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Cited by 54Telemedicine and Telehealth ImplementationTechnology Use by Older AdultsMobile Health and mHealth Applications

Trust in telemedicine portals for rehabilitation care: an exploratory focus group study with patients and healthcare professionals

Open access
Van Velsen, Lex, Wildevuur, Sabine, Flierman, Ina, Van Schooten, Boris, Tabak, Monique, Hermens, Hermie·2015·BMC Medical Informatics and Decision Making
DOI 10.1186/s12911-016-0250-2PMC PMC4728819
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Abstract

BACKGROUND: For many eServices, end-user trust is a crucial prerequisite for use. Within the context of Telemedicine, the role of trust has hardly ever been studied. In this study, we explored what determines trust in portals that facilitate rehabilitation therapy, both from the perspective of the patient and the healthcare professional. METHODS: We held two focus groups with patients (total n = 15) and two with healthcare professionals (total n = 13) in which we discussed when trust matters, what makes up trust in a rehabilitation portal, what effect specific design cues have, and how much the participants trust the use of activity sensor data for informing treatment. RESULTS: Trust in a rehabilitation portal is the sum of trust in different factors. These factors and what makes up these factors differ for patients and healthcare professionals. For example, trust in technology is made up, for patients, mostly by a perceived level of control and privacy, while for healthcare professionals, a larger and different set of issues play a role, including technical reliability and a transparent data storage policy. Healthcare professionals distrust activity sensor data for informing patient treatment, as they think that sensors are unable to record the whole range of movements that patients make (e.g., walking and ironing clothes). CONCLUSIONS: The set of factors that affect trust in a rehabilitation portal are different from the sets that have been found for other contexts, like eCommerce. Trust in telemedicine technology should be studied as a separate subject to inform the design of reliable interventions.

AI snapshot

Written from the paper’s full text.

TL;DR

This exploratory focus-group study found that trust in a rehabilitation telemedicine portal is made up of different factors for patients and healthcare professionals, and that these factors differ from those in contexts such as eCommerce. Patients emphasized control and privacy, while healthcare professionals emphasized technical reliability, secure data storage, transparent policies, and usability.

Key findings

  • Two patient focus groups (total n = 15) and two healthcare professional focus groups (total n = 13) showed that trust in a rehabilitation portal is the sum of trust in different factors, and the factors differ by group.
  • For patients, trust in portal technology was mostly made up of perceived level of control and privacy; for healthcare professionals, a larger and different set of issues played a role, including technical reliability, secure data storage, transparent policies, and usability.
  • Healthcare professionals distrusted activity sensor data for informing treatment because they thought sensors could not record the whole range of movements patients make (e.g., walking and ironing clothes).
  • Patients were negative about disclaimers and said they decreased trust; DigiD, the Dutch national authentication mechanism, also diminished trust for many patients due to negative media coverage. Patients were fine with rehabilitation centers, general practitioners, hospitals, and researchers storing activity data, but predominantly not with healthcare insurance companies, commercial companies, and health and safety officers.

Methods

  • Semi-structured focus groups were held in two Dutch rehabilitation centers: two with patients (total n = 15) and two with healthcare professionals (total n = 13).
  • Sessions used screenshots of a rehabilitation portal, patient journeys, trust models with cue cards, trust cues, and a demonstration of activity sensors; patients and professionals discussed when trust matters, what makes up trust, design cues, and sensor data use.
  • Data analysis grouped similar responses from visualizations and used inductive thematic analysis of audio recordings on a per-question basis, determining agreement levels among participants.

Limitations

  • The authors state the study was exploratory and should be seen as a starting point for statistically determining which factors make up trust and their importance; future research should acknowledge and expand these findings.
  • The authors state they focused on trusting beliefs, not the full life-cycle of trust formation and behavior, and that a longitudinal observational study would be more suitable for that goal.
  • The authors state the rehabilitation care context may not generalize to other care contexts, and the specific portal example with its unique feature set may have influenced results; the text also makes evident that the focus groups were small and qualitative, and patients had no experience with the specific telemedicine technology presented.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/s12911-016-0250-2

Cites

42 of 42 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 29 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Patient participants expected the professional to whom they were referred to be very trustworthy.

    “Patient participants expected the professional to whom they were referred, to be very trustworthy”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Participants can meaningfully verbalize their thoughts about trust in a rehabilitation portal when aided by visual materials.
    • The authors state this as an assumption: The selected rehabilitation portal is representative enough of state-of-the-art rehabilitation portals to evoke relevant trust discussions.
  • Findingown data

    When patient participants thought their situation was taken seriously, this increased trust in the healthcare professional.

