‘Telehealth for all’: capitalising on the power of virtual healthcare for persons with disability in India

‘Telehealth for all’: capitalising on the power of virtual healthcare for persons with disability in India | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article ‘Telehealth for all’: capitalising on the power of virtual healthcare for persons with disability in India Sarah Jameel, GVS Murthy, Emma George, Lalit Yadav, Vardharajan Srinivasan, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7461742/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Introduction: Virtual health care holds significant potential to advance inclusive healthcare for persons with disabilities in India, supporting the World Health Organization’s goal of Universal Health Coverage. However, individuals with disabilities often face barriers to accessing virtual healthcare due to a lack of disability-inclusive infrastructure, technology, and operational support, which further limits equitable service delivery.(1) This study aimed to investigate the experiences of persons with disabilities and their caregivers regarding virtual healthcare services in India. The focus was on assessing the accessibility, availability, acceptability, and quality (AAAQ) of these services. Methods: Data were collected through 20 in-depth interviews and five focus group discussions with persons with vision, hearing, physical, and intellectual disabilities, as well as their caregivers, across geographically diverse regions of India. Participants were recruited using a snowball sampling method, and thematic analysis was applied to identify key patterns and barriers. Results: The findings revealed that while virtual healthcare platforms offered convenience and reduced travel burdens for persons with disability, significant barriers persisted. Challenges included limited accessibility of digital platforms for screen readers, inconsistent availability of sign language interpreters, and insufficient disability-specific training for healthcare providers. Public platforms like eSanjeevani remained underutilized due to low awareness and usability issues. Discussion: This study emphasizes the need for disability-inclusive design and service delivery in virtual healthcare systems. Key recommendations include targeted training for healthcare staff, accessibility audits of virtual platforms, and policy reforms ensuring affordability and awareness of public virtual care services. Strengthening these areas can support equitable access to virtual healthcare. Disability Inclusion Virtual Healthcare Persons with Disabilities (PwDs) AAAQ Framework Digital Divide Figures Figure 1 Introduction Virtual health care is vital for promoting inclusive healthcare for persons with disabilities in India and advancing Universal Health Coverage (UHC). ( 2 , 3 )However, the lack of accessible technology, infrastructure, trained staff, and the high cost of inclusive platforms continues to hinder its equitable implementation. ( 4 ) To inform this research, a comprehensive scoping review was conducted to investigate the virtual health care landscape for persons with disabilities in India. ( 5 )This review found that there was limited research on the barriers faced by persons with disabilities in accessing these technologies, thus impeding the ability of virtual care service providers to plan and roll out accessible and equitable health care for persons with disabilities. ( 6 ) At a practice level, the National Telemedicine Service eSanjeevani online OPD (outpatient department) is a free virtual care initiative established by the Ministry of Health and Family Welfare in 2020. ( 7 ) In a forthcoming paper by this paper's authors, data was extracted from quantitative non-identifiable demographic information from over 5 million eSanjeevani appointments, demonstrating that users with disability are significantly underrepresented in use of telehealth platforms in India. If these digital systems are to contribute to UHC, it is critical to purposively and effectively include persons with disabilities so that universal coverage is assured.( 8 , 9 ) Given the importance of virtual health care for people with disability, this research aims to investigate how this existing mainstream virtual health care platform in India currently includes people with disabilities and to explore in qualitative depth the ways in which it can be strengthened Methodology This study adopted the Availability, Accessibility, Acceptability, and Quality (AAAQ) framework to assess the inclusivity of virtual health care services for persons with disabilities. ( 10 )( 11 ) The AAAQ framework evaluates health systems across four key dimensions, helping identify gaps and strengths to promote equitable and inclusive service delivery. Accessibility refers to the ease with which individuals with disabilities can reach and effectively use virtual care services, considering not just physical access but also digital usability, affordability, and the ability of caregivers to assist when needed. Availability pertains to the actual presence and timely provision of virtual healthcare services, inclusive platforms, and necessary technology or equipment that individuals require to engage in care. Acceptability highlights whether these services are ethically and culturally appropriate, respecting individual dignity, ensuring patient privacy, and being sensitive to life-cycle and dependency-related needs, such as when caregivers mediate access. Finally, quality addresses the standard and responsiveness of services, including how well consultations are conducted, whether platforms accommodate diverse needs (e.g., visual, hearing, cognitive), and whether staff are adequately trained to support inclusive care. Together, these dimensions help identify systemic strengths and gaps in virtual care delivery for people with disabilities. Topic guides were developed specifically for this study based on the AAAQ framework to capture participant experiences related to usability, access, satisfaction, and engagement. ( 10 , 11 ) To understand user experiences, 20 in-depth interviews (IDIs) and five focus group discussions (FGDs) were conducted. Topic guides were developed based on the AAAQ framework to capture participant experiences related to usability, access, satisfaction, and engagement. Interviews were customized based on participants’ prior virtual care usage. Participants included individuals with vision, hearing, physical, and intellectual disabilities, along with their caregivers. Both users and non-users of virtual care platforms were included to provide diverse perspectives. Participants were recruited through snowball sampling by leveraging networks with healthcare providers and disability-focused NGOs. Eligibility was limited to adults with disabilities and their caregivers. Participants were selects from geographically diverse regions of India, from the states of Andhra Pradesh, Telangana, Karnataka, Tamil Nadu, and Uttarakhand. The age range for participants spanned between 18 and 54 years. The details of participants based on disabilities and users versus non-users are included in the following Table 1 : Table 1 Participant details Groups Disability types IDIs FGDs Male Female Users Vision impairment 6 3 8 1 Hearing impairment - 3 2 1 Physical impairment 1 3 4 - Total (Users) 7 9 14 2 Non-users Vision impairment 7 1 4 4 Physical impairment 1 8 5 4 Intellectual disability - - - - Total (Non-users) 8 9 9 8 Caregivers of Persons with Disabilities Vision impairment 1 - 1 - Hearing impairment - - - - Physical impairment 1 - - 1 Intellectual disability 3 - 2 1 Total (Caregivers) 5 - 3 2 Sign language interpreters were present for participants with hearing impairments. Interviews lasted between 15–45 minutes and continued until thematic saturation was reached. All interviews were audio recorded, translated into English where needed, transcribed, and anonymized to ensure confidentiality. Thematic analysis was applied, involving systematic coding, identification of recurring patterns, and the development of overarching themes and subthemes. ( 12 , 13 ) Ethics approval: The institute review board of Indian Institute of Public Health, Hyderabad (IIPH-H) Ethics Committee approved the study (IIPHH/TRCIEC/364/2023-10/05/2023). Verbal or written consent was obtained prior to participation. Results Figure 1 presents the key themes emerging from the data organised and aligned to the AAAQ framework. The findings related to each of these four key areas capture the lived experiences of individuals and the extent to which virtual healthcare models met the needs of persons with disabilities. Emerging from the research were both positive aspects of virtual health care and areas where improvement was needed. Accessibility of services for persons with disabilities: While virtual health care offers a promising avenue for healthcare access, various factors were found to influence its effectiveness and utilization, including the ability for persons with disability to access providers, information, and technology. Costs and ease of use also became barriers for some participants. Access to Providers Users of government-provided virtual health care platforms often faced hurdles in accessing consistent and timely support. One participant explained: “Government, the service is slow but in private you get help easily so I prefer it.” (M, Caregiver of a child with Disability). However, the round-the-clock availability of the government helpline number was acknowledged as beneficial. Access to Information/Awareness Public awareness campaigns led by startups like Medibuddy ( 14 ) and Practo ( 15 ) have played a crucial role in educating the