Convenience sampling of users of DTC telemedicine services was used. Participants were recruited through an Australian digital health care company offering multiple DTC telemedicine services organized around targeted treatment pathways for specific conditions [16]. The company is a leading provider of DTC telemedicine services in Australia, with recent expansion internationally. At the time of data collection, the 5 different services it ran broadly dealt with the following areas: (1) Women’s health care focusing largely on weight management and menopause, (2) Men’s health care, (3) Skin care, (4) Women’s fertility, and (5) Sexual well-being. The company moderates closed Facebook groups for users of these different services to interact with one another, share their journeys, and ask questions (medical advice is not permitted in the Facebook groups). An advertisement to take part in the survey was posted on the company’s closed Facebook communities in November 2023 seeking the perspectives of Australian adults on their use of DTC services.

The web-based survey was conducted via REDCap hosted by Macquarie University. The survey included questions on traditional health care utilization, followed by a series of closed- and open-response questions about their use of DTC services, including reasons for using and their perceived benefits and concerns (see Multimedia Appendix 1). Finally, the survey asked for demographic information. All questions were optional to complete.

To assess reasons for using DTC telemedicine services, respondents were asked a series of closed-response questions about experiences with traditional health care services, including whether they had seen a general practitioner (GP) over the preceding 12 months, reasons for accessing traditional health care, satisfaction with this care, and ease of getting an appointment. They were also asked about how they had come to initiate the use of the DTC telemedicine service (ie, recommended by a health care provider, recommended by a family member or friend, or self-initiated) and their main reason(s) for using the service from a list of possible reasons derived from a literature review [3,5-9,16], which included, for example, challenges with accessing traditional health care and convenience.

To assess the perceived benefits of DTC services, we adapted the empowering outcomes scales from van Uden-Kraan et al [12] All 4 items from “being better informed” were used (eg, “I feel better informed as a patient”). From their “increased optimism and control” subscale, 5 of the 8 original items were used (eg, “I feel more in charge of the course of my health concern/s”). Minor modifications were made to wording, such as changing “illness” to “health concern/s.” Items for these subscales are answered on a 5-point Likert (1=completely disagree to 5=completely agree). To assess concerns about using digital health care technologies, participants were asked to select as many as apply from a range of options, derived from the literature [3,5-9,16], including safety and quality and the lack of regulation. Participants were also asked 2 open response questions, one about what they liked about using the DTC telemedicine service (ie, benefits), and one about their concerns with using digital health care technologies.

Closed-ended data were analyzed using descriptive statistics in IBM SPSS Statistics (version 29; IBM Corp.) to summarize patterns in experiences with traditional health care services, DTC telemedicine services accessed, reasons for using, perceived benefits, and concerns with using digital health care technologies. For location, postcode data were mapped to the Australian Statistical Geography Standard and classified as major city, regional area, or remote area. For the 2 open response questions, inductive content analysis [21] was conducted by KC in Microsoft Excel. This involved initial open coding to write short summaries (codes) of meaning units within each response; this was followed by identifying recurrent meaning units across responses to identify categories. Multiple categories could be present in the response for a single participant and were summarized by frequency and with example extracts.

The study received ethics approval from the Macquarie University Faculty of Medicine, Health and Human Sciences Low-Risk Ethics Subcommittee (No. 520221256844148). All participants opted in to participate and provided voluntary informed consent prior to completing the survey. The survey was designed to be anonymous, with no identifiable data collected. Those who took part in the survey had the option of going into the draw to win a $250 gift card.

Most participants (136/151, 90.1%) had seen a GP in the previous 12 months. Of the 15 respondents who had not, most (11/15, 73.3%) had not needed to; only 2 indicated it was too difficult to get an appointment, and 1 suggested it was too expensive. The most common reasons for seeing a GP were to get a prescription (67/136, 49.3%), management of an ongoing condition (64/136, 47.1%), a general or preventive health check-up (49/136, 35.0%), and for information/treatment of a new condition (46/136, 33.8%). A large majority of participants (118/136, 86.8%) were somewhat or very satisfied with the quality of care they received from their GP in the preceding 12 months. Approximately half found it easy or very easy to get an appointment with their GP (76/151, 50.3%), while a quarter found it difficult or very difficult (38/151, 25.2%), and the rest were neutral in their response. A majority of respondents either “never” (55/136, 40.4%) or “rarely” (23/136, 16.9%) discussed the information, advice, support, or treatment they received from the DTC telemedicine service with their GP; of the 136 respondents, 20 (14.7%) “sometimes” did and 22 (16.2%) either “often” or “always” talked to their GP.

Over four-fifths of respondents (128/151, 84.8%) indicated that they had self-initiated use of the DTC telemedicine service, while 16 of 151 (10.6%) reported that they had received a recommendation from a friend or family member; only 2 of 151 (1.3%) responded that their health care provider had recommended using the service. Reasons for accessing DTC telemedicine services are displayed in Table 2. The most frequently cited reasons were “convenience in accessing information, support, and treatment at a time and place of my choosing” (97/121, 80.2%), “the flexibility and choice available online” (71/121, 58.7%), and “difficulty in seeing a traditional health care provider in the timeframe I would like (eg, appointments booked out weeks in advance or times not suitable for me)” (44/121, 36.4%). Thirty-nine participants among 121 (32.2%) selected one of their main reasons as “gaining access to services or medications not available to me through traditional healthcare services.”

