Patient Experience, Satisfaction, and Characteristics at a Capsule Telemedicine Clinic: A Cross-Sectional Survey

Abstract

Background:

Telemedicine is now integral to health care delivery in Saudi Arabia. This study assessed patient characteristics, visit contexts, and patient-reported experiences at a capsule telemedicine clinic.

Methods:

We conducted a cross-sectional survey of 40 adult users of a capsule telemedicine clinic located within Masjid Al-Haram, Mecca, during a busy Ramadan Umrah period. Participants completed a questionnaire on demographics, visit context, satisfaction with services, clarity of results, and post-visit outcomes. Experience and outcome measures were summarized using descriptive statistics.

Results:

The median age was 50 years. Umrah pilgrims and other visitors comprised 75% and 25%, respectively. Visit reasons were evenly split between feeling unwell and routine checkups (40% each), with 20% for follow-up of an existing condition. Patient experience was highly positive: 95% (95% CI, 84–99) rated the location convenient, and 100% (95% CI, 91–100) rated staff helpfulness, service efficiency, and result clarity as “Good.” After teleconsultation, 100% (95% confidence interval [CI], 91–100) felt more confident about their health and would recommend the service. Twenty percent (8/40; 95% CI, 11–35) were referred for hospital evaluation, and no adverse events occurred. Exploratory subgroup comparisons suggested possible differences in referral patterns, but the small sample size precluded definitive inference.

Discussion:

Patients reported high satisfaction with the capsule telemedicine service during a Ramadan Umrah period. Most participants were not referred for immediate hospital evaluation, suggesting potential feasibility and acceptability in high-density pilgrimage settings. Further studies with clinical follow-up and objective outcome measures are needed to assess effectiveness and safety.

Introduction

Recently, telemedicine has rapidly transitioned from a niche innovation to the mainstream modality of health care delivery. ¹ Specifically, the coronavirus disease 2019 (COVID-19) pandemic catalyzed global telemedicine adoption at the peak of lockdown in April 2020, with approximately half of all outpatient visits conducted via telemedicine in some regions. ² Telehealth use has remained high since the pandemic; for example, an estimated 20–40% of adults in 2021–2022 continued to utilize it for health care needs. ¹ Per several studies, telemedicine can maintain patient satisfaction levels comparable to those of in-person consultations. In a large cohort study of nearly 39,000 clinic encounters in New York, video-based telemedicine visits achieved slightly higher patient satisfaction scores than did face-to-face visits (94.9% vs. 92.5%, p < 0.001). ³ Similarly, broad surveys indicate that over 80% of patients are satisfied with telemedicine services, a rate on par with that of conventional visits. ⁴

Telemedicine is considered a strategic solution for health care delivery in unique contexts, such as mass gatherings. Specifically, mass-gathering medicine involves providing health care during events that draw large crowds within a confined space and time, such as the Hajj. Hajj, the annual Islamic pilgrimage to Mecca in Saudi Arabia, is among the largest recurring mass gatherings in the world, with over two million pilgrims from around the globe convening each year.^5,6 Managing health care during the Hajj is exceptionally challenging due to the sheer volume and density of pilgrims and the international diversity of attendees.^7–11 Notably, Saudi Arabia has made it a national priority to deliver safe and high-quality medical services to Hajj pilgrims, expand facilities, and deploy innovations to meet the demand surge. Recently, digital health and telemedicine have been at the forefront of these innovations. ¹² Smart Medical Capsules are futuristic telemedicine kiosks equipped with self-service diagnostic tools and audiovisual links to remote physicians. They deliver on-site care to pilgrims, enabling basic examinations and video consultations without visiting a health care center, thereby reducing overcrowding at health care posts.

