Impact of telemedicine service quality on patient satisfaction: an empirical study using Servqual model and expectation confirmation theory 10.55131/jphd/2025/230308
Main Article Content
Abstract
The COVID-19 pandemic has expedited the digital transformation of healthcare, facilitating the adoption of telemedicine as an innovative model for enhancing the quality of patient care. This study aimed to investigate the factors influencing patient satisfaction with telemedicine and provide practical guidance for improving service quality. Specifically, this study examined how service responsiveness, reliability, assurance, and empathy affect patient satisfaction while considering the role of expectation confirmation. This study employed quantitative research methods to examine telemedicine’s effect on patient satisfaction, utilizing the SERVQUAL model and expectation-confirmation theory. A structured questionnaire using a seven-point Likert scale was developed to assess the dimensions of expectancy confirmation, responsiveness, reliability, assurance, and empathy. A random sample of 333 valid questionnaires was obtained through an online platform. Structural equation modeling (SEM) was employed to analyze the data; the findings indicated that all hypotheses were supported. Responsiveness significantly and positively influenced expectation confirmation, whereas expectation confirmation, responsiveness, reliability, assurance, and empathy significantly and positively affected patient satisfaction. The model exhibited strong explanatory power, indicating that these factors significantly influenced patient satisfaction with telemedicine. These findings provide valuable insights for healthcare providers to improve the quality of telemedicine services and patient satisfaction. These findings can guide healthcare organizations to develop more effective telemedicine platforms and training programs, contributing to the digital transformation of healthcare systems.
Article Details

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Cheng TC, Sylvia S, Yip W. Innovative approaches of measuring care quality in China's market for telemedicine. Lancet Reg Health West Pac. 2024;46:100932.
Foo D, Spanos S, Dammery G, Ellis LA, Willcock SM, Braithwaite J. The rise of direct-to-consumer telemedicine services in Australia: implications for primary care and future research. Med J Aust. 2023;219(5):230-2.
Maines M, Palmisano P, Del Greco M, Melissano D, De Bonis S, Baccillieri S, et al. Impact of COVID-19 Pandemic on Remote Monitoring of Cardiac Implantable Electronic Devices in Italy: Results of a Survey Promoted by AIAC. J Clin Med. 2021;10(18):4086.
Zhang YF, Qiu Y, He JS, Tan JY, Li XZ, Zhu LR, et al. Impact of COVID-19 outbreak on the care of patients with inflammatory bowel disease: a comparison before and after the outbreak in South China. J Gastroenterol Hepatol. 2021;36(3): 700-9.
Jose AP, Kaushik A, Tange H, van der Weijden T, Pandey N, Sharma A, et al. Redesigning telemedicine: preliminary findings from an innovative assisted telemedicine healthcare model. BMC Prim Care. 2024;25(1):380.
Lucas JW, Villarroel MA. Telemedicine use among adults: United States, 2021. Natl Health Stat Rep. 2022;(432):1-8.
Hyder MA, Razzak J. Telemedicine in the United States: An Introduction for Students and Residents. J Med Internet Res. 2020;22(11):e20839.
Lin Y, Xu X, Liu Y, Alias H, Hu Z, Wong LP. Perception and Acceptance of Telemedicine Use in Health Care Among the General Public in China: Web-Based Cross-Sectional Survey. J Med Internet Res. 2024;26:e53497.
Yasmine M, Nessib DB, Ferjani H, Triki W, Maatallah K, Kaffel D, et al. The usefulness of telemedicine in rheumatology: points of view of practitioners and patients. Ann Rheum Dis. 2022;81(Suppl 1):1780-1.
Drake C, Zhang Y, Chaiyachati KH, Polsky D. The limitations of poor broadband internet access for telemedicine use in rural America: an observational study. Ann Intern Med. 2019;171(5):382-4.
Harst L, Timpel P, Otto L, Richter P, Wollschlaeger B, Winkler K, et al. Identifying barriers in telemedicine-supported integrated care research: scoping reviews and qualitative content analysis. J Public Health (Berl). 2020;28(5):583-94.
Rawal S. Physician empathy in patient empowerment and patient empowerment in physician empathy. Med Educ. 2023;57(8):694-6.
Agosta L. Empathy: A bridge across the digital divide. Psychoanal Rev. 2022;109(4):439-59.
