. More than half of the participants (65.8%) do not require time off from work (Table 2).\u003c/p\u003e\n\u003cp\u003eTable 1: Socio-demographic characteristics of participants\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.99357945425361%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.287319422150883%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.719101123595507%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (100%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.99357945425361%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e10 \u0026ndash; 30 \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e31 \u0026ndash; 50\u003c/p\u003e\n \u003cp\u003e51 \u0026ndash; 70\u003c/p\u003e\n \u003cp\u003e71 \u0026ndash; 90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.287319422150883%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003cp\u003e185\u003c/p\u003e\n \u003cp\u003e43\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.719101123595507%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e19.1\u003c/p\u003e\n \u003cp\u003e23.6\u003c/p\u003e\n \u003cp\u003e46.4\u003c/p\u003e\n \u003cp\u003e10.8\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.99357945425361%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.287319422150883%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e208\u003c/p\u003e\n \u003cp\u003e190\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.719101123595507%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e52.3\u003c/p\u003e\n \u003cp\u003e47.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.99357945425361%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003cp\u003ePostgraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.287319422150883%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003cp\u003e165\u003c/p\u003e\n \u003cp\u003e172\u003c/p\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.719101123595507%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003cp\u003e6.5\u003c/p\u003e\n \u003cp\u003e41.5\u003c/p\u003e\n \u003cp\u003e43.2\u003c/p\u003e\n \u003cp\u003e7.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.99357945425361%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligion\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eChristianity\u003c/p\u003e\n \u003cp\u003eIslam\u003c/p\u003e\n \u003cp\u003eTraditionalist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.287319422150883%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e264\u003c/p\u003e\n \u003cp\u003e133\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.719101123595507%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e66.3\u003c/p\u003e\n \u003cp\u003e33.4\u003c/p\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.99357945425361%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003cp\u003eWidow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.287319422150883%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003cp\u003e291\u003c/p\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.719101123595507%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e17.1\u003c/p\u003e\n \u003cp\u003e73.1\u003c/p\u003e\n \u003cp\u003e4.0\u003c/p\u003e\n \u003cp\u003e5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.99357945425361%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment status\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003cp\u003eRetired\u003c/p\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.287319422150883%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e246\u003c/p\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.719101123595507%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e61.8\u003c/p\u003e\n \u003cp\u003e13.8\u003c/p\u003e\n \u003cp\u003e24.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.99357945425361%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eIncome bracket (₦)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e0-215\u003c/p\u003e\n \u003cp\u003e\u0026gt;215\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.287319422150883%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e384\u003c/p\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.719101123595507%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e96.5\u003c/p\u003e\n \u003cp\u003e3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.99357945425361%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRequire assistance\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003cp\u003eYes, bilateral assistance\u003c/p\u003e\n \u003cp\u003eYes, I use wheelchair\u003c/p\u003e\n \u003cp\u003eYes, unilateral assistance\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.287319422150883%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e336\u003c/p\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.719101123595507%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e84.4\u003c/p\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003cp\u003e12.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable 2: Access to the hospital\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.99357945425361%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.287319422150883%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.719101123595507%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.99357945425361%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime required to get to the health facility\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026lt; 1 hour\u003c/p\u003e\n \u003cp\u003e1 \u0026ndash; 2 hours\u003c/p\u003e\n \u003cp\u003e3 \u0026ndash; 4 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.287319422150883%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e197\u003c/p\u003e\n \u003cp\u003e180\u003c/p\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.719101123595507%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e49.5\u003c/p\u003e\n \u003cp\u003e45.2\u003c/p\u003e\n \u003cp\u003e5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.99357945425361%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime spent in the hospital\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e1 \u0026ndash; 2 hours\u003c/p\u003e\n \u003cp\u003e3 \u0026ndash; 4 hours\u003c/p\u003e\n \u003cp\u003e5 \u0026ndash; 6 hours\u003c/p\u003e\n \u003cp\u003e\u0026gt;6 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.287319422150883%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003cp\u003e153\u003c/p\u003e\n \u003cp\u003e180\u003c/p\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.719101123595507%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5.0\u003c/p\u003e\n \u003cp\u003e38.4\u003c/p\u003e\n \u003cp\u003e45.2\u003c/p\u003e\n \u003cp\u003e11.