public, including persons with disabilities, about the benefits of virtual healthcare. Only two virtual healthcare users with disability demonstrated awareness of eSanjeevani OPD , India’s largest public sector virtual care platform. One person stated: “We are not very aware about these services, what to use and what not, we also feel that the doctor should be made more aware whatever services are available.” (F, Community Head, Physical disability). Additionally, when asked about registration with the Ayushman Bharat Health Access (ABHA) number, only two participants (one user and one non-user) had availed themselves of this national government healthcare identifier. Access to disability-inclusive resources Accessibility concerns relating to the technology and user experience extended to date formats, calendar accessibility for keyboard users, and challenges faced by persons with vision impairment who depend on screen readers within the applications where certain types of visual content, particularly images depicting body parts such as hands and legs. These images were often misinterpreted by screen reader software as graphic content. This can be rectified by having medical descriptions for all images and graphics online. While websites may be navigable on laptops or computers, the limitations become glaring when transitioning to mobile applications and it’s important to perform comprehensive audits on existing virtual care platforms. For others, they can easily do the video calling, but it’s difficult for us because as I can’t take pictures without someone’s assistance if the doctors can remain on the video and ask me to show the medicines on the camera, at a point where they can see it, it would be great. (M, 29, Bank employee, Vision impairment) Additionally, participants raised issues regarding the usability of height scales on platforms, where precise measurements were hindered by the lack of auditory feedback or clear instructions indicating how to adjust the scales while signing in. Participants suggested providing alternative communication methods, offering training on accessible design practices to users, and incorporating user feedback into platform development. Prescription and Billing Persons with disability found the integration of prescriptions with online pharmacy services after virtual consultations to be a significant benefit compared to in-person visits where obtaining medications involved going through various departments, receiving explanations about the prescribed drugs from different individuals, and making payments at separate locations and this can inadvertently cause further communication barriers and, as the person with disabilities may not have the opportunity to ask questions or seek clarification directly from the providers. “Website, if you are using it with a laptop or a computer, it is absolutely fine. But when you are using an app, I cannot access their prescription and for me it is not even downloadable. I have to ask someone else even to see whether the prescription has come or not.” (M, 27, PhD student, Vision impairment) Affordability of Services Participants with hearing impairments highlighted the challenges related to interpreter costs for virtual care, noting that they “have to pay for two things, the doctor, and the interpreter” (M, Software employee, Hearing impairment) and emphasized the need for options such as free interpreter services or integrated solutions. 2. Availability of services: The availability of services was impacted by their level of inclusivity and adjustment for types of disability. Availability of Inclusive Platforms Persons with physical impairments pointed out that government primary health facilities are often understaffed and lack adequate medical resources, further exacerbating the challenges of accessing virtual care services; however, for many persons with disabilities, telehealth platforms were particularly helpful during the pandemic: During the pandemic, it is easier to connect with doctors remotely. (F, Caregiver of a Child with Vision Impairment) For persons with vision impairment, virtual platforms also meant that they were able to access consultations on their own: Persons sometimes hesitate to accompany us. In the case of virtual care, it can happen at home, we don’t have to go anywhere, it’s cost-effective and we have immediate doctor’s attention. (M, 29, Bank employee, Vision impairment) One participant noted that it would be helpful for parents of a person with disability to be better educated to support their children access these services: The parents would want to learn more about their child’s disabilities. And in that case, I strongly believe that instead of online options or video consultations options having online education would be really helpful for the caregivers (F, Caregiver of a child with Intellectual Disability) Availability of Technology and Equipment Some participants expressed reservations about the security of online transactions, particularly for persons with sensory disabilities. And while younger individuals may be more adept at navigating mobile applications and digital platforms, older individuals with disabilities find it challenging to adapt to new technologies. From the data, it also emerged that there was a need for disability advocacy groups to gather input and feedback on the specific needs and preferences of persons with disabilities, ensuring the platform design process incorporates feedback generated through extensive user testing by persons with disabilities. The calls come on the app and we need to answer them on the app, and it is not fully accessible. So, I faced challenges there and wished that they could have in mind that some users are screen readers, and make it more accessible for more help. (M, 29, Bank employee, Vision impairment) In the Practo app, for each specialization, the screen reader just says things like 'unable to read image' or similar messages, so we can’t really understand what we are clicking on. (M, 27, PhD student, Vision impairment) 3. Acceptability of services: Non-users with vision impairments highlighted the limitations of virtual care in addressing severe conditions and emphasized the need for in-person consultations for more impactful interactions. Patient Independence and Comfort Previously needing to rely on others for assistance, some participants with disability found they could manage their health autonomously through virtual health care. Arranging for online interpreters during virtual consultations was found to allow individuals with hearing impairments to effectively communicate in acceptable ways, enabling more independent participation in healthcare decision-making processes. Additionally, being in their own home could be particularly beneficial for persons with disabilities. One participant explained: “ The hospital environment makes any child anxious” (F, Caregiver of a child with intellectual disability). By receiving healthcare services in the familiar setting of their homes, parents of children with intellectual disabilities experienced less stress and discomfort. Additionally, companies such as Portea Medical ( 16 ) and Nightingales ( 17 ) have pioneered home healthcare services, providing convenience and accessibility and this was particularly important during the pandemic: Without teleconsultation, we were not able to do the therapies and we were very sad and lockdown came and teleconsultation started. And it was very good news for us. (F, Mother of Child with Vision Impairment) The same participant went on to explain that when “planning and traveling, you actually waste a full day when you can actually explain things over a phone call ,” which is especially challenging for caregivers who are balancing caregiving responsibilities with work commitments. Sharing of personal information: Participant trust in the platform or provider played a crucial role in acceptability, with participants expressing confidence in established institutions. While some participants felt secure and had not encountered issues, others acknowledged the need for caution. For example, one participant shared: “If the data leaks, the patient’s disease can be captured by pharma companies or healthcare companies. I don’t know how the government is restricting them.” (M, 29, Bank employee, Vision impairment). Participants highlighted the pervasive stigma surrounding mental health issues and its impact on individuals’ willingness to seek and engage with virtual mental health support. Not many persons would actually feel comfortable to discuss their mental issues. So, there are persons like me who don’t hesitate, but there is really India that is still, that is still kind of a big issue. (M, 24, PhD Student, Vision Impairment) 4. Quality of services Quality of Consultations There was a consensus that training programs should cover both technical aspects of telecommunication tools, as well as specific considerations for individuals with disabilities and providers. Some participants highlighted challenges, such as difficulty in lip reading due to masks worn by healthcare providers. One participant explained: "The doctor wears a mask so I cannot lip read, so they need to know some basic sign language to be able to communicate with me so I feel satisfied and understand." (M, 28, Photographer, Hearing impairment). Additionally, quality consultations in the context of disability also required patience from healthcare providers to ensure effective communication and understanding: "Staff should repeat things and practices once or twice and be trained on patience to cater to us and the users should be made aware about how to use it, any technology." (M, 28, Vision