Kuek A, Hakkennes S. Healthcare staff digital literacy levels and their attitudes towards information systems. Health Inform J. 2019;26(1):592-612.
Tegegne MD, Tilahun B, Mamuye A, Kerie H, Nurhussien F, Zemen E, et al. Digital literacy level and associated factors among health professionals in a referral and teaching hospital. Front Public Health. 2023;11:1130894.
Devaraj E, Satheesha TY, Yadav SPS, Kaviti RVP. Stress Management in an IT Professional Crisis. In: Rouco JC, Figueiredo PCN, editors. Business Continuity Management and Resilience: Theories, Models, and Processes. Hershey (PA): IGI Global; 2024. p. 128-61.
Wang N, Zhang J, Huang J, Ou W, Han W, Zhang Q. Telemedicine data secure sharing scheme based on heterogeneous federated learning. Cybersecurity. 2024;7(1):56.
Kee D, Verma H, Tepper DL, Hasegawa D, Burger AP, Weissman MA. Patient Satisfaction With Telemedicine Among Vulnerable Populations in an Urban Ambulatory Setting. Mayo Clin Proc Digit Health. 2024;2(1):8-17.
Mason AN. The Most Important Telemedicine Patient Satisfaction Dimension: Patient-Centered Care. Telemed J E Health. 2022;28(8):1206-14.
Preaux J, Casadesús M, Bernardo M. A Conceptual Model to Evaluate Service Quality of Direct-to-Consumer Telemedicine Consultation from Patient Perspective. Telemed J E Health. 2023;29(2):156-71.
Parasuraman AP, Zeithaml V, Berry L. A Conceptual Model of Service Quality and its Implication for Future Research (SERVQUAL). J Mark. 1985;49(4):41-50.
Oliver RL. A cognitive model of the antecedents and consequences of satisfaction decisions. J Mark Res. 1980;17(4):460-9.
Park E. User acceptance of smart wearable devices: An expectation-confirmation model approach. Telemat Inform. 2020;47:101318.
Wang C, Dai J, Zhu K, Yu T, Gu X. Understanding the continuance intention of college students toward new E-learning spaces based on an integrated model of the TAM and TTF. Int J Hum Comput Interact. 2023; 39(14):2134-47.
Rahi S, Gillie M, Abd Ghani M. Designing survey research: recommendation for questionnaire development, calculating sample size and selecting research paradigms. In: Economic and Social Development: Book of Proceedings; 2019. p. 1157-69.
Blount E, Davey MG, Joyce WP. Patient reported satisfaction levels with the use of telemedicine for general surgery-A systematic review of randomized control trials. Surg Pract Sci. 2023;12:100152.
Sengupta A, Sarkar S, Bhattacherjee A. The relationship between telemedicine tools and physician satisfaction, quality of care, and patient visits during the COVID-19 pandemic. Int J Med Inform. 2024;190:105541.
Bovonratwet P, Song J, LaValva SM, Chen AZ, Ondeck NT, Blevins JL, et al. Telemedicine in Arthroplasty Patients: Which Factors Are Associated With High Satisfaction? Arthroplasty Today. 2024;25:101285.
Olivos M, García V, De La Torre L. Evaluation of user satisfaction in parents or caregivers of pediatric patients with colorectal pathology in the use of telemedicine. J Pediatr Surg Open. 2023;4:100060.
Batool SH, Rehman AU, Sulehri I. The current situation of information literacy education and curriculum design in Pakistan: a discovery using Delphi method. Libr Hi Tech. 2022;40(6):1705-20.
Lang FR, John D, Lüdtke O, Schupp J, Wagner GG. Short assessment of the Big Five: robust across survey methods except telephone interviewing. Behav Res Methods. 2011;43(2):548-67.
McDowell I. Measuring health: a guide to rating scales and questionnaires. 3rd ed. New York: Oxford University Press; 2006.
Williams LJ, McGonagle AK. Four research designs and a comprehensive analysis strategy for investigating common method variance with self-report measures using latent variables. J Bus Psychol. 2016;31(3):339-59.
Shiau W-L, Sarstedt M, Hair JF. Internet research using partial least squares structural equation modeling (PLS-SEM). Internet Res. 2019;29(3): 398-406.
