1 Introduction

The use of telehealth services has significantly increased over the past decade [1,2,3], which has also been a national goal in Finland [4]. The COVID-19 pandemic in 2020 brought about changes, especially in the number of remote consultations conducted [5], as health care professionals quickly adapted to provide services to those in remote work and those in quarantine who could not physically attend appointments due to the risk of infection [6,7,8].

Telehealth services refer to the use of technology to examine, monitor, treat, diagnose, and make treatment decisions for clients or patients, such as through video communication. The content of telehealth services is comparable to physical visits [4, 9] and, generally, telehealth services aim to replace these face-to-face visits [10]. It has been found that the successful implementation of telehealth services is influenced by their perceived necessity, ease of access and the ability to use them efficiently and flexibly [11]. The adoption of telehealth services is also affected by the service provider’s positive attitude towards technology and experience of the benefits of telehealth services in daily practice [12]. It is also important that professionals have sufficient knowledge and skills to implement telehealth services, as the introduction of technology changes the ways of working [7, 13].

Clients benefit most from telehealth services when they are easy to use, readily available and speed up access to treatment, and when the security of telehealth services is ensured [3, 14,15,16]. Professionals, on the other hand, perceive telehealth services as a way to improve service availability, save time, operate cost-effectively, speed up access to treatment and promote regional equity in accessing services [15, 17]. However, there are also negative experiences, such as the reduction of face-to-face encounters [18], and technical malfunctions in the equipment and connections required for telehealth services can hinder the delivery of service and treatment [15, 19].

In Finland, the adoption of telehealth services due to the COVID-19 pandemic also accelerated in occupational health (OH) care [5]. In addition, changes in the compensation paid by the Social Insurance Institution of Finland to employers for OH costs have influenced the development of telehealth services in OH. Since 2016, treatment visits carried out remotely as part of OH services have been reimbursable [4], and preventive OH services have been reimbursable since 2017.

In OH care treatment visits are intended for those employees who have become ill or whose previous illnesses require health care assessment or follow-up. Preventive OH care encompass health check-ups and collaborative negotiations such as work ability discussions between employees and their supervisors and action plan consultations with employers [9]. Apart from treatment visits, health check-ups, and work ability negotiations, OH care also encompass counselling visits, which provide information and guidance to employees about work-related illnesses, occupational accidents, health-promoting factors associated with work and the work environment, and about lifestyles. The OH core team, consisting of an OH physician, an OH nurse, an OH psychologist, and an OH physiotherapist, all contribute to delivering these services. [20]

OH care also offers various online and mobile services, allowing clients to, for example, book appointments, monitor their own health status, access patient records entered by professionals, renew their prescriptions, or receive online coaching. Additionally, digital tools for managing work ability are offered to employers, HR managers and supervisors [21]. However, it is important to understand the experiences of professionals providing telehealth services, especially since services have previously been almost exclusively provided face-to-face [7].

Research on the usefulness and ease of use of occupational telehealth services in client work is still scarce. Previous studies have focused on digital workplace surveys [22], remote counselling and guidance [23] and work ability negotiations (manuscript). According to the results, technology can be used to assess workplace conditions remotely, but the technology must provide comprehensive information on occupational hazards, workload and resources for health assessment, and sufficient expertise is required to use the technology effectively [22]. Remote counselling and guidance by OH professionals are also possible when service users have a positive attitude towards technology use, and the professional has the desire to develop their remote counselling skills [23]. However, telehealth services bring unique characteristics to the interaction. The dynamics of conversation, collaboration and participation can change in video-mediated meetings compared to face-to-face activities (manuscript).

Previously, the digital skills of OH care professionals have also been investigated, which means, for example, the ability to create a positive client experience and use electronic tools as technology changes the way work is done. According to these studies, technology is perceived as streamlining work, improving the quality of client work, and streamlining information exchange and reporting [13, 18]. According to OH physicians, digitalisation has also had an impact in that clients have a more active role, information retrieval has been facilitated, but digitalisation has not accelerated actual reception work [24].

Although telehealth services are generally perceived positively in health care, more research is needed on their use [17, 18] and the experiences of professionals [25]. The purpose of this study is to investigate the experiences of OH care professionals (OH physicians, OH nurses, OH physiotherapists and OH psychologists) in the use of telehealth services in OH care, as well as their usefulness and ease of use. In addition, the aim is to identify factors related to the perceived usefulness and ease of use of occupational telehealth services. The aim of the study is to produce information that can be utilised in the development of telehealth services in OH care.

