108 CHAPTER 6 Step 1. The literature study resulted in 18 articles describing 34 questionnaires. Two validated questionnaires (i.e., construct validity confirmed, validated question set, strong survey to item correlation, validated scaling, and telemedicine and employee-related items) were further explored: the satisfaction questionnaire of the Basque Health Service and the Telehealth Usability Questionnaire (TUQ) [25,26]. The TUQ [25] (21 items) is applicable to different telehealth system types and includes usability components (usefulness, ease of use, effectiveness, reliability, and satisfaction) from the Technology Acceptance Model (TAM) [16], Post-Study System Usability Questionnaire (PSSUQ) [27] and Telemedicine Satisfaction Questionnaire (TSQ) [28]. The Basque Health Service Questionnaire [24] consists of 52 staff satisfaction aspects (e.g., working conditions, pay, and policy and strategy). All items of these questionnaires were combined in a list of 73 potentially relevant items for our questionnaire. Step 2. After the first focus group 57 items and one improvement item remained (Figure 6.1). Patient–clinician interaction questions of the TUQ (like I could easily talk to the clinician/patient using the telehealth platform) were considered as not relevant in the store-and-forward setting and excluded. Step 3. Participants in the second focus group rated 17 out of 57 items as not relevant in the telemedicine context (e.g., items related to job security and working conditions). It was decided to keep these items for completeness as the participants in the focus group did not represent the entire target population. Four items were added (occupation, frequency of use, self-reported computer skills, recommend to colleague), one deleted (information systems used in your workplace and other computer applications, are useful tools) and two reformulated (communication with telemedicine organization, telemedicine organization is an innovative and renewing company). Step 4. In pre-testing 10/18 (first round) and 8/21 (second round) HCPs participated. In the second round, excluding one outlier, the average completion time of the seven questionnaires was 8.4 min. Four background items were added (technology adoption, contacted and informed by telemedicine organization, and how they view the telemedicine organization (supplier, employer, partner, etc.)), and three items deleted (conditions regarding staff leave, employment stability, and acceptable way to receive health care). The pilot SAF-TSUQ included 61 items and a final open-ended question to provide any feedback or suggestions for improvement of the questionnaire. HCPs could also provide free-text comments in a separate textbox at the end of each section. Three communication questions and one working condition question did not follow the standard answering format and were proposed by the telemedicine organization for acquiring extra information. The payment section consisted of a screener question whereafter the subsequent three questions were only asked if the HCP received any reimbursement for providing the telemedicine service. Forty-four of the 49 items followed standard response
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