impairment) Need for Guidelines Participants emphasized the importance of standardized guidelines within virtual care systems so to accommodate individuals with disabilities. Training programs should incorporate such guidelines to promote consistency and quality in virtual care. The platforms need to flag and record a patient’s type of disability to adjust the treatment and follow protocols accordingly. Discussion Despite telemedicine's transformative potential to improve healthcare accessibility by overcoming geographical, financial, and infrastructural barriers, its usage remains suboptimal. ( 18 ) One factor to explain this gap is that virtual healthcare services, which are not fully designed with inclusivity in mind, can encompass significant barriers to accessibility and equity. Additionally, many users are unaware of the full range of services available. ( 19 )( 20 ). The AAAQ criteria emphasizes non-discrimination as a core to “accessibility.” This principle mandates that virtual care services should be accessible to all without discrimination. Non-discrimination, aligned with a human rights-based approach (HRBA) ( 11 ), is a crosscutting principle applicable to all AAAQ criteria. ( 21 ) Despite growing international commitments to equitable healthcare, persons with disabilities are still, at times, denied access to health services solely based on their disability status—either explicitly through discriminatory practices or implicitly through structural exclusion. This denial reflects not only social stigma but also systemic neglect in policy and service design. ( 22 , 23 ) Acceptability, relates to how well these services meet the cultural, social, and individual needs of users, ensuring they feel comfortable and valued when using them. For example, many digital health platforms fail to provide screen reader compatibility or plain language materials, excluding users with visual or intellectual impairments from essential health information. Additionally, attitudinal barriers—such as implicit bias or lack of provider training—can manifest virtually through hurried consultations, limited patient-provider communication, or disregard for the patient's autonomy.( 23 ) Evidence supports that when virtual care is codesigned and/or patient centred and culturally tailored for users can address specific barriers and promote both accessibility and acceptability. ( 24 ) Acceptability issues can arise from a lack of culturally appropriate care, inadequate patient-provider communication, and concerns about privacy and data security. Similarly, other studies have reported on increased privacy and security of virtual care so that it can be provided in a safe, efficient alternative to in-person consultations ( 25 , 26 ), offering flexibility and convenience for caregivers balancing caregiving responsibilities with other work commitments.( 27 ) ( 24 ) To strengthen these services for all persons with a disability, a development of standardized guidelines that sets out best practices to ensure consistency and quality in service delivery is important. A set of guidelines are currently in their initial phase of development and are expected to evolve alongside the research into best practices in virtual care. ( 28 ) Finally, to address the gaps outlined in this paper, future research should not only continue to improve the technical accessibility of virtual healthcare platforms but also focus on their acceptability among diverse user groups.( 29 ) This includes, like the present study, conducting studies with users to better understand patient experiences, preferences, and satisfaction levels. Limitations ` While the participants represent a small group, it would be valuable to explore virtual health care experiences across other Indian states. While snowball sampling was utilized for participant recruitment, this may overlook some users who are less informed or less able to access current healthcare systems, and these people are important to capture in the data in future studies. Participants who were recruited from specific platforms or institutions offering virtual care, may perceive a stigma associated with admitting to challenges or difficulties with the platform’s use. They may be hesitant to disclose such information, fearing judgment or negative perceptions from healthcare providers, caregivers, or peers. Conclusion The COVID-19 pandemic and our initial scoping review ( 5 )exposed a significant gap in public health: the consistent neglect of persons with disabilities in research and policy development related to healthcare accessibility.( 30 ) Using the AAAQ (Accessibility, Availability, Acceptability, Quality) framework, this study explores virtual care experiences among individuals with disabilities and their caregivers in India. Our findings highlight the potential of virtual care to overcome geographical barriers and offer flexible scheduling. While efforts to narrow the digital divide, such as increasing broadband affordability, are underway, these measures may fall short due to the dual challenges of lower income rates and device ownership among persons with disabilities. The quality of virtual care was generally well received, yet gaps remain in standardized protocols and provider training, particularly in disability-specific care. To fully realize the benefits of virtual care, further research is essential. This research should focus on refining virtual care protocols, expanding disability-specific training for providers, and advocating for inclusive design principles. This critical research is crucial to ensure that the opportunity that virtual healthcare services provide translates into real-world benefits for persons with disabilities. Declarations Statements and Declarations The authors declare that there is no conflict of interest related to the research, authorship, or publication of this manuscript on virtual healthcare for persons with disabilities. Authorship confirmation/contribution statement Name Roles Institute Affiliations Sarah Jameel* [email protected] Data curation, Analysis, Investigation/ Data collection, Resources, Visualization, Writing, Methodology Research Associate, Pragyaan Sustainable Health Outcomes Foundation, Hyderabad, India GVS Murthy Conceptualization, Supervisor, Validation, Writing-Review and Editing President, Pragyaan Sustainable Health Outcomes Foundation, Hyderabad, India Professor (Public Health Eye Care & Disability), LSHTM Emma George Conceptualization, Writing, Review and Editing, Analysis, Methodology, Resources, Validation School of Allied Health Science and Practice, University of Adelaide Lalit Yadav Writing, Validation, Resources, Methodology Adelaide Medical School, University of Adelaide, Adelaide, Australia Vardharajan Srinivasan Methodology, Resources, Writing- Review and Editing The George Institute for Global Health, Delhi, India Jayme Wearn Project Administrator, Resources, Validation, Writing-Review and Editing Nossal Institute for Global Health, The University of Melbourne, Melbourne, Australia Shailaja Tetali Conceptualization, Investigation, Project Administrator Indian Institute of Public Health- Hyderabad, Hyderabad, India Oommen John Conceptualization, methodology, validation and project administrator The George Institute for Global Health, Delhi, India Nathan Grills Conceptualization, Funding Acquisition, Methodology, Supervisor, Writing-Review and Editing Nossal Institute for Global Health, Australia India Institute, The University of Melbourne, Melbourne, Australia Ethics approval: The institute review board of Indian Institute of Public Health, Hyderabad (IIPH-H) Ethics Committee approved the study (IIPHH/TRCIEC/364/2023-10/05/2023). Free and formed consent was obtained in writing or verbally prior to participation. The study complied with the WMA Declaration of Helsinki. Consent for Publication Not Applicable. Declaration of Conflict of Interest The authors declare that there is no conflict of interest related to the research, authorship, or publication of this manuscript on virtual healthcare for persons with disabilities. Data Availability Due to the sensitive nature of this study involving in-depth interviews with persons with disabilities, full transcripts and raw qualitative data will not be made publicly available in order to protect participant confidentiality and uphold ethical commitments. However, de-identified excerpts or data summaries may be shared with qualified researchers upon reasonable request. Competing interests The authors declare that they have no competing interests Funding The authors gratefully acknowledge funding received from the Australia India Council, DFAT. The funder has had no specific role in the conceptualization, design, data collection, analysis, decision to publish, or preparation of the manuscript. Acknowledgements Not Applicable Author’s Contributions Name Roles Institute Affiliations Sarah Jameel* [email protected] Data curation, Analysis, Investigation/ Data collection, Resources, Visualization, Writing, Methodology Research Associate, Pragyaan Sustainable Health Outcomes Foundation, Hyderabad, India GVS Murthy Conceptualization, Supervisor, Validation, Writing-Review and Editing President, Pragyaan Sustainable Health Outcomes Foundation, Hyderabad, India Professor (Public Health Eye Care & Disability), LSHTM Emma George Conceptualization, Writing, Review and Editing, Analysis, Methodology, Resources, Validation School of Allied Health Science and Practice, University of Adelaide Lalit Yadav Writing, Validation, Resources, Methodology Adelaide Medical School, University of Adelaide, Adelaide, Australia Vardharajan Srinivasan Methodology, Resources, Writing- Review and Editing The George Institute for Global Health, Delhi, India Jayme Wearn Project Administrator, Resources, Validation, Writing-Review and Editing Nossal Institute for Global Health, The University of Melbourne, Melbourne, Australia Shailaja Tetali Conceptualization, Investigation, Project Administrator Indian Institute of Public Health- Hyderabad, Hyderabad, India Oommen John Conceptualization, methodology, validation and project administrator The George Institute for Global Health, Delhi, India Nathan Grills Conceptualization, Funding Acquisition, Methodology, Supervisor, Writing-Review and Editing Nossal Institute for Global Health, Australia India Institute, The University of Melbourne, Melbourne, Australia References Dastidar BG, Suri S, Nagaraja VH, Jani A. 