Older adults lack awareness of telehealth during pandemic

Older Southeast Asian adults showed a relatively poor understanding of telehealth services during the COVID-19 pandemic, and many of them held erroneous views regarding their use, according to a Singapore study.

“Although these individuals acknowledge the benefits of telehealth services, a reluctance to use such services over in-person consultations—due to a perceived lack of human interaction and accuracy of diagnoses, poor digital literacy, and a perceived lack of access to telehealth-capable devices—was observed,” the researchers said.

Seventy-eight individuals from Singapore (mean age 73.0 years, 51.3 percent female) were included in this qualitative study. They were interviewed via telephone between 13 May 2020 and 9 June 2020 during the first COVID-19 “circuit breaker” in the country.

The researchers asked the participants to describe their understanding of telehealth, their experience of and willingness to use such services, as well as the barriers and facilitators underlying their decision. Thematic analysis was performed to assess the transcripts, guided by the United Theory of Acceptance Use of Technology framework.

Of the participants, 24 (30.8 percent) succeeded in describing the range of telehealth services available, and 15 (19.2 percent) had previously availed themselves of these services. On the other hand, 14 (17.9 percent) participants believed that telehealth involved only home medication delivery, while about half (51.3 percent) were not aware of its existence. [Singapore Med J 2025;66:256-264]

Barriers

The elderly population in Singapore preferred in-person consultations despite the advantages offered by telehealth services, especially during the pandemic. Some of the reasons for this were a perceived lack of human interaction and accuracy of diagnoses, poor digital literacy, and a lack of access to telehealth-capable devices.

Participants who were already aware of telehealth services also reported several barriers associated with perceived communication difficulties. Specifically, they pointed out the lack of nonverbal cues along with a lack of physical examination and nervousness in conveying information through a virtual medium.

Previous studies have also noted similar concerns. [J Gen Intern Med 2020;35:1751-1758; Lawrence Erlbaum Associates Publishers 2003:179-219]

“The issue of communication is particularly egregious, with previously published studies reporting that the lack of nonverbal cues during teleconsultations has resulted in a perceived belief of a lack of attention being paid to patients’ concerns during telehealth consultations,” the researchers said.

“Participants’ suggestions of limiting telehealth services for appointments requiring minimal medical supervision (eg, biochemistry test reviews) may hence be a reflection of these concerns,” they added.

A gradual approach to incorporating telehealth services into current medical systems may be necessary until the abovementioned issues are addressed, either through better technology or targeted programs aimed at improving nonverbal cues, according to the researchers.

“[T]o maintain momentum for the adoption of telehealth services into routine medical care resulting from the COVID-19 pandemic, the key issues relating to lack of awareness and negative attitudes towards these services from the perspective of the elderly need to be addressed,” the researchers said. 

“Healthcare provider endorsement of telehealth services via mainstream and traditional news outlets may help improve awareness, while digital literacy programs may improve uptake and change negative perceptions towards telehealth services in our elderly Southeast Asian population,” they added.