Figure 1 displays the frequency of participants’ responses to items on “being better informed” and having “increased optimism and control” from using the DTC telemedicine service. Most participants agreed that the information, advice, and support they received from the service had made them feel more in control over what was happening to them (106/128, 82.9%) and feel more in charge of the course of their health concern/s (102/130, 78.5%). Most disagreed that the use of the DTC telemedicine service had led them to feel less in control over what was happening to them (98/128, 76.6%). The majority of respondents agreed that they had more correct knowledge at their disposal to manage their health concern/s (92/128, 71.9%) and felt better informed as a patient (94/131, 71.8%).

Seventy-four participants (74/151; 49%) provided an open response for what they liked about using the DTC telemedicine service(s). Eight categories of benefits were identified (Table 3), with “ease and convenience” (n=46) being the most frequently cited.

Table 4 shows the frequency of participants’ concerns with using digital health care technologies. The most frequently selected concern was “the costs associated with some of these services” (40/115, 34.8%), followed by “concerns over privacy and what the information I provide will be used for” (31/115, 27%).

Thirty-four respondents (34/151, 22.5%) provided open response answers for their concerns about using digital health care technologies, which were coded into 6 categories. The most frequent category of concern was related to “privacy and data security” (n=13). Table 5 summarizes the categories of concerns with using digital health care technologies.

This study of Australian users of new DTC telemedicine services, organized around specific health issues (eg, weight loss and skin concerns), demonstrated that users largely seek out these services of their own volition for reasons of convenience and flexibility. As a result of using these services, most users feel they are better informed and have greater control over their health concerns; they perceive further benefits in the ease of use and, to a lesser extent, the quality of the services. Users were less likely to indicate concerns with using digital health care technologies and, where they did, these mostly related to personal factors such as the costs of services or reservations about the privacy of personal health information.

Commentaries and empirical research have previously indicated that the use of DTC telemedicine services may support access to health care [3,10]. However, results from the present study do not indicate difficulty in accessing health care is a great driver of use, with most of the sample participants having seen a GP in the past year, reporting satisfaction with the service, and the ability to get an appointment. Prior research largely comes from the United States, which has a more pluralistic health care system with greater inequity in access than Australia. Moreover, these studies have predominately focused on DTC services providing synchronous “virtual visits” for urgent, but not life-threatening, conditions [3,5,10], rather than the new forms of DTC that offer “lifestyle medications” for the management of often ongoing health issues (eg, weight management, acne, and erectile dysfunction) [8,16]. For the latter service type, our results indicate that the benefit may be less in accessing health care than in accessing specific treatments that are otherwise inconvenient, difficult, or impossible to access through one’s traditional health care provider, even despite the increased adoption of telehealth in Australian general practice since the COVID-19 pandemic [22].

Very few respondents indicated that they used DTC telemedicine to complement traditional health care (such as getting second opinions or checking symptoms). This suggests DTC telemedicine may be tapping into previously unmet health care needs, rather than simply replacing conventional GP visits. Most respondents also rarely if ever discussed using these services with their GP, further implying the provision of care for their specific health condition remained separate to their use of traditional health care services. What is apparent, though, is that use of these services contributed to a sense of empowerment among participants, who indicated feeling better informed and able to manage their health condition, a finding also identified by Kyweluk [23] in a study of users of DTC ovarian reserve testing services.

Compared with these benefits, participants in this sample far less frequently highlighted concerns with using digital health care technologies, such as DTC telemedicine services. The most common apprehensions were related to personal issues of privacy and cost; few respondents indicated feeling concerned about more systemic factors such as lack of regulation, integration, and quality and safety, despite these being frequently raised in the literature [3,8,9]. The perception of these services as costly may be more pertinent to Australian consumers, many of whom have historically been able to visit a GP without incurring out-of-pocket costs [24], and then access heavily subsidized medicines through the Pharmaceutical Benefits Scheme [25].

The use of existing subscales on patient empowerment [12], and the triangulation of qualitative and quantitative data analysis, are strengths of the study. Limitations include potential self-selection bias in responses to the survey. Data were missing for some demographic characteristics and other variables due to attrition and the fact that all responses were optional; we lack information as to the profile of users of these DTC telemedicine services for specific health conditions to understand how representative the sample may have been.

This study provides insights into perspectives of patients who use DTC telemedicine services for specific health concerns, which is an emergent area of the health care system and one with limited research to date. Through a survey of users, benefits of these services were identified, including ease of access, convenience, and providing a sense of empowerment. Some concerns were identified related to data privacy and the costs of utilizing the services. Further research is needed to understand how the use of DTC telemedicine fits into the existing landscape of primary health care and the degree to which the use of these services provides a complement, supplement, or alternative to traditional general practice.