Telemedicine Use During the COVID-19 Pandemic in 8 Countries From the International Sexual Health and Reproductive Health Consortium: Web-Based Cross-Sectional Survey Study.
Tan R, Hensel D, et al. • Journal of medical Internet research • 2025
Telemedicine played a key role in addressing health care needs during the COVID-19 pandemic, with age, sex, economic status, and sexual orientation influencing its use across 8 countries.
Key Findings
Results
A majority of participants had never used telemedicine prior to COVID-19 measures, and nearly half who needed care did not use telemedicine after COVID-19 measures were introduced.
57.6% (n=1646) of 2857 participants had never used telemedicine prior to COVID-19 measures
45.9% (n=1311) of participants required health care but reported not using telemedicine services following the introduction of COVID-19 measures
Data were collected between April 2021 and July 2022 across 8 countries
Countries included Armenia (n=296), Egypt (n=889), Germany (n=138), Moldova (n=311), Nigeria (n=205), Portugal (n=951), Singapore (n=13), and Spain (n=54)
Results
Audio-based telemedicine was the most common mode of use in both high-income and low- to middle-income countries before and during the COVID-19 pandemic.
In high-income countries, 283 (71.8%) participants used audio-based telemedicine before COVID-19 and 417 (73.5%) did so during COVID-19
In high-income countries, text-based telemedicine was second most common: 152 (38.6%) before and 173 (30.5%) during COVID-19
In low- to middle-income countries, 288 (35.3%) used audio-based telemedicine before COVID-19 and 237 (40.8%) during COVID-19
In low- to middle-income countries, chat-based telemedicine was second most common: 265 (32.4%) before and 217 (37.3%) during COVID-19
Results
Older age and residing in countries with higher GDP per capita were associated with lower likelihood of ever having used telemedicine.
Older participants were less likely to have ever used telemedicine (aOR 0.99, 95% CI 0.99-1.00)
Participants in countries with higher gross domestic product per capita were less likely to have ever used telemedicine (aOR 0.99, 95% CI 0.98-1.00)
These findings were derived from multilevel modeling controlling for multiple sociodemographic factors
Results
Male sex assigned at birth was associated with lower likelihood of telemedicine use during the pandemic.
Participants of male sex assigned at birth were less likely to use telemedicine during the pandemic (aOR 0.79, 95% CI 0.65-0.96)
This association was identified through multilevel modeling
Results
Participants who perceived themselves as worse off financially were more likely to have switched to telemedicine during COVID-19 and more likely to report a poor or fair telemedicine experience.
Those perceiving themselves as worse off financially were more likely to have switched to telemedicine during COVID-19 (aOR 1.39, 95% CI 1.02-1.89)
Those perceiving themselves as worse off financially were more likely to report having a poor or fair experience of telemedicine services (aOR 1.75, 95% CI 1.34-2.29)
Results
Nonheterosexual individuals were more likely than heterosexual individuals to have used telemedicine both before and during COVID-19, and to have switched to telemedicine during the pandemic.
Nonheterosexual individuals were more likely to have ever used telemedicine prior to COVID-19 (aOR 1.35, 95% CI 1.08-1.69)
Nonheterosexual individuals were more likely to have used telemedicine during COVID-19 (aOR 1.58, 95% CI 1.24-2.02)
Nonheterosexual individuals were more likely to have switched to telemedicine during COVID-19 (aOR 1.55, 95% CI 1.09-2.21)
Sexual orientation was included as a separate model component in the multilevel analysis
Methods
The study analyzed data from the second wave of the International Sexual Health and Reproductive Health (I-SHARE) study covering sexual and reproductive health and telemedicine use.
Total sample size was 2857 participants across 8 countries
Data collection occurred between April 2021 and July 2022
The study used descriptive statistics and multilevel modeling to assess factors influencing telemedicine use
The survey covered sociodemographics, sexual and reproductive health (SRH), and telemedicine use
Singapore (n=13) and Spain (n=54) had notably small sample sizes compared to other countries
What This Means
This research suggests that telemedicine became an important tool for accessing health care during the COVID-19 pandemic, but its use was far from universal. Across 8 countries, more than half of participants had never used telemedicine before the pandemic, and nearly half of those who needed care still did not use telemedicine even after pandemic restrictions were in place. The most common way people accessed telemedicine was through phone calls (audio-based), both in wealthier and poorer countries, though the second most common method differed — text-based services in high-income countries versus chat-based services in lower-income countries.
This research suggests that certain groups were more or less likely to use telemedicine. Older people and those living in wealthier countries were actually less likely to have ever used telemedicine. Men were less likely to use it during the pandemic. People who felt they were financially worse off were more likely to switch to telemedicine, but they also reported worse experiences with it. Notably, nonheterosexual individuals were consistently more likely to use telemedicine — both before and during the pandemic — and to switch to it during COVID-19, which may reflect prior familiarity with telemedicine as a way to access sexual and reproductive health services.
This research suggests that while telemedicine helped fill gaps in health care access during the pandemic, significant barriers remain, particularly around quality of experience for economically vulnerable populations and overall adoption across different demographic groups. The findings highlight the need for telemedicine services that are accessible and equitable, and point to the importance of understanding who is — and who is not — being reached by digital health tools during health emergencies.
Tan R, Hensel D, Ivanova O, Bravo R, Olumide A, Adebayo E, et al.. (2025). Telemedicine Use During the COVID-19 Pandemic in 8 Countries From the International Sexual Health and Reproductive Health Consortium: Web-Based Cross-Sectional Survey Study.. Journal of medical Internet research. https://doi.org/10.2196/60369