Attitudes and experience of paramedical students toward telehealth in education, a cross-sectional study

Abstract

Introduction

Telehealth refers to the use of telecommunication technologies to deliver healthcare services, provider and patient education, and information. Paramedical students’ perspectives are key, as their readiness affects the future success of telehealth in clinical practice. Therefore, the aim of this study is to investigate the attitudes and experiences of paramedical students toward telehealth.

Materials and methods

This cross-sectional quantitative study was conducted from October 2024 to February 2025. Data were collected using a previously validated questionnaire developed by Rettinger et al. (2024). The questionnaire consisted of 18 items that addressed demographic information, respondents’ ICT competence, interest in telehealth, perceived knowledge, the importance and applications of telehealth, previous telehealth experiences, and three open-ended questions exploring students’ perspectives on telehealth. The questionnaire was administered online. A survey link was emailed to eligible students who had expressed interest in participating. Completing the survey took approximately 15 min. To ensure validity, the face validity of the questionnaire was reviewed by five faculty members. Reliability was evaluated through the test-retest method over a 10-day interval, yielding a Cronbach’s alpha of 0.78. Data were analyzed using SPSS version 16.

Results

A total of 132 students responded to the survey (response rate: 100%). 72.7% of the students were very or relatively interested in telehealth. 77.3% considered telehealth important during their studies. However, only 11.4% reported actual experience with telehealth programs in their field. The Kruskal-Wallis H test showed significant differences across education levels in terms of perceived knowledge (P = 0.014) and perceived importance of telehealth in education (P = 0.042).

Conclusion

Despite high levels of interest and generally positive attitudes, students reported limited experience and exposure of telehealth. These findings highlight the importance of integrating telehealth education into paramedical training.

Introduction

Telehealth is defined as the delivery and facilitation of health and health-related services—including medical care, provider and patient education, health information services, and self-care—via telecommunications and digital communication technologies, using innovative methods such as online consultations, remote monitoring, and the provision of healthcare services [1]. With remarkable advancements in technology, telehealth has become an integral component of modern healthcare, playing a significant role in improving the quality of medical services and facilitating access to healthcare [2–4]. According to recent estimates, over 60% of healthcare institutions in the United States and nearly half of the hospitals utilize telehealth, underscoring its importance in increasing access to care, reducing costs, and enhancing patient experience globally [1]. The World Health Organization (WHO) has also emphasized the importance of using information and communication technologies (ICT) in healthcare programs [5]. Telehealth is particularly recognized for its ability to reduce geographic barriers and improve access to healthcare for underserved populations, such as those in rural and disadvantaged areas [6–8].

The growing use of this technology highlights the need for telehealth education for healthcare providers [9]. To successfully implement telehealth and leverage its benefits, integrating telehealth into the curricula of future healthcare professionals is essential [10]. Notably, telehealth education for medical and nursing students began in the late 1990s, and many academic institutions have recently paid increased attention to this technology [11]. However, one of the major challenges in telehealth adoption is the need for proper education in this area [12]. A recent survey by the Association of American Medical Colleges (AAMC) revealed that currently only 58% of medical schools offer telehealth training [13, 14]. This educational gap became more pronounced during the COVID-19 pandemic, when the need for telehealth became increasingly evident [15].

Moreover, research indicates that a lack of knowledge and experience in telehealth is one of the main barriers to its adoption among students and healthcare providers [9]. However, telehealth education can enhance confidence, preparedness, and acceptance of this technology [10, 16, 17]. Despite its significance, formal telehealth education is still insufficiently incorporated into many academic programs [18, 19]. Numerous studies have examined the educational needs and existing challenges in delivering effective telehealth training, including those highlighting the importance of leveraging modern technologies to improve healthcare quality and enhance students’ capabilities in utilizing such technologies [19].

Additionally, recent studies, including those by Boos and Sabrina, have shown that experience-based educational modules can significantly improve students’ knowledge, attitudes, and confidence in using telehealth [20, 21]. Two systematic reviews conducted in 2021 identified major deficiencies in the integration of telehealth into health and nursing curricula, such as lack of coherence, absence of clear standards, and a mismatch between educational content and actual clinical needs [22, 23].

Therefore, a significant gap in the current literature is the lack of structured programs for telehealth education in Paramedical disciplines. Despite recent efforts to incorporate telehealth into education, most studies have focused on medical and nursing students, and there is limited information on the status of telehealth education and attitudes among Paramedical students. Accordingly, the aim of the present study is to explore the attitudes, experiences, and perceptions of Paramedical students at Mashhad University of Medical Sciences regarding telehealth. It is also worth noting that many studies, including the present one, assess students’ perceptions and understandings of the subject rather than actual competencies, which may not necessarily correlate directly with behavioral performance.

