Research BSN3G SetA Group1FINAL

St.
Paul University Philippines

Tuguegarao City, Cagayan 3500
LEVEL OF TELEHEALTH ACCEPTANCE AMONG

RURAL RESIDENTS IN TUGUEGARAO CITY, CAGAYAN
A Thesis Proposal Presented

to the School of Nursing and Allied Health Sciences
St. Paul University Philippines
Tuguegarao City, Cagayan
In Partial Fulfillment
of the Requirements for the Degree
BACHELOR OF SCIENCE IN NURSING
By
MA. CECILIA AMY S. CALIZAR

RACHELLE O. DELANTAR
REGINE VERA MAE S. EDUBALAD
KYLE IVAN ANGELO R. PONCIO
YVONNE M. SORIANO
July 2023
School of Nursing and Allied Health Sciences

Tuguegarao City, Cagayan 3500 ii
TABLE OF CONTENTS
Content Page
TITLE PAGE . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . .
. . . . . . i
TABLE OF CONTENTS . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . .
. . . . . . ii
LIST OF TABLES . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . .
. . . . . . iv
LIST OF FIGURES . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . .
. . . . . . v
Chapter 1 THE PROBLEM AND REVIEW OF RELATED

LITERATURE
Introduction . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . .
. . . . . . 1
Review of Related Literature and Studies .
. . . . . . . . . . . . . . . . . . . . .
. . . . . . 6
Conceptual Framework . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . .
. . . . . . 31
Statement of the Problem . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . .
. . . . . . 35
Hypotheses . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . .
. . . . . . 36
Scope and Limitation . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . .
. . . . . . 37
Significance of the Study . . . . . . . .
. . . . . . . . . . . . . . . . . . . . .
. . . . . . 38
Definition of Terms . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . .
. . . . . . 40

Tuguegarao City, Cagayan 3500 iii
Chapter 2 METHODOLOGY
Research Design . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . .
. . . . . . 46
Participants of the Study . . . . . . . .
. . . . . . . . . . . . . . . . . . . . .
. . . . . . 46
Instrumentation . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . .
. . . . . . 48
Data-Gathering Procedure . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . .
. . . . . . 50
Data Analysis . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . .
. . . . . . 51
REFERENCES . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . .
. . . . . . 54
APPENDICES
Appendix Informed Consent Form. . . . . . . . . . .
A. . . . . . . . . . . . . . . . . . . . . .
. . . . . . 63
Appendix Questionnaire. . . . . . . . . . . . . . .
B. . . . . . . . . . . . . . . . . . . . . .
. 68

Tuguegarao City, Cagayan 3500 iv
LIST OF TABLES
Table Title Page
1 Participants of the Study . . . . . . . . . .

. . . . . . . 47
2 Mean Interpretation and the Qualitative
Interpretation . . . . . . . . . . . . . . . .
. . . . . . . . . 52
3 Pearson R Correlation and the Qualitative
Interpretation. . . . . . 53

Tuguegarao City, Cagayan 3500 v
LIST OF FIGURES
Figure Title Page
1 Modified Technology Acceptance Model . . . . .

. . . . . . . . . . . . . . . . . . . . . . .
. . . . . . 32
2 Research Paradigm . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . .
. . . . . . 34

Tuguegarao City, Cagayan 3500 1
Chapter 1
THE PROBLEM AND REVIEW OF RELATED LITERATURE
Introduction
In an era characterized by remarkable advancements in
technology, the field of healthcare delivery has undergone a
significant transformation. One notable development in the
healthcare field is the emergence of telehealth, a concept
that has revolutionized healthcare by leveraging
telecommunications technologies to bridge the gap between
patients and healthcare providers. Telehealth has gained
recognition as an effective means of delivering healthcare
services, particularly in remote and underserved areas. (WHO,
2020; DOH, 2019).
Telehealth, as defined by the World Health Organization
[WHO], refers to the delivery of healthcare services through
the utilization of information and communication
technologies, providing valid information for the diagnosis,
treatment, and prevention of disease and injuries, research
and evaluation, and continuing education of healthcare
professionals, all in the interests of advancing the health
of the people, especially those who are in need. The WHO

emphasizes that telehealth aims to promote equitable access
to healthcare, enhance efficiency, and improve patient
outcomes.
The term “telehealth,” which can be used interchangeably
with “telemedicine,” encompasses a wide range of
applications, including virtual visits, chat-based
interactions, remote patient monitoring, and technology-
enabled modalities, among others (American Telemedicine
Association, 2023).
With its various approaches, the benefits of telehealth
are manifold. First, it overcomes geographical barriers,
enabling individuals in remote or underserved areas to access
quality healthcare services without the need for travel.
Additionally, telehealth enhances healthcare accessibility,
particularly for vulnerable populations, by reducing
transportation costs and time commitments. It also
facilitates timely interventions, preventive care, and early
detection of health issues, leading to better health outcomes
and reduced healthcare costs (Bashshur et al., 2014; Wade et
al., 2018).

The advent of the COVID-19 pandemic propelled the rapid
adoption of telehealth on a global scale. As healthcare
systems faced unprecedented challenges, telehealth emerged as
a crucial tool in maintaining continuity of care while
minimizing the risk of virus transmission.
Global statistics indicate a significant surge in
telehealth utilization during the pandemic, with a
substantial increase in virtual consultations and remote
monitoring services. A survey conducted by the WHO revealed
that around 58% of member states implemented telemedicine
services in response to the pandemic (WHO, 2020). Similarly,
a survey by the International Telecommunication Union [ITU]
and WHO in 2020 found out that telehealth consultations
increased significantly during the COVID-19 pandemic, with
some countries experiencing up to an 80% rise in usage.
Local statistics mirror this global trend, illustrating
a widespread shift towards telehealth in various regions. In
the context of the Philippines telehealth is gaining
recognition as a means to address healthcare access
challenges in rural areas. The Philippine Health Insurance
Corporation (PhilHealth) reported that as of 2020, around 70%
of telehealth consultations in the country were conducted in

rural areas (PhilHealth, 2020). Correspondingly, a study
conducted by Almoite and Almazan (2021) in a rural community
in Davao Oriental found that 72.4% of the respondents were
willing to use telehealth services, indicating the potential
for telehealth adoption in rural settings.
These statistics demonstrate the growing utilization of
telehealth in rural communities globally, including the
Philippines. They highlight the increasing recognition of
telehealth as an effective tool for improving healthcare
access and delivery in rural settings.
As we transition beyond the pandemic, the advantages of
utilizing telehealth persist. Telehealth offers convenience
and flexibility for patients, allowing them to seek
healthcare services from the comfort of their homes. It
reduces the burden on healthcare facilities, optimizing
resource allocation and improving efficiency. (Clemensen et
al., 2017; Wade et al., 2019). A study conducted by Jaudian
et al. (2021) in Tuguegarao City, Cagayan considers that
telemedicine might serve as an effective tool for
consultation and help clinicians attend to the needs of their
patients without running the risk of exposure in light of
social distancing measures throughout the pandemic's

development and the ongoing need for new ways for healthcare
professionals to interact with their patients. This further
proves the significance of telehealth utilization even
without pandemic situations.
While telehealth provides numerous benefits, its impact
is particularly noteworthy in rural communities. These areas
often face challenges related to limited access to healthcare
facilities and healthcare professionals. Telehealth bridges
this gap by bringing healthcare services directly to rural
residents, enabling virtual consultations, health education,
and remote monitoring. Telehealth has the potential to
improve health outcomes, enhance preventive care, and reduce
healthcare disparities in rural areas (Robinson et al., 2019;
Wade et al., 2019).
Despite the potential advantages of telehealth in rural
communities, acceptance and adoption may vary. The discussion
of telehealth acceptance relies on various statistics and
research findings that shed light on the preparedness and
acceptance of telehealth services in rural areas.
Understanding the barriers, challenges, and opportunities
associated with telehealth utilization in rural communities

is crucial for effective implementation and maximizing its
impact (Almoite & Almazan, 2021; Wade et al., 2019).
Therefore, the purpose of this study is to assess the
acceptance of rural communities towards telehealth
utilization, focusing on the specific context of Tuguegarao
City, Cagayan. By examining the perception and use intention
of rural residents towards telehealth, this research aims to
identify factors that influence the adoption of telehealth
services, evaluate existing barriers, and provide insights
for policy development and interventions to enhance
telehealth acceptance and accessibility in rural communities.
Review of Related Literature
Technology in Healthcare System
Technology has become an integral part of the healthcare
system. It is used to improve the quality of care, increase
efficiency, and reduce costs. Telehealth allows patients to
receive care from healthcare providers remotely, which can
improve access to care for underserved populations (Outcomes,
Practice and Evidence Network, 2020).