    “When patient participants thought their situation was taken seriously. This increased trust in the healthcare professional;”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Participants can meaningfully verbalize their thoughts about trust in a rehabilitation portal when aided by visual materials.
    • The authors state this as an assumption: The selected rehabilitation portal is representative enough of state-of-the-art rehabilitation portals to evoke relevant trust discussions.
  • Findingown data

    During the first face-to-face meeting between a healthcare professional and a patient, the decision was made for a patient to trust his/her healthcare professional or not.

    “During the first face-to-face meeting between a healthcare professional and a patient. This is the moment where, the patient participants stated, the decision was made for a patient to trust his/her healthcare professional or not.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Participants can meaningfully verbalize their thoughts about trust in a rehabilitation portal when aided by visual materials.
    • The authors state this as an assumption: The selected rehabilitation portal is representative enough of state-of-the-art rehabilitation portals to evoke relevant trust discussions.
  • Findingown data

    When a patient participant felt very dependent on the healthcare professional, this increased trust out of necessity.

    “When a patient participant felt very dependent on the healthcare professional. This increased trust out of necessity;”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Participants can meaningfully verbalize their thoughts about trust in a rehabilitation portal when aided by visual materials.
    • The authors state this as an assumption: The selected rehabilitation portal is representative enough of state-of-the-art rehabilitation portals to evoke relevant trust discussions.
  • Findingown data

    The use of DigiD appeared to diminish trust in the portal for many patient participants due to negative media coverage about its safety.

    “The use of the national authentication technique for Dutch eGovernment websites (DigiD) appeared to diminish trust in the portal. Due to negative media coverage about DigiD, many patient participants were wary about the mechanism’s safety.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Participants can meaningfully verbalize their thoughts about trust in a rehabilitation portal when aided by visual materials.
    • The authors state this as an assumption: The selected rehabilitation portal is representative enough of state-of-the-art rehabilitation portals to evoke relevant trust discussions.
  • May combine two claims. 36
  • Classified as probably not a substantial claim. 36
  • The quote only partly states this claim. 3

  • May combine two claims.

    Findingown data

    When diagnostics was performed, patient participants believed that their problems were dealt with, which increased trust.

    “When diagnostics was performed. This increased trust as the patient participants then believed that his or her problems were dealt with;”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Participants can meaningfully verbalize their thoughts about trust in a rehabilitation portal when aided by visual materials.
    • The authors state this as an assumption: The selected rehabilitation portal is representative enough of state-of-the-art rehabilitation portals to evoke relevant trust discussions.

  • May combine two claims.

    Findingown data

    For patients, a treatment must be good (competence) and clear what it entails (transparency) to be trusted.

    “For a treatment to be trusted it must be good (competence) and it must be clear what it entails (transparency).”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Participants can meaningfully verbalize their thoughts about trust in a rehabilitation portal when aided by visual materials.
    • The authors state this as an assumption: The selected rehabilitation portal is representative enough of state-of-the-art rehabilitation portals to evoke relevant trust discussions.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    None of the patients that participated had experience with the telemedicine technology that was presented during the focus groups.

    “None of the patients that participated had experience with the telemedicine technology that was presented during the focus groups.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Participants can meaningfully verbalize their thoughts about trust in a rehabilitation portal when aided by visual materials.
    • The authors state this as an assumption: The selected rehabilitation portal is representative enough of state-of-the-art rehabilitation portals to evoke relevant trust discussions.

  • May combine two claims.

    Findingown data

    Some patient participants preferred the small activity sensor and had no problems with commercial storage of activity data.

    “Some of them preferred the small sensor, as they liked the usability, and had no problems with commercial storage of this kind of data.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Participants can meaningfully verbalize their thoughts about trust in a rehabilitation portal when aided by visual materials.
    • The authors state this as an assumption: The selected rehabilitation portal is representative enough of state-of-the-art rehabilitation portals to evoke relevant trust discussions.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    None of the professionals that participated had experience with the specific telemedicine technology that was presented during the focus groups.

    “None of the professionals that participated had experience with the specific telemedicine technology that was presented during the focus groups.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Participants can meaningfully verbalize their thoughts about trust in a rehabilitation portal when aided by visual materials.
    • The authors state this as an assumption: The selected rehabilitation portal is representative enough of state-of-the-art rehabilitation portals to evoke relevant trust discussions.

  • The quote only partly states this claim.