Health kiosks are publicly accessible digital health stations that can support health information delivery, clinical measurement collection, screening, patient registration, telemonitoring, and teleconsultation. Prior reviews show that most published kiosk studies have focused on health information provision, clinical measurements, and screening, while telehealth functions were less commonly studied. A scoping review of health kiosks reported that only 11 of 134 primary studies involved telehealth functions, highlighting the limited evidence base for telehealth kiosk models. Evidence is particularly limited in high-density, transient populations such as pilgrims and visitors during religious mass gatherings. Therefore, evaluating patient experience with capsule telemedicine clinics in Masjid Al-Haram may help clarify the feasibility and acceptability of this model in a unique mass-gathering health care setting.^13–15

Far less is known about how pilgrims perceive and engage with Health services in this unique circumstances. Understanding patient experience and acceptance will help scale up these innovations. Therefore, this study aimed to examine patient experience and satisfaction with capsule telemedicine clinic during a high-density Ramadan Umrah period at Masjid Al-Haram.

Methods

Study design and setting

A cross-sectional survey was conducted at a capsule telemedicine clinic located within the Grand Mosque (Masjid Al-Haram) in Mecca, Saudi Arabia. The survey was conducted over several days in late March 2025, coinciding with a busy Umrah period (during Ramadan), to capture a diverse mosque visitor sample. The capsule clinic is a small, self-contained telemedicine kiosk located near the courtyard of the mosque. It is equipped with integrated diagnostic devices and a video link to off-site physicians and operates with on-site assistance from medical staff (nurses or technicians). The service is provided in multiple languages, free of charge, to pilgrims and visitors.

Participants

The target population consisted of adults who used capsule clinic services during the study period. We used a convenience sampling approach, in which all individuals exiting the capsule after their consultation were approached and invited to participate in the survey. Inclusion criteria were age ≥18 years, completion of a capsule clinic visit (teleconsultation) for any reason, and ability to provide informed consent. Participants were predominantly pilgrims performing Umrah, along with some local staff and visitors. No additional sampling stratification was applied.

During staffed survey periods, adult users were approached after completing their capsule telemedicine consultation. Participation was voluntary, and no compensation was provided. The total number of capsule users during the survey window, the number approached, and the number declining participation were not prospectively recorded. Therefore, a formal response rate could not be calculated. No incomplete surveys were included in the final analysis.

Survey instrument

The questionnaire was developed specifically for this study to capture demographic (Table 1), characteristics, visit context (Table 2), satisfaction with the capsule service, clarity of communication, referral outcome, confidence after the visit, and willingness to recommend the service. Items were selected based on the practical objectives of the capsule clinic evaluation and were reviewed by two health care professionals for face validity, clarity, and relevance. The questionnaire was prepared in English and Arabic, with back-translation used to ensure consistency between versions. Responses were recorded on an adjectival scale with options including “Good” and translated equivalents of “Average/Fine” or “Bad.” Post-visit outcomes included: (a) Hospital referral: a yes/no item (“Were you referred to the hospital for further care or tests after your capsule visit?”); (b) Confidence in health: (“Did your confidence in your health increase after the visit?”; yes/no); and (c) Recommendation: (“Would you recommend others to visit the capsule?”; yes/no).

Table 1.

Demographics of the Survey Participants

Demographics	n	% (95% CI)
Age, mean ± SD	49.7 ± 16.3	—
Age, 95% CI for mean	44.5 to 54.9	—
Female	11	27.5
Male	29	72.5
Has medical insurance in Saudi Arabia	12	30.0 (18.9–44.3)
No medical insurance in Saudi Arabia	28	70.0 (55.7–81.1)
Nationality	n	%
Yemeni	17	42.5
Egyptian	6	15.0
Pakistani	3	7.5
Moroccan	2	5.0
Saudi	2	5.0
Indonesian	2	5.0
Iraqi	2	5.0
Kenyan	2	5.0
Chadian	2	5.0
Omani	1	2.5
Unclear/Other	1	2.5

CI, confidence interval; SD, standard deviation.

Table 2.