Health outcomes in the Philippine healthcare system are
generally improving, but the stagnant maternal mortality
ratio and neonatal mortality rate, as well as the slow rate
of improvement in comparison to neighboring countries, are
concerning. Addressing health system inefficiencies and
health inequities due to disorganized governance, fragmented
health financing, and devolved and pluralistic service
delivery remain significant challenges for the Philippine
health system (Cordero, 2022).
Telehealth
The emergence of telehealth has been driven by various
factors, including the increasing availability of high-speed
internet (Monaghesh, & Hajizadeh, 2020), the development of
new and affordable telehealth technologies, the aging
population and the growing demand for healthcare services,
and the need to improve access to care in rural and
underserved areas (Outcomes, Practice and Evidence Network,
2020).
The history of telehealth can be traced back to the early
1960s, when the first experiments with telehealth were
conducted. However, it was not until the 1990s that telehealth

began to gain widespread adoption. The increasing
availability of high-speed internet and the development of
new and affordable telehealth technologies helped to drive
the growth of telehealth in the 1990s and 2000s (Provincial
Telehealth Resources, 2021).
A wide range of telehealth services are available, including
tele-consultations [6] PMC - NCBI, tele-monitoring, tele-
education, and tele-surgery (Kruse, et al.,2017; Monaghesh,
& Hajizadeh, 2020). Telehealth has been shown to be effective
in improving health outcomes and lowering risks of
hospitalization and readmission. Patients can access high-
quality healthcare for non-urgent conditions without going to
a health facility, saving resources and reducing unnecessary
burden on the health system (Noceda et al., 2023).
The use of telehealth is growing rapidly worldwide. In 2020,
an estimated 41.3 million telehealth visits were made in the
United States (Monaghesh, & Hajizadeh, 2020). The role of
telehealth during COVID-19 outbreak. The Philippines is also
seeing a growing interest in telehealth. In 2021, the
Philippine government launched a national telehealth program
called "Teleconsult." The program aims to provide telehealth

services to underserved populations in the Philippines
(Outcomes, Practice and Evidence Network, 2020).
Telehealth Utilization
Telehealth technologies have been maximized during public
health emergencies, especially in disaster management. On-
demand telehealth is a 21st-century approach that allows
patients to be efficiently screened; the care provided is
patient-centered and conducive to self-quarantine (Garfan et
al., 2021).
Rapidly evolving, modern information technologies have
provided a host of options to improve communication across
all fields, including medicine. Telehealth broadly refers to
the use of electronic information and telecommunications
technology to deliver and support health-related services
including both clinical and nonclinical as well as provider
education or medical training via the internet, video
conferencing, wireless communications, streaming multimedia
video, and store-and-forward telemedicine (Parisien et al.,
2020).
Telemedicine has been proposed as a viable solution to
increase virtual access to patient advocacy healthcare

education and training programs and has the potential to help
facilitate the delivery of health services to rural and remote
areas. It is anticipated that access to quality telehealth
services can minimize the need for in-person hospital visits
during the pandemic. Integrating and redesigning health
systems could improve the quality and efficiency of care
delivery. For the rural population at risk of COVID-19 or any
easily transmissible infection, telemedicine can provide
convenient access to routine care without provider-patient
contact, thereby limiting the spread of the virus. The
innovation also facilitates remote patient assessment and
monitoring of illness and treatment (Lynch, n.d.).
Benefits and Barriers to Telehealth
Telehealth, also known as telemedicine or virtual healthcare,
refers to the use of telecommunications technology to deliver
healthcare services remotely. It has gained significant
popularity and adoption in recent years, offering numerous
benefits for both patients and healthcare providers.
Telehealth was originally developed to provide basic care to
rural and underserved patients. Higher rates of use of
telehealth are now standard in many practices since the

coronavirus disease 2019 pandemic. Increasing emphases on
patient satisfaction, providing efficient and quality care,
and minimizing costs have also led to higher telehealth
implementation (Gajarawala et. Pelkowski, 2021). Telehealth
provides access to resources and care for patients in rural
areas or areas with provider shortages, improves efficiency
without higher net costs, reduces patient travel and wait
times, and allows for comparable or improved quality of care.
Better access to care, convenience, and reduced stress with
telehealth use also can increase patient satisfaction
(Gajarawala et. Pelkowski, 2021).
The review by Dorsey and Topol (2016) examined the state of
telehealth and emphasized its growing significance in
improving access to care, particularly in rural and
underserved areas. They highlighted the potential for
telehealth to address barriers such as geographical distance
and limited healthcare resources.
Patient satisfaction is a crucial aspect of healthcare
delivery, and telehealth has shown promising results in this
regard. Kruse et al. (2017) conducted a systematic review and
narrative analysis, revealing high levels of patient
satisfaction with telehealth services across various medical

specialties. Patients appreciated the convenience, reduced
travel time, and increased access to specialists.
The use of e-consultation services can be positively or
negatively influenced by external or internal factors.
External factors refer to the environment surrounding the
system as well as the system itself, while internal factors
refer to user behavior and motivation (Almathami et. al.,
2020). Although patients and providers enjoyed the benefits
of telehealth, the widespread adoption of telehealth has
unfortunately been hampered by a variety of barriers
including technology use among older adults and Internet
bandwidth speeds in rural or underserved areas (Gajarawala
et. Pelkowski, 2021).
While telehealth promises to increase access for underserved
populations, particularly those in rural areas, roadblocks
are slowing widespread availability. These roadblocks have
created disparities that are most acute in rural areas, and
for racial minorities, the elderly, and those with low levels
of educational attainment. The success of telehealth relies
on having reliable, high-quality broadband access,
facilitating interstate licensing for providers and parity in
reimbursement for telehealth. However, due to various

structural barriers, telehealth is not being adopted as
quickly in rural areas, where it is most needed (Cortelyou-
Ward et. al., 2020).
It is important to note that while telehealth offers numerous
benefits, it may not be suitable for all medical conditions
or situations. Certain healthcare needs may require in-person
consultations or physical examinations. Therefore, it is
essential to consult with healthcare professionals to
determine the appropriateness of telehealth for specific
cases.
Telehealth Acceptance
Telehealth has been shown to be effective in providing
healthcare services to rural residents, who often have
limited access to traditional healthcare. However, the
acceptance of telehealth among rural residents varies.
A study by Conocchiari Moran and Oukes (2021) found that
elderly patients in the Netherlands who used wearable health
technology were more likely to have a positive attitude
towards telehealth. The study also found that perceived

usefulness and perceived ease of use were important factors
in determining the behavioral intention to use telehealth.
Another study, by Wang & Cao (2022) found that Chinese
patients who had used telemedicine during the COVID-19
pandemic were more likely to continue using it in the future.
The study found that the factors that influenced the intention
to use telemedicine included perceived usefulness, perceived
ease of use, satisfaction, and social influence.
In the Philippines, a study by Li et al. (2023) found that
urban older adults who were interested in using remote health
management services were more likely to be motivated by
perceived usefulness, perceived ease of use, and
satisfaction.
Overall, the studies suggests that telehealth is generally
accepted by rural residents, but the factors that influence
acceptance vary. Perceived usefulness, perceived ease of use,
satisfaction, and social influence are all important factors
that need to be considered when designing and implementing
telehealth services for rural residents.