Methods

Study design

This cross-sectional quantitative study was conducted from October 2024 to February 2025 (corresponding to Mehr to Bahman 1403 in the Iranian academic calendar.). All ethical principles outlined in the Declaration of Helsinki were strictly adhered to [24]. Accordingly, students were clearly informed about the objectives, procedures, potential benefits and risks, and possible discomforts related to the study. Participation was voluntary, and informed consent was obtained from all participants. As an incentive for participation, the objectives of the study were explained at the beginning of the questionnaire, and participants were informed that they would receive a general feedback on the results upon completion of the study. All personal information was kept confidential and anonymized for research purposes only.

Sample size

The study population included all students enrolled in the School of Paramedical Sciences and Rehabilitation at Mashhad University of Medical Sciences during the 2024 academic year. These students were from eight disciplines: Health Information Technology, Laboratory Sciences, Optometry, Radiology, Speech Therapy, Occupational Therapy, Physiotherapy, and Social Work, and were studying at undergraduate, master’s, and doctoral levels. Stratified proportional sampling was employed: students were first categorized by discipline and academic level, and then a proportionate sample was selected from each stratum based on Cochran’s formula (with a confidence level of 95% and α = 0.05). The initial sample size was 87; however, to enhance accuracy and generalizability, a total of 132 participants were ultimately included.

n = Number of samples required to carry out the design.

Z = The value of the statistic equivalent to the area under the standard normal curve.

P and q = The frequency ratio of the desired trait in the target population.

d = Effect size or precision.

Inclusion criteria were all students actively enrolled at the School of Paramedical Sciences and Rehabilitation at the time of the study. Exclusion criteria included transfer or visiting students from other universities, students on academic leave during data collection, international students, and those unwilling to participate.

Participation was entirely voluntary and based on informed consent. Participants were assured that their information would remain confidential and be used solely for research purposes.

Data collection

To evaluate students’ attitudes and experiences, a pre-developed standardized questionnaire by Retinger et al. was used [9]. To evaluate the face and content validity, the initial version of the questionnaire was reviewed by five faculty members in the fields of Health Information Technology and Medical Informatics. They assessed the clarity, relevance, and conceptual coverage of the items. Their suggestions were incorporated into the final version of the questionnaire.

.Its reliability was assessed using the test-retest method with a 10-day interval (Cronbach’s alpha: 78%). The questionnaire included 18 questions covering demographic data (age, gender, educational level, field of study), respondents’ ICT competence, and interest in telehealth, perceived telehealth knowledge, importance of telehealth, and various applications of telehealth, telehealth experiences, telehealth in education, and three open-ended questions exploring students’ perspectives on telehealth. The questionnaire was designed electronically, and an email with the survey link was sent to eligible students willing to participate. Two reminder emails were sent at one-week intervals. Participation was voluntary, and responses were anonymous.

Interest in telehealth was rated on a 5-point Likert scale (1 = not interested, 2 = slightly interested, 3 = somewhat interested, 4 = very interested, 5 = no opinion). Perceived knowledge of telehealth was assessed by choosing one of five statements ranging from never having heard of telehealth to knowing many of its applications professionally. Perceived importance of telehealth in education was rated on a 5-point Likert scale (1 = very important to 5 = not at all important). The importance of telehealth post-COVID-19 was also measured on a 5-point Likert scale (1 = absolutely, 2 = maybe, 3 = rarely, 4 = not at all, 5 = no opinion). Experience-related questions offered options like “self-performed,” “observed,” and “neither performed nor observed.”

Statistical analysis

Data were analyzed using SPSS version 16, which was employed due to institutional licensing limitations. Despite being an older version, it fully supported the statistical tests used in this study and did not affect the validity of results. Descriptive data were analyzed using frequency and percentage for categorical variables and mean ± standard deviation for continuous variables. Chi-square, t-test, and Kruskal-Wallis tests were used to analyze relationships between categorical variables. A significance level of P < 0.05 was considered.

Results

A total of 132 students participated in the study to assess Paramedical students’ attitudes and experiences regarding telehealth. Table 1 summarizes the demographic characteristics of students. The average age of participants was 23.04 ± 4.04 years; 72% were female and 28% male. Regarding ICT skills, 42.4% rated their competence as “good” and 20.5% as “very good.” Only 6.8% considered their ICT skills “insufficient.” The majority of students were from the Health Information Technology (HIT) (34.8%, n = 46), while Physiotherapy had the fewest (6.8%, n = 9).