Cham TH, Cheng BL, Low MP, Cheok JBC. Brand image as the competitive edge for hospitals in medical tourism. Eur Bus Rev. 2020;33(1):31-59.
Hair Jr JF, Sarstedt M, Hopkins L, Kuppelwieser VG. Partial least squares structural equation modeling (PLS-SEM): An emerging tool in business research. Eur Bus Rev. 2014;26(2): 106-21.
Roberts P, Priest H. Reliability and validity in research. Nurs Stand. 2006;20(44):41-6.
Christmann A, Van Aelst S. Robust estimation of Cronbach's alpha. J Multivar Anal. 2006;97(7):1660-74.
Liu Y, Wu AD, Zumbo BD. The impact of outliers on Cronbach's coefficient alpha estimate of reliability: Ordinal/rating scale item responses. Educ Psychol Meas. 2010; 70(1):5-21.
Wolter KM. An investigation of some estimators of variance for systematic sampling. J Am Stat Assoc. 1984;79(388):781-90.
Cheung GW, Cooper-Thomas HD, Lau RS, Wang LC. Reporting reliability, convergent and discriminant validity with structural equation modeling: A review and best-practice recommendations. Asia Pac J Manag. 2024;41(2):745-83.
Fornell C, Larcker DF. Evaluating structural equation models with unobservable variables and measurement error. J Mark Res. 1981; 18(1):39-50
Ftouni R, AlJardali B, Hamdanieh M, Ftouni L, Salem N. Challenges of telemedicine during the COVID-19 pandemic: a systematic review. BMC Med Inform Decis Mak. 2022; 22(1):207.
Ramírez-Saltos D, Acosta-Vargas P, Acosta-Vargas G, Santórum M, Carrion-Toro M, Ayala-Chauvin M, et al. Enhancing Sustainability through Accessible Health Platforms: A Scoping Review. Sustainability. 2023; 15(22):15916.
Herranz C, Martín-Moreno Banegas L, Dana Muzzio F, Siso-Almirall A, Roca J, Cano I. A Practice-Proven Adaptive Case Management Approach for Innovative Health Care Services (Health Circuit): Cluster Randomized Clinical Pilot and Descriptive Observational Study. J Med Internet Res. 2023;25:e47672.
Hort M, Kechagia M, Sarro F, Harman M. A survey of performance optimization for mobile applications. IEEE Trans Softw Eng. 2021;48(8): 2879-904.
Effendi DE, Handayani S, Nugroho AP, Ardani I, Fitrianti Y, Karlina K, et al. The Significance of Physician-Patient Communication on Telemedicine Patients' Health Outcomes: Evidence from Indonesia. Health Commun. 2024;39(10):1932-41.
Oudbier SJ, Souget-Ruff SP, Chen BS, Ziesemer KA, Meij HJ, Smets EM. Implementation barriers and facilitators of remote monitoring, remote consultation and digital care platforms through the eyes of healthcare professionals: a review of reviews. BMJ Open. 2024;14(6): e075833.
Oh SS, Kim K-A, Kim M, Oh J, Chu SH, Choi J. Measurement of digital literacy among older adults: systematic review. J Med Internet Res. 2021;23(2):e26145.
Ali D, Gillie M, Carstarphen KJ. Bridging the digital divide for vulnerable patient telehealth. Innov Aging. 2020;4(Suppl 1):928.
Kumar KA, Natarajan S. An extension of the Expectation Confirmation Model (ECM) to study continuance behavior in using e-Health services. Innov Mark. 2020;16(2):15-26.
Hamza V, Zakkariya K. A study on the dimensions of customer expectations and their relationship with cognitive dissonance. Int J Manag Stud. 2013; 3(2):47-54.
Askari R, Rafiei S, Montazerolfaraj R, Sepaseh F, Dehghani Tafti A, Irany Nasab M. Evaluation of Non-Medical Services' Responsiveness Using a National Model: Patients' Viewpoint. Biotechnol Health Sci. 2017;4(1):25-9.
Sharma D, Taggar R, Bindra S, Dhir S. A systematic review of responsiveness to develop future research agenda: a TCCM and bibliometric analysis. Benchmark Int J. 2020;27(9):2649-77.