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.99357945425361%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployer permission for health facility visit/Time off work\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003cp\u003eNot working\u003c/p\u003e\n \u003cp\u003eYes, a day\u003c/p\u003e\n \u003cp\u003eYes, less than a day\u003c/p\u003e\n \u003cp\u003eYes, more than a day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.287319422150883%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e262\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003cp\u003e119\u003c/p\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.719101123595507%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e65.8\u003c/p\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003cp\u003e29.9\u003c/p\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.99357945425361%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAccompanying person\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003cp\u003eSometimes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.287319422150883%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e255\u003c/p\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.719101123595507%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e64.1\u003c/p\u003e\n \u003cp\u003e22.6\u003c/p\u003e\n \u003cp\u003e13.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.99357945425361%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMeans of transportation\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMotorcycle\u003c/p\u003e\n \u003cp\u003ePrivate car\u003c/p\u003e\n \u003cp\u003ePublic buses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.287319422150883%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003cp\u003e252\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.719101123595507%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e19.4\u003c/p\u003e\n \u003cp\u003e17.3\u003c/p\u003e\n \u003cp\u003e63.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eMajority (87.7%) of the participants have used the internet, and 42.7% utilized it for medical purposes. The majority (95.7%) had smartphones, and 84.4% had personal email addresses. Video/social media platforms popular among the participants were WhatsApp (91.2%), followed by Zoom (21.9%) and Google Meet (16.3%) Table 3. Only 3% of the respondents had previous experience with telemedicine, and only 5% have heard about it before. Majority of the respondents (78.1%) were open to using telemedicine as a means of consultation. More than half of the respondents (56.5%) preferred teleconsultation to telephone calls. Disadvantages of telemedicine noted include limitations in assessing neurological status (94.7%), difficulty in explaining health problems (84.4%), and lack of technical support (14.6%). Majority (96.5%) believed that telemedicine will help save time. Most participants (76.4%) are open to upload their personal information on the Internet. Only 13.8% believed telemedicine is complete. Situation in which telemedicine could replace hospital visitation include living far from hospital (96.5%), patient with mobility issues (93%), medication change (27.1%) and emergency situation (16.8%).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;(Table 4)\u003c/p\u003e\n\u003cp\u003eTable 3: Internet access and use\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.346153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eUse the internet\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.346153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e349\u003c/p\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e87.7\u003c/p\u003e\n \u003cp\u003e12.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eUse a digital device (preference)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003cp\u003ePersonal computer\u003c/p\u003e\n \u003cp\u003eSmart phone\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eTablet\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.346153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003cp\u003e381\u003c/p\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003cp\u003e95.7\u003c/p\u003e\n \u003cp\u003e1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eUse the internet for medical reasons\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.346153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e228\u003c/p\u003e\n \u003cp\u003e170\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e57.3\u003c/p\u003e\n \u003cp\u003e42.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eUse the email\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.346153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e306\u003c/p\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e76.9\u003c/p\u003e\n \u003cp\u003e23.