Table 1.

Frequency distribution and demographic characteristics of students (N = 132)

Characteristics	Total, n (%)
Age (Median)	23.04 ± 4.04
Gender
Male	37 (28)
Female	95 (72)
Programs
Bachelor	99
Master	31
Ph.D	2
Self-assessed ICT b competence
1 = very good	27 (20.5)
2 = good	56 (42.4)
3 = medium	20 (15.2)
4 = sufficient	20 (15.2)
5 = not sufficient	9 (6.8)
Field of study
Health Information Technology	46 (34.8)
Laboratory Science	20 (15.1)
Optometry	14 (10.6)
Radiology	11 (8.3)
Speech Language Therapy	11 (8.3)
Occupational Therapy	11 (8.3)
Social Work	10 (7.5)
Physiotherapy	9 (6.8)

Differences among subgroups

Kruskal-Walli’s test results (Table 2) indicated statistically significant differences between educational levels regarding telehealth knowledge (P = 0.014) and perceived importance of telehealth in education (P = 0.042). However, no significant differences were found based on gender or academic semester in terms of interest, perceived knowledge, or perceived importance of telehealth, including after the COVID-19 pandemic.

Table 2.

Results of the Kruskal Wallis H test for each subgroup test

	Telehealth Interest		Perceived Knowledge of Telehealth		Telehealth Importance in Education		Telehealth Relevance After Covid19
	Kruskal Wallis H test (df)	P value	Kruskal Wallis H test (df)	P value	Kruskal Wallis H test (df)	P value	Kruskal Wallis H test (df)	P value
Educational level	(3.9)2	0.138	(8.4)2	.014	(6.3)2	.042	(1.6)2	0.441
Genders	(0.179)1	0.672	(0.259)1	0.611	(0.033)1	0.856	(0.293)1	0.588
Semester	(3.1)7	0.870	(9.3)7	0.229	(4.8)7	0.674	(7.4)7	0.382

Interest in telehealth

Overall, 21.2% of students (n = 28) were very interested, and 51.5% (n = 68) were somewhat interested in telehealth. Fields with the highest interest were SPT (100%, n = 11), HIT (85%, n = 39), and LS (65%, n = 13). Least interested fields were PT (50%, n = 4) and OT (45%, n = 5). Mean scores by field are shown in Fig. 1.

Fig. 1.

Heatmap of telehealth interest, Perceived knowledge of telehealth, Telehealth importance in education, and Telehealth after Covid19 for each field of study. HIT: Health information technology, OPT: Optometry, RL: Radiology, LS: Laboratory Science, OT: Occupational Therapy, SW: Social Work, PT: Physiotherapy, SLT: Speech Language Therapy

Perceived knowledge of telehealth

Only 3.8% (n = 5) reported extensive knowledge and professional exposure to telehealth applications. 7.6% (n = 10) knew some applications; 50% (n = 66) were familiar with telehealth in medical services but not in their profession. 24.2% (n = 32) were aware of the term but had little information, and 14.4% (n = 19) had never heard of it. Averages by field are illustrated in Fig. 1.

Importance of telehealth in education

27.3% (n = 36) found telehealth very important in their education, while 50% (n = 66) considered it relatively important. Fields with the highest importance scores were HIT (91.3%), SPT (91%), and OT (81.9%). Only 6.8% (n = 9) found it unimportant, and 6.8% (n = 9) considered it not important at all. See Fig. 1 for field-based averages.

Telehealth after -COVID-19

56.1% (n = 74) believed telehealth would be relevant to their profession post-pandemic, while 25% (n = 33) thought it might be. Most confident fields: SPT (100%), HIT (93.5%), OPT (71.5%), and LS (70%). Meanwhile, 10.6% (n = 14) believed it would not be relevant, and 0.75% (n = 1) were sure of its irrelevance. Figure 1 provides further details.

Various applications of telehealth

The various forms of telehealth services, in order of frequency from most to least, include: the use of self-management programs in healthcare (40.3% [132/53]), virtual reality/gaming or home exercise (36.4% [132/48]), telephone consultation (34.8% [132/46]), video call consultations (16.7% [132/40]), self-management information through video calls or websites (29.5% [132/39]), video call treatments (28.8% [132/38]), movement or activity monitoring using sensors (27.3% [132/36]), monitoring vital signs via sensors (23.5% [132/31]), telephone treatment (17.4% [132/23]), and 22 students had no opinion on this matter (25.3%). Details of the various applications of telehealth are shown in Fig. 2.

