Determinants of patient satisfaction with virtual primary health care clinics in Jeddah, 2024–2025

ABSTRACT

Background:

Virtual clinics have become essential in modern healthcare delivery, especially following the COVID-19 pandemic. In Saudi Arabia, the Ministry of Health has expanded telemedicine services to enhance accessibility and efficiency. However, limited research has examined user perceptions within the city of Jeddah.

Objective:

This study was conducted in the city of Jeddah, Saudi Arabia, among patients attending Ministry of Health primary health care centers offering virtual family medicine services.

Methods:

A cross-sectional qualitative design was employed using semi-structured interviews and a structured survey (N = 318). Descriptive statistics and thematic content analysis were applied. Key themes were triangulated with participant demographics and service usage patterns.

Results:

Participants expressed appreciation for the convenience and time-saving aspects of virtual clinics. Nonetheless, concerns were raised regarding diagnostic accuracy, communication barriers, and the absence of physical examination. Gender differences and prior exposure to telehealth significantly influenced preference, with males showing higher favorability toward in-person consultations. Providers emphasized the need for better training and integration of virtual tools.

Conclusion:

The transition toward virtual healthcare requires not only technological adoption but also attention to user trust and satisfaction. Enhancing digital literacy, addressing infrastructure gaps, and offering hybrid models may optimize the effectiveness and acceptance of virtual care in the Hail region.

Introduction

Virtual clinics are defined by the World Health Organization as the remote delivery of healthcare services using information and communication technologies to support diagnosis, treatment, and follow-up care.[1] Although telemedicine has existed for several decades,[2] its adoption increased substantially during the COVID-19 pandemic as health systems sought to maintain continuity of care while reducing in-person visits. In Saudi Arabia, the Ministry of Health (MOH) expanded digital health services across primary health care centers, supporting the national Vision 2030 agenda to enhance accessibility and efficiency.[3] One notable development is the Seha Virtual Hospital, launched in 2022, which connects more than 224 hospitals and provides over 40 specialized services nationwide.[4]

Family medicine has been among the specialties most engaged in virtual consultations due to its high patient load and need for routine follow-up. Recent studies from Saudi Arabia report high satisfaction with virtual primary care services. For example, a study in Jeddah found that more than 90% of participants would recommend telemedicine,[5] while another reported that 82.7% of patients were satisfied with virtual consultations.[6] National findings similarly highlight positive experiences related to scheduling, audiovisual quality, and provider interaction.[7] International and regional evidence also identifies convenience, reduced travel, and shorter waiting times as major contributors to patient satisfaction.[8,9]

Despite these favorable outcomes, satisfaction levels vary across demographic groups and regions. Studies conducted during the pandemic reported mixed results, with satisfaction ranging from 38% to 68%, influenced by age, gender, education, and digital literacy.[10,11,12] Much of this literature reflects early pandemic experiences and may not capture the post-pandemic improvement in digital health infrastructure or evolving patient expectations. Importantly, limited data are available on satisfaction with virtual family medicine clinics specifically in Jeddah, particularly during 2024–2025.

Given these gaps, updated evidence is needed to evaluate patient satisfaction, identify determinants of positive or negative experiences, and guide improvements in virtual service delivery. Understanding these factors is essential for strengthening hybrid care models and supporting Saudi Arabia’s ongoing digital health transformation.

Methods

Study design and setting

This analytical cross-sectional study was conducted in Ministry of Health (MOH) primary healthcare centers in Jeddah, Saudi Arabia, during 2023. The study focused on patients who used virtual family medicine clinics offered through these centers.

Sampling and population

A simple random sampling approach was used to select 20 virtual family medicine clinics from the 47 MOH-affiliated primary healthcare centers providing virtual consultation services. Eligible participants were adults aged 18 years or older who had used virtual family medicine services at least once within the previous 12 months. Individuals with cognitive, hearing, or language difficulties that prevented survey participation were excluded.

Sample size calculation

Based on an estimated monthly population of 7000 virtual clinic users, a minimum required sample of 364 participants was calculated using OpenEpi (version 3.01) with a 95% confidence level, 5% margin of error, and an assumed satisfaction proportion of 50%. To account for possible nonresponse, the target sample was increased to 400. A total of 318 completed responses were included in the final analysis (response rate: 79.5%).

Data collection and instrument

Data were collected through structured telephone interviews conducted between September and December 2023. Trained data collectors contacted eligible participants, explained the purpose of the study, and obtained verbal informed consent before starting the interview. All interviews were conducted in Arabic.