The research questions are:

  1. 1.

    How much is the use of occupational telehealth service in health check-ups, counselling visits, work ability negotiations, and treatment visits?

  2. 2.

    How useful and easy to use are telehealth services in client work, as assessed by occupational health professionals?

  3. 3.

    What factors are associated with the perceived usefulness and ease of use of telehealth services as experienced by occupational health professionals?

2 Methods

The study is a part of the project implemented by the Finnish Institute of Occupational Health and funded by the Social Insurance Institution of Finland. Seven OH care providers participated in the study, and their designated contacts forwarded an electronic survey to their staff who provided OH services in May and June 2022. One reminder was sent to encourage responses. A total of 380 individuals responded to the survey, resulting in a low response rate of 8.7%. Of those who opened the survey link (n = 1013), 37.5% responded to the survey. This article reports on the results of OH physicians, OH nurses, OH physiotherapists and OH psychologists who had experience with the use of occupational telehealth services (n = 362).

The survey used in the study included questions on the respondent’s background information: profession, education, work experience, number of employee clients, number of employer clients, information and communication technology skills (ICT) related to the use of occupational telehealth services, as well as statement questions about the usefulness and ease of use of occupational telehealth services. Davis’ (1989) Technology Acceptance Model (TAM) was used in the survey design, in which usefulness refers to the improvement of technology in job performance, and ease of use refers to the ease of using technology. According to Davis (1989), perceived ease of use affects perceived usefulness. That is, the easier the system is to use, the more useful it is generally perceived to be. Perceived ease of use and perceived usefulness are also related to a person’s intention to use the system [26]. The survey was pretested with five OH professionals, and the questionnaire was refined on the basis of the feedback received.

The survey data was analysed descriptively using frequency analysis in SPSS Statistics 27 software. Cross-tabulation and the Chi-square test were used as statistical methods to examine differences between occupational groups in the use of telehealth services on the basis of the responses. The key variables of the survey (variables that investigate the usefulness and ease of use of telehealth services) were aggregated into sum variables, and their associations with the respondents’ occupational groups, work experience, employee and employer client numbers, and self-assessed ICT skills were examined. Before forming the ease of use sum variable, the scales of the variables were coded in the same direction. Additionally, before forming the sum variables, their consistency was measured with Cronbach’s alpha coefficient, which was 0.921 for the usefulness sum variable and 0.755 for the ease of use sum variable. One-way analysis of variance (ANOVA) and Scheffe’s post-hoc test were used for pairwise comparisons when examining group-level differences in the sum variables based on the TAM model. A p-value < 0.01 indicates a statistically significant result.

3 Results

Of the 362 respondents, 222 were OH nurses, 55 were OH physicians, 52 were OH psychologists and 33 were OH physiotherapists. The majority of respondents (290/359, 80.8%) had completed or were currently undergoing the necessary training for providing OH services.

Most respondents (n = 362) had more than two years of work experience in OH services: 29.6% had over 2–10 years, 27.3% had over 10–20 years and 16.0% had over 20 years of experience. Half of the respondents (183/360, 50.8%) rated their ICT skills for their work as good, while a quarter (90/360, 25.0%) rated them as very good. Table 1 shows the distribution of respondents’ work experience, the number of employee and employer clients they are responsible for, and their work-related ICT skills by occupational group.

Table 1 Respondents’ characteristics
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3.1 The usage of telehealth services in occupational health care

Three-quarters of the respondents (281/362, 77.60%) had used telehealth services in their OH care work for at least one year. Almost all of those who used telehealth services (338/361, 93.6%) had access to guidelines on the use of telehealth services provided by their employer, but slightly fewer (308/361, 85.3%) had received training from their employer on the use of telehealth services.