    Findingown data

    Patient participants indicated that the presence of a familiar logo increases their trust when logging in.

    “The presence of a familiar logo. The patient participants indicated they looked for the logo of the rehabilitation center they were being treated at.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Participants can meaningfully verbalize their thoughts about trust in a rehabilitation portal when aided by visual materials.
    • The authors state this as an assumption: The selected rehabilitation portal is representative enough of state-of-the-art rehabilitation portals to evoke relevant trust discussions.

  • May combine two claims.

    Findingown data

    For professionals, trust in the treatment was made up of a myriad of factors, none of which appeared to be the single most important one.

    “Trust in the treatment was made up of a myriad of factors, none of which appeared to be the single most important one.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Participants can meaningfully verbalize their thoughts about trust in a rehabilitation portal when aided by visual materials.
    • The authors state this as an assumption: The selected rehabilitation portal is representative enough of state-of-the-art rehabilitation portals to evoke relevant trust discussions.

  • May combine two claims.

    Findingown data

    For patients, portal technology is trusted when they perceive they are in control and their data is kept private.

    “For example, trust in technology is made up, for patients, mostly by a perceived level of control and privacy”
    • Also stated in: § Patients · plain
      “Portal technology, finally, was trusted when the patient participants perceived they were in control, and their data was kept private.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Participants can meaningfully verbalize their thoughts about trust in a rehabilitation portal when aided by visual materials.
    • The authors state this as an assumption: The selected rehabilitation portal is representative enough of state-of-the-art rehabilitation portals to evoke relevant trust discussions.

  • May combine two claims.

    Findingown data

    Almost all patient participants were negative about disclaimers and stated that disclaimers decreased trust in portal technology.

    “Almost all patient participants were negative about disclaimers and stated that they actually decreased trust in portal technology.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Participants can meaningfully verbalize their thoughts about trust in a rehabilitation portal when aided by visual materials.
    • The authors state this as an assumption: The selected rehabilitation portal is representative enough of state-of-the-art rehabilitation portals to evoke relevant trust discussions.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    All professionals had worked with telemedicine technology in the course of their work, including rehabilitation portals and activity sensors for informing treatment.

    “However, all professionals had worked with telemedicine technology in the course of their work (including rehabilitation portals and activity sensors for informing treatment).”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Participants can meaningfully verbalize their thoughts about trust in a rehabilitation portal when aided by visual materials.
    • The authors state this as an assumption: The selected rehabilitation portal is representative enough of state-of-the-art rehabilitation portals to evoke relevant trust discussions.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Professionals thought trust mattered during the first and last face-to-face meeting between patient and healthcare professional, especially as initial trust was set during the first meeting.

    “During the first and last face-to-face meeting between patient and healthcare professional. Especially as during the first meeting the initial trust between the two parties was set.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Participants can meaningfully verbalize their thoughts about trust in a rehabilitation portal when aided by visual materials.
    • The authors state this as an assumption: The selected rehabilitation portal is representative enough of state-of-the-art rehabilitation portals to evoke relevant trust discussions.

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    Several patient participants stated that they perceived a lack of control over their personal data, which decreased their trust.

    “Second, several patient participants stated that they perceived a lack of control over their personal data: They wanted to be able to change things themselves (such as their name, address, etc.).”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Participants can meaningfully verbalize their thoughts about trust in a rehabilitation portal when aided by visual materials.
    • The authors state this as an assumption: The selected rehabilitation portal is representative enough of state-of-the-art rehabilitation portals to evoke relevant trust discussions.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Patient participants believed that the presence of a disclaimer is a way for a care organization to get rid of its responsibility and is used as an excuse for providing bad technology without having to deal with the consequences.

    “They believed that the presence of a disclaimer is a way for a care organization to get rid of its responsibility and is used as an excuse for providing bad technology without having to deal with the consequences.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Participants can meaningfully verbalize their thoughts about trust in a rehabilitation portal when aided by visual materials.
    • The authors state this as an assumption: The selected rehabilitation portal is representative enough of state-of-the-art rehabilitation portals to evoke relevant trust discussions.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Professionals stated that when communicating with a patient via an online portal, it should be guaranteed that this communication cannot be read by an outsider.

    “When communicating with a patient via an online portal, professionals stated, it should be guaranteed that this communication cannot be read by an outsider.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Participants can meaningfully verbalize their thoughts about trust in a rehabilitation portal when aided by visual materials.
    • The authors state this as an assumption: The selected rehabilitation portal is representative enough of state-of-the-art rehabilitation portals to evoke relevant trust discussions.

