Introduction

Telehealth and telemedicine have significantly transformed the healthcare landscape, providing innovative platforms for delivering medical services remotely. Over the past six decades, these technologies have facilitated unprecedented access to healthcare services, enabling medical screenings, evaluations, treatments, and emergency assistance from afar.1–3 The broad scope of telehealth encompasses not only clinical care but also medical education and training, highlighting its comprehensive impact on the healthcare sector.4,5

The World Health Organization (WHO) defines telemedicine as the use of information and communication technology (ICT) to bridge geographical barriers, allowing healthcare professionals to provide services across distances.6 This is particularly pertinent for diagnosis, treatment, and the prevention of diseases, underscoring the essential nature of telemedicine in today’s healthcare delivery system.

The COVID-19 pandemic further underscored telemedicine’s importance, with countries worldwide adopting telehealth services to maintain healthcare access amidst social distancing measures.7–11 Both high-income and some low- and middle-income countries have demonstrated telemedicine’s effectiveness in maintaining healthcare delivery during the pandemic.12–14

In Saudi Arabia, the 937-Call Center exemplifies the nation’s commitment to enhancing healthcare accessibility through telehealth. Operating 24/7, the center provides services ranging from medical consultations to emergency triage, particularly benefiting those without internet access or the ability to visit healthcare facilities in person.15–23 This initiative aligns with global telehealth efforts while addressing the unique challenges faced by the Saudi population.

Despite the broad adoption of telehealth, there is limited literature on healthcare providers’ perceptions and experiences with specific telemedicine programs like Saudi Arabia’s 937-Call Center. This study aims to fill this gap by evaluating the center’s effectiveness, healthcare provider satisfaction, and identifying areas for improvement. The findings will contribute to the current literature on telehealth by providing insights into healthcare providers’ experiences with the 937-Call Center, thereby informing strategic enhancements to telehealth infrastructure in Saudi Arabia. These enhancements are vital for aligning telehealth services with Saudi Vision 2030’s healthcare objectives.

MethodologyStudy Design and Context

This investigation utilized an online survey to conduct a cross-sectional descriptive analysis, specifically chosen for its efficacy in capturing a snapshot of healthcare providers’ current experiences and challenges with the 937-Call Center services within the Kingdom of Saudi Arabia (KSA). The study was conducted from November 20th to December 15th, 2022, allowing a sufficient timeframe to observe meaningful outcomes and maximize participation while accommodating the busy schedules of healthcare professionals. This design is particularly suited for exploratory research, where the objective is to establish associations and trends rather than causal relationships, allowing for a comprehensive evaluation of the status quo across diverse geographical regions and healthcare settings.

Participant Selection

All 454 healthcare providers actively engaged with the 937-Call Center across the KSA were identified as potential participants for this study. This group comprised a diverse array of professionals, including individuals from various regional directorates, part-time staff, full-time staff from the General Directorate of Medical Consultations (GDMC), and trainee physicians. The selection of this varied cohort was strategically designed to capture a comprehensive snapshot of experiences, ensuring a wide representation of perspectives within the healthcare provision spectrum.

To facilitate the recruitment process, invitations to participate in the study were disseminated electronically via email. Email addresses of the healthcare providers were verified through the General Directorate of Medical Consultations to ensure accurate and effective communication. The Email invitations detailed the study’s purpose, what participation entailed, and assured confidentiality and anonymity of responses. Criteria for selection were primarily based on the participants’ active engagement with the 937-Call Center.

Instrumentation

The survey instrument was developed in English, drawing upon and adapting from a prior study on the Sehhaty app,24 ensuring relevance and applicability to the 937-Call Center context. The instrument’s reliability was tested, resulting in a Cronbach’s alpha coefficient of 0.88, signifying a high level of internal consistency. The instrument was also validated through pre-test/pilot testing with a small group of healthcare providers in Saudi Arabia, leading to minor modifications to improve clarity and relevance.

The questionnaire included sections on demographic information, professional background, service evaluation, and identification of operational challenges. Responses were measured using a Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). The survey instrument is provided as supplementary material (Appendix A) to this manuscript.