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Telehealth Med Today. 2023;8(3). The Impact of Telemedicine on Healthcare. Accessibility and Affordability | ACL Digital [Internet]. [cited 2024 Sep 3]. Available from: https://healthcare.acldigital.com/blogs/impact-telemedicine-healthcare-accessibility-and-affordability Goyal D, Hunt X, Kuper H, Shakespeare T, Banks LM. Impact of the COVID-19 pandemic on people with disabilities and implications for health services research. https://doi.org/101177/13558196231160047 [Internet]. 2023 Feb 23 [cited 2024 Dec 7];28(2):77–9. Available from: https://journals.sagepub.com/doi/ 10.1177/13558196231160047 Additional Declarations No competing interests reported. Supplementary Files VirtuCareSSIandFGDTools.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 25 Nov, 2025 Reviews received at journal 14 Nov, 2025 Reviews received at journal 02 Nov, 2025 Reviews received at journal 28 Oct, 2025 Reviewers agreed at journal 26 Oct, 2025 Reviewers agreed at journal 22 Oct, 2025 Reviewers agreed at journal 22 Oct, 2025 Reviewers agreed at journal 19 Sep, 2025 Reviewers invited by journal 18 Sep, 2025 Editor assigned by journal 03 Sep, 2025 Submission checks completed at journal 02 Sep, 2025 First submitted to journal 02 Sep, 2025 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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07:15:25","extension":"html","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":101226,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7461742/v1/cf3599f635d7742b5cc22b8a.html"},{"id":92475077,"identity":"7e7f0039-f7f4-44c3-8db0-c1e1535ae7f0","added_by":"auto","created_at":"2025-09-30 07:15:25","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":906442,"visible":true,"origin":"","legend":"\u003cp\u003eAAAQ Findings for the research\u003c/p\u003e\n\u003cp\u003eThis diagram illustrates the four key dimensions of equitable and inclusive health service delivery—Availability, Accessibility, Acceptability, and Quality—and the interconnected factors influencing them.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7461742/v1/33e078a74968a3960f4a7cc9.jpg"},{"id":92479957,"identity":"76a03d64-8d42-4124-ab4d-b886cd42f8d7","added_by":"auto","created_at":"2025-09-30 07:39:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1754287,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7461742/v1/17c8603f-947d-4b63-a3d2-3088f5c201c1.pdf"},{"id":92478469,"identity":"b32f62fd-977b-4a2c-8cc8-10cd4859453a","added_by":"auto","created_at":"2025-09-30 07:31:25","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":2745764,"visible":true,"origin":"","legend":"","description":"","filename":"VirtuCareSSIandFGDTools.docx","url":"https://assets-eu.researchsquare.com/files/rs-7461742/v1/38cfb5d4e91cdc2afa3a9e96.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"‘Telehealth for all’: capitalising on the power of virtual healthcare for persons with disability in India","fulltext":[{"header":"Introduction","content":"\u003cp\u003eVirtual health care is vital for promoting inclusive healthcare for persons with disabilities in India and advancing Universal Health Coverage (UHC). (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)However, the lack of accessible technology, infrastructure, trained staff, and the high cost of inclusive platforms continues to hinder its equitable implementation. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eTo inform this research, a comprehensive scoping review was conducted to investigate the virtual health care landscape for persons with disabilities in India. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)This review found that there was limited research on the barriers faced by persons with disabilities in accessing these technologies, thus impeding the ability of virtual care service providers to plan and roll out accessible and equitable health care for persons with disabilities. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eAt a practice level, the National Telemedicine Service eSanjeevani online OPD (outpatient department) is a free virtual care initiative established by the Ministry of Health and Family Welfare in 2020. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) In a forthcoming paper by this paper's authors, data was extracted from quantitative non-identifiable demographic information from over 5\u0026nbsp;million eSanjeevani appointments, demonstrating that users with disability are significantly underrepresented in use of telehealth platforms in India. If these digital systems are to contribute to UHC, it is critical to purposively and effectively include persons with disabilities so that universal coverage is assured.(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eGiven the importance of virtual health care for people with disability, this research aims to investigate how this existing mainstream virtual health care platform in India currently includes people with disabilities and to explore in qualitative depth the ways in which it can be strengthened\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003e This study adopted the Availability, Accessibility, Acceptability, and Quality (AAAQ) framework to assess the inclusivity of virtual health care services for persons with disabilities. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) The AAAQ framework evaluates health systems across four key dimensions, helping identify gaps and strengths to promote equitable and inclusive service delivery.\u003c/p\u003e\u003cp\u003eAccessibility refers to the ease with which individuals with disabilities can reach and effectively use virtual care services, considering not just physical access but also digital usability, affordability, and the ability of caregivers to assist when needed. Availability pertains to the actual presence and timely provision of virtual healthcare services, inclusive platforms, and necessary technology or equipment that individuals require to engage in care. Acceptability highlights whether these services are ethically and culturally appropriate, respecting individual dignity, ensuring patient privacy, and being sensitive to life-cycle and dependency-related needs, such as when caregivers mediate access. Finally, quality addresses the standard and responsiveness of services, including how well consultations are conducted, whether platforms accommodate diverse needs (e.g., visual, hearing, cognitive), and whether staff are adequately trained to support inclusive care. Together, these dimensions help identify systemic strengths and gaps in virtual care delivery for people with disabilities.\u003c/p\u003e\u003cp\u003eTopic guides were developed specifically for this study based on the AAAQ framework to capture participant experiences related to usability, access, satisfaction, and engagement. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eTo understand user experiences, 20 in-depth interviews (IDIs) and five focus group discussions (FGDs) were conducted. Topic guides were developed based on the AAAQ framework to capture participant experiences related to usability, access, satisfaction, and engagement. Interviews were customized based on participants\u0026rsquo; prior virtual care usage.\u003c/p\u003e\u003cp\u003eParticipants included individuals with vision, hearing, physical, and intellectual disabilities, along with their caregivers. Both users and non-users of virtual care platforms were included to provide diverse perspectives. Participants were recruited through snowball sampling by leveraging networks with healthcare providers and disability-focused NGOs. Eligibility was limited to adults with disabilities and their caregivers.\u003c/p\u003e\u003cp\u003eParticipants were selects from geographically diverse regions of India, from the states of Andhra Pradesh, Telangana, Karnataka, Tamil Nadu, and Uttarakhand. The age range for participants spanned between 18 and 54 years.