There are several reasons why telehealth is often well-
accepted by rural residents. First, telehealth can help to
overcome the challenges of distance and limited access to
healthcare. Second, telehealth can provide rural residents
with access to specialists who may not be available in their
local area. Third, telehealth can be more affordable than
traditional healthcare, which is important for many rural
residents. (Chao, C., 2019; Li et al., 2023).
Despite the benefits of telehealth, there are some challenges
that can limit its acceptance among rural residents. One
challenge is that telehealth can be difficult to use for
people who are not familiar with technology (Chao, C., 2019).
Another challenge is that telehealth can be expensive,
especially if the patient does not have health insurance (Wang
& Cao (2022).
More research is needed to understand the factors that
influence telehealth acceptance and behavioral intention to
use among rural residents. This research will help to ensure
that telehealth services are designed and implemented in a
way that meets the needs of rural residents.

Perception Towards Telehealth
Since telehealth makes healthcare services more accessible,
it is frequently seen favorably in rural areas. There are
insufficient healthcare facilities and specialists in many
rural parts of the Philippines. It was viewed as a way to
close the accessibility gap between rural areas and
healthcare resources. By using technology, people in remote
locations can access medical specialists, get medical advice,
and even get prescriptions without having to go far. For
someone with restricted mobility or in an emergency, this can
be especially useful.
Telehealth can assist healthcare systems, organizations, and
providers in expanding access to and improve the quality of
rural healthcare. Using telehealth in rural areas to deliver
and assist with the delivery of healthcare services can reduce
or minimize challenges and burdens patients encounter, such
as transportation issues related to traveling for specialty
care. Telehealth can also improve monitoring, timeliness, and
communications within the healthcare system.

Telehealth became a more prominent mode of providing
healthcare during the COVID-19 pandemic, when patients and
providers sought to decrease in-person contact for routine
visits. In order to expand access to telehealth from patients'
homes and increase provider flexibility, laws, reimbursement
policies, and regulations were temporarily changed through
emergency orders and legislation. Some of these policy
changes at the state and federal level have become permanent
or extended beyond the COVID-19 public health emergency
(PHE), while others have ended.
Due to unfamiliarity or worries about the level of treatment,
there may initially be some skepticism or hesitation
concerning telehealth services. It may be necessary to launch
education and awareness efforts that stress the efficacy,
security, and privacy safeguards put in place for telehealth
consultations in order to gain the trust of rural populations.
Furthermore, the cultural practices and beliefs of rural
populations in the Philippines may have an impact on how they
see healthcare. Telehealth service providers must be aware of
cultural quirks and modify their offerings as necessary.
Including cultural customs and values in telemedicine

consultations helps promote acceptance and trust in these
communities. Telehealth offers the potential to improve
healthcare access and delivery for those living in rural areas
of the Philippines.
Efficiency
In basic healthcare settings, telehealth interventions are a
useful addition to conventional face-to-face counseling.
According to UNESCO, efficiency can result in the smallest
quantity of resources possible, including effort and time.
Telemedicine may be efficient since most people nowadays rely
on the use of technology. Usage of Telemedicine had a higher
success rate than the face-to-face setup. The benefit of
Telemedicine has also been emphasized by Caulfield (2015) in
terms of efficiency and the reduction of travel times.
A study conducted by Funderburk et al. (2019) found that
though initially, postoperative patients were hesitant in
engaging in telemedicine services. Hersh et al. (2006) noted
mixed results when evaluating the efficiency of Telemedicine
in terms of diagnosis, wherein it was found that specialties
that relied heavily on verbal interaction between the
healthcare provider and the patient were found to have a more

efficient and effective diagnosis such as in neurology,
psychiatry and the management of chronic diseases among known
patients. Jain et al. (2019) noted that Telemedicine
streamlines the entire process of consultations, stating a
more standardized, consistent, and efficient process; the
presence of a comprehensive health questionnaire also avoids
unnecessary interaction and increases physician efficiency.
In relation to our study, telemedicine can provide patients
with more frequent contact with their healthcare providers,
which can help build trust and confidence in the healthcare
system. This increased access to healthcare can also help
patients develop a greater sense of self-efficacy by
providing them with the knowledge and resources they need to
manage their health conditions effectively. Additionally,
there is evidence to suggest that telemedicine can be an
effective tool for improving patients' self-efficacy and
empowering them to take an active role in managing their
healthcare.
Reliability
Reliability is defined as the capability of Telemedicine to
accurately and dependably carry out all of the services that

it claims to be able to perform (Lin, 2017). Discussion
sessions and consensus meetings were held to increase the
inter-rater reliability of the group as they conducted the
screening and analysis. During the consensus meetings,
factors and themes were identified through observation and
discussion; for example, as we discussed the articles, it
became evident that patient satisfaction was often stated in
terms of effectiveness and efficiency, so these became the
themes.
Additionally, because Telemedicine involves the use of the
internet, aside from the accuracy and reliability of
diagnosis, reliability is also concerned with the
professionalism of the service provider, dependability of the
information provided, security, privacy, and technology
reliability (Lin, 2017). According to Lin (2017), one patient
concern regarding the reliability of Telemedicine is the
identity and qualification of online healthcare providers.
The health care provider can build cognitive, interpersonal
trust with the patient by presenting trusted evidence such as
medical certificates to verify the health care provider's
education and professional ability (Lee et al., 2019).

When it comes to reliability, if feasibility and
effectiveness are met in the implementation of Telemedicine,
improvement in patient mobility, autonomy, and health‐related
quality of life, in particular for those patients living alone
or in rural areas, can be met. This is important particularly
for those who live in rural areas and lack knowledge and
understanding of diseases. When telemedicine reliability is
met, it empowers patients and encourages them to manage their
conditions (Hazenberg et al., 2020).
In relation to our study, the reliability of telehealth in
rural areas can be influenced by several factors including
the availability and quality of internet connectivity,
telehealth technology, and the capacity and reliability of
healthcare providers using telehealth. Though, one of the key
challenges of using telehealth in rural areas is the
availability and quality of internet connectivity. Many rural
areas have limited or no access to high-speed internet, which
can affect the reliability of telehealth services. Slow
internet connection or network congestion can affect the
quality of telehealth services, making it difficult for
individuals and healthcare providers to connect and
communicate effectively. Thus, it is important to address

these challenges and ensure that telehealth services are
reliable and effective in providing, or enhancing rather,
healthcare service to rural communities.
Financial Cost
In a developing country such as the Philippines, financial
cost plays a significant role in developing patient
perception whereby cheaper the cost leads to a positive
patient perception. According to Kruse et al. (2018), the
cost has always been one barrier to Telemedicine usage. Bali
(2018) stated that the application of Telemedicine would
incur huge costs as older technology must be replaced, and
smooth operation of telemedicine systems would require a fast
internet connection which also adds to the cost. Furthermore,
Combi et al. (2016) found that telemedicine systems are far
more expensive in developing countries than maintenance costs
in developed countries because of their difference in
hospital budgets and technological infractures.
Despite the benefits of telemedicine, challenges related to
the patient (e.g., costs, access), health provider and system
(e.g., financial and time constraints), and external factors

