Insights from Frontline Healthcare Workers and Patients on Post Implementation and Delivery of Telemedicine in Hard-to-reach Areas of Rajasthan: A Qualitative Study (Preprint)

BACKGROUND Telemedicine has emerged as a critical strategy to address healthcare access gaps in hard-to-reach areas, particularly in resource-constrained settings. While telemedicine services have expanded across India, evidence on post-implementation experiences of frontline healthcare workers and patients remains limited. OBJECTIVE This study explored perceptions, experiences, and implementation processes of telemedicine services among frontline healthcare workers and patients in hard-to-reach villages of Rajasthan, India. METHODS A qualitative descriptive study was conducted in five remote villages of Balotra district, Rajasthan, following a ten-month telemedicine intervention. In-depth interviews were conducted with 28 participants, including medical officers (n=3), nursing officers and ASHA/ANMs (n=10), and patients (n=15). Cadre-specific semi-structured interview guides were developed using the Consolidated Framework for Implementation Research (CFIR) and Technology Acceptance Model (TAM). Interviews were analysed using both inductive and deductive approaches in NVivo 15. Triangulation across participant groups and analytic perspectives enhanced credibility. RESULTS Telemedicine was perceived as acceptable and beneficial in improving access to care, reducing travel burden, and supporting continuity of services in hard-to-reach areas. Frontline healthcare workers reported increased clinical confidence, coordination, and workflow efficiency. Patients valued doorstep consultations, cost savings, and trust in telemedicine services, with gradual acceptance facilitated by local healthcare workers. CONCLUSIONS Telemedicine is a feasible and acceptable model for extending primary healthcare services in hard-to-reach areas when supported by trained frontline workers and responsive systems. INTERNATIONAL REGISTERED REPORT RR2-92996