116 CHAPTER 6 combines these themes. The SAF-TSUQ items have some overlap with the UTAUT model [17] in behavioral intention, facilitating conditions, attitude toward using technology, and performance and effort expectancy (similar to perceived usefulness and ease of use in the TAM model [16]). Self-efficacy, social influence, and anxiety items of the UTAUT model were not revealed as relevant items for the SAF-TSUQ. These items seem to be less applicable to already deployed telemedicine platforms as in our study wherein most respondents had sufficient, good, or excellent computer skills, worked daily or weekly with the platform or had collaborated with the telemedicine organization for several years. These items might be considered in future studies with novel users. Law et al. [29] developed a conceptual framework of five elements (professionals’ demographics, care settings, motivations, experiences, and overall satisfaction) to evaluate HCPs’ satisfaction in utilizing telemedicine. Only 12 physicians validated this framework, whereas we validated the SAF-TSUQ among 181 HCPs. The framework of Law and co-authors was published after we had developed SAF-TSUQ but despite some overlap in items, it focuses on HCPs’ satisfaction and motivation for utilizing telemedicine in general (patient benefits, professionals time, care quality etc.) and the care setting, whereas SAF-TSUQ also evaluates HCPs’ satisfaction with the services of the contracted telemedicine organization and used platform. The first strength of this study is that we applied a four-step structured methodology to develop the SAF-TSUQ-instrument, consisting of both qualitative and quantitative phases. Second, we included a mix of HCPs from a variety of (telemedicine) specialties to assure that SAF-TSUQ is applicable to a wide spectrum of disciplines. Third, we reported the psychometric properties and construction details of our SAF-TSUQ instrument. One of the limitations is that the current SAF-TSUQ is mainly based on store-and-forward (asynchronous) contexts of Ksyos. Second, bias in the selection of HCPs may have occurred, despite disproportionate stratification and systematic sampling from a wide variety of specialties. Third, some general, communication and financial compensation items of SAF-TSUQ were necessarily excluded from the psychometric analysis despite reimbursement being a major telemedicine service adoption barrier [10-15]. These questions should be reconsidered for inclusion depending on health care contexts. Fourth, if the SAF-TSUQ is used in another national setting, correct linguistic translation and cultural adaptation are needed to reassure the content validity of SAF-TSUQ [30]. SAF-TSUQ should be nationally tailored and validated again when used in English or other languages than Dutch. Organizations that supply telemedicine services to HCPs have to proactively assess HCPs’ needs and issues or gaps on their performance and platform as part of a continuous quality improvement cycle for which the SAF-TSUQ can be used. The outcomes can assist these organizations in identifying important issues as perceived by HCPs and developing strategies to address these issues and improve their telemedicine service quality. SAFTSUQ can be used as a baseline measure against which the results of subsequent
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