PATIENT TRUST AND SATISFACTION WITH TELEMEDICINE IN

THE AGE OF COVID-19 PANDEMIC IN THE PHILIPPINES

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The World Health Organization (WHO) officially declared Coronavirus Disease 2019
(COVID-19) as a pandemic on March 11, 2020 because of its rate and scale of transmission (WHO,
2020). Unfortunately, the Philippines is not spared by the pandemic. Local data from the
Department of Health (DOH) website has reported a total of 356,618 cases, with 39,808 active
cases, 310,158 recoveries, and 6,652 deaths as of October 17, 2020. The majority of the cases came
from the National Capital Region (Villamor, 2020). Since then, COVID-19 has been challenging
the world in several ways no one has foreseen.

Telemedicine, as a means of providing healthcare in other countries, is widely accepted

both by the physicians and patients. However, it poses a lot of trust issues in the local setting. Some
common problems include: (a) difficult access for patients with low technological ability; (b) lack
of information; (c) vulnerability of the platform being used; (d) privacy concerns; (e) no local
telemedicine regulations; (f) inadequate insurance coverage or reimbursement, and (g) poor
internet signal and bandwidth. It also poses a challenge for physicians because of the lack of
guidelines from their respective specialty societies. Some are not trained to diagnose and treat
virtually.

A growing body of research is cluttered with different scales available to measure an

individual’s general level of trust. Several trusts and satisfaction scales have been developed to
measure interorganizational trust, interpersonal trust between individuals, and inter-firm trust.
Measuring trust is challenging because several factors affect the result. Games and self-reports are
the most common techniques in studying trust (Jasielska, 2018) but these pose some
interpretational difficulties. As mentioned by Hall et al. (2001), trust predictors are categorized
into three types: patient characteristics, physician characteristics, and situational factors. This
study will inject all three factors in determining the trust and satisfaction with telemedicine. Based
on the available literature, there has been little effort to integrate these perspectives. There is a
variety in the approach to trust and it is largely a function of the different theoretical perspectives
in trust research (Lewicki & Bunker, 1996). Patient characteristics deal with demographic factors,
such as age, gender, educational attainment, and socioeconomic status. Physician’s behavior on
which patients base their trust includes competence, compassion, privacy and confidentiality,
reliability and dependability, and communication. Psychogenic factors refer to patient perception
and belief, which include unjustified views in supernatural causation, ancient beliefs and practices,
relying on advice from family and friends, and faith healers. The situational factors, in this case,
will be the proximity and access of patients to a tertiary hospital, availability of specialists in the
area, and the chronicity of the disease.

The focus of this study is on the physician-patient relationship during the COVID-19
pandemic. This research will deal with the view of the relationships between patient satisfaction,
patient trust, and the demographics of patients. To date, available literature on gender and age
show an inconsistent relationship. A study done by Bonds et al. (2004) showed that patient trust
was associated with female gender and inversely related to patient age. In contrast to this, Hall et
al. (2001) revealed that older patients trust their physicians more than younger patients. In a
retrospective cohort study by Ramaswamy et al. (2020), it was concluded that younger age, female
gender, and new visit type were associated with lower patient satisfaction with telemedicine during
the COVID-19 pandemic. However, Valikodath et al. (2017) did a study on patient demographics
and they found that demographic factors were not associated with outcomes.

Because of the paucity of available literature, this study specifically seeks to answer the
following research questions: (a) What is the trust rating of patients to telemedicine across their
characteristics in the age of COVID-19 pandemic?; (b) What is the patients’ level of satisfaction
with telemedicine across their characteristics; (c) How do patients’ characteristics, physicians’
behavior, psychogenic behavior of the patients, and situational factors affect their trust rating?;
and (e) Is there a bidirectional relationship between patient trust and satisfaction with
telemedicine? The research contribution of this work will focus on two areas: (a) to fill the
important gap in the literature on the factors affecting the trust and satisfaction of Filipino patients
with telemedicine in the age of COVID-19 pandemic in the Philippines; and (b) the value-added
investigation on the bidirectional relationship between the patient trust and satisfaction with
telemedicine. To achieve the objectives of the study, the following variables will be carefully
analyzed: (a) age of the respondents; (b) gender; (c) average monthly income; (d) years of
schooling; (e) psychogenic factors (views in supernatural causation, ancient beliefs and practices,
relying on advice from family and friends, and faith healers); physician’s behavior (competence,
compassion, privacy and confidentiality, reliability and dependability, and communication); and
(f) situational factors (acute or chronic disease, location or accessibility to hospital, and availability
of specialists in the locale).

This study will utilize primary data that will be gathered from third party platforms that
offer telemedicine in the Philippines during COVID-19 pandemic. The locale of the study will
randomly vary from different parts of the country. A combination of purposive, convenience, and
snowball sampling methods will be used to survey 500 respondents who will be selected on the
basis of predetermined set of criteria. These are the patients who availed of telemedicine services
during the time of pandemic. Information will be elicited from the respondents using a combination
of both synchronous (online) structured interview and asynchronous (online) questionnaire.

Descriptive statistics will be used to describe the participants’ profiles such as frequency
distribution, percent, arithmetic mean, standard deviation, and range. The trust rating of patients
to telemedicine using the PATAT survey instrument, which is a standardized, validated survey
instrument for patients’ trust rating (Velsen et al., 2016), will be evaluated using arithmetic mean.
Multinomial ordered logistic regression will be used to determine the factors affecting trust rating
and satisfaction with telemedicine and the bidirectional relationship between trust rating and
satisfaction. ANOVA will be used to compare the trust rating and satisfaction of the patients with
telemedicine across respondents’ characteristics.

The findings of this study will be very timely given that strict quarantine implementation
by the government restricts the population from going out of public areas. This research also
contributes conceptually to current knowledge on outcomes of patient trust and satisfaction with a
new contribution to telemedicine during the pandemic. It will, likewise, broaden the theoretical
base in health care research. Knowing the sentiments of Filipinos to telemedicine, the government
can develop guidelines to regulate the practice of virtual medicine in the country. The development
of effective regulations and policies is an important aspect to help ensure patients’ trust and safe
quality healthcare. This paper can serve as a valuable reference in developing local clinical practice
guidelines. It can help third-party e-platform service providers to reflect on their current practices.
It will provide evidence upon which developers can base their recommendations.
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