Visit Context and Care Pathways Among Visitors Using Capsule Clinics

Visit context and pathways	Category	n	% (95% CI)
Reason for capsule visit	Feeling unwell	16	40.0 (26.3–55.4)
	Routine checkup	16	40.0 (26.3–55.4)
	Checking an existing condition	8	20.0 (10.5–34.8)
How the capsule was found	By chance	30	75.0 (59.8–85.8)
	Through someone	8	20.0 (10.5–34.8)
	Haram Hospital/Employees	2	5.0 (1.4–16.5)
Referred to the hospital	No	32	80.0 (65.2–89.5)
	Yes	8	20.0 (10.5–34.8)
Reason for visiting Haram	Umrah	30	75.0 (59.8–85.8)
	Work	7	17.5 (8.7–31.9)
	Prayer	3	7.5 (2.6–19.9)

CI, confidence interval.

Formal pilot testing, construct validation, and reliability testing were not performed. The participants completed the survey on a tablet, with study staff available to clarify any questions. All responses were anonymized. The Institutional Review Board of Doctor Soliman Fakeeh Hospital approved the study protocol. No compensation was received.

Data analysis

Survey responses were entered into a spreadsheet and analyzed using the SPSS statistical software (version 21; IBM Corp., Armonk, N.Y., USA). Descriptive statistics were used to summarize patient characteristics and visit contexts. Categorical variables were presented as frequencies and percentages. We calculated the proportion of participants who responded positively to each experience/satisfaction item and outcome, along with the Wilson score and 95% confidence intervals (95% CI). Because of the small sample size, the analysis was primarily descriptive. Exploratory subgroup comparisons were performed for hospital referral by visit reason and insurance status using Fisher’s exact test. No definitive inferential conclusions were made.

Data availability statement

Survey data that support the findings of this study, including item-level responses and the data dictionary, are available from the corresponding author on reasonable request. Any shared data will be provided under a data use agreement that permits use for non-commercial research purposes only and prohibits any attempt at re-identification or further sharing.

Results

Participant characteristics and visit context

Forty participants were surveyed after their capsule clinic visits. The age ranged from 20 to 76 years, with a mean and median of 49.7 ± 16.3 and 50 years, respectively. The cohort was predominantly male (29/40, 72.5%). ∼70% (28/40) of participants reported having no medical insurance coverage in Saudi Arabia, whereas 30% had local insurance. Regarding the reason for visiting Masjid Al-Haram, the majority (30/40, 75%) were there to perform Umrah. Regarding the reason for visiting Masjid Al-Haram, 30 participants (75%) were performing Umrah, 7 (17.5%) were there for work, and 3 (7.5%) were there for prayer. Thus, while most were pilgrims, a minority of local visitors also utilized the service.

When asked, “How did you find the capsule?”, by far the largest proportion of participants, 30 of 40 (75%), reported finding it “by chance,” essentially stumbling upon the capsule during time at the mosque. A minority of two (5%) learned of it via Haram Hospital staff or employees. Participants cited varied reasons for visiting. Exactly half (20/40) had a health concern: 16 (40%) reported “feeling unwell” and sought evaluation of an acute symptom, and eight (20%) reported “checking on a condition you have.” The remainder (16/40, 40%) described a “routine checkup.”

Patient experience and satisfaction metrics

Patient-reported experience with the capsule telemedicine clinic was very positive across all measured dimensions. Most participants found the physical location and the convenience of accessing the capsule satisfactory. Specifically, 38 of 40 participants rated the capsule location as “Good,” representing 95% of the sample (95% CI: 83.5–98.6%). All participants (100%) rated the staff managing the capsule as “Good” (95% CI: 91.2–100%). All participants (100%) also rated service efficiency as “Good” (95% CI: 91.2–100%). Every participant (100%) reported that results or explanations were clear (95% CI: 91.2–100%); in response to “How clear were the results of your visit?”, 39 chose “Good” and one selected a term akin to “Fine.” For confidence in health, all 40 respondents answered “Yes” to “Did your confidence in your health increase after the visit?” In other words, everyone felt more reassured or empowered regarding their health following the use of the service. Similarly, 100% of participants said they would recommend the capsule clinic to others (95% CI 91.2–100%) (Table 3).