\u003c/p\u003e\u003cp\u003eThe details of participants based on disabilities and users versus non-users are included in the following Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e:\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eParticipant details\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGroups\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDisability types\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIDIs\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFGDs\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eUsers\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVision impairment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHearing impairment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePhysical impairment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eTotal (Users)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e7\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e9\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e14\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eNon-users\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVision impairment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePhysical impairment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntellectual disability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eTotal (Non-users)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e9\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e9\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e\u003cb\u003eCaregivers of Persons with Disabilities\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eVision impairment\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHearing impairment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePhysical impairment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntellectual disability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eTotal (Caregivers)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e Sign language interpreters were present for participants with hearing impairments. Interviews lasted between 15\u0026ndash;45 minutes and continued until thematic saturation was reached. All interviews were audio recorded, translated into English where needed, transcribed, and anonymized to ensure confidentiality.\u003c/p\u003e\u003cp\u003eThematic analysis was applied, involving systematic coding, identification of recurring patterns, and the development of overarching themes and subthemes. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthics approval:\u003c/strong\u003e\u003cp\u003e The institute review board of Indian Institute of Public Health, Hyderabad (IIPH-H) Ethics Committee approved the study (IIPHH/TRCIEC/364/2023-10/05/2023). Verbal or written consent was obtained prior to participation.\u003c/p\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the key themes emerging from the data organised and aligned to the AAAQ framework. The findings related to each of these four key areas capture the lived experiences of individuals and the extent to which virtual healthcare models met the needs of persons with disabilities. Emerging from the research were both positive aspects of virtual health care and areas where improvement was needed.\u003c/p\u003e\u003cp\u003eAccessibility of services for persons with disabilities:\u003c/p\u003e\u003cp\u003eWhile virtual health care offers a promising avenue for healthcare access, various factors were found to influence its effectiveness and utilization, including the ability for persons with disability to access providers, information, and technology. Costs and ease of use also became barriers for some participants.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eAccess to Providers\u003c/h2\u003e\u003cp\u003eUsers of government-provided virtual health care platforms often faced hurdles in accessing consistent and timely support. One participant explained:\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Government, the service is slow but in private you get help easily so I prefer it.\u0026rdquo; (M, Caregiver of a child with Disability).\u003c/em\u003e\u003c/p\u003e\u003cp\u003eHowever, the round-the-clock availability of the government helpline number was acknowledged as beneficial.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eAccess to Information/Awareness\u003c/h3\u003e\n\u003cp\u003ePublic awareness campaigns led by startups like Medibuddy (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) and Practo (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) have played a crucial role in educating the public, including persons with disabilities, about the benefits of virtual healthcare.\u003c/p\u003e\u003cp\u003eOnly two virtual healthcare users with disability demonstrated awareness of \u003cem\u003eeSanjeevani OPD\u003c/em\u003e, India\u0026rsquo;s largest public sector virtual care platform. One person stated:\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;We are not very aware about these services, what to use and what not, we also feel that the doctor should be made more aware whatever services are available.\u0026rdquo; (F, Community Head, Physical disability).\u003c/em\u003e\u003c/p\u003e\u003cp\u003eAdditionally, when asked about registration with the Ayushman Bharat Health Access (ABHA) number, only two participants (one user and one non-user) had availed themselves of this national government healthcare identifier.\u003c/p\u003e\n\u003ch3\u003eAccess to disability-inclusive resources\u003c/h3\u003e\n\u003cp\u003eAccessibility concerns relating to the technology and user experience extended to date formats, calendar accessibility for keyboard users, and challenges faced by persons with vision impairment who depend on screen readers within the applications where certain types of visual content, particularly images depicting body parts such as hands and legs. These images were often misinterpreted by screen reader software as graphic content. This can be rectified by having medical descriptions for all images and graphics online. While websites may be navigable on laptops or computers, the limitations become glaring when transitioning to mobile applications and it\u0026rsquo;s important to perform comprehensive audits on existing virtual care platforms.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eFor others, they can easily do the video calling, but it\u0026rsquo;s difficult for us because as I can\u0026rsquo;t take pictures without someone\u0026rsquo;s assistance if the doctors can remain on the video and ask me to show the medicines on the camera, at a point where they can see it, it would be great.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003e(M, 29, Bank employee, Vision impairment)\u003c/h3\u003e\n\u003cp\u003eAdditionally, participants raised issues regarding the usability of height scales on platforms, where precise measurements were hindered by the lack of auditory feedback or clear instructions indicating how to adjust the scales while signing in. Participants suggested providing alternative communication methods, offering training on accessible design practices to users, and incorporating user feedback into platform development.\u003c/p\u003e\n\u003ch3\u003ePrescription and Billing\u003c/h3\u003e\n\u003cp\u003ePersons with disability found the integration of prescriptions with online pharmacy services after virtual consultations to be a significant benefit compared to in-person visits where obtaining medications involved going through various departments, receiving explanations about the prescribed drugs from different individuals, and making payments at separate locations and this can inadvertently cause further communication barriers and, as the person with disabilities may not have the opportunity to ask questions or seek clarification directly from the providers.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Website, if you are using it with a laptop or a computer, it is absolutely fine. But when you are using an app, I cannot access their prescription and for me it is not even downloadable. I have to ask someone else even to see whether the prescription has come or not.\u0026rdquo; (M, 27, PhD student, Vision impairment)\u003c/em\u003e\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eAffordability of Services\u003c/h2\u003e\u003cp\u003eParticipants with hearing impairments highlighted the challenges related to interpreter costs for virtual care, noting that they \u003cem\u003e\u0026ldquo;have to pay for two things, the doctor, and the interpreter\u0026rdquo; (M, Software employee, Hearing impairment)\u003c/em\u003e and emphasized the need for options such as free interpreter services or integrated solutions.\u003c/p\u003e\u003cp\u003e2. Availability of services:\u003c/p\u003e\u003cp\u003eThe availability of services was impacted by their level of inclusivity and adjustment for types of disability.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eAvailability of Inclusive Platforms\u003c/h3\u003e\n\u003cp\u003ePersons with physical impairments pointed out that government primary health facilities are often understaffed and lack adequate medical resources, further exacerbating the challenges of accessing virtual care services; however, for many persons with disabilities, telehealth platforms were particularly helpful during the pandemic:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eDuring the pandemic, it is easier to connect with doctors remotely.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003e(F, Caregiver of a Child with Vision Impairment)\u003c/h3\u003e\n\u003cp\u003eFor persons with vision impairment, virtual platforms also meant that they were able to access consultations on their own:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003ePersons sometimes hesitate to accompany us. In the case of virtual care, it can happen at home, we don\u0026rsquo;t have to go anywhere, it\u0026rsquo;s cost-effective and we have immediate doctor\u0026rsquo;s attention.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e(M, 29, Bank employee, Vision impairment)\u003c/h2\u003e\u003cp\u003eOne participant noted that it would be helpful for parents of a person with disability to be better educated to support their children access these services:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe parents would want to learn more about their child\u0026rsquo;s disabilities. And in that case, I strongly believe that instead of online options or video consultations options having online education would be really helpful for the caregivers\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e(F, Caregiver of a child with Intellectual Disability)\u003c/h2\u003e\u003cdiv id=\"Sec13\" class=\"Section3\"\u003e\u003ch2\u003eAvailability of Technology and Equipment\u003c/h2\u003e\u003cp\u003eSome participants expressed reservations about the security of online transactions, particularly for persons with sensory disabilities. And while younger individuals may be more adept at navigating mobile applications and digital platforms, older individuals with disabilities find it challenging to adapt to new technologies.