Responses were entered electronically using a REDCap-based standardized data entry form with automated validation checks to minimize entry errors.

The questionnaire was adapted from a previously validated telemedicine satisfaction instrument [Kruse et al., 2017]. It consisted of three main sections:

1. Sociodemographic characteristics

2. Perceptions of virtual care quality

3. Access, communication, and ease of use.

The tool underwent expert review and pilot testing with 20 individuals to ensure clarity and cultural appropriateness.

To ensure inter-rater reliability among data collectors, agreement was assessed using Cohen’s kappa for categorical variables and the intraclass correlation coefficient (ICC) for ordinal items. All reliability indicators met acceptable thresholds.

Each satisfaction item was measured on a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree).

Statistical analysis

Data were coded and cleaned in Microsoft Excel and analyzed using IBM SPSS Statistics version 28.0.1.1. Descriptive statistics (frequencies, percentages, means, and standard deviations) summarized participant characteristics and responses.

Bivariate analysis using Chi-square (χ²) tests assessed associations between satisfaction and variables such as gender, education level, and consultation preference.

Because the study was analytical, binary logistic regression was performed to identify predictors of higher satisfaction. Variables with P < 0.20 in the bivariate analysis were included in the multivariable model. Adjusted odds ratios (AORs) with 95% confidence intervals were reported. A P value < 0.05 was considered statistically significant.

Ethical considerations

Ethical approval for this study was obtained from the Ministry of Health Institutional Review Board in Jeddah. All participants provided verbal informed consent before data collection.

Results

A total of 318 participants were included in this study. The majority were male (74.8%, n = 238), while females accounted for 25.2% (n = 80). In terms of educational attainment, over one-third held a bachelor’s degree (34.9%, n = 111), followed by those with below secondary education (23.3%, n = 74), secondary degrees (21.7%, n = 69), diplomas (14.2%, n = 45), and postgraduate qualifications (10.4%, n = 33). The majority of respondents were Saudi nationals (91.2%, n = 290), with non-Saudi participants comprising 8.8% (n = 28) [Table 1].

Table 1.

Demographic characteristics of participants (n=318)

Variable	Category	n (%)
Gender	Male	238 (74.8)
	Female	80 (25.2)
Education	Below Secondary	74 (23.3)
	Secondary Degree	69 (21.7)
	Diploma	45 (14.2)
	Bachelor	111 (34.9)
	Postgraduate	33 (10.4)
Citizenship	Saudi	290 (91.2)
	Non-Saudi	28 (8.8)

When asked to rate their overall experience with virtual family medicine clinics, most participants expressed favorable views: 46.2% (n = 147) rated it as “very good,” 37.7% (n = 120) as “good,” and 10.4% (n = 33) as “excellent.” Only a small percentage rated their experience as “fair” (4.7%, n = 15) or “poor” (0.9%, n = 3).

In comparing virtual care to traditional in-office visits, 46.5% (n = 148) found the experiences to be about the same, while 20.8% (n = 66) reported virtual visits were better. However, 26.7% (n = 85) considered virtual care to be less satisfactory, and 6.0% (n = 19) rated it as “much worse.”

When asked whether virtual care was more satisfying than in-person visits, 35.5% (n = 113) agreed, while 45.6% (n = 145) were unsure, and 18.9% (n = 60) disagreed, Table 2.

Table 2.

Satisfaction and comparative views (n=318)

Question	Response	n (%)
Overall, how would you rate the virtual care?	Poor	3 (0.9)
	Fair	15 (4.7)
	Good	120 (37.7)
	Very Good	147 (46.2)
	Excellent	33 (10.4)
Compared to in-office visits, how was the experience?	Better	66 (20.8)
	About the same	148 (46.5)
	Not as good	85 (26.7)
	Much worse	19 (6.0)
Is virtual care more satisfying than in-office visits?	Agree	113 (35.5)
	Not sure	145 (45.6)
	Disagree	60 (18.9)
Preferred consultation type if given a choice?	Virtual Clinics	94 (29.6)
	In-Office Appointments	184 (57.9)
	Not sure	40 (12.6)

Regarding consultation preferences, over half of the participants (57.9%, n = 184) preferred in-office appointments, whereas 29.6% (n = 94) favored virtual clinics. A smaller proportion (12.6%, n = 40) were undecided [Figure 1].