Table 2 presents the results regarding the usage of telehealth services in health check-ups, counselling visits, work ability negotiations, and treatment visits. Among OH professionals, the use of telehealth services was most prevalent in health check-ups conducted by OH nurses (192/219, 87.7%). In contrast, the majority of OH physicians (33/54, 61.1%), OH psychologists (23/43, 53.5%), and OH physiotherapists (23/30, 76.7%) reported that they do not use any telehealth services at all in the health check-ups they conduct. The most common use of telehealth services was observed in counselling visits, although OH physiotherapists (2/32, 6.3%) used them less frequently on a weekly basis compared to other professionals. Among OH psychologists, over three-quarters (40/52, 76.9%) reported utilizing remote services for counselling visits on a weekly basis, while nearly half of the OH nurses (104/219, 47.5%) and slightly fewer OH physicians (22/54, 40.7%) did the same. Instead, OH physicians reported the highest use in treatment visits and work ability negotiations (49/55, 89.1%). The groups showed statistically significant differences (p < 0.001).

Table 2 Use of occupational telehealth services at client work by occupational health professionals
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3.2 Perceived usefulness and ease of use of occupational telehealth services

According to attitude statements describing the usefulness of occupational telehealth services (Fig. 1), about one-third of respondents completely agreed that telehealth services are useful in client work (119/362, 32.9%). Just over a quarter of respondents completely agreed that telehealth services give them greater control over their work (102/362, 28.2%), and about one-fifth agreed that they also make it easier for them to do their job (77/361, 21.3%).

Regarding the ease of use of occupational telehealth services (Fig. 2), almost half of the respondents completely agreed that operating telehealth services is easy to learn (172/361, 47.6%) and two-fifths (145/361, 40.2%) that it is easy to remember how to perform tasks using telehealth services. Additionally, about one-fifth of respondents (71/361, 19.7%) completely agreed and almost half (173/361, 47.9%) somewhat agreed that using telehealth services requires a lot of mental effort.

Fig. 1
figure 1

Professionals’ experiences of the usefulness of occupational telehealth services (% of respondents)

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Fig. 2
figure 2

Experiences of the ease of use of occupational telehealth services (% of respondents)

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3.3 Factors associated with perceived usefulness and perceived ease of use of occupational telehealth services

We analysed the usefulness and ease of use of telehealth services in OH care using analysis of variance (ANOVA) and compared the differences according to background variables (professional group, work experience, number of workplace clients, number of employee clients, self-rated ICT skills, received guidance on using telehealth services) (Table 3). Regarding usefulness, the ANOVA test results showed statistically significant differences among professional groups (F(3, 358) = 5.704, p = 0.001), work experience (F(3, 358) = 5.095, p = 0.002), and ICT skills (F(2, 357) = 10.509, p < 0.001). Regarding ease of use, the ANOVA test showed highly statistically significant differences among professional groups (F(3, 357) = 6.649, p < 0.001) and ICT skills (F(2, 356) = 43.156, p < 0.001).

Post-hoc tests (Scheffe) showed (Table 3) that regarding the evaluation of telehealth services’ usefulness, OH nurses’ ratings (mean 3.63) significantly differed from both OH physicians’ (mean 3.25) and OH physiotherapists’ (mean 3.10) ratings (both p = 0.008). The ratings of those who had worked in OH care for up to two years (mean 3.75) regarding the usefulness of telehealth services significantly differed (p = 0.001) from those who had worked in OH care for over 10 but up to 20 years (mean 3.25). Regarding perceived usefulness and self-rated ICT skills, the ratings significantly differed (p < 0.001), with those who had excellent ICT skills (mean 3.77) finding telehealth services more useful than those who rated their ICT skills as moderate or poor (mean 3.18). The Scheffe test used for pairwise comparisons of group means also showed that regarding perceived ease of use and self-rated ICT skills, all group means differed statistically significantly from each other (p < 0.001).

Table 3 Differences between perceived usefulness and ease of use of occupational telehealth services and respondents’ characteristics
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4 Discussion

The purpose of the study was to investigate the experiences of OH professionals regarding the usage, usefulness, and ease of use of telehealth services. The results revealed that telehealth services were most commonly used for counselling visits, particularly by OH psychologists. The next most common use of telehealth services was for treatment visits by OH physicians. OH nurses also frequently provided treatment visits remotely, but they conducted health check-ups remotely more often than any other services. The results are consistent with the annual statistics on OH care [27] regarding health check-ups, counselling visits, and treatment visits. In addition, the results showed that telehealth services were the least frequently used for work ability negotiations, although OH physicians participated in these negotiations more often than other professional groups. It should be noted that, in general, OH physicians participate in work ability negotiations more often than other professional groups [28].

