Factors influencing user decision of telemedicine applications in Thailand

Chadakan Yan; Boonyarat Samphanwattanachai; Chitsanupong Ratarat; Phichayut Phinyo

doi:10.1371/journal.pone.0325512

Peer Review History

Original SubmissionFebruary 8, 2025
8 Feb 2025 Author Response https://doi.org/10.1371/journal.pone.0325512.r001
16 Apr 2025 Decision Letter - Alexander Maniangat Luke, Editor PONE-D-25-05830Factors Influencing User Decision of Telemedicine Applications in ThailandPLOS ONE Dear Dr. Phinyo, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Kindly review the manuscript with respect to sample size for the study and the sample used for reliability of the questionnaire. Please mention the limitations of the study. Please submit your revised manuscript by May 31 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . 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The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf . 2. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please delete it from any other section. 3. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Additional Editor Comments: The author needs to ensure that the sample size for the piloting is clearly mentioned as opposed to the total sample used for analysis. The mention of the study limitations will enhance the quality of the paper [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: I Don't Know Reviewer #3: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Interesting study. 1) Abstract = okay 2)Introduction = okay 3) Materials and methods: I would like to understand why the statistic for individuals who have been using the telemedicine application was only 30, while for individuals who have used telemedicine application services in Thailand it was 385. The discrepancy between the numbers seems quite large to me. 4) Results= okay 5) Discussion = Okay 6) Conclusion+ Okay Reviewer #2: This manuscript presents a well-structured and relevant study on the factors influencing the adoption of telemedicine applications in Thailand. Here are some suggestions for the authors: The methodology is sound, with appropriate use of exploratory factor analysis and regression, and the findings—highlighting trust, ease of use, system quality, benefits, price, and service quality—are both timely and impactful. The writing is generally clear, though a few typographical errors (e.g., “Decisio” in keywords and “service quality” in the abstract) should be corrected. The study would benefit from a clearer summary of the factor analysis results, perhaps in the form of a table or diagram. Additionally, briefly situating the findings within global telemedicine adoption literature could strengthen the discussion. Reviewer #3: The study has been well presented with apropriate sections. The methodology part has been well described and is robust, but nevertheless a seperate paragraph on limitations will improve the readablity of your study ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy . Reviewer #1: No Reviewer #2: No Reviewer #3: Yes: sudhir Rama varma ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/ . PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org . Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0325512.r002
Revision 1
17 Apr 2025 Author Response Response to Reviewers We sincerely thank the editor and reviewers for their thoughtful comments and constructive feedback, which have significantly strengthened the manuscript. We have addressed each comment below in detail and indicated specific line numbers in the revised manuscript where changes were made. All edits were made in accordance with PLOS ONE’s formatting and editorial requirements. Manuscript Title: Factors Influencing User Decision of Telemedicine Applications in Thailand Manuscript ID: PONE-D-25-05830 Editor Comments When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf. Response: We have revised the manuscript to conform to PLOS ONE formatting guidelines, including file naming and structure, as recommended. 2. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please delete it from any other section. Response: The ethics statement now appears exclusively in the Materials and Methods section (Lines 85-86). It has been removed from all other sections. 3. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Response: The reference list has been carefully reviewed for completeness and correctness. No retracted articles are cited. All references have been updated and formatted according to PLOS ONE guidelines. Additional Editor Comments: The author needs to ensure that the sample size for the piloting is clearly mentioned as opposed to the total sample used for analysis. The mention of the study limitations will enhance the quality of the paper Response: Clarification of Sample Size for Pilot Study We have clarified the distinction between the pilot sample (n = 30) and the main study sample (n = 385) in the Materials and Methods section. The revised text (Lines 89-94) reads: “Prior to data collection, a pilot study was conducted with 30 Thai individuals aged 18–65 who had prior experience using telemedicine applications to assess the questionnaire’s internal consistency. Cronbach’s alpha coefficients for each construct ranged from 0.763 to 0.984, exceeding the accepted threshold of 0.70 [15, 16], and indicating good to excellent reliability (S1 Table). This pilot sample was independent of the main study population of 385 participants used for exploratory factor analysis and regression.” Limitations Section We have added a clearly defined limitations paragraph to the Discussion section (Lines 239-247), as suggested: “This study is subject to several limitations. First, its cross-sectional design precludes the establishment of causal relationships between the identified factors and telemedicine application usage. Second, the reliance on self-reported data introduces potential recall and response bias. Third, the use of quota sampling may limit the generalizability of findings to the broader Thai population, particularly among individuals without internet access. Moreover, the study included only individuals aged 18–65 years with prior telemedicine experience, thereby excluding younger and older age groups who may exhibit different usage patterns. Lastly, although exploratory factor analysis (EFA) was utilized to identify latent constructs, confirmatory factor analysis (CFA) is warranted in future studies to validate the factor structure and ensure construct validity.” Reviewers' comments Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes Response: None ________________________________________ 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: I Don't Know Reviewer #3: Yes Response: None ________________________________________ 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes Response: None ________________________________________ 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes Response: None ________________________________________ 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Interesting study. 