such as poor connectivity pose problems to its wide-scale
implementation [6, 8, 12]. Barriers to patient adoption, in
particular, need to be addressed to encourage continued use.
Studies on factors influencing telemedicine use and
satisfaction have provided recommendations on how to improve
the design and delivery of quality telemedicine services
[13, 14]. To date however, only three local studies have
documented patient perspectives and experiences with
telemedicine services during the pandemic and all reported
good levels of satisfaction.
In relation to our study, Telehealth can be a cost-effective
solution for providing healthcare services in rural areas.
One of the main advantages of telehealth is that it can reduce
healthcare costs by eliminating the need for travel and
reducing the need for in-person medical consultations. This
can be particularly beneficial in rural areas where patients
may have to travel long distances to access medical care. The
cost-effectiveness of telehealth in rural areas depends on
several factors, including the cost of the telehealth
technology, the availability of high-speed internet, and the
willingness of patients and healthcare providers to adopt
telehealth services. However, studies have shown that

telehealth has the potential to be a cost-effective solution
for providing healthcare services in rural areas, reducing
healthcare costs and improving healthcare outcomes for
patients.
Interaction
One of the key aspects of telehealth is the interaction
between the patient and the healthcare provider. This
interaction can be conducted through a variety of channels,
including video conferencing, telephone, and text messaging.
The quality of this interaction is essential to the success
of telehealth, as it determines the patient's satisfaction
with the care they receive.
Telehealth has been gaining popularity in recent years, as it
offers a convenient and accessible way to receive medical
care. However, some studies found that there is still some
uncertainty about how rural residents perceive telehealth
interaction.
A study by Gustin et al. (2019) found that nurse practitioners
in rural areas had generally positive perceptions of
telehealth interaction. The study participants reported that
telehealth allowed them to provide care to patients who would

otherwise have difficulty accessing care, and that it was a
convenient and efficient way to deliver care.
Another study by Albarrak et al. (2021), found that physicians
in Saudi Arabia had positive perceptions of telemedicine. The
study participants reported that telemedicine was a valuable
tool for providing care to patients in rural areas, and that
it was a convenient and efficient way to deliver care.
However, not all rural residents have positive perceptions of
telehealth interaction. A study by Katt et al. (2020) found
that some patients in rural areas were hesitant to use
telehealth, as they were concerned about the quality of care
and the lack of physical interaction with their provider.
Another study, by Jiang et al. (2022), found that some older
patients with chronic obstructive pulmonary disease (COPD)
were hesitant to use telehealth, as they were concerned about
the lack of physical interaction with their provider and the
potential for technical difficulties.
The studies above suggest that there is a range of perceptions
towards telehealth interaction among rural residents. More
research is needed to better understand these perceptions and

to identify the factors that influence them. This research
could help to improve the design and delivery of telehealth
services to rural residents.
Perceived Ease of Use
Perceived ease of use is a key factor in the adoption of
telehealth services (Nguyen, 2022). Studies have shown that
perceived ease of use is positively influenced by perceived
usefulness (Lin, Z., 2017), and that it is a significant
predictor of intention to use telehealth (Holtz et al., 2022).
Rural residents are more likely to perceive telehealth as
easy to use than urban residents (An, 2021). This is likely
due to the fact that rural residents are more likely to have
limited access to healthcare providers, and telehealth can
provide them with a convenient way to receive care.
However, some rural residents may perceive telehealth as
difficult to use, due to factors such as a lack of familiarity
with technology or concerns about the quality of the video
connection (Terry & Buntoro, 2021). Additionally, rural
residents may be more likely to have slower internet speeds,
which can make it difficult to use telehealth services.

These studies suggest that more research is needed to
understand the factors that influence perceived ease of use
of telehealth, particularly among rural residents. This
research could help to identify ways to improve the usability
of telehealth services and make them more accessible to rural
residents.
Perceived Usefulness
Telehealth is the use of telecommunications and information
technology to deliver healthcare services remotely. It has
been shown to be a valuable tool for improving access to
healthcare, especially in rural areas. However, the perceived
usefulness of telehealth among rural residents is not well
understood (Lin, Z., 2017).
Some studies have found that rural residents have a positive
perceived usefulness of telehealth. For example, a study by
Lin, Z. (2017) found that rural residents who had used
telehealth were more likely to believe that it was useful for
managing their health. Another study by Smith et al. (2020)
found that rural residents who had used telehealth were more
likely to believe that it was convenient and saved them time.

However, other studies have found that rural residents have
a negative perceived usefulness of telehealth. A study by
Eikelboom and Atlas (2015) found that rural residents were
concerned about the quality of care they would receive through
telehealth. Another study by Choi et al. (2004) found that
rural residents were concerned about the cost of telehealth.
The research on telehealth perceived usefulness among rural
residents is mixed. More research is needed to better
understand the factors that influence rural residents'
perceptions of telehealth. This research could help to
identify ways to improve the perceived usefulness of
telehealth among rural residents and increase its adoption in
rural areas.
Telehealth Perception and Acceptance in Terms of Demographic
Profile
The perception and acceptance of telehealth can vary
depending on various demographic factors including age, sex,
socioeconomic status, and educational attainment.
A number of studies have found that age is a significant
factor in telehealth perception and acceptance. For example,
a study of adults aged 18-34 in Manila, Philippines during

the COVID-19 pandemic found that younger adults were more
likely to have a positive perception of telehealth than older
adults (Umayam et al., 2022). Another study found that older
adults with chronic conditions were more likely to report
using telehealth services than younger adults with chronic
conditions (Jones & Darrow, 2019).
These findings suggest that it is important to consider age
when designing and implementing telehealth programs. By
understanding the needs and preferences of different age
groups, providers can improve the likelihood of telehealth
acceptance and use. However, it is important to note that
these studies only looked at a limited range of ages. More
research is needed to understand how telehealth perception
and acceptance varies across all ages. For example, it is
possible that older adults may be more likely to use
telehealth services for certain conditions, such as chronic
diseases.
Sex is another demographic factor that has been shown to
influence telehealth perception and acceptance. For example,
a study of telehealth use and acceptance among African
American and Hispanic patients with chronic conditions found

that female patients were more likely to report using
telehealth services than male patients (Achar et al., 2019).
However, other studies have found no significant difference
in telehealth perception and acceptance between males and
females. A study of telehealth acceptance and use among rural
older adults found that there was no significant difference
in the likelihood of using telehealth between male and female
participants (DeLapp et al., 2019).
More research is needed to better understand the relationship
between sex and telehealth perception and acceptance.
Socioeconomic status and educational attainment are other
demographic factors that have been shown to influence
telehealth perception and acceptance. A systematic review of
telehealth acceptance and use among patients with chronic
conditions found that individuals with lower socioeconomic
status were less likely to use telehealth services than
individuals with higher socioeconomic status and that
individuals with higher levels of education were more likely
to have a positive perception of telehealth than individuals
with lower levels of education (Chen et al., 2019).

This is likely due to a number of factors, including access
to technology, cost, and lack of knowledge about telehealth.
It is also possible to consider that individuals with higher
levels of education are more likely to be familiar with
technology and have access to the internet. However, more
research is needed to understand how telehealth perception
and acceptance varies in terms of socioeconomic status and
educational attainment for there is a possibility of contrast
to the result of other studies.
In conclusion, demographic factors such as age, sex,
socioeconomic status, and educational attainment can
influence telehealth perception and acceptance. More research
is needed to understand how telehealth perception and
acceptance varies across all demographic groups. By
understanding the needs and preferences of different
populations, providers can improve the likelihood of
telehealth acceptance and use.
Conceptual Framework
This study will utilize a modified Technology Acceptance
Model (TAM). This model has been utilized by numerous studies
to explain user acceptance behavior towards technology

utilization and the variables that affect the willingness to
use and accept new technology. Thus, this model is relevant
in explaining telehealth acceptance, specifically the
perception and intention towards telehealth utilization among
rural residents.
Figure 1. Modified Technology Acceptance Model

The study will assess telehealth acceptance by
determining the perception and intention of use towards
telehealth and the significant relationship between these
variables. The demographic profiles of respondents to be
explored in this study include: age, sex, marital status,
educational attainment, and socioeconomic status. The
predetermined variables or mediating mechanisms of overall
perception includes: efficiency, reliability, financial cost,
interaction, perceived usefulness, and perceived ease of use.
Since the target respondents may differ in terms of
demographics and the predetermined variables influencing
overall perception, their relationship with each other and
the direct influence to the intention of use is to be studied.