  • May combine two claims.

    Findingown data

    Several patient participants mentioned that the homepage did not appear personal, which decreased their trust.

    “First, the homepage did not appear personal. The patient participants mentioned that they did not think it was their personal space, as their name was not mentioned anywhere.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Participants can meaningfully verbalize their thoughts about trust in a rehabilitation portal when aided by visual materials.
    • The authors state this as an assumption: The selected rehabilitation portal is representative enough of state-of-the-art rehabilitation portals to evoke relevant trust discussions.

  • May combine two claims.

    Findingown data

    A considerable number of patient participants disliked receiving automatically generated login data and would prefer to log in with their email address as identifier and choose a password themselves.

    “The right way of providing and managing login data. A considerable number of patient participants indicated that they disliked it when they receive a set of automatically generated login data from an organization. Rather, they would like to login with their email address as an identifier, after which they can choose a password themselves.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Participants can meaningfully verbalize their thoughts about trust in a rehabilitation portal when aided by visual materials.
    • The authors state this as an assumption: The selected rehabilitation portal is representative enough of state-of-the-art rehabilitation portals to evoke relevant trust discussions.

  • May combine two claims.

    Findingown data

    Other patient participants valued private data storage and preferred the large activity sensor with data stored on the servers of a rehabilitation center.

    “Other patient participants valued private data storage and therefore preferred the large activity sensor whereby data could be stored on the servers of a rehabilitation center.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Participants can meaningfully verbalize their thoughts about trust in a rehabilitation portal when aided by visual materials.
    • The authors state this as an assumption: The selected rehabilitation portal is representative enough of state-of-the-art rehabilitation portals to evoke relevant trust discussions.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Many professionals commented on the homepage's clarity and ease of use, but stated that this is not related to trust in the technology.

    “When we showed the participating professionals the homepage of the rehabilitation portal, many commented on its clarity and ease of use. They also stated, however, that this is not related to trust in the technology.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Participants can meaningfully verbalize their thoughts about trust in a rehabilitation portal when aided by visual materials.
    • The authors state this as an assumption: The selected rehabilitation portal is representative enough of state-of-the-art rehabilitation portals to evoke relevant trust discussions.

  • May combine two claims.

    Findingown data

    The factors that make up trust in a rehabilitation portal and what makes up these factors differ for patients and healthcare professionals.

    “These factors and what makes up these factors differ for patients and healthcare professionals.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Participants can meaningfully verbalize their thoughts about trust in a rehabilitation portal when aided by visual materials.
    • The authors state this as an assumption: The selected rehabilitation portal is representative enough of state-of-the-art rehabilitation portals to evoke relevant trust discussions.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Participating healthcare professionals indicated that healthcare insurers and commercial stakeholders should preferably not be allowed to store and view activity data.

    “Healthcare insurers and commercial stakeholders should, according to them, preferably not be allowed to store and view such data.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    For professionals, trust in portal technology is mainly affected by the policies behind the portal.

    “Trust, they stated, is mainly affected by the policies behind the portal.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Participants can meaningfully verbalize their thoughts about trust in a rehabilitation portal when aided by visual materials.
    • The authors state this as an assumption: The selected rehabilitation portal is representative enough of state-of-the-art rehabilitation portals to evoke relevant trust discussions.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Participating healthcare professionals indicated that only medical professionals should be allowed to store and view activity data, while researchers should also have the option to view it.

    “They indicated that only medical professionals should be allowed to store and view data, while researchers should also have the option to view it.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    One participating healthcare professional did not see the sensor's limitations as a problem given the goal of the sensor.

    “Another participant, however, agreed with the limitations but did not see a problem, considering the goal of the sensor”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Some participating healthcare professionals were afraid of patients cheating with activity data.

    “Finally, some participants were afraid of patients cheating”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    For professionals, reliability of portal technology is a combination of technical reliability and scientifically proven effectiveness.

    “one participant summarized this as a combination of technical reliability and scientifically proven effectiveness:“That it works properly; is not constantly offline. But also scientifically reliable.””
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Participants can meaningfully verbalize their thoughts about trust in a rehabilitation portal when aided by visual materials.
    • The authors state this as an assumption: The selected rehabilitation portal is representative enough of state-of-the-art rehabilitation portals to evoke relevant trust discussions.

  • May combine two claims.

    Findingown data

    Some participating healthcare professionals were against data storage by a commercial organization, while others did not see harm.