Data Processing and Analysis

Upon collection, responses were digitized and prepared for analysis using SPSS v.27.0. Preliminary checks were performed to ensure the integrity and quality of the data, including screening for and handling missing data, identifying and addressing outliers, and testing for the normality of the distribution. Missing data were handled using multiple imputation methods to minimize bias.

Descriptive statistics were used to summarize the data, providing an overview of the central tendencies, dispersion, and general distribution of responses. Independent t-tests, ANOVA (Analysis of Variance), and Pearson’s correlation analyses were employed to explore the relationships between variables. The choice of these specific statistical tests was driven by the nature of the research questions and the characteristics of the data. The significance threshold was set at p < 0.05 for all tests, adhering to conventional criteria for determining statistical significance.

Ethical Considerations

Ethical approval for this study was obtained from the Institutional Review Board at King Saud University [KSU-HE-23-1221]. Prior to participation, all potential participants were briefed on the objectives and procedures of the study, and electronic informed consent was obtained, ensuring confidentiality and anonymity of responses. There were no conflicts of interest identified that could have influenced the study outcomes. Data security was maintained through rigorous data encryption and secure storage protocols, with access restricted to authorized members of the research team. This study complies with the principles outlined in the Declaration of Helsinki.

ResultsResponse Rate

Engagement with the study was high, with 411 out of the 454 healthcare providers (HCPs) targeted for the survey completing it, yielding an impressive response rate of 90.5%. This robust participation underscores the relevance of the study to the professional community and indicates a strong interest in telehealth evaluation among HCPs.

Demographic and Occupational Characteristics

The demographic and occupational characteristics of healthcare providers using the 937-Call Center are detailed in Table 1. The respondent pool consisted of 60.3% females and 63.5% non-Saudi nationals, illustrating the center’s diverse user base. Family physicians were the most substantial specialty group among respondents, highlighting the call center’s broad applicability across various medical fields. Significant associations were found between HCPs’ demographic backgrounds, occupational roles, and their evaluations of the telehealth service. For instance, non-Saudi HCPs displayed higher satisfaction and effectiveness scores than their Saudi counterparts, suggesting variations in telehealth adaptation across nationalities. Additionally, older HCPs, particularly those aged over 60, expressed greater appreciation for the service, indicating telehealth’s value in enhancing the practice of more experienced practitioners.

Table 1 Demographic, and Occupational Related Characteristic Among HCPs

Evaluation of the 937 Virtual Medical Call Center’s Services in KSA

Table 2 presents the evaluation of the 937-Call Center services in Saudi Arabia. The majority of healthcare providers (90.1%) highlighted the system’s effectiveness in enhancing healthcare accessibility, speeding up patient service (76.6%), and boosting productivity (59.1%). Ease of use was broadly confirmed by 92.8% of the respondents, and 81.1% felt comfortable in patient interactions. Challenges were noted in accessing patient records, with 43.7% finding it difficult. Furthermore, the service was recognized for maintaining patient confidentiality (76.4%) and delivering quality care (65.3%). Overall satisfaction among HCPs was high at 86.8%, with a strong inclination towards continued telehealth utilization.

Table 2 Evaluation of the Service Provided by 937-Call Center in KSA

Correlation Analysis of Evaluation Scores

Table 3 shows the correlation analysis among evaluation metrics of the 937-Call Center services, employing the Pearson correlation coefficient to explore relationships between Perceived Usefulness (PU), Perceived Ease of Use (PEU), Perceived Effectiveness (PE), and Satisfaction and Future Use (SFU). A moderate to strong association was identified between SFU and PE (r = 0.69, p < 0.001***), indicating a significant link between the effectiveness of the call center and healthcare providers’ satisfaction and willingness to use the service in the future. Other significant correlations include those between PU and PEU, PEU and PE, and PU and PE, highlighting the interconnectedness of these aspects in influencing overall evaluation.

Table 3 The Correlation Between the Three Evaluation Items

Detailed Examination of Challenges and Areas for Enhancement

Table 4 presents a detailed examination of the challenges faced by healthcare providers and areas for enhancement. Approximately 41% of respondents identified the difficulty of providing accurate medical assessments through telehealth as a significant concern. Other concerns included the clarity of telehealth regulations (25.3%) and the need for enhanced management support and consultation processes (16%). Providers also emphasized the need for involving medical specialists (61.3%), better integration with existing electronic health systems (38.2%) and ensuring continuity of care (25.5%).

