Background: The rapid digitisation of healthcare, particularly telemonitoring during COVID-19, underscores the need for healthcare services to adapt. However, there is limited understanding of the perspectives of rheumatoid arthritis (RA) patients, caregivers, and healthcare professionals (HCPs) regarding telemedicine. Few studies examine RA patients’ readiness to adopt telemedicine, including perceived benefits and challenges.

Objectives: To explore the readiness of RA patients for telemedicine adoption and the perspectives of RA patients, caregivers, and HCPs on telemedicine’s role in managing RA.

Methods: This study utilised a sequential exploratory mixed methods design with a quantitative phase followed by a qualitative phase. RA patients were recruited from an outpatient rheumatology clinic in Singapore. In the first phase participants completed two questionnaires: (1) the Telemedicine Readiness Survey, originally developed and validated by Gurupur et al. (2017) and adapted for the local population, and (2) the eHealth Literacy Scale. In the second phase, four focus groups were held: two with RA patients and caregivers (one in English, one in Mandarin) and two with HCPs (one for nurses/allied health staff and one for physicians). The semi-structured interviews focused on factors influencing telemedicine readiness and acceptance. Audio-recorded interviews were transcribed, pseudonymised, and thematically analysed. Quantitative data were analysed using descriptive statistics, while qualitative data underwent thematic analysis. Results were integrated using a triangulation approach.

Results: Patient surveys

A total of 138 RA patients (81.9% female, 55.1% Chinese) with a mean age of 58.4 years participated. Of the patients, 63 (45.7%) had tertiary education, and 57 (41.3%) were employed full-time. Regarding telemedicine access, 92.0% owned a mobile phone, and 45.6% owned a laptop/tablet. Half of the patients (52.2%) had prior telemedicine experience, with phone calls being the most common modality (76.4%). Regarding the Telemedicine Readiness Survey, 60.1% of patients felt telemedicine saved time and money, while 52.2% had concerns about understanding their doctor during video consultations. In the eHealth Literacy Scale, 67.4% found the internet helpful for health decisions, but only 44.2% felt confident using online information for health decisions (Table 1).

Focus groups

Patients and caregivers

Six patients and four caregivers were included. Eight overarching themes with 16 subthemes were identified, four each for facilitators and barriers to telemedicine (Figure 1). While participants expressed a preference for face-to-face visits, they acknowledged the ability of telemedicine to improve access and reduce unnecessary trips to clinics. Trust and rapport with HCPs were key factors influencing positive telemedicine experiences. Autonomy in choosing technological modalities empowered patients, although family support varied, with some receiving assistance in device setup while others had no support. Barriers included concerns about telemedicine quality, such as the lack of physical assessments, rushed consultations, and limited direct access to HCPs. Additional challenges included technological issues, IT security concerns, and perceived cost parity with in-person consultations.

HCPs

Three rheumatologists, two nurses and one physiotherapist were included. Nine overarching themes with 13 subthemes were identified, comprising three facilitators and six barriers (Figure 1). Facilitators for telemedicine adoption included clear guidelines, patient selection criteria, convenience, and adequate training. However, significant barriers included technical constraints, personal preferences, and varying comfort levels with technology. Physicians particularly emphasized the lack of effective communication and physical assessments as major drawbacks. Additional concerns centred on patient confidentiality, IT security, and the potential impact of telemedicine on cost and care quality. Legal considerations, such as liability issues and regulatory compliance emerged as critical barriers. Nonetheless, HCPs recognized the potential of telemedicine as a complement to in-person consultations and advocated for a hybrid model, provided specific patient criteria were met. The integration of quantitative and qualitative results identified alignment in perceived telemedicine convenience and its ability to enhance accessibility. However, both patients and HCPs highlighted concerns about physical assessment limitations and IT security. Disparities emerged in confidence levels, with patients reporting lower eHealth literacy scores compared to HCPs’ assumptions about patient digital competency. These findings underscore the need for targeted educational interventions and a hybrid telemedicine model to address readiness gaps and optimise adoption.

Conclusion: Although telemedicine use increased during COVID-19, only half of surveyed RA patients had prior experience with it, suggesting mixed readiness for adoption. Focus group discussions revealed a preference for in-person consultations due to concerns over quality, physical assessments, and technological issues. However, telemedicine was recognised for its convenience and potential to complement in-person care. A hybrid care model tailored to specific barriers and leveraging telemedicine’s strengths could optimise care delivery for RA patients in the evolving digital healthcare environment.

REFERENCES: NIL.

Acknowledgements: NIL.

Disclosure of Interests: None declared.

© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.