\u003c/p\u003e\u003cp\u003eFrom the data, it also emerged that there was a need for disability advocacy groups to gather input and feedback on the specific needs and preferences of persons with disabilities, ensuring the platform design process incorporates feedback generated through extensive user testing by persons with disabilities.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe calls come on the app and we need to answer them on the app, and it is not fully accessible. So, I faced challenges there and wished that they could have in mind that some users are screen readers, and make it more accessible for more help.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003e(M, 29, Bank employee, Vision impairment)\u003c/h2\u003e\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eIn the Practo app, for each specialization, the screen reader just says things like 'unable to read image' or similar messages, so we can\u0026rsquo;t really understand what we are clicking on.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003e(M, 27, PhD student, Vision impairment)\u003c/h2\u003e\u003cp\u003e3. Acceptability of services:\u003c/p\u003e\u003cp\u003eNon-users with vision impairments highlighted the limitations of virtual care in addressing severe conditions and emphasized the need for in-person consultations for more impactful interactions.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003ePatient Independence and Comfort\u003c/h2\u003e\u003cp\u003ePreviously needing to rely on others for assistance, some participants with disability found they could manage their health autonomously through virtual health care. Arranging for online interpreters during virtual consultations was found to allow individuals with hearing impairments to effectively communicate in acceptable ways, enabling more independent participation in healthcare decision-making processes.\u003c/p\u003e\u003cp\u003eAdditionally, being in their own home could be particularly beneficial for persons with disabilities. One participant explained:\u003c/p\u003e\u003cp\u003e\u0026ldquo;\u003cem\u003eThe hospital environment makes any child anxious\u0026rdquo; (F, Caregiver of a child with intellectual disability).\u003c/em\u003e\u003c/p\u003e\u003cp\u003eBy receiving healthcare services in the familiar setting of their homes, parents of children with intellectual disabilities experienced less stress and discomfort. Additionally, companies such as Portea Medical (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) and Nightingales (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) have pioneered home healthcare services, providing convenience and accessibility and this was particularly important during the pandemic:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eWithout teleconsultation, we were not able to do the therapies and we were very sad and lockdown came and teleconsultation started. And it was very good news for us.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003e(F, Mother of Child with Vision Impairment)\u003c/h2\u003e\u003cp\u003eThe same participant went on to explain that when \u003cem\u003e\u0026ldquo;planning and traveling, you actually waste a full day when you can actually explain things over a phone call\u003c/em\u003e,\u0026rdquo; which is especially challenging for caregivers who are balancing caregiving responsibilities with work commitments.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eSharing of personal information:\u003c/h2\u003e\u003cp\u003eParticipant trust in the platform or provider played a crucial role in acceptability, with participants expressing confidence in established institutions.\u003c/p\u003e\u003cp\u003eWhile some participants felt secure and had not encountered issues, others acknowledged the need for caution. For example, one participant shared:\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;If the data leaks, the patient\u0026rsquo;s disease can be captured by pharma companies or healthcare companies. I don\u0026rsquo;t know how the government is restricting them.\u0026rdquo; (M, 29, Bank employee, Vision impairment).\u003c/em\u003e\u003c/p\u003e\u003cp\u003eParticipants highlighted the pervasive stigma surrounding mental health issues and its impact on individuals\u0026rsquo; willingness to seek and engage with virtual mental health support.\u003c/p\u003e\u003cp\u003e\u003cem\u003eNot many persons would actually feel comfortable to discuss their mental issues. So, there are persons like me who don\u0026rsquo;t hesitate, but there is really India that is still, that is still kind of a big issue.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003e(M, 24, PhD Student, Vision Impairment)\u003c/h2\u003e\u003cp\u003e4. Quality of services\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eQuality of Consultations\u003c/h2\u003e\u003cp\u003eThere was a consensus that training programs should cover both technical aspects of telecommunication tools, as well as specific considerations for individuals with disabilities and providers. Some participants highlighted challenges, such as difficulty in lip reading due to masks worn by healthcare providers. One participant explained:\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"The doctor wears a mask so I cannot lip read, so they need to know some basic sign language to be able to communicate with me so I feel satisfied and understand.\" (M, 28, Photographer, Hearing impairment).\u003c/em\u003e\u003c/p\u003e\u003cp\u003eAdditionally, quality consultations in the context of disability also required patience from healthcare providers to ensure effective communication and understanding:\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Staff should repeat things and practices once or twice and be trained on patience to cater to us and the users should be made aware about how to use it, any technology.\"\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003e(M, 28, Vision impairment)\u003c/h2\u003e\u003cdiv id=\"Sec22\" class=\"Section3\"\u003e\u003ch2\u003eNeed for Guidelines\u003c/h2\u003e\u003cp\u003e Participants emphasized the importance of standardized guidelines within virtual care systems so to accommodate individuals with disabilities. Training programs should incorporate such guidelines to promote consistency and quality in virtual care. The platforms need to flag and record a patient\u0026rsquo;s type of disability to adjust the treatment and follow protocols accordingly.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eDespite telemedicine's transformative potential to improve healthcare accessibility by overcoming geographical, financial, and infrastructural barriers, its usage remains suboptimal. (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eOne factor to explain this gap is that virtual healthcare services, which are not fully designed with inclusivity in mind, can encompass significant barriers to accessibility and equity. Additionally, many users are unaware of the full range of services available. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e)(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). The AAAQ criteria emphasizes non-discrimination as a core to \u0026ldquo;accessibility.\u0026rdquo; This principle mandates that virtual care services should be accessible to all without discrimination. Non-discrimination, aligned with a human rights-based approach (HRBA) (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), is a crosscutting principle applicable to all AAAQ criteria. (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eDespite growing international commitments to equitable healthcare, persons with disabilities are still, at times, denied access to health services solely based on their disability status\u0026mdash;either explicitly through discriminatory practices or implicitly through structural exclusion. This denial reflects not only social stigma but also systemic neglect in policy and service design. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eAcceptability, relates to how well these services meet the cultural, social, and individual needs of users, ensuring they feel comfortable and valued when using them. For example, many digital health platforms fail to provide screen reader compatibility or plain language materials, excluding users with visual or intellectual impairments from essential health information. Additionally, attitudinal barriers\u0026mdash;such as implicit bias or lack of provider training\u0026mdash;can manifest virtually through hurried consultations, limited patient-provider communication, or disregard for the patient's autonomy.(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) Evidence supports that when virtual care is codesigned and/or patient centred and culturally tailored for users can address specific barriers and promote both accessibility and acceptability. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eAcceptability issues can arise from a lack of culturally appropriate care, inadequate patient-provider communication, and concerns about privacy and data security. Similarly, other studies have reported on increased privacy and security of virtual care so that it can be provided in a safe, efficient alternative to in-person consultations (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), offering flexibility and convenience for caregivers balancing caregiving responsibilities with other work commitments.