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of email address\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eFriends\u003c/p\u003e\n \u003cp\u003ePersonal\u003c/p\u003e\n \u003cp\u003eRelative\u003c/p\u003e\n \u003cp\u003eWork\u003c/p\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.346153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003cp\u003e336\u003c/p\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003cp\u003e84.4\u003c/p\u003e\n \u003cp\u003e5.3\u003c/p\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003cp\u003e7.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"69.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVideo/social media platform (Multiple entries)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eWhatsApp\u003c/p\u003e\n \u003cp\u003eZoom\u003c/p\u003e\n \u003cp\u003eGoogle meet\u003c/p\u003e\n \u003cp\u003eTeams\u003c/p\u003e\n \u003cp\u003eFaceTime\u003c/p\u003e\n \u003cp\u003eskype\u003c/p\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.346153846153847%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e363\u003c/p\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.423076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e91.2\u003c/p\u003e\n \u003cp\u003e21.9\u003c/p\u003e\n \u003cp\u003e16.3\u003c/p\u003e\n \u003cp\u003e10.6\u003c/p\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003cp\u003e3.3\u003c/p\u003e\n \u003cp\u003e9.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 4: Knowledge about telemedicine\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.92307692307692%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (100%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.92307692307692%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHeard of telemedicine\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003cp\u003e378\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5.0\u003c/p\u003e\n \u003cp\u003e95.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.92307692307692%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrevious telemedicine experience\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003cp\u003e386\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3.0\u003c/p\u003e\n \u003cp\u003e97.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.92307692307692%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEvaluation of previous telemedicine experience if any\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eSome connection problems but solved\u003c/p\u003e\n \u003cp\u003eNo connection problems\u003c/p\u003e\n \u003cp\u003eAssistance needed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e66.8\u003c/p\u003e\n \u003cp\u003e16.6\u003c/p\u003e\n \u003cp\u003e16.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.92307692307692%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOpen to using telemedicine\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNo, not interested\u003c/p\u003e\n \u003cp\u003eYes, I would like to\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003cp\u003e311\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e21.9\u003c/p\u003e\n \u003cp\u003e78.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.92307692307692%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdvantages of telemedicine (multiple entry)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNo accompanying person needed\u003c/p\u003e\n \u003cp\u003eSaves money\u003c/p\u003e\n \u003cp\u003eSaves time\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003cp\u003e311\u003c/p\u003e\n \u003cp\u003e384\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e25.4\u003c/p\u003e\n \u003cp\u003e78.1\u003c/p\u003e\n \u003cp\u003e96.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.92307692307692%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDisadvantages of telemedicine (Multiple entry)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eDifficult to explain medical/health problems\u003c/p\u003e\n \u003cp\u003eNo possibility of assessing neurological status\u003c/p\u003e\n \u003cp\u003eDifficult to use\u003c/p\u003e\n \u003cp\u003eUnreliable\u003c/p\u003e\n \u003cp\u003eLack of technological support\u003c/p\u003e\n \u003cp\u003eIt is expensive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e336\u003c/p\u003e\n \u003cp\u003e377\u003c/p\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e84.4\u003c/p\u003e\n \u003cp\u003e94.7\u003c/p\u003e\n \u003cp\u003e5.0\u003c/p\u003e\n \u003cp\u003e11.1\u003c/p\u003e\n \u003cp\u003e14.6\u003c/p\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.92307692307692%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTelemedicine is complete\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003cp\u003eNeutral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003cp\u003e265\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e13.8\u003c/p\u003e\n \u003cp\u003e19.6\u003c/p\u003e\n \u003cp\u003e66.6\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.92307692307692%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTelemedicine is preferable over the telephone\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo/not sure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e225\u003c/p\u003e\n \u003cp\u003e173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e56.5\u003c/p\u003e\n \u003cp\u003e43.5\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.92307692307692%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSituations where telemedicine can replace center visit (Multiple entry)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eEvaluation of medication change\u003c/p\u003e\n \u003cp\u003eMultidisciplinary counselling\u003c/p\u003e\n \u003cp\u003ePatients with mobility issue\u003c/p\u003e\n \u003cp\u003ePatients from far places\u003c/p\u003e\n \u003cp\u003eEvaluation of new symptoms\u003c/p\u003e\n \u003cp\u003eIn emergency situations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e108\u003c/p\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003cp\u003e370\u003c/p\u003e\n \u003cp\u003e384\u003c/p\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e27.1\u003c/p\u003e\n \u003cp\u003e10.3\u003c/p\u003e\n \u003cp\u003e93.0\u003c/p\u003e\n \u003cp\u003e96.5\u003c/p\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003cp\u003e16.