Research Paradigm
Figure 2. Research Paradigm
The framework above presents the study’s input, process,
and output. The researchers will gather information about the
demographic profile and the overall perception and intention
of use in order to get information regarding telehealth
acceptance. The questionnaires will be administered
physically to the participants from the different rural
barangays. The data will then be organized and analyzed. The
output will be the level of telehealth acceptance among rural
residents, their level of perception, as well as the
relationship between the two variable.

Statement of the Problem
Generally, this study aims to assess the level of
telehealth acceptance among rural residents in Tuguegarao
City, Cagayan. The study will determine the rural residents’
level of overall perception and their intention to use
telehealth in order to identify the level of telehealth
acceptance.
Specifically, the study seeks to answer the following
questions:
1. What are the rural residents’ characteristics in terms
of the following:
1.1. Age
1.2. Gender
1.3. Educational Attainment
1.4. Socioeconomic Status
2. What is the level of perception of the rural residents
towards telehealth in terms of the following:
2.1. Efficiency
2.2. Reliability
2.3. Financial Cost
2.4. Interaction
2.5. Perceived Ease of Use
2.6. Perceived Usefulness

3. What is the degree of the rural residents’ intention of
use towards telehealth?
4. Is there a significant difference in the rural
residents’ overall perception towards telehealth when
grouped according to profile variables?
5. Is there a significant difference in the rural
residents’ intention of use towards telehealth when
grouped according to profile variables?
6. Is there a significant relationship between the rural
resident’s overall perception and their intention of use
towards telehealth?
Hypotheses
The study will test the following hypotheses at 0.05
level of significance:
1. There is no significant difference in the rural
residents’ overall perception towards telehealth when
grouped according to profile variables.
2. There is no significant difference in the rural
residents’ intention of use towards telehealth when
grouped according to profile variables.

3. There is no significant relationship between the rural
resident’s overall perception and their intention of use
towards telehealth.
Scope and Limitations
Scope:
The scope of this study is to assess the readiness of
rural residents in Tuguegarao City, Cagayan, in terms of their
access and utilization of telehealth services. The study aims
to describe the current situation of telehealth readiness
among the rural residents of Tuguegarao City, Cagayan, and to
identify the factors that affect their readiness,
specifically their overall perception and intention to use
Telehealth services.
Limitation:
There are some limitations for this study. Firstly, the
study only focuses on rural residents in Tuguegarao City,
Cagayan, and may not be applicable to other areas or
populations. It is limited to a descriptive quantitative
approach, which may not allow for a deeper understanding of
the participants' experiences and perspectives. The study may

not capture the experiences and perspectives of rural
residents who do not have access to telehealth services or
who choose not to use them.
Significance of the Study
A study on the telehealth acceptance of rural residents in
Tuguegarao City, Cagayan is significant in its potential to
improve healthcare delivery, address healthcare disparities,
inform policy and decision-making, and contribute to the
literature on telehealth acceptance.
Rural residents. Understanding the telehealth acceptance of
rural residents is essential in determining the feasibility
and potential benefits of telehealth adoption in this
population. By identifying the factors that influence
telehealth adoption among rural residents, the study can
inform the development of strategies to overcome barriers and
facilitate the adoption of telehealth services.
Government and Department of Health. As the government and
the Department of Health has a role in the implementation and
delivery of telehealth services, the findings if this study
can assist in the development of policies and programs that
promote the integration of telehealth services into the local

healthcare system. This can lead to improved access to
healthcare services, better health outcomes, and more cost-
effective healthcare delivery for rural residents in
Tuguegarao City, Cagayan.
Healthcare Professionals, Hospitals, and Rural Health Units.
The results of the study can be used by healthcare
professionals to improve the implementation of telehealth
services in their practice. Rural health units and hospitals
can learn about the challenges and opportunities of
telehealth implementation in rural areas and develop
strategies to overcome these challenges.
Nursing Students. This study can provide nursing students
with learning opportunities about telehealth and its impact
on healthcare delivery in rural areas. Nursing students can
learn about the challenges and opportunities of using
telehealth in rural areas and develop skills in providing
care through telehealth services.
Future Researchers. The findings of this study can benefit
future researchers by conducting further research to explore
the factors that influence telehealth adoption among rural
residents, investigating the effectiveness of telehealth
interventions in improving health outcomes, exploring the

potential of telehealth services in addressing specific
healthcare needs of rural residents, investigating the role
of healthcare providers and policymakers in promoting the
adoption of telehealth services, and exploring the ethical
and legal implications of telehealth services.
Definition of Terms
Assessment. is the process of evaluating or measuring a
person's knowledge, skills, abilities, or other
characteristics. In an educational context, assessment can
refer to the evaluation of students' learning, such as through
tests, assignments, and other forms of evaluation. In a
healthcare context, assessment can refer to the evaluation of
a patient's health status, such as through medical history,
physical examination, and laboratory tests. Assessment can
also refer to the evaluation of a program, policy, or
intervention to determine its effectiveness or impact.
Efficiency. refers to the ability to accomplish a task or
goal using the least number of resources, time, or effort. In
other words, efficiency is the measure of how well resources
are utilized to achieve a specific objective. An efficient
system, process, or organization can achieve its goals in a

timely manner, with minimal waste, and with optimal use of
available resources. Efficiency is an important concept in
many fields, including business, engineering, economics, and
healthcare, where it is used to evaluate the effectiveness of
a system or process. High efficiency is generally considered
desirable as it can result in cost savings, improved
productivity, and better outcomes.
Financial Cost. refer to the monetary expenses associated
with the implementation of telehealth services for rural
residents in Tuguegarao City, Cagayan. Financial cost may
include the costs of telehealth technology, such as hardware,
software, and telecommunications infrastructure. It may also
include the costs of training healthcare professionals and
patients to use telehealth services, as well as the costs of
maintaining and upgrading the technology.
Intention to Use. refer to rural residents' willingness or
plan to use telehealth services to access healthcare. The
study may explore factors that influence rural residents'
intention to use telehealth services, such as perceived
usefulness, ease of use, accessibility, and affordability.
Understanding rural residents' intention to use telehealth
services is important for designing effective strategies to

promote the adoption and use of telehealth technology in rural
areas.
Interaction. refer to the communication and exchange of
information between rural residents and healthcare
professionals through telehealth services. The study may
explore the quality and effectiveness of the interaction
between rural residents and healthcare professionals through
telehealth services, as well as the factors that influence
the interaction, such as the quality of the technology, the
level of training of healthcare professionals and patients,
and the communication skills of the parties involved.
Understanding the quality of interaction in telehealth
services is important for improving the effectiveness and
acceptance of telehealth services in rural areas.
Overall Perception. general impression or evaluation of
telehealth services. The study may explore rural residents'
perceptions of the benefits, drawbacks, and effectiveness of
telehealth services, as well as the factors that influence
their overall perception, such as their experiences with the
technology, their beliefs about the quality of care provided
through telehealth, and their attitudes towards technology
adoption. Understanding rural residents' overall perception

