Development And Validation Of A Malay Version Questionnaire To Evaluate Remote Health Monitoring Of Covid-19 Via Telehealth Applications: Navigating Telehealth Evolution

The rapid adoption of telehealth services due to the COVID-19 pandemic has highlighted the necessity for effective tools to evaluate patient experiences. This study developed and validated the Telehealth Usability, Acceptability, and Satisfaction Questionnaire (TUASQ) for virtual COVID-19 Assessment Centres (CACs) in Malaysia, aiming to comprehensively measure usability, acceptability, and satisfaction.
Methodology
The TUASQ was developed in two phases. Initially, the questionnaire development phase included item
generation guided by the Technology Acceptance Model (TAM) and the Health Belief Model (HBM), with
feedback from a panel of six experts. Items were refined through Content Validity Index (CVI) - Item-Level
Content Validity Index (I-CVI) ≥ 0.82, Scale-Level Content Validity Index (S-CVI) ≥ 0.82, and Content
Validity Ratio (CVR ≥ 0.78); and Face Validity Index (FVI) by 10 respondents - Item-Level Face Validity Index
(I-FVI) ≥ 0.82 and Scale-Level Face Validity Index (S-FVI ≥ 0.82). The psychometric validation phase
involved a cross-sectional study of 705 respondents, recruited through convenience sampling from March to
July 2024, to perform Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA), followed by
reliability testing using Cronbach's alpha, Composite Reliability (CR), and Average Variance Extracted (AVE).
Results
Content validation showed that most items' I-CVI exceeded 0.82, indicating significant expert consensus on
relevance and clarity. The CVR also surpassed the 0.78 threshold, affirming their essential role. Face
validation indices generally exceeded 0.80, confirming the questionnaire’s clarity and comprehensiveness
from the users’ perspective. EFA with 250 participants indicated a high Kaiser-Meyer-Olkin Measure of
Sampling Adequacy (KMO) of 0.933 and significant Bartlett’s test (χ² (136) = 3752.698, p < 0.001), supporting
the factorability of the data and extracting three distinct factors. CFA with 455 participants initially showed
a poor fit, prompting model adjustments that subsequently improved the fit indices (Root Mean Square Error
of Approximation (RMSEA) = 0.076, Standardized Root Mean Square Residual (SRMR) = 0.045, Goodness of
Fit Index (GFI) = 0.94, Tucker-Lewis Index (TLI) = 0.96, Comparative Fit Index (CFI) = 0.97). Reliability
testing revealed a high internal consistency with Cronbach’s alpha of 0.975. CR for each factor exceeded the
0.70 threshold, and the AVE for each factor was above 0.50, indicating good convergent validity.
Conclusion
The validated TUASQ is a reliable and effective instrument for assessing the experiences of Malaysian
patients using virtual CAC. Demonstrating robust psychometric properties through comprehensive
validation processes, the TUASQ accurately measures usability, acceptability, and satisfaction, identifying
strengths and areas for improvement in telehealth services. This contributes to enhanced care quality and
patient satisfaction in the evolving healthcare landscape