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.92307692307692%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOpen to having your personal information on the internet\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003cp\u003eNot sure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e304\u003c/p\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e76.4\u003c/p\u003e\n \u003cp\u003e13.1\u003c/p\u003e\n \u003cp\u003e10.5\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThere was a statistically significant association between propensity to use telemedicine and time off work (\u0026lt;0.001). Average time spent in the hospital had a statistically significant association with propensity to use telemedicine (P-0.045) Table 5. The propensity to use telemedicine was statistically significant to the use of email (0.001) and type of email address (0.001). Table 6\u003c/p\u003e\n\u003cp\u003eTable 5: Association between Access to the hospital and open to use telemedicine\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.905829596412556%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.57100149476831%\" valign=\"top\"\u003e\n \u003cp\u003eOpen to use telemedicine n (%)\u003c/p\u003e\n \u003cp\u003eNO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.95665171898356%\" valign=\"top\"\u003e\n \u003cp\u003eOpen to use telemedicine n (%)\u003c/p\u003e\n \u003cp\u003eYES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.566517189835576%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003ep\u0026nbsp;\u003c/em\u003evalue\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.905829596412556%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime required to get to the health facility\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026lt;1 hour\u003c/p\u003e\n \u003cp\u003e1 \u0026ndash; 2 hours\u003c/p\u003e\n \u003cp\u003e3 \u0026ndash; 4 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.57100149476831%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e39 (19.8)\u003c/p\u003e\n \u003cp\u003e40 (22.2)\u003c/p\u003e\n \u003cp\u003e8 (38.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.95665171898356%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e158 (80.2)\u003c/p\u003e\n \u003cp\u003e140 (77.8)\u003c/p\u003e\n \u003cp\u003e13 (61.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.566517189835576%\" valign=\"top\"\u003e\n \u003cp\u003e0.072\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.905829596412556%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime spent in the hospital\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e1 \u0026ndash; 2 hours\u003c/p\u003e\n \u003cp\u003e3 \u0026ndash; 4 hours\u003c/p\u003e\n \u003cp\u003e5 \u0026ndash; 6 hours\u003c/p\u003e\n \u003cp\u003e\u0026gt;6 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.57100149476831%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4 (20.0)\u003c/p\u003e\n \u003cp\u003e29 (19.0)\u003c/p\u003e\n \u003cp\u003e37 (20.6)\u003c/p\u003e\n \u003cp\u003e17 (37.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.95665171898356%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e16 (80.0)\u003c/p\u003e\n \u003cp\u003e124 (81.0)\u003c/p\u003e\n \u003cp\u003e143 (79.4%)\u003c/p\u003e\n \u003cp\u003e28 (62.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.566517189835576%\" valign=\"top\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.905829596412556%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployer permission for health facility visit/Time off work\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003cp\u003eNot working\u003c/p\u003e\n \u003cp\u003eYes, a day\u003c/p\u003e\n \u003cp\u003eYes, less than a day\u003c/p\u003e\n \u003cp\u003eYes, more than a day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.57100149476831%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e74 (28.2)\u003c/p\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003cp\u003e13 (10.9)\u003c/p\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.95665171898356%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e188 (71.8)\u003c/p\u003e\n \u003cp\u003e2 (100.0)\u003c/p\u003e\n \u003cp\u003e106 (89.1)\u003c/p\u003e\n \u003cp\u003e11 (100.0)\u003c/p\u003e\n \u003cp\u003e4 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.566517189835576%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.905829596412556%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAccompanying person\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003cp\u003eSometimes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.57100149476831%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e62 (24.3)\u003c/p\u003e\n \u003cp\u003e17 (18.9)\u003c/p\u003e\n \u003cp\u003e8 (15.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.95665171898356%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e193 (75.7)\u003c/p\u003e\n \u003cp\u003e73 (81.1)\u003c/p\u003e\n \u003cp\u003e45 (84.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.566517189835576%\" valign=\"top\"\u003e\n \u003cp\u003e0.097\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.905829596412556%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMeans of transportation\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMotorcycle\u003c/p\u003e\n \u003cp\u003ePrivate car\u003c/p\u003e\n \u003cp\u003ePublic buses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.57100149476831%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6 (7.8)\u003c/p\u003e\n \u003cp\u003e18 (26.1)\u003c/p\u003e\n \u003cp\u003e63 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.95665171898356%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e71 (92.2)\u003c/p\u003e\n \u003cp\u003e51 (73.9)\u003c/p\u003e\n \u003cp\u003e189 (75.