Fig. 2.

Students’ perception of the relevance of various applications of telehealth in relation to their professions

Experience with telehealth

In this study, the experience domains included: [1] Consultation or therapy via phone or video call [2], Use of apps for self-management, self-learning, or remote monitoring [3], Use of sensor support, exergaming, or virtual reality from a distance. To assess students’ experience with telehealth, each item was presented with three response options: Carried out by yourself, observed, not carried out or observed.

Overall, 28.8% (38/132) of the students had experience with telehealth. Additionally, 97.8% (126/132) of students had observed various telehealth applications during their internship or professional career. 10.6% (14/132) of the students had engaged in phone or video call consultation or treatment, and 37.9% (50/132) had observed phone or video call consultation or treatment.

10.6% (14/132) of the students had used telehealth programs for self-management, self-learning, or remote monitoring. 32.6% (43/132) had observed the use of telehealth programs for self-management, self-learning, or remote monitoring. 7.6% (10/132) of the students had engaged in exergaming or exercise (video games) or virtual reality, and 27.3% (36/132) had observed these activities. Moreover, in response to open-ended questions about other experiences, students mentioned instances such as online dermatology consultations, checking patients’ living environments via video calls, and online treatments conducted through platforms like Google Meet.

Telehealth content in the curriculum

Students’ preferences for telehealth content in their curriculum, ranked from highest to lowest, include: (1) practical training with devices, software, or applications (mean 1), (2) technical skills for using devices and software (mean 2), (3) technical knowledge of device and software principles (mean 3), (4) practical application in fieldwork (mean 2), (5) analytical skills for data interpretation (mean 2), (6) practical tips and exercises for delivering telehealth services (mean 1), (7) content on usability, user experience, and telehealth acceptance (mean 2), (8) case examples for telehealth with different target groups (mean 1), (9) scientific evidence on telehealth (mean 2), (10) data protection in telehealth (mean 2), 11) introduction to devices, software, or applications (mean 1.5), 12) content related to gamification and feedback systems (mean 2.5), 13) knowledge about movement analysis through telehealth (mean 2), 14) development of telehealth content (e.g., video exercises or educational programs; median 2), 15) legal aspects of telehealth (mean 2), and 16) knowledge about critical evaluation of telehealth programs (mean 2). Details of the academic programs are shown in Fig. 3.

Fig. 3.

Students’ preferences for telehealth content in the curriculum

Based on the results, 25.8% (132/34) of students preferred to learn with peers from the same field, 9.1% (132/12) preferred to learn with students from other fields, and 56.8% (132/75) of students preferred to learn about telehealth with both groups of students from the same and other fields. 9.09% (132/12) of students had no interest in learning telehealth, and 8.3% (132/11) had no opinion on this matter. Furthermore, 23.5% (132/31) of students preferred telehealth to be taught as a mandatory course in their curriculum, 57.6% (132/76) preferred it as an elective course, 1.5% (132/2) opposed telehealth education in the curriculum, and 17.4% (132/23) had no opinion on this issue. Regarding the preferred time for teaching telehealth, in the undergraduate program, 10.5% (132/18) of students preferred the first or second semester, 60.5% (132/9) preferred the third or fourth semester, and 26.8% (132/25) preferred the fifth or sixth semester. 2.1% (132/2) of participants had no opinion. In the master’s program, 30% (132/9) of students preferred the first or second semester, and 68% (132/5) preferred the third or fourth semester. In the doctoral program, 50% (132/1) of students preferred the first or second semester, and 50% (132/1) preferred the seventh or eighth semester.

Discussion

The present study found that most paramedical students have a positive attitude toward telehealth and show a high level of interest in learning and using it in their future professional careers. The highest interest was reported among students in Health Information Technology, Speech Therapy, and Laboratory Sciences, which aligns with the technology-driven nature of these fields. Differences in interest based on field of study and gender were also observed. Although these differences cannot be conclusively analyzed due to the predominance of female students, they correspond with findings from a U.S. study that showed women are more inclined to adopt new healthcare technologies [25].

