115 THE STORE-AND-FORWARD TELEMEDICINE SERVICE USER-SATISFACTION QUESTIONNAIRE DISCUSSION This study presents our development and validation approach of the 61-item SAFTSUQ instrument measuring HCPs’ satisfaction with contracted store-and-forward telemedicine organizations (their services and used platform). The SAF-TSUQ proved to be a reliable and valid questionnaire. Internal consistency of SAF-TSUQ was sufficient and FA confirmed six factors: training, communication, organization policy and strategy, interaction telemedicine platform, usage telemedicine platform, and working conditions. Our study showed that aspects related to “organization, policy and strategy” of a telemedicine organization and “working conditions” were rated as having low relevance within the second focus group and in the validation phase. This is in line with the fact that very few respondents consider the telemedicine organization as their employer but mainly as a supply organization. Further, most questions on “organization, policy and strategy” generated over 25% “NA” responses. In contrast, optometrists (the largest group to complete these questions) generated over 25% “NA” responses for only 2 of the 13 “organization, policy and strategy” questions. This indicates that certain HCPs are more informed on these organizational issues or that these issues are more applicable to their health care setting. Whether or not to retain these “organization, policy and strategy” and “working conditions” questions in future applications of SAF-TSUQ depends on the aim of the study and the settings of invited HCPs. Further, certain SAF-TSUQ items were redundant. For example, Q21 and Q22 both focused on the innovativeness of the telemedicine provider. Certain questions overlapped in flexibility in working hours (Q39, Q40), or in how easy (Q24, Q25) or enjoyable (Q26, Q27) it is to use the platform. Lastly, Q37 and Q38 were both related to satisfaction with the platform and the possibility to recommend it to others. Factors of these redundant items had relatively high internal consistency (≥0.77). Deleting an item from one of these pairs results in a slightly lower Cronbach’s alpha. These items were therefore retained in the SAF-TSUQ FA. Removal of these redundant or high “NA” items to shorten the questionnaire could be decided in discussion with stakeholders. Different instruments have been developed to assess HCPs’ satisfaction with telemedicine, but these focus merely on privacy, comfort, ease of use, or technical sound and image quality [8]. Moreover, few of these instruments have been validated and their psychometric properties or construction details are often not reported [7,8]. Further, these studies had small respondent numbers, and mainly focus on usefulness, acceptance, overall satisfaction, technical evaluation of a telemedicine system. None of these combine telemedicine platform items with supplier related aspects like training, communication, organization policy and strategy, and working conditions such as the SAF-TSUQ. The used TUQ [25] focuses on telehealth usability components from the TAM [16], PSSUQ [27], and TSQ [28], and the Basque Health Service Questionnaire [26] focuses specifically on employee satisfaction in health care settings where SAF-TSUQ 6
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