Table 4 The Concerns and Challenges, the Areas of Improvement in the 937 Medical Call Centers

The findings from our investigation into the experiences of healthcare providers with the 937 Virtual Medical Call Center reveal a highly positive reception towards telehealth services in the Kingdom of Saudi Arabia. A significant majority of respondents acknowledge the pivotal role of the call center in enhancing healthcare accessibility, efficiency, and provider productivity. Notably, the data indicates nuanced variations in satisfaction and perceived effectiveness across demographic and professional lines, suggesting that telehealth’s impact is multifaceted and influenced by a range of factors including nationality, age, and professional role. These insights underscore the critical importance of considering diverse provider experiences and needs in the ongoing development and optimization of telehealth services.

Furthermore, the identification of challenges and areas for improvement, such as the need for better integration with existing health systems and the involvement of medical specialists, points to actionable avenues for enhancing telehealth’s effectiveness and user satisfaction. As the telehealth landscape continues to evolve, particularly in response to the global shift towards more digital healthcare delivery models, the lessons learned from the 937-Call Center’s operation can inform both policy and practice. Future research should build on these findings to explore targeted interventions and innovations that address the identified challenges, thereby contributing to the refinement and expansion of telehealth services to meet the diverse needs of healthcare providers and patients alike.

Discussion

This study represents a pioneering exploration into healthcare providers’ perceptions and experiences with the 937 medical call center in Saudi Arabia, focusing on its usefulness, ease of use, effectiveness, satisfaction, and future use, alongside perceived challenges and areas for improvement. Until now, detailed insights into healthcare providers’ experiences, technological perceptions, and specific challenges within the 937-Call Center have remained largely unexplored in existing literature. While the impact of COVID-19 on the utilization of Saudi Arabia’s 937 telephone health services has been documented,25 prior studies have only begun to scratch the surface of HCPs’ perceptions towards telehealth in clinical settings. For instance, Alghamdi et al’s 2022 study delves into HCPs’ perceptions and barriers towards telehealth, revealing positive attitudes towards its utility, ease of use, and effectiveness in patient care.26 Similarly, Alsaleh et al’s 2021 research on the Sehha app underscores a significant boost in telehealth satisfaction during the pandemic, with over 80% of HCPs noting improved experiences and more than half expressing satisfaction with the app.24

Our investigation not only fills this critical gap by providing a nuanced understanding of these perceptions specifically within the context of the 937-Call Center operations but also aligns with the strategic objectives of Saudi Vision 2030, aiming to enhance telehealth accessibility and foster a comprehensive national healthcare network. By doing so, it contributes significantly to the ongoing discourse on telehealth’s role in the evolution of healthcare delivery in the Kingdom, marking a substantial advancement in understanding the dynamics of telehealth adoption among healthcare professionals in Saudi Arabia.

Our study’s compelling findings, marked by a 90.5% response rate from healthcare providers, significantly exceed prior research benchmarks during the pandemic’s onset. This heightened engagement not only highlights the medical community’s growing acknowledgment of telehealth’s efficacy in managing patient care and reducing healthcare professionals’ load but also its crucial role in safeguarding against pathogen spread, a pivotal concern highlighted in recent studies.25–37 This enthusiastic response underlines the healthcare sector’s readiness to embrace telehealth advancements, reflecting an optimistic outlook toward integrating such technologies in future healthcare strategies.34

Our study’s demographics reveal a predominant female participation (60.3%), with the majority aged between 30 and <40 years (37.0%), and a significant proportion being non-Saudi (63.5%). Notably, family physicians formed the largest group (51.8%), and a substantial number were specialists with a decade or two of experience (42.1%). These findings resonate with Idriss et al’s 2022 study, albeit contrasting with their observation of male dominance among telemedicine-involved physicians.38 Similarly, Alghamdi et al (2022) and Alsaleh et al (2021) noted a significant male representation and a comparable age distribution, respectively, in their studies on telehealth in Saudi Arabia,24,39 highlighting diverse practitioner engagement in telehealth.