Table 3.

Service Quality, Clarity of Information, and Perceived Outcomes Among Visitors Using Capsule Clinics

Service quality, clarity, and outcomes	Category	n	% (95% CI)
Service efficiency	Good	40	100.0 (91.2–100)
Staff (“people responsible”)	Good	40	100.0 (91.2–100)
Capsule location	Good	38	95.0 (83.7–98.7)
	Average	1	2.5 (0.4–12.9)
	Bad	1	2.5 (0.4–12.9)
Clarity of visit results	Good	39	97.5 (87.1–99.6)
	Fine	1	2.5 (0.4–12.9)
Confidence in health increased after visit	Yes	40	100.0 (91.2–100)
Recommend the capsule to others	Yes	40	100.0 (91.2–100)

CI, confidence interval.

Finally, regarding the hospital referral outcome, eight of 40 patients (20%) were referred to a hospital for further evaluation or treatment after capsule consultation (95% CI, 10.5–34.8%). We anticipated that those visiting because of feeling unwell might have higher referral rates (because they potentially have acute conditions) compared to those visiting for routine checks. Referral occurred in 5 of 16 participants who presented feeling unwell compared with 3 of 24 participants attending for routine checkup or existing-condition review. No definitive inference can be made from these comparisons.

Discussion

This study evaluated a telemedicine capsule clinic deployed during the Ramadan Umrah period, which is a high-density pilgrimage setting, revealing encouraging patient satisfaction levels. To our knowledge, this is among the first telemedicine assessments in the field during the Ramadan Umrah period. Patient satisfaction with the capsule clinic was high, mirroring the positive reception of telemedicine reported in other settings.^16,17 Although our sample was unique, their satisfaction aligned with global telemedicine trends. For instance, prior studies of outpatient populations have consistently reported telehealth satisfaction rates well above 80%. ⁴ In an analogous survey of a gastroenterology teleclinic, 86% of the patients rated their teleconsultation as good or excellent. ¹⁸ Our findings reflect that when telemedicine is implemented with adequate support, patients readily accept it and feel that their health care needs have been met. The high satisfaction ratings suggest that surveyed users perceived the capsule clinic as convenient and acceptable during a crowded pilgrimage period, given the logistical hurdles of navigating crowded clinics or hospitals during high-density time. This high satisfaction is particularly noteworthy because Ramadan pilgrims come from varied cultural and socioeconomic backgrounds, and telemedicine services have achieved broad acceptance.

Participants appreciated receiving medical advice and basic diagnostics on-site in the capsule, avoiding lengthy travel or hospital queues. Quantitatively, telehealth saves time and cost; one large study reported an average of 2.5 h saved per telemedicine visit, translating into considerable indirect cost savings for patients. ¹⁶ This advantage is particularly valuable in the time-compressed context, where pilgrims have packed schedules.

Publicly available Umrah statistics provide useful context for interpreting representativeness. In Q1 2025, the General Authority for Statistics reported 15,222,497 Umrah performers, with males representing 60.5% and females 39.5%. In comparison, our surveyed cohort was more male-predominant, with 72.5% male participants. This suggests possible male overrepresentation among surveyed capsule users. Age distribution data for the exact Masjid Al-Haram visitor population during the survey period were not available, so representativeness by age could not be formally assessed. ¹⁹

Importantly, only a small proportion of consultations required referral to a hospital for urgent in-person evaluation. This low escalation rate is comparable to other telemedicine kiosk programs, where most issues are resolved virtually. For example, Nachum et al. reported that ∼10–16% of telemedicine visits required urgent in-person follow-up, ¹⁹ suggesting that telehealth can appropriately handle most acute concerns without compromising safety. Notably, the lack of physical examinations was not a major variable for satisfaction in our cohort. In our context, patients appeared to accept this trade-off given its convenience, though it remains an important consideration. Another insight was the apparent appropriateness of referrals correlating with clinical needs, with those feeling unwell doubling the referral rate of those on routine visits. From a quality standpoint, this is reassuring; it indicates the degree of service effectiveness. Our data did not capture clinical details; however, referrals included suspected cardiac issues and abnormal vital signs that were correctly escalated. In this framework, low referral rates for urgent care are viewed as a sign of effective telemedicine management when coupled with high patient satisfaction, both observed in our survey.