of telehealth services is important for improving the
acceptance and adoption of telehealth services in rural areas
and for developing effective strategies to address any
negative perceptions or barriers to adoption.
Perceived Ease of Use. refer to rural residents' subjective
perception of how easy it is to use telehealth services to
access healthcare. The study may explore rural residents'
perceptions of the ease of use of telehealth services, as
well as the factors that influence their perceived ease of
use, such as the quality of the technology, the level of
training or education provided, and the user interface of the
technology. Understanding rural residents' perceived ease of
use of telehealth services is important for designing
effective strategies to promote the adoption and use of
telehealth technology in rural areas, as perceived ease of
use is often a significant predictor of technology adoption
and usage behavior.
Perceived Usefulness. refer to rural residents' subjective
perception of the benefits or advantages of using telehealth
services to access healthcare. The study may explore rural
residents' perceptions of the usefulness of telehealth
services, as well as the factors that influence their

perceived usefulness, such as the quality of care provided
through telehealth, the convenience of the technology, and
the potential cost savings.
Reliability. refer to the consistency and stability of the
data obtained from the survey or assessment of rural
residents' telehealth readiness. The study may explore the
reliability of the measurement instrument used to assess
telehealth readiness, such as the survey questionnaire or
interview protocol, and may also investigate the reliability
of the assessors or data collectors who administer the
assessment. Ensuring the reliability of the data obtained
from the assessment is important for ensuring the validity
and accuracy of the study findings and for making reliable
conclusions and recommendations based on the data collected.
Rural Residents. refer to individuals who live in the rural
areas of Tuguegarao City, Cagayan, and who may be at risk of
experiencing limited access to healthcare services due to
their geographic location and other related factors. The
study may explore the telehealth readiness of rural residents
in Tuguegarao City and identify the factors that influence
their readiness, such as their level of education, income,
health status, and access to technology and other resources.

Understanding the telehealth readiness of rural residents is
important for identifying strategies to improve access to
healthcare services and promote the use of telehealth
technology to bridge the gap between rural and urban
healthcare delivery systems.
Telehealth. refer to the use of telehealth technology and
services by rural residents in Tuguegarao City to access
healthcare services remotely. The study may explore the
telehealth readiness of rural residents and the factors that
influence their willingness and ability to use telehealth
services, such as their access to technology, their
perceptions of the usefulness and effectiveness of
telehealth, and their level of comfort and familiarity with
digital health tools. Understanding the telehealth readiness
of rural residents is important for identifying strategies to
promote the adoption and use of telehealth technology in rural
areas and improve access to healthcare services for
underserved populations.
Telehealth Acceptance. This refers to the extent to which
rural residents in Tuguegarao City are prepared and willing
to use telehealth technology and services to access
healthcare remotely.

Chapter 2
METHODOLOGY
This chapter presents the methods and procedures that
were used in the study. It includes the research design,
participants of the study, instrumentation, data gathering
procedure, and data analysis tools.
Research Design
This study will utilize a cross-sectional research
design in order to determine the current telehealth
acceptance of rural residents in Tuguegarao City.
Furthermore, it will utilize a descriptive quantitative
approach for it is appropriate in assessing the level of
perception and the intention of use towards telehealth and
the relationship between the rural resident’s overall
perception and their intention of use towards telehealth.
Participants of the Study
One group of participants will be involved in the study,
namely, the residents of Rural Barangays in Tuguegarao City,
Cagayan with age 18 years old and above.

The participants are from the 17 rural barangays in
Tuguegarao City which includes Bagay, Capatan, Cataggaman
Pardo, Cattagaman Viejo, Dadda, Gosi Norte, Gosi Sur, Larion
Alto, Larion Bajo, Linao East, Linao Norte, Linao West,
Namabbalan Norte, Namabbalan Sur, Pallua Norte, Pallua Sur,
and Tagga. With these participants, the study will be able to
determine the readiness of the rural residents for telehealth
utilization.
Having a total population size of 27,387, a sample size
of 379 was obtained through the Raosoft Software, with a
confidence level of 95% and a margin of error of 5%. The study
will use stratified random sampling in order to obtain
appropriate number of participants from each barangay that
will represent the characteristics of the total population.
The table below shows the summary of the participants of
the study.
Table 1. Participants of the Study
No. of
Barangay Total Population
Participants
Bagay 2265 31
Capatan 2163 30
Cataggaman Pardo 2720 38
Cataggaman Viejo 2564 35
Dadda 772 11
Gosi Norte 646 9
Gosi Sur 706 10

Larion Alto 1320 18

Larion Bajo 1456 20
Linao East 4189 58
Linao Norte 2106 29
Linao West 1078 15
Namabbalan Norte 868 12
Namabbalan Sur 478 7
Pallua Norte 1510 21
Pallua Sur 1712 24
Tagga 834 11
Total:27387 Total: 379
Instrumentation
The study will utilize a questionnaire that is adopted from
the study of Jaudian et al. (2021) in order to evaluate the
perception and use intention of middle-aged adult individuals
in a secondary hospital in Tuguegarao City towards
Telemedicine during the COVID- 19 pandemic. The adopted
questionnaire is a modification of the questionnaire used by
Lin, Z. in 2017. Jaudian et al. (2021) predetermined six
variables to obtain overall perception and questions
regarding the intention of use were also asked. The
reliability of the questionnaire through Cronbach's Alpha was
conducted to test the internal consistency and validity of
the measurements; the result of the Cronbach's Alpha ranges
from 0.7 -to 0.9, which indicates well the high reliability
of the instrument. The questionnaire also has a good validity

as Lin, Z. (2017) showed that there is correlation between
variables.
The adopted questionnaire contains 28 key statements, and the
respondents were then asked to rank statements. The
respondents were asked to follow the ranking scheme that
categorizes the statements into 1 of 5 rankings: 1 as strongly
disagree, 2 as disagree, 3 as neutral, 4 as agree, and 5 as
strongly agree.
The first part of the questionnaire identifies the
demographic data of the individuals. The items that were
present include names of the respondent, age, gender,
educational attainment, marital status, and socioeconomic
status. The second portion of the questionnaire included
statements that focus on determining level of perception
towards Telehealth, respectively. The second part
specifically assesses the perception factors: efficiency (4
items), reliability (5 items), financial cost (3 items),
interaction (5 items), perceived ease of use (4 items), and
perceived usefulness (3 items). The third part determines the
intention of use towards Telehealth, consisting of present
items include the respondent's names 3 item- statements.

Data Gathering Procedure
The researchers will send a communication letter to the
University’s administrators and the Research Ethics
Committee. After the approval, the researchers will write a
letter of request to the participants asking for their
permission to be a participant in conducting the survey. The
researchers will also write a letter of permission to the
Barangay Captains of 17 Rural Barangays in Tuguegarao City:
Bagay, Capatan, Cataggaman Pardo, Cattagaman Viejo, Dadda,
Gosi Norte, Gosi Sur, Larion Alto, Larion Bajo, Linao East,
Linao Norte, Linao West, Namabbalan Norte, Namabbalan Sur,
Pallua Norte, Pallua Sur, and Tagga. The researchers will
adopt a questionnaire from the study of Jaudian et. al in
2021. The researcher will use a questionnaire to do a study
in Tuguegarao City's rural barangays. The researcher will
explain to the participants the significance of their
responses to the study. The researcher will define specific
words for the respondents so that they can answer the
questionnaire fully aware of their duty as the subject of the
study. The researcher will ask the respondents to answer
honestly. Before answering the questionnaire, participants
will be given a consent form that explains the study. The
researcher will gather a total of 379 respondents that are 18

years old and above that fulfill the inclusion requirements.
It will be made clear that confidentiality would be preserved,
and that all information acquired would be used solely for
the purposes of the study. Once all of the necessary data
will be gathered, the researchers will begin processing and
analyzing the survey results using statistical methods.
Data Analysis
The level of telehealth acceptance among rural residents in
Tuguegarao City, Cagayan will be analyzed by the researchers
through the utilization of the following statistical tools:
Frequency and Percentage. This is a statistical tool used to
determine the relative frequency of specific answers. This is
also used to determine the fraction of the whole of a certain
level of a factor. This will be used to analyze demographic
profiles, such as age, gender, marital status, educational
attainment and socioeconomic status.
Weighted Mean. The researchers will use this statistical
treatment to determine the respondents' Intention to Use,
Overall Perception, and Perception in terms of Efficiency,
Reliability, Financial Cost, Interaction, Perceived Ease of