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.566517189835576%\" valign=\"top\"\u003e\n \u003cp\u003e0.433\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable 6: Association between Access to the internet and open to use telemedicine\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.288261515601782%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.09509658246657%\" valign=\"top\"\u003e\n \u003cp\u003eOpen to use telemedicine n (%)\u003c/p\u003e\n \u003cp\u003eNO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.55274888558692%\" valign=\"top\"\u003e\n \u003cp\u003eYes, Open to use telemedicine n (%)\u003c/p\u003e\n \u003cp\u003eYES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.063893016344725%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.288261515601782%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eUse the internet\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.09509658246657%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e76 (20.7)\u003c/p\u003e\n \u003cp\u003e11 (35.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.55274888558692%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e291 (79.3)\u003c/p\u003e\n \u003cp\u003e20 (64.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.063893016344725%\" valign=\"top\"\u003e\n \u003cp\u003e0.056\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.288261515601782%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eUse a digital device (preference)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003cp\u003ePersonal computer\u003c/p\u003e\n \u003cp\u003eSmart phone\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eTablet\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.09509658246657%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3 (50.0)\u003c/p\u003e\n \u003cp\u003e2 (40.0)\u003c/p\u003e\n \u003cp\u003e81 (21.3)\u003c/p\u003e\n \u003cp\u003e1 (17.0)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.55274888558692%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3 (50.0)\u003c/p\u003e\n \u003cp\u003e3 (60.0)\u003c/p\u003e\n \u003cp\u003e300 (78.7)\u003c/p\u003e\n \u003cp\u003e5 (83.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.063893016344725%\" valign=\"top\"\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.288261515601782%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eUse the internet for medical reasons\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.09509658246657%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e21 (12.4)\u003c/p\u003e\n \u003cp\u003e66 (28.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.55274888558692%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e149 (87.6)\u003c/p\u003e\n \u003cp\u003e162 (71.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.063893016344725%\" valign=\"top\"\u003e\n \u003cp\u003e0.739\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.288261515601782%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eUse the mail\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.09509658246657%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e49 (16.0)\u003c/p\u003e\n \u003cp\u003e38 (41.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.55274888558692%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e257 (84.0)\u003c/p\u003e\n \u003cp\u003e54 (58.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.063893016344725%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.288261515601782%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of email address\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eFriends\u003c/p\u003e\n \u003cp\u003ePersonal\u003c/p\u003e\n \u003cp\u003eRelatives\u003c/p\u003e\n \u003cp\u003eWork\u003c/p\u003e\n \u003cp\u003ePersonal and work\u003c/p\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.09509658246657%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003cp\u003e61 (18.2)\u003c/p\u003e\n \u003cp\u003e3 (14.3)\u003c/p\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003cp\u003e23 (79.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.55274888558692%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5 (100.0)\u003c/p\u003e\n \u003cp\u003e275 (81.8)\u003c/p\u003e\n \u003cp\u003e18 (85.7)\u003c/p\u003e\n \u003cp\u003e6 (100.0)\u003c/p\u003e\n \u003cp\u003e1 (100.0)\u003c/p\u003e\n \u003cp\u003e6 (20.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.063893016344725%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eTelemedicine refers to healthcare delivery that entails the exchange of health information across distances and it is neither a branch of medicine nor a technology in itself [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].It is an emerging means of the practice of medicine with a lot of potential in decreasing the healthcare gap in neglected areas. In this study, we have focused on neurological patients as it is important to assess their perceptions and identify potential factors that may impact the utilization of telemedicine.\u003c/p\u003e \u003cp\u003eNearly all participants (98.5%) have at least primary school education. The level of education has been shown to influence the use of telemedicine as patients with tertiary education are likely to use telemedicine, [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], with more than half of our participants (50.5%) having tertiary education, this must have influenced their high level of openness to adopt telemedicine, as noted in our study. More than 90% of our respondents earned less than 215 USD monthly, this is in contrast to a study in which 50.1% of respondents were high-medium income-earners with no association with adoption of telemedicine [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. This might have accounted for many of our respondents who were open to the use of telemedicine as a means of consultation.