(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e To strengthen these services for all persons with a disability, a development of standardized guidelines that sets out best practices to ensure consistency and quality in service delivery is important. A set of guidelines are currently in their initial phase of development and are expected to evolve alongside the research into best practices in virtual care. (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eFinally, to address the gaps outlined in this paper, future research should not only continue to improve the technical accessibility of virtual healthcare platforms but also focus on their acceptability among diverse user groups.(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e) This includes, like the present study, conducting studies with users to better understand patient experiences, preferences, and satisfaction levels.\u003c/p\u003e\u003cp\u003eLimitations `\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eWhile the participants represent a small group, it would be valuable to explore virtual health care experiences across other Indian states.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eWhile snowball sampling was utilized for participant recruitment, this may overlook some users who are less informed or less able to access current healthcare systems, and these people are important to capture in the data in future studies.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eParticipants who were recruited from specific platforms or institutions offering virtual care, may perceive a stigma associated with admitting to challenges or difficulties with the platform\u0026rsquo;s use. They may be hesitant to disclose such information, fearing judgment or negative perceptions from healthcare providers, caregivers, or peers.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe COVID-19 pandemic and our initial scoping review (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)exposed a significant gap in public health: the consistent neglect of persons with disabilities in research and policy development related to healthcare accessibility.(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) Using the AAAQ (Accessibility, Availability, Acceptability, Quality) framework, this study explores virtual care experiences among individuals with disabilities and their caregivers in India. Our findings highlight the potential of virtual care to overcome geographical barriers and offer flexible scheduling.\u003c/p\u003e\u003cp\u003eWhile efforts to narrow the digital divide, such as increasing broadband affordability, are underway, these measures may fall short due to the dual challenges of lower income rates and device ownership among persons with disabilities. The quality of virtual care was generally well received, yet gaps remain in standardized protocols and provider training, particularly in disability-specific care.\u003c/p\u003e\u003cp\u003eTo fully realize the benefits of virtual care, further research is essential. This research should focus on refining virtual care protocols, expanding disability-specific training for providers, and advocating for inclusive design principles. This critical research is crucial to ensure that the opportunity that virtual healthcare services provide translates into real-world benefits for persons with disabilities.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eStatements and Declarations\u003c/p\u003e\n\u003cp\u003eThe authors declare that there is no conflict of interest related to the research, authorship, or publication of this manuscript on virtual healthcare for persons with disabilities.\u003c/p\u003e\n\u003cp\u003eAuthorship confirmation/contribution statement\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"601\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\u003cstrong\u003eName\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 244px;\"\u003e\u003cstrong\u003eRoles\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 219px;\"\u003e\u003cstrong\u003eInstitute\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAffiliations\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003eSarah Jameel*\u003cbr\[email protected]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 244px;\"\u003eData\u0026nbsp;curation, Analysis,\u003cbr\u003eInvestigation/ Data collection, Resources, Visualization, Writing, Methodology\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 219px;\"\u003eResearch\u0026nbsp;Associate,\u0026nbsp;Pragyaan Sustainable Health Outcomes Foundation,\u0026nbsp;Hyderabad, India\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003eGVS\u0026nbsp;Murthy\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 244px;\"\u003eConceptualization, Supervisor, Validation, Writing-Review and Editing\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 219px;\"\u003ePresident,\u0026nbsp;Pragyaan\u003cbr\u003eSustainable Health Outcomes Foundation,\u0026nbsp;Hyderabad, India\u003cbr\u003e\u0026nbsp;\u003cbr\u003eProfessor\u0026nbsp;(Public\u0026nbsp;Health\u0026nbsp;Eye Care \u0026amp; Disability), LSHTM\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003eEmma George\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 244px;\"\u003eConceptualization, Writing, Review\u0026nbsp;and\u0026nbsp;Editing,\u0026nbsp;Analysis, Methodology, Resources,\u003cbr\u003eValidation\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 219px;\"\u003eSchool\u0026nbsp;of\u0026nbsp;Allied\u0026nbsp;Health Science and Practice, University of Adelaide\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003eLalit Yadav\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 244px;\"\u003eWriting,\u0026nbsp;Validation,\u0026nbsp;Resources, Methodology\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 219px;\"\u003eAdelaide\u0026nbsp;Medical\u0026nbsp;School, University of Adelaide,\u003cbr\u003eAdelaide, Australia\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003eVardharajan\u0026nbsp;Srinivasan\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 244px;\"\u003eMethodology, Resources,\u0026nbsp;Writing-\u0026nbsp;Review and Editing\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 219px;\"\u003eThe\u0026nbsp;George\u0026nbsp;Institute\u0026nbsp;for\u0026nbsp;Global Health, Delhi, India\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003eJayme Wearn\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 244px;\"\u003eProject\u0026nbsp;Administrator, Resources,\u0026nbsp;Validation, Writing-Review and Editing\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 219px;\"\u003eNossal\u0026nbsp;Institute\u0026nbsp;for\u0026nbsp;Global Health, The University of Melbourne, Melbourne,\u003cbr\u003eAustralia\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003eShailaja Tetali\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 244px;\"\u003eConceptualization,\u0026nbsp;Investigation, Project\u0026nbsp;Administrator\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 219px;\"\u003eIndian\u0026nbsp;Institute\u0026nbsp;of\u0026nbsp;Public\u003cbr\u003eHealth-\u0026nbsp;Hyderabad,\u0026nbsp;Hyderabad, India\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003eOommen John\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 244px;\"\u003eConceptualization, methodology,\u003cbr\u003evalidation\u0026nbsp;and\u0026nbsp;project\u0026nbsp;administrator\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 219px;\"\u003eThe\u0026nbsp;George\u0026nbsp;Institute\u0026nbsp;for\u0026nbsp;Global Health, Delhi, India\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003eNathan\u0026nbsp;Grills\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 244px;\"\u003eConceptualization,\u0026nbsp;Funding Acquisition, Methodology,\u003cbr\u003eSupervisor,\u0026nbsp;Writing-Review and Editing\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 219px;\"\u003eNossal\u0026nbsp;Institute\u0026nbsp;for\u0026nbsp;Global Health, Australia India\u003cbr\u003eInstitute,\u0026nbsp;The\u0026nbsp;University\u0026nbsp;of Melbourne, Melbourne,\u003cbr\u003eAustralia\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eEthics approval:\u003c/p\u003e\n\u003cp\u003eThe institute review board of Indian Institute of Public Health, Hyderabad (IIPH-H) Ethics Committee approved the study (IIPHH/TRCIEC/364/2023-10/05/2023). Free and formed consent was obtained in writing or verbally prior to participation. The study complied with the WMA Declaration of Helsinki.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsent for Publication\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e\n\u003cp\u003eDeclaration of Conflict of Interest\u003c/p\u003e\n\u003cp\u003eThe authors declare that there is no conflict of interest related to the research, authorship, or publication of this manuscript on virtual healthcare for persons with disabilities.