Figure 1.

Satisfaction and comparative views of virtual family medicine clinics among patients in Jeddah (N = 318)

Participants were asked to rate their level of agreement with several statements related to their experience with virtual family medicine clinics. A majority agreed or strongly agreed that virtual services were convenient (71.4%, n = 227), and 60.4% (n = 192) reported being seen within 15 minutes of their scheduled appointment.

However, 56.3% (n = 179) of respondents acknowledged some difficulty explaining their medical concerns during the virtual consultation, while 41.2% (n = 131) reported experiencing technical difficulties. Despite these challenges, overall confidence in virtual clinics remained strong: 78.6% (n = 250) stated they would recommend virtual consultations to others [Table 3].

Table 3.

Agreement with statements on virtual clinics (n=318)

Statement	Strongly Agree	Agree	Not Sure	Disagree	Strongly Disagree
Virtual services are convenient	104 (32.7)	123 (38.7)	58 (18.2)	26 (8.2)	7 (2.2)
You were seen within 15 minutes of scheduled time	89 (28.0)	103 (32.4)	70 (22.0)	46 (14.5)	10 (3.1)
You faced difficulty explaining medical needs	37 (11.6)	142 (44.7)	65 (20.4)	61 (19.2)	13 (4.1)
You experienced technical difficulties	45 (14.2)	86 (27.0)	84 (26.4)	83 (26.1)	20 (6.3)
You would recommend virtual clinics to others	123 (38.7)	127 (39.9)	44 (13.8)	18 (5.7)	6 (1.9)

Analysis of overall satisfaction stratified by gender showed no statistically significant difference. Among males, 46.2% (n = 110) rated the service as “very good” or “excellent,” compared to 50.0% (n = 50) of females. The Chi-square test did not reveal a significant association (χ²(4) = 2.099, P = 0.7176), indicating that gender did not influence overall satisfaction levels [Table 4].

Table 4.

Gender and overall satisfaction with virtual care (n=318)

Gender	Poor	Fair	Good	Very Good	Excellent	Total
Male	3	10	95	105	25	238
Female	0	5	25	42	8	80
Total	3	15	120	147	33	318

A statistically significant association was found between gender and service preference (χ²(3) = 11.197, P = 0.0107). Male participants were more likely to prefer in-office consultations, whereas females demonstrated a relatively higher preference for virtual services [Figure 2].

Figure 2.

Gender-based differences in preferred consultation type for virtual family medicine clinics (N = 318)

Educational attainment was significantly associated with satisfaction levels (χ²(20) = 49.559, P = 0.0003). Participants with bachelor’s or postgraduate degrees reported higher satisfaction rates compared to those with lower education levels. For instance, 62.2% of participants with postgraduate education rated their experience as “very good” or “excellent,” compared to only 39.2% among those with below secondary education [Table 5].

Table 5.

Education level and overall satisfaction (n=318)

Education Level	Poor	Fair	Good	Very Good	Excellent	Total
Below Secondary	2	6	20	35	11	74
Secondary	1	5	25	30	8	69
Diploma	0	1	20	20	4	45
Bachelor	0	2	40	50	19	111
Postgraduate	0	1	15	12	5	33
Total	3	15	120	147	47	332

Participants’ experiences with virtual clinic services varied across the measured items. As shown in Figure 3, most respondents agreed that virtual services were convenient, with 71.4% expressing either agreement or strong agreement. Similarly, 60.4% reported being seen within 15 minutes of their scheduled appointment. In contrast, more than half of the participants (56.3%) indicated some difficulty explaining their medical concerns during the virtual visit, and 41.2% experienced technical difficulties.

Figure 3.

Distribution of participant responses to virtual clinic experience items in Jeddah (N = 318)

No significant association was found between citizenship and consultation preference (χ²(3) = 3.940, P = 0.2680). Both Saudi and non-Saudi participants demonstrated similar patterns of preference, with a majority favoring in-office appointments [Table 6].

Table 6.

Citizenship and service preference (n=318)

Citizenship	Virtual Clinics	In-Office Appointments	Not Sure	Total
Saudi	86 (27.0)	168 (52.8)	36	290
Non-Saudi	8 (2.5)	16 (5.0)	4	28
Total	94 (29.6)	184 (57.9)	40	318

Chi-square test: χ²(3)=3.940, P=0.2680 → Not significant

Discussion

The findings of this study indicate that most participants held positive views toward virtual family medicine clinics. Many rated their overall experience as good or very good, which aligns with previous research highlighting rising acceptance of remote healthcare services when they offer practical benefits such as shorter waiting times, easier access, and reduced need for travel.[11,12] These advantages appear to support patient comfort with virtual consultations, particularly for routine or follow-up care.