The demographic findings from our study illuminate the potential impact of physician characteristics on telemedicine adoption and utilization. The notable preference among family physicians for telemedicine underscores its relevance and potential benefits to their practice. This observation is echoed by Alsaleh et al’s 2021 research, which also identified a significant engagement from family physicians with the Sehha app.24 Conversely, the reticence among general physicians towards telemedicine usage might stem from concerns over diagnostic accuracy and diminished interaction times, crucial for effective patient care.35,40 Additionally, technological limitations have been identified as barriers to telemedicine’s broader adoption among general practitioners,41,42 highlighting areas for targeted improvement to facilitate its wider use.

In our study, regarding the perceived usefulness of the 937 medical call centers, the majority of HCPs reported that telehealth technology like 937 increased access to care (371; 90.1%), expedited patient needs compared to in-person visits (315; 76.6%), and made them feel more productive (243; 59.1%). This suggests that the 937-call center enhances access to medical care in Saudi Arabia. Telehealth services like the 937-call center have been shown to improve access and timely care delivery, particularly during the COVID-19 pandemic, making it a convenient way to access medical advice and support.43,44 Additionally, telehealth has the potential to increase access and efficiency of care, especially by empowering primary care teams to provide hybrid (virtual/in-person) services, thereby expanding access to healthcare services.45,46

In the analysis of the 937 medical call center’s usability, an overwhelming majority of HCPs concurred on its user-friendliness (92.8%) and the comfort it provided in patient interactions (81.1%). However, a notable contention arose regarding the ease of accessing patient records, with a significant minority (47.6%) finding it challenging. This observation aligns with existing literature, notably Alsaleh et al (2021), which also highlighted ease of use but identified record access as a hurdle in the Sehha app’s usage.24 The critical role of perceived ease of use as a determinant in adopting telemedicine practices by both physicians44 and patients47 underscores its importance in the broader telehealth implementation framework. This aspect warrants further attention to streamline telehealth services and enhance their integration into healthcare systems.48

In evaluating the 937-Call Center’s perceived efficacy, a significant majority of healthcare professionals concurred that it facilitates an acceptable modality for healthcare delivery (87.2%), assures patient data confidentiality (76.4%), and achieves a standard of care commensurate with face-to-face consultations (65.3%). This endorsement likely stems from the Ministry of Health’s dedicated initiatives to uphold superior telehealth service standards, pivotal for advancing digital health transformation and empowering healthcare providers.49 As an endorsed and efficacious platform by the Ministry of Health, the 937-Call Center offers comprehensive medical and administrative services, operating continuously to meet healthcare needs.50 Notwithstanding the broad equivalence in care quality between telemedicine and traditional consultations reported in the literature,51,52 disparities in perceived care quality have been noted, as Alsaleh et al (2021) identified among some users of the Sehha app.24

Regarding satisfaction and future use, the majority of HCPs agreed that they were satisfied with their work through 937 (357; 86.8%) and believed their patients were satisfied with the care provided via 937 (78.5%). They also expressed willingness to use telehealth technologies like the 937-Call Center in the future. While specific information about physician satisfaction with the 937-Call Center is lacking, the high satisfaction rates observed in our study are consistent with other research on telehealth services. For example, a study by Barriga et al in 2022 investigated satisfaction with telemedicine services in a Peruvian hospital and found high satisfaction rates among non-physician professionals.53 Additionally, Becevic et al’s 2015 study on telehealth technologies reported a high level of satisfaction among all users, including patients and HCPs.28 A study by Wali et al in 2022 on primary care physicians’ perception and satisfaction with telehealth in Saudi Arabia also reported high satisfaction levels among HCPs.54

We also found a statistically significant relationship between the mean total evaluation score, including perceived usefulness, ease of use, effectiveness, satisfaction, future use, nationality, and age groups. The total evaluation score was significantly higher among non-Saudi HCPs compared to Saudi HCPs, which can be attributed to our study’s higher proportion of non-Saudi HCPs. Moreover, the total evaluation score was significantly higher among HCPs over 60 compared to other age groups, indicating that physicians with more experience or increased age may be more satisfied with the service.

