# Attitudes and Barriers to the Use of Telemedicine in the Ultra-Orthodox Society in Israel: A Cross-Sectional Study

## TL;DR

This study explores how cultural and religious factors affect telemedicine use among the Ultra-Orthodox community in Israel, highlighting barriers and opportunities for improving healthcare access.

## Contribution

The study provides insights into telemedicine adoption among a culturally distinct minority group, emphasizing the role of religious-ideological barriers and the potential of phone-based solutions.

## Key findings

- Phone consultations are the most common form of telemedicine used by the Ultra-Orthodox population.
- Religious-ideological reasons are the main barrier to telemedicine adoption.
- Demographic factors like age, income, and internet use significantly influence telemedicine use.

## Abstract

Public health relevance—How does this work relate to a public health issue?
This study identified factors and barriers influencing the use of telemedicine among the Ultra-Orthodox population in Israel, a minority group with unique cultural constraints.Telemedicine can improve healthcare access but at the same time, it may also widen public health disparities among minority populations, especially those who face cultural or religious barriers and limited access to technology like the Ultra-Orthodox population.

This study identified factors and barriers influencing the use of telemedicine among the Ultra-Orthodox population in Israel, a minority group with unique cultural constraints.

Telemedicine can improve healthcare access but at the same time, it may also widen public health disparities among minority populations, especially those who face cultural or religious barriers and limited access to technology like the Ultra-Orthodox population.

Public health significance—Why is this work of significance to public health?
Despite cultural and technological challenges, the study’s findings reveal that telemedicine is being used within the Ultra- Orthodox community, with phone consultation, being the most common use of telemedicine services -indicating its potential as an accessible modality for populations facing cultural or technological barriers.The main barrier to the use of telemedicine among the research participants is a religious-ideological reason, and about a third of the respondents stated that they do not have a smart phone or internet- posing a specific public health challenge.

Despite cultural and technological challenges, the study’s findings reveal that telemedicine is being used within the Ultra- Orthodox community, with phone consultation, being the most common use of telemedicine services -indicating its potential as an accessible modality for populations facing cultural or technological barriers.

The main barrier to the use of telemedicine among the research participants is a religious-ideological reason, and about a third of the respondents stated that they do not have a smart phone or internet- posing a specific public health challenge.

Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health?
The study findings may assist policy makers and healthcare systems in expanding the provision of telemedicine services within the Ultra-Orthodox community, for example, by further developing and scaling telephone-based telemedicine services for this population in Israel.The finding underscores the need for careful consideration when implementing telemedicine services within the Ultra-Orthodox community, through the development of culturally tailored solutions and strategies that align with its unique characteristics and may enhance motivation to use telemedicine.

The study findings may assist policy makers and healthcare systems in expanding the provision of telemedicine services within the Ultra-Orthodox community, for example, by further developing and scaling telephone-based telemedicine services for this population in Israel.

The finding underscores the need for careful consideration when implementing telemedicine services within the Ultra-Orthodox community, through the development of culturally tailored solutions and strategies that align with its unique characteristics and may enhance motivation to use telemedicine.

The use of telemedicine by the Ultra-Orthodox (UO) population in Israel presents challenges due to unique cultural characteristics, including limited internet use for religious ideological reasons and lower levels of digital literacy. This cross-sectional survey examines the rate of telemedicine use in the UO society in Israel according to religious groups, factors, attitudes and barriers associated with telemedicine use. The study included 1460 adult UO participants using quota by gender, and religiosity groups. The participants underwent a phone interview assessing telemedicine use (defined as at least one monthly phone/video call/e-mail correspondence with a medical professional, during the last year), attitudes, and perceived barriers. In total, 39% of participants used telemedicine and 42% performed one or more administrative actions. Phone consultations were the most common mode of communication with healthcare providers. The main barrier to using telemedicine was religious-ideological. Multiple logistic regression revealed that female sex, participants aged 30–44, married status, above-average income, frequent family physician visits, and internet use significantly associated with telemedicine use. Compared to <30, adults aged 60+ years use less telemedicine (OR 0.52, 95% CI 0.32–0.86). These findings indicate telemedicine use within the UO population, though substantial cultural barriers remain, and may assist policymakers in expanding its implementation.