    “As was the case for the patient participants, some professionals were against data storage by a commercial organization. Whereas others, again, did not see any harm.”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    Participating healthcare professionals in Amsterdam were more trusting of telemedicine technology in general than those in Enschede.

    “In Amsterdam, the participating professionals were more trusting of telemedicine technology in general”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Participating healthcare professionals in Amsterdam stated that automatic logout after a period of inactivity would increase their trust in the portal because it would prevent misuse.

    “One question that the participating professionals in Amsterdam had was whether or not the system would automatically log out a user after a period of inactivity. This would increase their trust in the portal, as misuse would be prevented this way.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Patients and healthcare professionals more or less agree on the factors that make up trust in the rehabilitation center that provides the portal and the factors that make up trust in a treatment.

    “Table 1 shows that patients and healthcare professionals more or less agree on the factors that make up trust in the rehabilitation center that provides the portal, and the factors that make up trust in a treatment.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Patients look for cues including a secure Internet connection, a familiar logo, the option to alter login credentials and personal data, and a personal approach to determine their trust in a rehabilitation portal.

    “Patients look for several cues to determine their trust in a rehabilitation portal: A secure Internet connection, a familiar logo (of the healthcare organization providing the technology), the option to alter login credentials and personal data, and a personal approach (e.g., a homepage with the patient’s name).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Healthcare professionals think that some patients lack the skills needed to give good information or are not honest to them.

    “They think that some patients lack the skills needed to give good information or are not honest to them.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Findingnone given

    Official national authentication mechanisms can decrease trust due to negative media publicity, as was the case for DigiD, the Dutch national authentication mechanism.

    “Official, national authentication mechanisms can decrease trust, due to negative media publicity, as was the case for DigiD, the Dutch, national authentication mechanism.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Healthcare professionals thought activity sensors were inferior devices because single sensors could not assess different kinds of activities and lacked the option to record contextual information.

    “They thought activity sensors were inferior devices, as single sensors could not assess different kinds of activities (e.g., walking and ironing) and lacked the option to record contextual information.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Professionals focus on the presence of their name on the homepage (which ensures a sense of personal responsibility) and automatically being logged out after inactivity as trust-increasing cues.

    “Professionals also focus on several trust-increasing cues. Specifically, they focus on the presence of their name on the homepage (which ensures a sense of personal responsibility), and automatically being logged out after a period of inactivity.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Telemedicine is a different kind of service from eCommerce/eGovernment because end-users do not purchase a good or service but use a technology as part of treatment, and the offering party is a medical organization that bought the technology and offers it free of charge.

    “And telemedicine is a different kind of service: End-users (patients) do not purchase a good or service, but use a technology as part of treatment, while the party offering the service is a medical organization that bought the technology from a developer and offers it free of charge (depending on the nature of the technology and the applicable healthcare insurance or government regulations) [10].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [10] Van Velsen L, Wentzel J, Van Gemert-Pijnen JEWC. Developing eHealth that matters via a multidisciplinary requirements development approach. JMIR Research Protocols. 2013;2(1), e21. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    Telemedicine is part of patient treatment and it can be expected that trust works differently here, as it is likely to be influenced by relationships with a healthcare professional or a healthcare organization.

    “Telemedicine is part of patient treatment and it can be expected that trust works differently here, as it is likely to be influenced by relationships with a healthcare professional or a healthcare organization.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In telemedicine, trust has been found to be an important antecedent of patient acceptance, patients' and healthy persons' thoughts on the usefulness of a personal health record, and physicians' intention to use a telemedicine service.

    “This is also the case for telemedicine, where trust has been found to be an important antecedent of patient acceptance [4], patients’ and healthy persons’ thoughts on the usefulness of a personal health record [5], and physicians’ intention to use a telemedicine service [6].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [4] Park H, Chon Y, Lee J, Choi I, Yoon K. Service design attributes affecting diabetic patient preferences of telemedicine in South korea. Telemedicine and eHealth. 2011;17(6):442–51. source

      Not checked in the free run.

    • cites [5] Cocosila M, Archer N. Perceptions of chronically ill and healthy consumers about electronic personal health records: A comparative empirical investigation. BMJ open. 2014;4:e005304. source

      Not checked in the free run.

    • cites [6] Wu J, Shen W, Lin L, Greenes RA, Bates DW. Testing the technology acceptance model for evaluating healthcare professionals' intention to use an adverse event reporting system. International J Qual Health Care. 2008;20(2):123–9. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Models that explain trust have been developed for online services within contexts like eCommerce or eGovernment, but are lacking for telemedicine.