Despite the favorable satisfaction ratings, more than half of the participants still preferred in-office appointments. This preference reflects enduring concerns about the limitations of virtual care, especially in situations where physical examination is considered essential. Studies from various settings have reported similar findings, noting that some patients experience uncertainty during remote assessments and feel more assured when interacting with providers face to face.[13,14] These observations suggest that virtual services remain more suitable for specific types of visits rather than all clinical scenarios.

Gender differences also emerged, with males showing greater inclination toward in-office visits, whereas females demonstrated a slightly higher preference for virtual care. Comparable trends have been documented elsewhere, with explanations often related to past experiences with digital platforms, comfort with technology, or personal expectations about communication in clinical settings.[15,16] Educational level showed a similar pattern: Participants with higher education tended to express greater satisfaction. This trend may reflect stronger familiarity with digital tools or improved ability to navigate virtual communication systems, which mirrors conclusions from earlier work.[17]

Technical difficulties were reported by a notable proportion of respondents. Although these challenges did not completely diminish satisfaction, they remain important barriers that can affect the overall experience. Prior studies have shown that unreliable Internet connections, audio disruptions, and unfamiliar device interfaces continue to hinder virtual appointments in many countries.[18,19] Addressing these barriers may require improved platform design, clearer guidance for users, and accessible technical support.

Even with these challenges, a substantial number of participants stated that they would recommend virtual clinics to others. This observation reflects appreciation for the practical benefits of remote services, especially when they are consistent, easy to access, and suitable for nonurgent conditions. Similar results have been reported in studies examining virtual primary care, where convenience and timely communication were frequently cited as reasons for recommending telemedicine.[11,20]

Overall, the results of this study support the idea that virtual family medicine clinics are most effective when offered as part of a hybrid model that includes both remote and in-person options. Such flexibility allows healthcare systems to respond to diverse clinical needs and patient preferences. Previous research has also indicated that combined models provide greater adaptability and can help maintain continuity of care while still offering the advantages of digital access.[14,19] Moving forward, strengthening digital literacy, enhancing technical infrastructure, and preparing healthcare providers for effective virtual communication may help improve satisfaction and support broader integration of virtual services in primary care.

Strengths and limitations

This study has several strengths. It explores patient satisfaction with virtual family medicine clinics during a period when digital health has become widely adopted. The use of a structured questionnaire and the inclusion of a diverse sample improved the clarity and reliability of the findings.[20,21] The study also contributes region-specific evidence at a time when virtual services continue to expand across primary care settings in the Gulf.[22]

At the same time, several limitations should be considered. The cross-sectional design does not allow assessment of changes in perceptions over time.[23] Self-reported data may introduce recall bias, and because the sample was restricted to one city, the findings may not reflect views in other regions of Saudi Arabia. Additionally, the study did not capture healthcare provider perspectives, and factors such as digital literacy, prior experience with virtual care, or underlying health conditions were not examined in detail.[24]

Conclusion

This study examined patient perceptions of virtual family medicine clinics within MOH primary healthcare centers in Jeddah during 2024–2025. Participants reported several benefits, particularly convenience and reduced waiting time, yet concerns remained regarding the absence of physical examination, occasional technical difficulties, and uncertainty about clinical accuracy. Differences in satisfaction and consultation preference were also associated with factors such as gender and educational level.

The findings highlight the need to strengthen digital health training, improve technical support systems, and ensure that platforms are accessible for individuals with varying levels of digital familiarity. Combining virtual and in-person services may help accommodate patient needs more effectively and support the continued integration of technology into routine care.

Limitations

This study has several limitations. First, its cross-sectional design limits the ability to assess changes in perceptions over time. Second, data were collected from a single city, which may restrict the generalizability of the results to other regions. Third, reliance on self-reported information introduces the possibility of recall bias or over- or underestimation of satisfaction. In addition, factors such as type of illness, chronic disease status, or prior clinical outcomes were not examined and may have influenced patient responses.

Author contributions

All authors contributed to the study’s conception, data interpretation, drafting of the manuscript, and approval of the final version. All authors agree to be accountable for the work presented.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.