Use, and Perceived Usefulness of rural residents regarding
telehealth.
Table 2. Mean Interpretation and the Qualitative
Interpretation
POINT RANGE SCALING INTERPRETATION

1.00 - 1.80 Strongly Agree
1.81 - 2.61 Disagree
2.62 - 3.42 Neutral
3.43 - 4.23 Agree
4.24 - 5.00 Strongly Disagree
Pearson R Correlation. This is a statistical technique used
to determine relationships between two quantitative and
continuous variables. This is used to assess and measure the
association between two variables and determine how strong or
weak the relationship is. This method will determine the
relationship of different factors to the respondents'
perception of Telehealth.
Decision (Pearson R Correlation):
If P-Value is greater than or equal to 0.05, the researcher
does not reject the null hypothesis. This means that there is
no significant relationship between the variables.

If P-Value is less than 0.05, the researcher rejects the null
hypothesis. This means that there is a significant
relationship between the variables.
Table 3. Pearson R Correlation and the Qualitative
Interpretation
POINT SCALE RANGE INTERPRETATION

Very Strong Positive
1.00 - 0.8
Relationship
Strong Positive
0.79 - 0.60
Relationship
Moderate Positive
0.59 - 0.40
Relationship
Weak Positive
0.39 - 0.20
Relationship
Negligible/No
0.19 - -0.19
correlation
Weak Negative
-0.20 - -0.29
Relationship
Moderate Negative
-0.40 - -0.59
Relationship
Strong Negative
-0.60 - -0.79
Relationship
Very Strong Negative
-0.80 - 1.00
Relationship

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St Paul University Philippines Form No: 07C
Research Ethics Committee
Version No: 03
INFORMED CONSENT FORM Approval Date:
Effectivity Date:
[Informed Consent Form for Rural Residents]
This informed consent form is for residents of rural barangays in Tuguegarao City and who we are inviting to
participate in the research, entitled "Telehealth Readiness of Rural Health Residents in Tuguegarao City, Cagayan:
A Descriptive Quantitative Approach.”
Name of Principal Investigators: Ma. Cecilia Amy S.Calizar

Rachelle O. Delantar
Regine Vera Mae S. Edubalad
Kyle Ivan Angelo R. Poncio
Yvonne M. Soriano
Name of Organization: St. Paul University Philippines
Name of Research: Telehealth Readiness of Rural Health Residents in Tuguegarao City, Cagayan: A Descriptive
Quantitative Approach
This Informed Consent Form has two parts:

• Information Sheet (to share information about the study with you)
• Certificate of Consent (for signatures if you choose to participate)
You will be given a copy of the full Informed Consent Form
Part I: Information Sheet
A. Introduction
We are BSN 3G students of St. Paul University Philippines. We are conducting research on the telehealth
readiness of rural residents in Tuguegarao City. We will provide you with information and invite you to participate
in this research. You are not required to immediately decide today whether or not to participate in the study.
Before making a decision, you can discuss the research with anybody you trust.
There may be words on this consent form that you do not understand. Please ask us to pause as we go over the
material, and we will explain. If you have any further queries, you can contact any of the researchers.
B. Purpose of the research
Technology has been a helpful tool in improving healthcare services and one of these technologies is the use
of telehealth. Telehealth is a way for people to communicate with healthcare providers regarding their health
concerns, especially for those who finds it hard to visit healthcare facilities. As such, we believe that you, being
a resident in a rural community and having lesser access to healthcare services, can greatly help us by telling
the readiness of the rural community people for the utilization of telehealth. We would also want to know
specifically your perception and intention of use towards telehealth.
Version No: 03
Effectivity Date:
C. Type of Research Intervention
This research will involve your participation in answering a questionnaire that will take only about 10–15
minutes.
D. Participant Selection
You are being invited to participate in this study because we believe that the information you will provide us
regarding your perception and intention of use towards telehealth will greatly contribute in the understanding the
telehealth readiness of rural communities.
E. Voluntary Participation
Your participation in this study is completely voluntary. It is entirely up to you whether or not to engage. If you
opt not to participate, all of the services you receive at this location will remain unchanged. Your decision will
have no impact on your job or any work-related assessments or reports. (Even though you agreed to participate
earlier, you may change your mind afterwards.)
F. Procedures
We would like to ask you to assist us in learning more about telehealth readiness in your community. We would
like to invite you to participate in this research project. If you accept, you will be asked numerous questions in
the form of a questionnaire.
⮚ Fill out a questionnaire, which researchers will provide and collect once completed, or you can answer
the questionnaire yourself, or it can be read to you, and you can speak out loud the response you
want me to take down.
⮚ If you do not intend to answer any of the questionnaire's questions, you may skip them and move on
to the next one. The information recorded is confidential; your name is not included on the forms;
only a number will identify you; and no one else will have access to your survey except us researchers.
G. Duration
The length of time that the research study will be conducted is 2-3 months in estimation. During that time period,
we will visit you two times: the first time would be to get your consent and the second time would be for answering
the questionnaire.
H. Risks
This study will ask for your opinions on Telehealth utilization in this city. As such, there is a possibility that you
might unintentionally tell some private or confidential information, or that you might find some of the topics
awkward to discuss. Both of these possibilities are possible. However, we do not intend for this to take place.
Version No: 03
Effectivity Date:
You are not compelled to respond to any questions or engage in the discussion, interview, or survey if you
believe that any of the topics are too personal or that talking about them makes you feel uneasy.
In order to protect you from Reportable Negative Events (i.e., injury to your physical, mental health, or social
well-being), the researcher will promptly get in touch with SPUP REC and report any RNE by submitting Form
12. Reportable Negative Events Form. In general, the study should be temporarily put on hold while waiting for
SPUP REC's decision.
I. Benefits
Although you are unlikely to get any immediate benefits your participation will probably allow us to learn more
about how prepared your community is to use Telehealth as a form of healthcare. With this, we are humbly asking
that you give us a small fraction of your time to conduct our study.
J. Reimbursements
It is quite very unlikely that you will be compensated in any way for taking part in the study. However, we will
compensate you monetarily for any expenses that you paid as a result of your participation in our study. This
presents an additional opportunity for us to let you know how much we appreciate you for your involvement in
the survey.
K. Confidentiality
If you participate in our study being conducted in the community, you can receive questions from other members
of the community. However, you can be confident that we will not provide any information about you to anyone
besides the research team. We will maintain the privacy of the data we gather for this study project. Any
information about you will be identified by a number rather than your name, and the researchers will be the only
ones who know it. And except for those who will participate in our research study and are directly involved in
your care, your information will not be disclosed to or given to anyone else.
L. Who to Contact
In the event that you have any questions regarding the research, you are more than welcome to get in touch with
the researcher in question by phoning [Contact Number], [Name of the Researcher], or [Email Address]. In the
event that you require any further information regarding the study project, please do not hesitate to get in touch
with us.
Additionally, the SPUP REC, a body tasked with ensuring that research participants are safeguarded from harm,
has reviewed and approved this proposal. The SPUP REC was tasked with ensuring that research participants are
safeguarded from harm. You can get additional information about the organization through email
(rec@spup.edu.ph) or you may contact the SPUP REC Chair (078) 396-1987 to 1997 Local: 201 and talk to the
Version No: 03
Effectivity Date:
SPUP REC. You can also use this number to report any major issues that took place throughout the course of
this study.
Part II: Certificate of Consent
I have been invited to take part in a study on telehealth implementation in rural health facilities in Tuguegarao
City.
I have read the foregoing information, or it has been read to me. I have had the opportunity to ask questions about it
and any questions I have been asked to have been answered to my satisfaction. I consent voluntarily to be a participant
in this study
Print Name of Participant______________________