    “Models that explain trust have been developed for online services within contexts like eCommerce [8] or eGovernment [9], but are lacking for telemedicine.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [8] McKnight DH, Choudhury V, Kacmar C. Developing and validating trust measures for e-Commerce: An integrative approach. Inf Syst Res. 2002;13(3):334–59. source

      Not checked in the free run.

    • cites [9] Warkentin M, Gefen D, Pavlou PA, Rose GM. Encouraging Citizen Adoption of e-Government by Building Trust. Electron Mark. 2002;12(3):157–62. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The disposition to trust any telemedicine service by healthcare professionals is dependent on personality traits (e.g., one's need for control or competitiveness).

    “Brown and colleagues [20], finally, stated that the disposition to trust any telemedicine service by healthcare professionals is dependent on personality traits (e.g., one’s need for control or competitiveness).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] Brown HG, Poole MS, Rodgers TL. Interpersonal traits, complementarity, and trust in virtual collaboration. J Manag Inf Syst. 2004;20(4):115–37. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisecitation

    Focus groups are a good means to explore a new concept.

    “Focus groups were chosen as a method as they are a good means to explore a new concept [23].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] Kitzinger J. Focus groups. In: Pope C, Mays N, editors. Qualitative research in health care. 3rd ed. Malden, MA: Blackwell publishing; 2006. p. 21–31. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Physicians' trust in electronic health care records was found to be influenced by perceived risk and information integrity.

    “Physicians’ trust in electronic health care records was found to be influenced by perceived risk and information integrity [19]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] Egea JMO, González MVR. Explaining physicians' acceptance of EHCR systems: An extension of TAM with trust and risk factors. Comput Hum Behav. 2011;27:319–32. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Visual design and navigation design play a crucial role in forming trust.

    “because visual design and navigation design play a crucial role in forming trust [31].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [31] Urban GL, Amyx C, Lorenzon A. Online Trust: State of the Art, New Frontiers, and Research Potential. J Interact Mark. 2009;23(2):179–90. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    The patients were shown screenshots of a rehabilitation portal in which cues were embedded that have been found to increase trust in online services: login procedures with different authentication technologies, disclaimers, and visual appearance of the homepage.

    “The patients were shown screenshots of a rehabilitation portal in which cues were embedded that have been found to increase trust in online services: Login procedures with different authentication technologies [28], disclaimers [29], and the visual appearance of the homepage [30].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [28] Wilkowska W, Ziefle M. Privacy and data security in e-health: Requirements from the user's perspective. Health Informatics J. 2012;18(3):191–201. source

      Not checked in the free run.

    • cites [29] Beldad A, De Jong M, Steehouder M. Reading the last read? Indicators of users' intention to consult privacy statements on municipal websites. Gov Inf Q. 2010;27(3):238–44. source

      Not checked in the free run.

    • cites [30] Sillence E, Briggs P, Harris P, Fishwick L. A framework for understanding trust factors in web-based health advice. Int J Hum Comput Stud. 2006;64:697–713. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The study was officially exempt from medical ethical assessment by the Medical Ethical Committee of Twente.

    “The study was officially exempt from medical ethical assessment by the Medical Ethical Committee of Twente.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    Two analysts grouped similar responses separately for patients and healthcare professionals to identify which factors were named most often when stating what makes up trust in a healthcare professional, rehabilitation center, treatment, or portal technology, and disputes were resolved by discussion.

    “Two analysts (LvV and IF) grouped similar responses (separately for patients and healthcare professionals) to identify which factors were named most often when stating what makes up trust in a healthcare professional, rehabilitation center, treatment, or portal technology. Any disputes were resolved by discussion.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Healthcare professionals' trust in an adverse event reporting system was found to be influenced by the subjective norm.

    “healthcare professionals’ trust in an adverse event reporting system was found to be influenced by the subjective norm [6].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] Wu J, Shen W, Lin L, Greenes RA, Bates DW. Testing the technology acceptance model for evaluating healthcare professionals' intention to use an adverse event reporting system. International J Qual Health Care. 2008;20(2):123–9. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    The factors that have been identified so far to explain trust in telemedicine services do not disclose a coherent picture and are only approached from the healthcare professionals' perspective.

    “However, the factors that have been identified so far to explain trust in telemedicine services do not disclose a coherent picture and are only approached from the healthcare professionals’ perspective.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Research on trust in telemedicine services is still in a stage of infancy, and only a few studies have made a first attempt at identifying factors that affect trust in telemedicine services.