Approximately half of the students had experience with or had observed telehealth services, although their overall awareness was relatively low. These findings are consistent with Kunjumon et al. [26], who reported a moderate level of telehealth knowledge among paramedical students. While students acknowledge telehealth’s importance, there is still a lack of deep understanding and practical training in this field. In contrast, Pitt et al. [21] reported higher levels of knowledge among medical students, reflecting possible disciplinary differences.

Byambasuren [27] supports the effectiveness of telephone and video consultations, which aligns with the positive experiences and attitudes reported by students in this study. Telehealth methods such as phone calls, video conferencing, and secure messaging have significantly grown, especially after the COVID-19 pandemic [28]. In our study, 48.5% of students reported experience with remote consultations or treatments via phone or video, and 43.2% used telehealth apps for self-management and learning. These results mirror findings from Turkey, where most physiotherapy and rehabilitation students used telehealth during the COVID-19 pandemic, making it a key part of education and healthcare [29]. This suggests that practical training and access to technological tools, especially in Health Information Technology and Physiotherapy, significantly influence students’ experience and interest in telehealth. Similarly, Davies et al. [25] found physiotherapy students feel well-prepared to use telehealth for clinical consultations, considering it a practical treatment option. Further studies like Campbell et al. [30] emphasize the importance of hands-on training, with many doctoral physiotherapy students desiring more telehealth education to integrate these methods into their future practice.

While this study primarily explored paramedical students’ attitudes and experiences toward telehealth, it also highlights the need for a structured pedagogical framework to incorporate telehealth education into curricula. Previous research demonstrates the effectiveness of digital technology and non-specialist interventions in healthcare education, particularly in resource-limited settings [18]. This aligns with increasing emphasis on preparing students for remote patient monitoring and wearable technologies, which are becoming integral to clinical practice [19]. Moreover, Maheu et al. [31] emphasize the importance of interprofessional telehealth experiences, especially in telebehavioral health, which requires coordinated efforts across healthcare disciplines. These findings support systematically integrating telehealth competencies into paramedical curricula to equip students with the skills necessary for effective telehealth delivery in diverse settings.

Limitations

This study had several limitations that may have influenced the results. First, since the study was conducted at a single university, the generalizability of the findings may be limited, although students from different disciplines and academic levels were included to enhance diversity. Second, the questionnaire primarily assessed self-reported attitudes, awareness, and perceived familiarity rather than objective knowledge or observed practical skills; therefore, the findings do not represent students’ actual competencies or clinical performance. Moreover, due to the very small number of Ph.D. students in the sample (n = 2), the results for this subgroup lack sufficient statistical power and should be interpreted with caution. Additionally, due to curriculum constraints and limited clinical opportunities, students’ exposure to telehealth may have been restricted, impacting the responses. Furthermore, the study lacked a specific educational framework for interpreting the results and was not designed to evaluate the impact of the curriculum. These limitations highlight the need for future research using interdisciplinary approaches and established evaluation models, such as the Kirkpatrick Model and the Dreyfus Model [32, 33], to better assess skill development and the effectiveness of educational interventions in telehealth.

Conclusion

While telehealth is recognized as an important tool for healthcare delivery in the future, there is a need for greater focus on practical education and the provision of appropriate tools in this field. The results of this study and others indicate that Paramedical students and other healthcare-related groups are eager to adopt these technologies but require more education and preparation to use them effectively. The findings of this study can serve as an initial step in identifying the educational needs of students in telehealth and help create a foundation for developing skill-based and educational interventions. Therefore, it is recommended that universities and educational institutions incorporate telehealth training into their curricula through practical and applied courses, ensuring that students are adequately prepared for the effective use of these methods in their future careers.

Abbreviations

WHO

World Health Organization

ICT

Information and Communications Technology

AAMC

Association of American Medical Colleges

HIT

Health Information Technology

LS

Laboratory Science

OPT

Optometry

RL

Radiology

SLT

Speech Language Terapy

OT

Occupational Terapy

SW

Social Work

PT

Physioterapy

Author contributions

RNA: Contributed to Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Software, Validation, Visualization, writing – original draft, KhK: Project administration, Supervision, Validation, Visualization, writing – original draft, writing – review and editing, MS, and SFM: Data curation, Resources. All authors read and approved the final manuscript.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Data availability

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

Declarations

Ethics approval and consent to participate

This study is derived from a research project approved by Mashhad University of Medical Sciences (Ethics Code: IR.MUMS.FHMPM.REC.1403.136). All ethical principles in the research were observed according to the Hellenic Declaration. Students entered the research with informed consent after the research was explained. All information from individuals was used confidentially and without revealing their names.approval and consent to participate.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.