# Development and Validation of the Kazakhstan Version of the Questionnaire Based on the Telehealth Usability Questionnaire and Model for Assessment of Telemedicine Models for Evaluating the Usability and Effectiveness of Telemedicine Services Among Physicians: Multiphase Cross-Sectional Study

## TL;DR

This study created and validated a questionnaire to assess how physicians in Kazakhstan perceive and use telemedicine services.

## Contribution

The study developed TUQ-MAST-KZ, a locally adapted tool for evaluating telemedicine in Kazakhstan.

## Key findings

- The TUQ-MAST-KZ questionnaire has high content validity and excellent internal consistency.
- Organizational barriers like limited infrastructure and insufficient training were identified as key challenges.
- The questionnaire is structured clearly and relevant to clinical practice in Kazakhstan.

## Abstract

Kazakhstan has lacked validated tools to comprehensively assess physicians’ perceptions, usability, and perceived effectiveness of telemedicine services. International frameworks such as the Telehealth Usability Questionnaire (TUQ) and the Model for Assessment of Telemedicine (MAST) have not previously been adapted to the national clinical and organizational context.

This study aims to develop and validate TUQ-MAST-KZ, a Kazakhstan-adapted questionnaire integrating components of the TUQ and MAST models to assess physicians’ perceptions, usability, and effectiveness of telemedicine services.

A multiphase study was conducted, including literature review, questionnaire development, linguistic and cultural adaptation, expert content validity assessment, and pilot testing. An online survey (Google Forms) was administered to 156 physicians representing different regions and levels of health care delivery in Kazakhstan. Internal consistency (Cronbach α) and content validity indices were calculated. Additional evaluations covered clarity, structure, and practical applicability.

The final TUQ-MAST-KZ instrument contains 27 items capturing technological, clinical, organizational, and behavioral dimensions of telemedicine use. The scale demonstrated high content validity (scale-level content validity index=0.94). Internal consistency was excellent, with an overall Cronbach α of 0.924. Respondents reported that the questionnaire was clearly structured, easy to complete, and relevant to clinical practice. Organizational items identified key barriers to telemedicine adoption, including limited infrastructure, insufficient managerial support, and the need for additional training.

TUQ-MAST-KZ is a valid, reliable, and practice-oriented instrument for assessing physicians’ perceptions of telemedicine services in Kazakhstan. It can support digital health monitoring, implementation analysis, educational planning, and policy development. Future studies should evaluate its applicability across broader samples and diverse clinical specialties.