    “However, the research on trust in telemedicine services is still in a stage of infancy [18], and only a few studies have made a first attempt at identifying factors that affect trust in telemedicine services.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [18] Beldad A, De Jong M, Steehouder M. How shall I trust the faceless and the intangible? A literature review on the antecedents of online trust. Comput Hum Behav. 2010;26:857–69. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Overviews of factors that affect trust in online health information do not list trust in healthcare professionals, trust in treatment, or trust in patients; usability and rich, unbiased information play a crucial role in those overviews.

    “These factors are also not listed in overviews of factors that affect trust in online health information, where usability and rich, unbiased information play a crucial role [30].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [30] Sillence E, Briggs P, Harris P, Fishwick L. A framework for understanding trust factors in web-based health advice. Int J Hum Comput Stud. 2006;64:697–713. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Trust in healthcare professionals and trust in treatment are antecedents of trust unique for telemedicine, identified from existing research and confirmed by participants.

    “We have identified several antecedents of trust that are unique for telemedicine: Trust in healthcare professionals and trust in treatment, which were identified from existing research and confirmed by participants”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    For healthcare professionals, the first meeting with a patient also establishes trust in portal technology.

    “For healthcare professionals, this meeting also establishes the trust in portal technology.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationown data

    Prior experience with telemedicine plays a role in the formation of trust beliefs among healthcare professionals, with bad experiences leading to low trust.

    “We also found an indication of prior experience with telemedicine playing a role in the formation of trust beliefs among healthcare professionals, where bad experiences led to low trust.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The loss of a first face-to-face meeting in fully self-help Internet health interventions may have a detrimental effect on patient trust.

    “It is important to remind ourselves that the loss of a first face-to-face meeting in such interventions may have a detrimental effect on patient trust.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    The first meeting between a patient and a healthcare professional is the moment where the patient largely determines his or her trust in the healthcare professional.

    “First meetings between a patient and healthcare professional should be done in a face-to-face setting, as this is the moment where the patient largely determines his or her trust in the healthcare professional.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Competence and openness of the healthcare professional have been identified in previous research as important for creating trust in a physician.

    “The competence and openness of the healthcare professional were also identified by others as important for creating trust in a physician [33]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [33] Thom DH, The Stanford trust study physicians. Physician behaviors that predict patient trust. J Fam Pract. 2001;50(4):323–8.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The importance of these cues for building online trust has already been identified for other types of websites.

    “The importance of these cues for building online trust has already been identified for other types of websites [38]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [38] Seckler M, Heinz S, Forde S, Tuch AN, Opwis K. Trust and distrust on the web: User experiences and website characteristics. Comput Hum Behav. 2015;45:39–50. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Factors affecting trust in a telemedicine portal for rehabilitation care overlap with and differ from factors in leading models that explain trust in eServices.

    “The factors that, we found, affect trust in a telemedicine portal for rehabilitation care appeared to both overlap and differ, when compared to the factors that make up leading models that explain trust in eServices.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The model by McKnight et al. includes factors like perceived site quality and institution-based trust.

    “The model by McKnight et al. [8], for example, also includes factors like perceived site quality and institution-based trust.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [8] McKnight DH, Choudhury V, Kacmar C. Developing and validating trust measures for e-Commerce: An integrative approach. Inf Syst Res. 2002;13(3):334–59. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationnone given

    Trust in the healthcare professional and trust in patients are unique for each end-user group.

    “Trust in the healthcare professional and patients are, of course, unique for each end-user group.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    The model by Koufaris and Hampton-Sosa identifies organization reputation, perceived ease of use, and perceived security control as important antecedents, but does not include healthcare-specific factors.

    “The model for developing initial trust in an online company by Koufaris and Hampton-Sosa [35] identifies organization reputation, perceived ease of use, and perceived security control as important antecedents, but does not include healthcare-specific factors.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [35] Koufaris M, Hampton-Sosa W. The development of initial trust in an online company by new customers. Inf manag. 2004;41(3):377–97. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Usability has been identified in previous research as a pivotal part of trust in eServices.

    “while usability has also been identified as a pivotal part of trust in eServices before [34]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] Flavián C, Guinalíu M, Gurrea R. The role played by perceived usability, satisfaction and consumer trust on website loyalty. Inf manag. 2006;43:1–14. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    The specific portal example used as a conversation starter may have influenced results, so caution is needed in generalizing to other health or rehabilitation portals with a distinctly different set of functionalities.