\u003c/p\u003e \u003cp\u003eAlthough it takes the majority of respondents (94.7%) two hours or less to get to the hospital for their health visit, 95% spent 3 hours or more in the hospital on average during each health visit. This large amount of time spent at each visit could easily lead to fatigue, impede a patient's work and productivity, and could discourage attendance at future visits. This cascade could be a determining factor for considering telemedicine usage.\u003c/p\u003e \u003cp\u003eOnly about 29.9% of patients were given a day off work for health visits compared to 65.8% who weren\u0026rsquo;t granted permission off duty for hospital visits. It is not surprising that the majority of patients (98.5%) believe that telemedicine would help in saving time spent accessing healthcare. Our study found an association between openness to use telemedicine and hours spent in the hospital, and time off at work. This is in contrast with a study among patients with multiple sclerosis in that those factors do not influence propensity to use telemedicine. Patients in other countries who have utilized telemedicine have attested to its cost-effectiveness, time saving and convenience [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. It is also helpful in reaching patients in rural areas who may not have access to medical care and ultimately reducing rural-urban health disparities [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].Patients can save valuable time, while healthcare providers can optimize their schedules, a lot specific time slots for patients, and enhance overall efficiency in patient care delivery.\u003c/p\u003e \u003cp\u003eOur study showed that 84.4% of patients do not require mobility aids but more than half of the participants do require an accompanying person. These findings are consistent with a previous study among patients with multiple sclerosis in which 75% of the patients did not require mobility assistance [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Although telemedicine is believed to assist healthcare delivery, especially for patients with varying degrees of mobility impairment [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], both studies didn't find any significant correlation between the propensity to use telemedicine and the patient's level of disability. More than half of our participants use public transport, and though our study did not find an association between openness to telemedicine and means to transport, telehealth has been shown to address transport barriers. In a study in the US, 41% of respondent\u0026rsquo;s experience transport problems that led to missed and rescheduling appointments, and 78.3% of telehealth users find it easier to access medical care without the need to travel [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAs it is a digital age, it is unsurprising that almost all participants in this study (98.5%) possessed a mobile device or personal computer, with nearly 90% having internet access. These figures align with a separate study indicating that 97% of African American parents own cell phones, and 80% have internet access [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Given the rising use of mobile health technologies in Nigeria,\u003csup\u003e\u003cb\u003e21\u003c/b\u003e\u003c/sup\u003e the widespread availability of mobile devices, internet connectivity, and familiarity with online platforms are pivotal for advancing and embracing teleneurology in the region. Notably, our study revealed no significant association between internet access and a willingness to explore telemedicine.\u003c/p\u003e \u003cp\u003eOur findings demonstrated that over three-quarters of respondents were acquainted with electronic mails, and 84.4% had personal email addresses. Our results also show that the use of email and type of email address were associated with higher propensity to use telemedicine.\u003c/p\u003e \u003cp\u003eEmail address has been shown to be helpful in providing access to medical treatment, improving follow up and adherence to treatment [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Email addresses are used as a primary means of consultation and tele-diagnosis in successful telemedicine projects [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Our findings suggest that the majority of our participants are familiar with digital platforms such as WhatsApp, Zoom, Google Meet and FaceTime. These platforms are suitable platforms for telemedicine and means of communications.\u003c/p\u003e \u003cp\u003eDespite the fact that only 3% of the respondents had prior experience with telemedicine, and only about 5% had heard about it before the study, the majority (78.1%) expressed openness to televisitations This emphasizes the existing user gap, and highlights the potential for its adoption among patients. This study serves as a crucial step in addressing the understanding of tele-neurology and acceptance rates among patients in Nigeria. Our finding is similar to another study in India, where 82.6% of participants were initially unaware of telemedicine, but their attitude shifted positively once they gained a better understanding of the technology [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Another study in Italy reported a slightly lower percentage (54%) of Multiple Sclerosis patients being open to telemedicine visits. Importantly, a larger percentage of their patients (43%) were already aware of telemedicine even before the COVID-19 