1) Abstract = okay 2) Introduction = okay 3) Materials and methods: I would like to understand why the statistic for individuals who have been using the telemedicine application was only 30, while for individuals who have used telemedicine application services in Thailand it was 385. The discrepancy between the numbers seems quite large to me. 4) Results= okay 5) Discussion = Okay 6) Conclusion+ Okay Response: We appreciate the reviewer’s observation and welcome the opportunity to clarify this point. The two sample sizes served distinct methodological purposes within the study design. The 30 participants were recruited solely for a pilot study to assess the internal consistency of the self-developed questionnaire. This step was conducted prior to the main data collection phase. The pilot sample consisted of Thai individuals aged 18–65 who had prior experience using telemedicine applications. Their responses were used to calculate Cronbach’s alpha coefficients for each domain in the instrument. All values exceeded the recommended threshold of 0.70, indicating satisfactory internal consistency. Importantly, this pilot sample was independent of the primary study sample used in the final analysis. The use of 30 participants in pilot reliability testing is supported in the literature. According to methodological guidelines, a sample size of 30 is generally considered sufficient to evaluate reliability measures such as Cronbach’s alpha in early-stage instrument validation, particularly when the aim is to refine survey tools rather than perform inferential analysis [1-3]. References: 1. Hertzog MA. Considerations in determining sample size for pilot studies. Res Nurs Health. 2008;31(2):180–191. doi:10.1002/nur.20247 2. Johanson GA, Brooks GP. Initial scale development: Sample size for pilot studies. Educ Psychol Meas. 2010;70(3):394–400. doi:10.1177/0013164409355692 3. Van Teijlingen ER, Hundley V. The importance of pilot studies. Soc Res Update. 2001;35(1):1–4. The 385 participants included in the main study were recruited through quota sampling across different regions of Thailand. This sample was used for exploratory factor analysis and multiple linear regression to identify determinants of telemedicine application usage. The sample size was calculated to ensure sufficient statistical power and generalizability of the findings. We have revised the Methods section (Lines 89-94) to make this distinction clearer in the manuscript. “Prior to data collection, a pilot study was conducted with 30 Thai individuals aged 18–65 who had prior experience using telemedicine applications to assess the questionnaire’s internal consistency. Cronbach’s alpha coefficients for each construct ranged from 0.763 to 0.984, exceeding the accepted threshold of 0.70 [15, 16], and indicating good to excellent reliability (S1 Table). This pilot sample was independent of the main study population of 385 participants used for exploratory factor analysis and regression.” Reviewer #2: This manuscript presents a well-structured and relevant study on the factors influencing the adoption of telemedicine applications in Thailand. Here are some suggestions for the authors: The methodology is sound, with appropriate use of exploratory factor analysis and regression, and the findings—highlighting trust, ease of use, system quality, benefits, price, and service quality—are both timely and impactful. The writing is generally clear, though a few typographical errors (e.g., “Decisio” in keywords and “service quality” in the abstract) should be corrected. The study would benefit from a clearer summary of the factor analysis results, perhaps in the form of a table or diagram. Additionally, briefly situating the findings within global telemedicine adoption literature could strengthen the discussion. Response: Thank you for the suggestion. All typographical errors in the abstract and keywords have been corrected. We have included summary tables (S2–S4) in the Supporting Information to report the results of the factor analysis, including factor loadings and explained variance. These results are described in the Results section (Lines 129-132). We have added a paragraph to the Discussion section (Lines 225-238) to contextualize our findings within the global literature. The paragraph reads: “The findings of this study are consistent with international evidence on telemedicine adoption across varied healthcare contexts. Prior research from high- and middle-income countries, including the United States, China, and several European nations, has consistently identified trust, perceived ease of use, system quality, and cost as key determinants influencing the uptake of telemedicine services [48-50]. For instance, a systematic review by Almathami et al. emphasized that trust in both healthcare providers and digital platforms is critical for the acceptance and sustained use of real-time, home-based telemedicine consultations [48]. In the context of China, Guo et al. demonstrated that perceived ease of use and service quality significantly predicted users’ intention to adopt mobile health services, particularly under heightened demand during the COVID-19 pandemic [49]. Moreover, a global systematic review by Kruse et al. underscored the role of cost as a significant barrier to telemedicine implementation, especially in low- and middle-income settings, where affordability can critically affect both initial adoption and continued use [50]. The concordance between these international findings and the present study reinforces the generalizability of the identified determinants and highlights the necessity of user-centered, context-specific strategies to support the sustainable adoption of telemedicine services.” Reviewer #3: The study has been well presented with appropriate sections. The methodology part has been well described and is robust, but nevertheless a separate paragraph on limitations will improve the readability of your study Response: We agree and have now included a standalone limitations paragraph in the Discussion section (Lines 239-247), as detailed above. ________________________________________ 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No Reviewer #3: Yes: sudhir Rama varma Response: None ________________________________________ We are grateful for the opportunity to revise our manuscript. We believe the revisions have improved the manuscript and fully addressed the comments raised by the reviewers and editorial team. Thank you for your time and consideration. Sincerely, Phichayut Phinyo, M.D., M.Sc., Ph.D. On behalf of all authors Email: phichayutphinyo@gmail.com Attachments Attachment Submitted filename: Response to Reviewer.docx https://doi.org/10.1371/journal.pone.0325512.r003
15 May 2025 Decision Letter - Alexander Maniangat Luke, Editor Factors Influencing User Decision of Telemedicine Applications in Thailand PONE-D-25-05830R1 Dear Dr. Phinyo, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. 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If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed Reviewer #3: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #3: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know Reviewer #3: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #3: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #3: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The revisions suggested by this reviewer have been made. I have only one comment: I believe the Abstract should include more information about the results. In its current form, only the last sentence provides the information that truly reflects what we expect to learn from the article. Reviewer #3: The suggestions and remarks highlighted have been addressed well. Appropriate rebuttal has been provided. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy . Reviewer #1: No Reviewer #3: Yes: Sudhir Rama Varma ******** https://doi.org/10.1371/journal.pone.0325512.r004
Formally Accepted
Acceptance Letter - Alexander Maniangat Luke, Editor PONE-D-25-05830R1 PLOS ONE Dear Dr. Phinyo, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset You will receive further instructions from the production team, including instructions on how to review your proof when it is ready. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few days to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Alexander Maniangat Luke Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0325512.r005

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