Telehealth Usability, Engagement Patterns, and Technical Infrastructure in Managing Noncommunicable Diseases Among Health Care Professionals in Brazil, Ghana, Honduras, and the United Kingdom: Multinational Cross-Sectional Study

Clinical Snapshot

Key Findings

• P Value: Not explicitly reported but confidence intervals exclude null

• Effect Size: Connection stability: b=5.06 points; Support satisfaction: b=5.02 points; Frequent use: b=3.05 points

• Primary Outcome: System Usability Scale scores ranging from 63.09 (Honduras) to 79.75 (Ghana)

• Nnt Or Sensitivity: Technical infrastructure factors show strongest associations with usability (effect sizes >5 points on 100-point scale)

• Confidence Interval: Connection stability: 95% CI 3.06-7.05; Support satisfaction: 95% CI 3.27-6.75

Clinical Application

High feasibility given existing Australian telehealth infrastructure and Medicare telehealth items Directly applicable to Australian practice with established Medicare telehealth items for chronic disease management, RACGP telehealth guidelines, and National Digital Health Strategy priorities Healthcare professionals using telehealth for NCD management, particularly relevant for Australian rural and remote practice

Abstract

BACKGROUND: Noncommunicable diseases (NCDs) account for over 70% of global deaths, with hypertension and diabetes serving as major contributors. The COVID-19 pandemic disrupted traditional health care services for NCDs and highlighted telehealth as a crucial alternative. Telehealth-encompassing synchronous and asynchronous electronic communication to deliver clinical services remotely-can overcome geographical barriers and enhance patient engagement. However, telehealth usability among health care professionals (HCPs) remains under-studied across low-, middle-, and high-income countries. OBJECTIVE: This study aimed to examine which telehealth engagement patterns, technical infrastructure factors, and user profiles were most strongly associated with usability among HCPs and to descriptively compare these across 4 diverse countries: Brazil (high- to middle-income country), Ghana (low- to middle-income country), Honduras (low- to middle-income country), and the United Kingdom (high-income country). METHODS: A multinational cross-sectional survey was conducted with 290 HCPs across 4 countries. Participants completed the System Usability Scale and provided data on telehealth engagement (eg, frequency, duration, and number of systems used), technical infrastructure (connection stability and support satisfaction), and their user profile (demographics, job role, and training received). Descriptive statistics summarized these patterns and usability scores. Multiple linear regression with bootstrap-based sensitivity analyses identified factors associated with telehealth usability. Given the nonprobability design, no formal inferential comparisons were made between countries. Instead, observed patterns were reported descriptively. RESULTS: Higher telehealth usability scores were associated with greater connection stability (b=5.06, 95% CI 3.06-7.05), higher satisfaction with online support information (b=5.02, 95% CI 3.27-6.75), more frequent use (b=3.05, 95% CI 1.36-4.73), longer duration of use (b=1.59, 95% CI 0.49-2.68), and being a physician by profession (b=3.82, 95% CI 0.23-7.40). Average usability scores were highest among users in Ghana (mean 79.75, SD 14.19) and the United Kingdom (mean 79.00, SD 14.71), followed by Brazil (mean 72.01, SD 14.62) and Honduras (mean 63.09, SD 15.57). According to System Usability Scale guidelines, scores corresponded to "good" usability for users in Ghana, the United Kingdom, and Brazil and were below the "good" threshold for users in Honduras. While most users in Ghana (97/111, 87.4%), Honduras (31/38, 81.6%), and Brazil (57/80, 70.4%) reported using only 1 telehealth system, two-thirds of UK users (40/60, 66.7%) reported using 2 or more systems. User profiles also varied; prepandemic use was highest in Ghana (84/111, 75.7%) and lowest in Honduras (7/38, 18.4%). Other engagement patterns across countries were reported. CONCLUSIONS: Telehealth usability is driven by technical infrastructure reliability, a robust online support infrastructure, and an "experience effect" from frequent and long-term engagement. Descriptive differences in engagement patterns and infrastructure highlight the need for tailored strategies to address setting-specific challenges. These are essential to optimize telehealth integration and improve health care outcomes for patients with NCDs worldwide.

References

1. 1.Brackstone, K., Gonçalves, R. L., Pagano, A. S., Reis, Z. S. N., Afagbedzi, S. K., Zambrano, L. I., Lopes, T. C. P., Cordeiro, S. A., Nunes, J. M., Meira, W., Batchelor, J., & Ribeiro, A. L. P. (2026). Telehealth usability, engagement patterns, and technical infrastructure in managing noncommunicable diseases among health care professionals in Brazil, Ghana, Honduras, and the United Kingdom: Multinational cross-sectional study. Journal of Medical Internet Research. https://doi.org/10.3233/SHTI190653