Telemedicine for persons with epilepsy in India: a mixed methods study.

BACKGROUND: The pandemic associated restrictions hastened adoption of telemedicine. We used a mixed methods approach to evaluate the frequency, patterns and determinants of telemedicine use for persons with epilepsy (PWE) in a low middle income country. METHODS: We carried out an explanatory sequential QUAN◊qual study of PWE on telemedicine use. We collected socio-demographic and epilepsy related data, and estimated satisfaction with telemedicine. For the qualitative part we purposively sampled 30 PWE and conducted 4 focus group discussions and 6 interviews. For the physician perspective we surveyed 49 physicians from 5 allied departments and conducted a focus group discussion and 5 key informant interviews. We explored domains of knowledge, technology, organisation, environment, innovation and health care specific factors using expert validated guides. We analysed the survey descriptively using STATA ver 14.2, STATA Corp, USA. We coded transcripts both inductively and deductively using Nvivo 12, USA. Joint displays were generated. RESULTS: Telemedicine was used by 386 (50.1%; 95%CI: 46.5-53.7%) of 770 surveyed PWE. Higher education, living farther away and lower income were significantly associated with telemedicine use. Most PWE needed help to use telemedicine. Physicians and PWE agreed appropriate selection was a facilitator for telemedicine use. Physicians were most concerned about communication while PWE were most concerned about medications. CONCLUSION: Telemedicine reached about half of PWE during the pandemic. Lack of awareness including digital literacy among PWE and lack of training and/or opportunity for providers were important barriers. Selection of appropriate provider and PWE are key factors in ensuring an optimal telemedicine encounter.