Additionally, the findings of this study revealed several significant correlations that highlight the complexity of telehealth adoption. The total evaluation score, which included perceived usefulness, ease of use, effectiveness, satisfaction, and future use, was significantly higher among non-Saudi HCPs compared to Saudi HCPs. This could be attributed to the higher proportion of non-Saudi HCPs in our study sample. Furthermore, the total evaluation score was notably higher among HCPs over 60 compared to other age groups, suggesting that more experienced or older physicians may find greater value in telehealth services. These insights emphasize the importance of considering demographic variables when developing and implementing telehealth solutions to ensure they meet the diverse needs of healthcare providers.

Looking at concerns and challenges, a significant percentage of doctors expressed difficulty in providing accurate medical assessments (41%), concerns about unclear regulations and rules for telehealth services (25.3%) and reported a lack of management support and overlapping consultations (16%). These concerns are valid, as virtual consultations differ from in-person ones regarding accurate patient assessment and examination. However, the 937-Call Center employs technology, quality assurance processes, and training to ensure the accuracy of medical assessments offered by HCPs. Challenges such as unclear regulations, lack of management support, and overlapping consultations are common in telemedicine and require comprehensive guidelines and standardized formats.55,56

Analyzing the areas of improvement, HCPs identified three main areas: involvement of medical specialists (61.3%), integration and connection with other electronic systems (38.2%), and continuity of care (25.5%). Enabling specialists from various fields to explore patient cases in telemedicine is essential for well-informed decisions. Integrating electronic health records (EHR) with telemedicine platforms offers several benefits, including increased efficiency, improved patient care, and enhanced clinical decision-making. The 937-Call Center’s positive perception by HCPs suggests that it is aligned with the Ministry of Health’s goals to enhance telehealth services in Saudi Arabia. This is consistent with other research indicating growing telehealth awareness and knowledge.48,57,58

While our study has primarily focused on the experiences of physicians with the 937 medical call center, it unveils a crucial understanding of telemedicine’s current landscape in Saudi Arabia, notably emphasizing the strong interest and positive perceptions among family physicians. These findings underscore telemedicine’s significant potential to transform healthcare delivery, making it more accessible and efficient, particularly in the realm of primary care. Our investigation reveals that the 937-Call Center is highly regarded for its usefulness, ease of use, and effectiveness, with healthcare providers appreciating the platform’s ability to enhance patient care and operational efficiency.

Notably, the study highlights areas for enhancement, such as the integration with electronic health systems and the involvement of medical specialists, pointing towards actionable pathways to elevate telehealth’s utility further. These insights are pivotal for policymakers, healthcare leaders, and telehealth platform developers as they strive to refine telehealth services, ensuring they meet the evolving needs of healthcare providers and patients alike.

However, the limited data on perceptions from other healthcare professions suggests a gap that future research should address to provide a more holistic view of telehealth adoption and utilization across the healthcare spectrum. This broader perspective is essential for tailoring telehealth solutions that cater to the diverse needs of the entire healthcare community.

Furthermore, the Discussion of our Results highlights the critical importance of aligning telehealth initiatives with national healthcare strategies, such as Saudi Vision 2030. This vision emphasizes the need for enhanced telehealth accessibility and the development of a comprehensive national healthcare network.59–64 Our study contributes to this strategic objective by demonstrating that telehealth services, such as the 937-Call Center, play a pivotal role in improving healthcare delivery. The findings, which show high levels of satisfaction and perceived effectiveness, are consistent with other studies indicating that telehealth can significantly enhance patient care and operational efficiency.35–37 By integrating our results with existing literature, we underscore the potential for telehealth to not only meet immediate healthcare needs but also to evolve as a sustainable solution for future healthcare challenges. Highlighting these correlations and the alignment with broader healthcare goals provides a clear and concise narrative that supports the continued investment and development in telehealth services.

In sum, our study not only enriches the understanding of telehealth’s impact among physicians in Saudi Arabia but also lays the groundwork for continuous improvement and expansion of telehealth services. By addressing the identified challenges and leveraging the insights gained, there is a significant opportunity to enhance the effectiveness and satisfaction of telehealth, contributing to the overarching goals of Saudi Vision 2030 for a more integrated and accessible healthcare system.