\u003c/p\u003e\n\u003cp\u003eData Availability\u003c/p\u003e\n\u003cp\u003eDue to the sensitive nature of this study involving in-depth interviews with persons with disabilities, full transcripts and raw qualitative data will not be made publicly available in order to protect participant confidentiality and uphold ethical commitments. However, de-identified excerpts or data summaries may be shared with qualified researchers upon reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThe authors gratefully acknowledge funding received from the Australia India Council,\u0026nbsp;DFAT. The funder has had no specific role in the conceptualization, design, data collection, analysis, decision to publish, or preparation of the manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eNot Applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAuthor\u0026rsquo;s Contributions\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"601\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\u003cstrong\u003eName\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 244px;\"\u003e\u003cstrong\u003eRoles\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 219px;\"\u003e\u003cstrong\u003eInstitute\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAffiliations\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003eSarah Jameel*\u003cbr\[email protected]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 244px;\"\u003eData\u0026nbsp;curation, Analysis,\u003cbr\u003eInvestigation/ Data collection, Resources, Visualization, Writing, Methodology\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 219px;\"\u003eResearch\u0026nbsp;Associate,\u0026nbsp;Pragyaan Sustainable Health Outcomes Foundation,\u0026nbsp;Hyderabad, India\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003eGVS\u0026nbsp;Murthy\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 244px;\"\u003eConceptualization, Supervisor, Validation, Writing-Review and Editing\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 219px;\"\u003ePresident,\u0026nbsp;Pragyaan\u003cbr\u003eSustainable Health Outcomes Foundation,\u0026nbsp;Hyderabad, India\u003cbr\u003e\u0026nbsp;\u003cbr\u003eProfessor\u0026nbsp;(Public\u0026nbsp;Health\u0026nbsp;Eye Care \u0026amp; Disability), LSHTM\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003eEmma George\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 244px;\"\u003eConceptualization, Writing, Review\u0026nbsp;and\u0026nbsp;Editing,\u0026nbsp;Analysis, Methodology, Resources,\u003cbr\u003eValidation\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 219px;\"\u003eSchool\u0026nbsp;of\u0026nbsp;Allied\u0026nbsp;Health Science and Practice, University of Adelaide\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003eLalit Yadav\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 244px;\"\u003eWriting,\u0026nbsp;Validation,\u0026nbsp;Resources, Methodology\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 219px;\"\u003eAdelaide\u0026nbsp;Medical\u0026nbsp;School, University of Adelaide,\u003cbr\u003eAdelaide, Australia\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003eVardharajan\u0026nbsp;Srinivasan\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 244px;\"\u003eMethodology, Resources,\u0026nbsp;Writing-\u0026nbsp;Review and Editing\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 219px;\"\u003eThe\u0026nbsp;George\u0026nbsp;Institute\u0026nbsp;for\u0026nbsp;Global Health, Delhi, India\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003eJayme Wearn\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 244px;\"\u003eProject\u0026nbsp;Administrator, Resources,\u0026nbsp;Validation, Writing-Review and Editing\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 219px;\"\u003eNossal\u0026nbsp;Institute\u0026nbsp;for\u0026nbsp;Global Health, The University of Melbourne, Melbourne,\u003cbr\u003eAustralia\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003eShailaja Tetali\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 244px;\"\u003eConceptualization,\u0026nbsp;Investigation, Project\u0026nbsp;Administrator\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 219px;\"\u003eIndian\u0026nbsp;Institute\u0026nbsp;of\u0026nbsp;Public\u003cbr\u003eHealth-\u0026nbsp;Hyderabad,\u0026nbsp;Hyderabad, India\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003eOommen John\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 244px;\"\u003eConceptualization, methodology,\u003cbr\u003evalidation\u0026nbsp;and\u0026nbsp;project\u0026nbsp;administrator\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 219px;\"\u003eThe\u0026nbsp;George\u0026nbsp;Institute\u0026nbsp;for\u0026nbsp;Global Health, Delhi, India\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003eNathan\u0026nbsp;Grills\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 244px;\"\u003eConceptualization,\u0026nbsp;Funding Acquisition, Methodology,\u003cbr\u003eSupervisor,\u0026nbsp;Writing-Review and Editing\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 219px;\"\u003eNossal\u0026nbsp;Institute\u0026nbsp;for\u0026nbsp;Global Health, Australia India\u003cbr\u003eInstitute,\u0026nbsp;The\u0026nbsp;University\u0026nbsp;of Melbourne, Melbourne,\u003cbr\u003eAustralia\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDastidar BG, Suri S, Nagaraja VH, Jani A. A virtual bridge to Universal Healthcare in India. Communications Medicine 2022 2:1 [Internet]. 2022 Nov 16 [cited 2024 May 18];2(1):1\u0026ndash;3. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.nature.com/articles/s43856-022-00211-7\u003c/span\u003e\u003cspan address=\"https://www.nature.com/articles/s43856-022-00211-7\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eADA and Telehealth Challenges Faced by People with Disabilities Accessing Telehealth. Services\u0026thinsp;\u0026lt;\u0026thinsp;Southeast ADA Center [Internet]. [cited 2024 Mar 4]. 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Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://journals.sagepub.com/doi/\u003c/span\u003e\u003cspan address=\"https://journals.sagepub.com/doi/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/13558196231160047\u003c/span\u003e\u003cspan address=\"10.1177/13558196231160047\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Disability Inclusion, Virtual Healthcare, Persons with Disabilities (PwDs), AAAQ Framework, Digital Divide","lastPublishedDoi":"10.21203/rs.3.rs-7461742/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7461742/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIntroduction:\u003cbr\u003e\n Virtual health care holds significant potential to advance inclusive healthcare for persons with disabilities in India, supporting the World Health Organization’s goal of Universal Health Coverage. However, individuals with disabilities often face barriers to accessing virtual healthcare due to a lack of disability-inclusive infrastructure, technology, and operational support, which further limits equitable service delivery.(1)\u003c/p\u003e\n\u003cp\u003eThis study aimed to investigate the experiences of persons with disabilities and their caregivers regarding virtual healthcare services in India. The focus was on assessing the accessibility, availability, acceptability, and quality (AAAQ) of these services.\u003c/p\u003e\n\u003cp\u003eMethods:\u003cbr\u003e\nData were collected through 20 in-depth interviews and five focus group discussions with persons with vision, hearing, physical, and intellectual disabilities, as well as their caregivers, across geographically diverse regions of India. Participants were recruited using a snowball sampling method, and thematic analysis was applied to identify key patterns and barriers.\u003c/p\u003e\n\u003cp\u003eResults:\u003cbr\u003e\nThe findings revealed that while virtual healthcare platforms offered convenience and reduced travel burdens for persons with disability, significant barriers persisted. Challenges included limited accessibility of digital platforms for screen readers, inconsistent availability of sign language interpreters, and insufficient disability-specific training for healthcare providers. Public platforms like eSanjeevani remained underutilized due to low awareness and usability issues.\u003c/p\u003e\n\u003cp\u003eDiscussion:\u003cbr\u003e\nThis study emphasizes the need for disability-inclusive design and service delivery in virtual healthcare systems. Key recommendations include targeted training for healthcare staff, accessibility audits of virtual platforms, and policy reforms ensuring affordability and awareness of public virtual care services. Strengthening these areas can support equitable access to virtual healthcare.\u003c/p\u003e","manuscriptTitle":"‘Telehealth for all’: capitalising on the power of virtual healthcare for persons with disability in India","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-30 07:15:20","doi":"10.21203/rs.3.rs-7461742/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-25T12:08:18+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-14T20:37:45+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-02T13:13:23+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-28T12:05:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"158983076566327878293509753458105027296","date":"2025-10-26T12:32:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"247021714861269245196088165497234089103","date":"2025-10-22T19:35:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"188273331969308674902904449978173388758","date":"2025-10-22T05:01:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"236169317309368717299527133340977715825","date":"2025-09-19T11:18:32+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-18T05:08:42+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-04T02:50:26+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-03T01:24:50+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-09-03T01:22:12+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b3d3bea7-03a7-494a-a025-54d5d7acaf7b","owner":[],"postedDate":"September 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-29T06:23:15+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-30 07:15:20","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7461742","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7461742","identity":"rs-7461742","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}