Signature of Participant _______________________
Date _________________________
Day/month/year
If illiterate 1
I have witnessed the accurate reading of the consent form to the potential participant, and the individual has had the
opportunity to ask questions. I confirm that the individual has given consent freely.
Print name of witness____________ Thumb print of participant

Signature of witness _____________
Date ________________________
Day/month/year
Statement by the researcher/person taking consent
I have accurately read out the information sheet to the potential participant, and to the best of my ability made sure
that the participant understands that the following will be done:
1.
2.
3.
I confirm that the participant was given an opportunity to ask questions about the study, and all the questions asked
by the participant have been answered correctly and to the best of my ability. I confirm that the individual has not been
coerced into giving consent, and the consent has been given freely and voluntarily.
1
A literate witness must sign (if possible, this person should be selected by the participant and should have no
connection to the research team). Participants who are illiterate should include their thumb print as well.
Version No: 03
Effectivity Date:
A copy of this ICF has been provided to the participant.

Print Name of Researcher/person taking the consent________________________
Signature of Researcher /person taking the consent__________________________
Date ___________________________
Day/month/year
QUESTIONNAIRE
PART I. Participants’ Profile
Instruction: Please write the needed information on the space provided and put a check (✓) beside
the option that is applicable to you.
Name (Optional): ___________________________________
Age: ( ) Young Adult (18-35 years old) Gender: ( ) Male ( ) Female
( ) Middle Adult (36-55 years old)
( ) Older Adult (56 years old and above)
Marital Status: ( ) Single ( ) Married
( ) Separated ( ) Widow/Widower
Educational Attainment: ( ) Illiterate
( ) Elementary
( ) High School
( ) College
( ) Post Graduate
Socioeconomic Status (monthly income): ( ) Class E (below 8,000 php)
( ) Class D (8,001 – 15,000 php)
( ) Broad C (15,001 – 30,000 php)
( ) Upper Class C (30,001 – 50,000 php)
( ) Class B (50,001 – 99,000 php)
( ) Class A (100,000 php and up)
PART II. Overall Perception Towards Telehealth
Instruction: The following statements will determine your perception towards telehealth,
specifically regarding: efficiency, reliability, financial cost, interaction, perceived, ease of use,
and perceived usefulness.
Please read the following statements and put a check on the items that signify your response.
5 – Strongly Agree
4 - Agree
3 – Neutral
2 – Disagree
1 – Strongly Disagree
Efficiency 5 4 3 2 1
1. I think Telemedicine saves time in traveling to hospitals and
waiting for registration
2. I think Telemedicine saves time of unnecessary physical
examination; therefore, it makes the diagnosis efficient
3. I think Telemedicine saves time in traveling to different
departments within the hospital
4. I think Telemedicine saves in time giving medical prescription
Reliability
5. I think the diagnosis is reliable in Telemedicine
6. I think the healthcare provider who is charge of the services of
Telemedicine is professional
7. Even without physical examination, the healthcare provider can
learn about my health condition
8. The information (comments on healthcare providers, fees, etc.)
provided is accurate and reliable
9. The Telemedicine will not have technical problems
Financial Cost
10. I think Telemedicine saves money in traveling to and from the
hospitals
11. I think Telemedicine has a cheaper registration fee
12. The service fee of Telemedicine is reasonable
Interaction
13. I can get more attention from medical service providers via
Telemedicine
14. I feel more comfortable communicating with medical service
providers through Telemedicine
15. Communication with medical service providers through
Telemedicine is similar to face to face communication
16. I can engage in communication with Telemedicine service
providers needed
17. The communication frequency is reasonable in Telemedicine
Perceived Ease of Use
18. I think getting access to Telemedicine is easy, such as
downloading and installing the application
19. I think it is easy to understand the form and the service process
of Telemedicine
20. I think it is easy to use Telemedicine
21. I do not need the assistance of medical service providers or
technicians to use services of Telemedicine
Perceived Usefulness
22. I think Telemedicine can aid in the management of my
condition
23. I can understand my health condition and manage my health
time
24. I think Telemedicine is useful
PART III. Intention of Use Towards Telehealth

Instruction: The following statements will determine your intention of using telehealth.
Please read the following statements and put a check on the items that signify your response.
5 – Strongly Agree
4 - Agree
3 – Neutral
2 – Disagree
1 – Strongly Disagree
Intention of Use 5 4 3 2 1
1. In general, I think Telemedicine is acceptable
2. I will choose Telemedicine next time if needed
3. I will always choose Telemedicine whenever I need medical
services

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St.

Paul University Philippines

LEVEL OF TELEHEALTH ACCEPTANCE AMONG

A Thesis Proposal Presented

MA. CECILIA AMY S. CALIZAR

School of Nursing and Allied Health Sciences

Chapter 1 THE PROBLEM AND REVIEW OF RELATED

School of Nursing and Allied Health Sciences

School of Nursing and Allied Health Sciences

Table Title Page

1 Participants of the Study . . . . . . . . . .

School of Nursing and Allied Health Sciences

Figure Title Page

1 Modified Technology Acceptance Model . . . . .

School of Nursing and Allied Health Sciences

THE PROBLEM AND REVIEW OF RELATED LITERATURE

In an era characterized by remarkable advancements in

technology, the field of healthcare delivery has undergone a

significant transformation. One notable development in the

healthcare field is the emergence of telehealth, a concept

that has revolutionized healthcare by leveraging

telecommunications technologies to bridge the gap between

patients and healthcare providers. Telehealth has gained

recognition as an effective means of delivering healthcare

services, particularly in remote and underserved areas. (WHO,

2020; DOH, 2019).

Telehealth, as defined by the World Health Organization

[WHO], refers to the delivery of healthcare services through

the utilization of information and communication

technologies, providing valid information for the diagnosis,

treatment, and prevention of disease and injuries, research

and evaluation, and continuing education of healthcare

professionals, all in the interests of advancing the health

of the people, especially those who are in need. The WHO

School of Nursing and Allied Health Sciences

emphasizes that telehealth aims to promote equitable access

to healthcare, enhance efficiency, and improve patient

The term “telehealth,” which can be used interchangeably

with “telemedicine,” encompasses a wide range of

applications, including virtual visits, chat-based

interactions, remote patient monitoring, and technology-

enabled modalities, among others (American Telemedicine

With its various approaches, the benefits of telehealth

are manifold. First, it overcomes geographical barriers,

enabling individuals in remote or underserved areas to access

quality healthcare services without the need for travel.

Additionally, telehealth enhances healthcare accessibility,

particularly for vulnerable populations, by reducing

transportation costs and time commitments. It also

facilitates timely interventions, preventive care, and early

detection of health issues, leading to better health outcomes

and reduced healthcare costs (Bashshur et al., 2014; Wade et

School of Nursing and Allied Health Sciences

The advent of the COVID-19 pandemic propelled the rapid

adoption of telehealth on a global scale. As healthcare

systems faced unprecedented challenges, telehealth emerged as

a crucial tool in maintaining continuity of care while

minimizing the risk of virus transmission.