Limitations

The Limitations of this study are multifaceted, reflecting both methodological constraints and broader challenges in generalizing findings.

Firstly, the cross-sectional design, while efficient for gathering data from a broad demographic, captures only a snapshot in time. This limits our ability to observe changes and trends over a longer period, potentially overlooking evolving experiences and perceptions of healthcare providers with the 937 medical call center services. Future studies could benefit from employing longitudinal designs to more comprehensively explore these dynamics and their impact on healthcare delivery and provider satisfaction over time.

Secondly, the reliance on self-reported data introduces the potential for response bias, which may affect the accuracy of reported satisfaction and effectiveness rates. Self-reported data can be influenced by participants’ perceptions and willingness to provide honest responses. Future research might incorporate objective measures of telemedicine’s impact, such as patient health outcomes or usage metrics, to provide a more balanced and accurate assessment.

Thirdly, while the study provides valuable insights into telemedicine practices within Saudi Arabia, its findings may not be directly applicable to other contexts with differing healthcare infrastructures, cultural norms, and regulatory frameworks. Comparative studies across various regions are necessary to identify universal versus locale-specific challenges and opportunities in telemedicine. This would help in understanding the broader applicability of the findings and tailoring telehealth solutions to different healthcare environments.

Moreover, the high response rate, although indicative of significant engagement, predominantly reflects the views of female and non-Saudi healthcare providers. This may not fully capture the diversity of perspectives among all healthcare providers utilizing the 937 call center. Stratified sampling or targeted outreach to underrepresented groups in future surveys could enhance the diversity and representativeness of the insights gathered, ensuring a more comprehensive understanding of telehealth adoption and utilization.

Lastly, the study did not delve deeply into technological and infrastructural challenges critical to telemedicine’s efficacy, such as internet connectivity issues or platform usability. These factors are crucial for the successful implementation and operation of telehealth services. Future investigations focusing on these aspects could yield important insights into optimizing telemedicine infrastructure, thus improving overall service delivery and user satisfaction.

By addressing these limitations, future research can build on our findings to develop more nuanced understandings of telemedicine’s role in healthcare. This will ensure that telehealth services are effectively tailored to meet the diverse needs of healthcare providers and patients alike, ultimately enhancing the quality and accessibility of healthcare delivery.

Conclusion

This cross-sectional descriptive study provides a comprehensive overview of HCPs experiences and perceptions regarding the 937 medical call center in Saudi Arabia. The findings indicate that the 937-Call Center is highly valued for its perceived usefulness, ease of use, and effectiveness in delivering healthcare services, aligning with the strategic objectives of Saudi Vision 2030. High satisfaction rates and willingness to continue using telehealth technologies underscore the growing acceptance and integration of telemedicine in the Saudi healthcare system.

Key takeaways from this study include the critical role of the 937-Call Center in enhancing healthcare accessibility and efficiency, especially during the COVID-19 pandemic. However, significant challenges remain, such as difficulties in conducting accurate remote medical assessments, the need for clearer telehealth regulations, and improved management support. Addressing these issues through regular updates, comprehensive telehealth guidelines, integration with electronic health systems, and involving a broader range of medical specialists can further optimize telehealth services.

Future research should focus on longitudinal studies to track the evolving experiences and perceptions of HCPs over time, incorporate objective measures of telemedicine’s impact, and explore technological and infrastructural challenges in depth. By addressing these areas, there is a significant opportunity to enhance the effectiveness, satisfaction, and future utilization of telehealth services in Saudi Arabia, contributing to a more integrated and resilient healthcare system as envisioned in Saudi Vision 2030.

Institutional Review Board Statement

Ethical approval was secured from the Institutional Review Board at King Saud University [KSU-HE-23-1221].

Data Sharing Statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Acknowledgments

The authors would like to extend their appreciation to King Saud University for funding this work through the Researchers Supporting Project number (RSPD2024R649), King Saud University, Riyadh, Saudi Arabia.

Disclosure

The authors declare no conflicts of interest.

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