pandemic. This disparity shows the knowledge gap and health disparity between low-middle income countries and high-income countries [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e The consensus among nearly all participants in our study regarding the benefits of telemedicine use was centered on its time and cost-saving advantages. Of the participants with prior experience, more than 80% reported encountering connection issues and assistance during usage, although these were deemed resolvable. The remaining participants were evenly divided between those requiring assistance to address the problems and those who encountered no connection issues at all. Our study also identified concerns about the limitation of telemedicine in assessing neurological status as a significant drawback. Other challenges included difficulty in articulating health problems and a lack of technical support. These findings align with a multi-country study highlighting technical challenges and the absence of physical examination as major hurdles to virtual visits [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Physicians have also acknowledged these limitations, particularly the absence of physical examination, as a challenge to reaching an accurate diagnosis with telemedicine [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. These limitations stress the need for ongoing modification and adaptation of telemedicine strategies.\u003c/p\u003e \u003cp\u003eFurthermore, the study explored potential applications of telemedicine, with a substantial number of respondents recognizing its effectiveness for individuals facing mobility challenges, such as those living with disabilities and the elderly. Telemedicine, by offering virtual consultations, addresses this obstacle. Respondents also identified additional scenarios where telemedicine could be beneficial, particularly for individuals residing at long distances who endure extensive journeys to access healthcare. This suggests that individuals facing such challenges would be open to considering telemedicine if it becomes readily available.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eTeleneurology presents a feasible means of healthcare delivery which should be explored in low-middle income countries. These should be complementary tools to traditional hospital visits, rather than a complete replacement. Telemedicine has the potential to save time and reach patients who reside far from healthcare facilities, especially those in rural areas who may lack access to specialized care. This is particularly relevant considering the limited ratio of neurologists-to-the-population in countries such as Nigeria. Telemedicine should prioritize the needs of both healthcare providers and patients and implement a feedback mechanism that helps to identify and address the challenges, allowing for necessary adjustment and improvement. Also, a regulatory body dedicated to overseeing telemedicine usage is crucial to maintaining high standards of care and maximizing its benefits.\u003c/p\u003e \u003cp\u003eWhile there are challenges such as technological barriers, lack of supportive policies, and biases among patients and healthcare personnel in sub-Saharan Africa, we remain confident that these challenges can be overcome and with the right strategies and implementation, telemedicine can thrive in Nigeria and the entire African continent.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate \u0026ndash; The study protocol was approved by the Ethical Committee of the Institute of Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria (Approval number-UI/UCH/23/0499). A written informed consent was obtained from each participant before administering the questionnaire.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e- Not applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e-\u0026nbsp;The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e-The author declared no \u0026nbsp; competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e- Research was self-funded by the authors\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e- All authors was involved in the writing and review of the final manuscript.\u003c/p\u003e\n\u003cp\u003eA.Y was involved in conceiving of the project, design of the research proposal, data analysis, supervision of the projects.\u003c/p\u003e\n\u003cp\u003eOO- was involved in the design of the research proposal and supervision of the projects.\u003c/p\u003e\n\u003cp\u003eMS - was involved in the design of the research proposal and supervision of the projects.\u003c/p\u003e\n\u003cp\u003eAA- was involved in the design of the research proposal and supervision of the projects.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAA, HS and AA were involved in data collection and supervision of the project\u003c/p\u003e\n\u003cp\u003eAcknowledgements- Not applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDemeke HB, Pao LZ, Clark H, Romero L, Neri A, Shah R, et al. 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J Telemed Telecare. 2005;11(1):3\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eChirra M, Marsili L, Wattley L, Sokol LL, Keeling E, Maule S, et al. Telemedicine in neurological disorders: Opportunities and challenges. Telemed J E Health [Internet]. 2019;25(7):541\u0026ndash;50. Available from: http://dx.doi.org/10.1089/tmj.2018.0101\u003c/li\u003e\n\u003cli\u003eYolanda Smith BP. Types of telemedicine [Internet]. News-Medical. 2010 [cited 2024 Jan 28]. Available from: https://www.news-medical.net/health/Types-of-Telemedicine.aspx\u003c/li\u003e\n\u003cli\u003eLatifi R, Doarn CR. Perspective on COVID-19: Finally, telemedicine at centre stage. Telemedicine Journal and E-health [Internet]. 