Limitations

This study had some limitations. The sample size (n = 40) was small, and the study was conducted over a short period at a few sites. Thus, the results may not be fully generalizable to all pilgrims or periods. High satisfaction could partly reflect a selection bias: those who chose to use the capsule (and agreed to participate in the survey) might have been inherently more open to telemedicine or had relatively straightforward experiences. Severely ill pilgrims would likely go directly to a hospital rather than use the capsule; therefore, our data do not capture the most critical cases. Additionally, there may have been a response bias towards positive reporting. Given that the survey was administered on-site by staff, participants might have been reluctant to criticize the service. The satisfaction scale in the survey was somewhat coarse (with “Good” as the top label in English; no option was explicitly labeled “Excellent”), which may have limited differentiation some participants might have considered the service excellent but still ticked “Good,” potentially underestimating the true satisfaction level. Despite these issues, the consistency of responses provides confidence in the overall direction of the findings.

The number approached, and the number of declining participation were not fully captured, thus, the formal response rate could not be calculated. This limits assessment of nonresponse bias. In addition, the sample was more male-predominant than the broader Q1 2025 Umrah population, and age distribution data for the exact Masjid Al-Haram population during the survey window were not fully available. Therefore, the findings should be interpreted as descriptive patient-reported experience data from surveyed capsule users rather than as representative estimates for all pilgrims or visitors. ²⁰

Additionally, the questionnaire was developed specifically for this study and underwent face-validity review only. Formal pilot testing, construct validation, and reliability testing were not performed, which may limit interpretation of the satisfaction and experience measures. Therefore, the results should be interpreted as descriptive patient-reported experience findings rather than as outcomes from a fully validated satisfaction scale.

Recommendation

“The capsule telemedicine clinic appeared highly acceptable to surveyed users and may represent a feasible model for improving access to care in high-density pilgrimage settings. Future implementation should be paired with stronger visibility, multilingual outreach, and structured evaluation of referral completion, downstream clinical outcomes, safety, nearby facility load, and cost-effectiveness. These data are needed before drawing conclusions about clinical effectiveness or broader scale-up.

In conclusion, this cross-sectional survey suggests that capsule telemedicine was feasible and highly acceptable among adult users during a Ramadan Umrah period at Masjid Al-Haram. Participants reported high satisfaction with service convenience, staff support, efficiency, and clarity of information. Most participants were managed without immediate hospital referral, although the study did not assess diagnostic accuracy, referral completion, follow-up outcomes, or clinical effectiveness. Larger studies with objective clinical outcomes are needed to evaluate the role of capsule telemedicine in supporting health care delivery in high-density pilgrimage settings.

Authors’ Contributions

O.M.S.: Conceptualization, methodology, investigation, data curation, formal analysis, visualization, project administration, writing—original draft, writing—review and editing. A.A.K.: Conceptualization, methodology, investigation, data curation, supervision, and writing—review and editing. G.R.A.: Conceptualization, methodology, supervision, and writing—review and editing. All authors have read and approved the final article and agree to be accountable for all aspects of the work.

Abbreviations Used

CI

Confidence interval

COVID-19

Coronavirus disease 2019

IRB

Institutional Review Board

SD

Standard deviation

SPSS

Statistical Package for the Social Sciences

Cite this article as: Saggaf OM, Khojah AA, Alharbi GR (2026) Patient experience, satisfaction, characteristics at a capsule telemedicine clinic: A cross-sectional survey, Telemedicine Reports, 2026, 7, 26924366261470600, DOI: 10.1177/26924366261470600.