Wang G, Fiedler AK, Warth RJ, Bailey L, Shupe PG, Gregory JM. Reliability and accuracy of telemedicine-based shoulder examinations. J Shoulder Elbow Surg. 2022;31(8):e369-75.
Toscano S, Patti F, Chisari CG, Arena S, Finocchiaro C, Schillaci CE, et al. Reliability of televisits for patients with mild relapsing-remitting multiple sclerosis in the COVID-19 era. Neurol Sci. 2022;43(4):2253-61.
Pham C, Nguyen KK, Cheriet M, Shabah A. Joint Horizontal and Vertical Backup for Highly Reliable Telemedicine Services. In: IEEE International Conference on Communications (ICC); 2023 May 28-Jun 1; Rome, Italy. IEEE; 2023. p. 2451-6.
Malathi A, Jasim KM. Validating the relationship between service quality, patient sensitivity and experience towards medical applications using SERVQUAL. Int J Med Inform. 2022;168:104883.
Guttikonda J, Sanchit A, Krishnamoorthy A, Chaudhary K, Likitha B, Prabakaran N. No Barrier: Breaking Language Barriers With NMT and Digital Twin Synergies. In: Ponnusamy S, Assaf M, Antari J, Singh S, Kalyanaraman S, editors. Digital Twin Technology and AI Implementations in Future-Focused Businesses. Hershey (PA): IGI Global; 2024. p. 195-205.
Meuter RFI, Gallois C, Segalowitz NS, Ryder AG, Hocking J. Overcoming language barriers in healthcare: A protocol for investigating safe and effective communication when patients or clinicians use a second language. BMC Health Serv Res. 2015;15(1):371.
Broadbridge E, Greene K, Venetis MK, Lee LE, Banerjee SC, Buckley de Meritens A, et al. The Influence of Perceived Provider Empathic Communication on Disclosure Decision-Making. Health Commun. 2024;39(9):1807-24.
Rey Velasco E, Demjén Z, Skinner TC. Digital empathy in behaviour change interventions: A survey study on health coach responses to patient cues. Digit Health. 2024;10:205520 76231225889.
Parkinson B, Lea M. Video-linking emotions. In: Kappas A, Krämer NC, editors. Face-to-Face Communication over the Internet: Emotions in a Web of Culture, Language, and Technology. Cambridge: Cambridge University Press; 2011. p. 100-26.
Cadet F, Sainfort F. Service quality in health care: empathy as a double-edged sword in the physician-patient relationship. Int J Pharm Health Mark. 2023;17(1):115-31.
Kim HY, Ali G, Hwang JI. Enhancing doctor-patient communication in surgical explanations: Designing effective facial expressions and gestures for animated physician characters. Comput Animat Virtual Worlds. 2024;35(3):e2236.
Gleeson HB, Kalsi AS. Remote clinical consultations in restorative dentistry-A survey. J Dent. 2022; 117:103914.
Power E, Attard MC, Lanyon LE, Togher L. Efficacy of online communication partner training package for student healthcare professionals. Int J Lang Commun Disord. 2024;59(1):304-26.
Kalms E. Is the Empathy and Clarity Rating Scale a way to assess empathy in realistic clinical encounters? Med Educ Online. 2019;24(1):1680101.
Maeckelberghe E, Zdunek K, Marceglia S, Farsides B, Rigby M. The ethical challenges of personalized digital health. Front Med. 2023;10: 1123863.
Dey J, Bhowmik A, Karforma S. Neural perceptron & strict lossless secret sharing oriented cryptographic science: fostering patients' security in the "new normal" COVID-19 E-Health. Multimed Tools Appl. 2022;81(13):17747-78.
Tazi F, Dykstra J, Rajivan P, Chalil Madathil K, Hughart J, McElligott J, et al. Improving privacy and security of telehealth. Commun ACM. 2024;67(9):27-30.
Yeh T-F, Chang Y-C, Yang S-Y, Yang C-C. Effect of Successful Aging on Technology Acceptance: The Moderating Role of Selection, Optimization, and Compensation Strategies. Soc Sci Comput Rev. 2024;42(2):324-41.
Rademakers J, Delnoij D, Nijman J, de Boer D. Educational inequalities in patient-centred care: patients' preferences and experiences. BMC Health Serv Res. 2012;12(1):261.