2020 Sep 1;26(9):1106\u0026ndash;9. Available from: https://doi.org/10.1089/tmj.2020.0132\u003c/li\u003e\n\u003cli\u003eMubaraki AA, Alrabie AD, Sibyani AK, Aljuaid RS, Bajaber AS, Mubaraki MA. Advantages and disadvantages of telemedicine during the COVID-19 pandemic era among physicians in Taif, Saudi Arabia. Saudi Medical Journal [Internet]. 2021 Jan 1;42(1):110\u0026ndash;5. Available from: https://doi.org/10.15537/smj.2021.1.25610\u003c/li\u003e\n\u003cli\u003eNews-Medical. What is Telemedicine? [Internet]. News-Medical. 2023. Available from: https://www.news-medical.net/health/What-is-Telemedicine.aspx\u003c/li\u003e\n\u003cli\u003eDing C, Wu Y, Chen X, Chen Y, Wu Z, Lin Z, et al. Global, regional, and national burden and attributable risk factors of neurological disorders: The Global Burden of Disease study 1990\u0026ndash;2019. Frontiers in Public Health [Internet]. 2022 Nov 29;10. Available from: https://doi.org/10.3389/fpubh.2022.952161\u003c/li\u003e\n\u003cli\u003eNigeria population (2024) - Worldometer [Internet]. Available from: https://www.worldometers.info/world-population/nigeria-population/\u003c/li\u003e\n\u003cli\u003eImam I, Akinyemi R. Nigeria. Pract Neurol. 2016 Feb;16(1):75-7. doi: 10.1136/practneurol-2015-001226. Epub 2015 Sep 18. PMID: 26386027.\u003c/li\u003e\n\u003cli\u003eLandi D, Ponzano M, Nicoletti CG, Cola G, Cecchi G, Grimaldi A, et al. Patient\u0026rsquo;s point of view on the use of telemedicine in multiple sclerosis: a web-based survey. Neurol Sci [Internet]. 2022;43(2):1197\u0026ndash;205. Available from: http://dx.doi.org/10.1007/s10072-021-05398-6\u003c/li\u003e\n\u003cli\u003eCraig J, Patterson V. Introduction to the practice of telemedicine. Journal of Telemedicine and Telecare [Internet]. 2005 Jan 1;11(1):3\u0026ndash;9. Available from: https://doi.org/10.1177/1357633x0501100102\u003c/li\u003e\n\u003cli\u003eMiyawaki A, Tabuchi T, Ong M, Tsugawa Y. Age and Social Disparities in the Use of Telemedicine During the COVID-19 Pandemic in Japan: Cross-sectional Study. Journal of Medical Internet Research [Internet]. 2021 Jul 23;23(7):e27982. 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Available from: http://dx.doi.org/10.1136/bmj.329.7463.435\u003c/li\u003e\n\u003cli\u003eHeinzelmann PJ, Jacques G, Kvedar JC. Telemedicine by email in remote Cambodia. J Telemed Te lecare [Internet]. 2005;11 Suppl 2(2_suppl):S44-7. Available from: http://dx.doi.org/10.1258/135763305775124858\u003c/li\u003e\n\u003cli\u003eMeher SK, Tyagi RS, Chaudhry T. Awareness and attitudes to telemedicine among doctors and patients in India. J Telemed Telecare [Internet]. 2009;15(3):139\u0026ndash;41. Available from: http://dx.doi.org/10.1258/jtt.2009.003011\u003c/li\u003e\n\u003cli\u003eMubaraki AA, Alrabie AD, Sibyani AK, Aljuaid RS, Bajaber AS, Mubaraki MA. Advantages and disadvantages of telemedicine during the COVID-19 pandemic era among physicians in Taif, Saudi Arabia. Saudi Med J [Internet]. 2021;42(1):110\u0026ndash;5. Available from: http://dx.doi.org/10.15537/smj.2021.1.25610\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Teleneurology, developing country, remote consultation, telemedicine, telecommunications.","lastPublishedDoi":"10.21203/rs.3.rs-3956565/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3956565/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBACKGROUND\u003c/p\u003e\n\u003cp\u003eTelemedicine has been recognized as a viable solution for addressing the shortage of medical professionals in developing countries such as Nigeria. Tele-neurology has the potential to provide remote consultations and care for patients with neurological conditions, thereby reducing the burden of travel and improving access to medical care. Despite its growing popularity, there is a lack of research on patient’s view on this mode of care delivery in Nigeria. This study was conducted to investigate patient's perspective on the use of tele-neurology in Nigeria.\u003c/p\u003e\n\u003cp\u003eMETHODOLOGY\u003c/p\u003e\n\u003cp\u003eA descriptive cross-sectional study was conducted among 398 neurology patients at Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria. The data obtained were analyzed using descriptive statistics and a chi-square test using p \u0026lt; 0.05\u003c/p\u003e\n\u003cp\u003eRESULTS\u003c/p\u003e\n\u003cp\u003eOnly 3% of our respondents had previously used telemedicine, with 78.1% of the respondents open to using telemedicine as a means of consultation. The disadvantages of telemedicine noted include limitations in assessing neurological status (94.7%), difficulty in explaining health conditions (84.4%), and lack of technical support (14.6%). The majority of respondents (96.5%) believe telemedicine will help in saving time. There was a statistically significant association between propensity to use telemedicine and time spent in the hospital (0.045), and time off work (\u0026lt;0.001). The propensity to use telemedicine was statistically significant to the use of email (0.001) and type of email address (0.001).\u003c/p\u003e\n\u003cp\u003eCONCLUSION\u003c/p\u003e\n\u003cp\u003eThe findings suggest that there is a need for healthcare providers and policymakers to invest in developing telemedicine to improve access to care.\u003c/p\u003e","manuscriptTitle":"Telemedicine and Neurology: A survey of Neurology patients in a Nigerian tertiary hospital","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-19 12:28:59","doi":"10.21203/rs.3.rs-3956565/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"33f57943-d69a-4cc9-8459-79fe1ebec0b5","owner":[],"postedDate":"February 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-02-23T18:15:53+00:00","versionOfRecord":[],"versionCreatedAt":"2024-02-19 12:28:59","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3956565","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3956565","identity":"rs-3956565","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}