    “The collection of features that is unique for this portal may have influenced results and we should be cautious with generalizing results to other health or rehabilitation portals with a distinctly different set of functionalities.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Other researchers have found disclaimers to increase trust.

    “Disclaimers, which other researchers have found to increase trust [29]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] Beldad A, De Jong M, Steehouder M. Reading the last read? Indicators of users' intention to consult privacy statements on municipal websites. Gov Inf Q. 2010;27(3):238–44. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The study took an explorative approach because little work has been done on the topic.

    “We took an explorative approach as only little work has been done on the topic so far.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Only little work has been done on trust in telemedicine portals for rehabilitation care.
64 of 64

  • The authors state this as an assumption.

    Participants can meaningfully verbalize their thoughts about trust in a rehabilitation portal when aided by visual materials.

    “We anticipated that it would be difficult for participants to verbalize their thoughts about a concept as abstract as trust. To help them, we used visual materials to support all parts of the session, such as large sheets of paper on which the participants could draw and write down their thoughts.”

  • The authors state this as an assumption.

    The selected rehabilitation portal is representative enough of state-of-the-art rehabilitation portals to evoke relevant trust discussions.

    “We selected this portal as a discussion starter, as it entails different functionalities that utilize different kinds of (personal) data, including activity monitoring (which can be considered to be a ‘quantified self’ application). Therefore, we expected it to evoke a lot of discussion about end-users’ thoughts on the value of technology (as part of treatment), and the storage and use of personal”

  • The authors state this as an assumption.

    People go through several trust-related steps before actual use of a service and each step must have a positive outcome before the final desired behavior takes place.

    “This line of thought assumes that people go through several trust-related steps before actual use of a service and that each of these steps must have a positive outcome before the final, desired behavior takes place.”

  • The authors state this as an assumption.

    The cue cards and predefined factors (healthcare professionals, rehabilitation center, treatment, and rehabilitation portal) cover the relevant factors that make up trust.

    “Both, patients and healthcare professionals noted down what, for them, makes up trust in four factors which we anticipated would affect trust in a telemedicine service, offered by a rehabilitation center: Healthcare professionals, the rehabilitation center, the treatment, and the rehabilitation portal.”

  • The paper relies on this without support.

    Only little work has been done on trust in telemedicine portals for rehabilitation care.

    “We took an explorative approach as only little work has been done on the topic so far.”

  • The paper relies on this without support.

    Trusting beliefs are a first step in actually performing the desired trusting behavior.

    “Trusting beliefs are a first step in actually performing the desired trusting behavior, and things might go wrong along the way”

  • The paper relies on this without support.

    The factors mentioned most often during the focus groups are the factors that make up trust in a telemedicine portal.

    “Included in this table are the factors that were mentioned most often during the focus groups”
7 of 7

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Manual for the review of medical research involving human subjects. [ http://www.ccmo-online.nl ] Accessed 21 Jan 2016

Cited by

Sorted by citations

Related

Authors
Van Velsen, L., Wildevuur, S., Flierman, I., Van Schooten, B., Tabak, M., & Hermens, H.
Affiliations
  • Waag Futurelab (NL)
  • Roessingh, Centrum voor Revalidatie (NL)
  • Roessingh Research and Development (NL)
ORCID
Venue
BMC Medical Informatics and Decision Making
Publisher
Springer Science and Business Media LLC
Published
2015-12
Volume
16
Issue
1
Pages
11-11
ISSN
1472-6947 (ISSN-L)
DOI
10.1186/s12911-016-0250-2
PMC
PMC4728819
OpenAlex
W2274580781
Semantic Scholar
e0f410c868bc2bf5dafd1373ad550ea54b72e6b5
Cited by
54
References
42
Citations by year
2026: 2 · 2025: 3 · 2024: 6 · 2023: 6 · 2022: 6 · 2021: 8 · 2020: 5 · 2019: 8 · 2018: 4 · 2017: 3 · 2016: 2 · 2014: 1
FWCI
3.21
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • BMC Medical Informatics and Decision Making (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • University of Twente Research Information (publishedVersion, other-oa)
  • University of Twente Research Information (submittedVersion, other-oa)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
  • Social Sciences › Demography › Technology Use by Older Adults
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
Keywords
rehabilitation therapy, patient trust, perceived control, privacy, technical reliability
MeSH terms
Adult, Aged, Attitude of Health Personnel, Female, Humans, Male, Middle Aged, Patient Acceptance of Health Care, Rehabilitation, Focus Groups, Telemedicine, Trust

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

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