The disparities in the use of telehealth services undoubtedly arise from the differing focuses of OH professionals’ tasks in health check-ups, counselling, work ability support, and a treatment of illnesses. Also, these differences might stem from the frequency with which each professional typically conduct these services. While a multiprofessional approach is a common practice in OH services, visits related to work ability and illnesses often initiate with OH physicians, as they quite often arise from an underlying reason hindering the ability to work.

The survey did not ask for the reasons for using or not using telehealth services, but the limited use of telehealth services may be due to a reluctance to use them, also [29]. This reluctance may be due to the perception that telehealth services are disruptive [30] and complex [31], or that their use requires a lot of new learning [32]. Previous research indicates that professionals emphasize the importance of technology being user-friendly and easy to learn. Additionally, they expect technology to improve the quality of care [18, 33]. If this is not the case, professionals become frustrated and may be resistant to using new technology. Frustration is often caused by the lack of integration of the technology with other existing information systems [33]. Besides, the technology use may be low if they are not sufficiently integrated into the care processes [11].

When introducing telehealth services, it is important to consider the legislation that guides the operations. In Finland, for example, the law requires that the providers of telehealth services have the appropriate training for the operation [4]. The results also showed that almost all respondents had received instructions from their employers on how to use telehealth services, and most had also received training on using telehealth services. Additionally, the results showed that the self-assessed ICT skills of OH professionals were at a good level for the majority, but not for all. There is scope for improvement, as one in four respondents reported having moderate or poor ICT skills. This result is consistent with a study that investigated the digital skills of OH professionals, which also found that professionals are often more concerned about their clients’ skills in using telehealth services than their own skills [18]. It will be important to ensure the competence of everyone using the new technology when introducing it [7, 33], as it may already be difficult to operate in OH care without technological skills. It is also important to emphasize the possible limitations of using telehealth services in addition to their benefits [34] in training sessions for professionals. Adequate support should also be provided, as the support of more technologically proficient colleagues is valued by those whose skills are not as good [35, 36].

According to the theoretical framework of the TAM model [26], which was the basis for this study, perceived ease of use affects perceived usefulness. In other words, the easier a system is to use, the more useful it is generally perceived to be. Perceived ease of use also has a connection to whether a person intends to use the system. On the other hand, perceived usefulness is also related to a person’s intention to use the system, since a system that is perceived to be useless would not be desirable to use, even if it were easy to use. Although the TAM model has been widely used in research, it has also been criticized for being too narrow and simplistic [37, 38]. However, in this study, the simplicity of the TAM model proved to be a useful framework for investigating the use of telehealth services. In the future, it would be necessary to examine in more detail how OH professionals’ practices change when OH services are provided remotely comparing to face-to-face services.

Regarding the perceived usefulness and ease of use of occupational telehealth services, this study provides a very positive picture as perceived by OH professionals. When the results consider those who disagree with positive attitude statements and those who agree with negative attitude statements, it can be said that there is room for improvement in the perceived usefulness and ease of use of occupational telehealth services.

According to the results of the study investigating the usefulness of occupational telehealth services, the majority of respondents found telehealth services to be useful, but about a quarter of them assessed that telehealth services do not improve the quality of the work. In addition, a quarter of the respondents believed that telehealth services do not allow them to work more than usual, and even one-fifth assessed that telehealth services do not increase work efficiency or make it possible to accomplish tasks more quickly. However, previous research suggests that professionals generally expect telehealth services to increase service efficiency. They are perceived as efficient when they speed up work processes, but inefficient when the technology used is slow and time-consuming [15, 29, 35].

According to the results that investigated the ease of use of telehealth services, the respondents mainly felt that using telehealth services was easy and also easy to learn. However, just over a quarter of respondents felt that the technical implementation of telehealth services was sometimes inflexible, and they cannot use telehealth services as they wish. When technological solutions are perceived as inflexible or unnecessary, professionals become frustrated and may even be reluctant to use them [35]. A clear majority also felt that using telehealth services requires a lot of mental effort. This is required, for example, in ensuring data protection and information security in client work, when a professional must always assess on a on a case-by-case basis whether it is suitable to provide the service remotely [4]. This assessment must also consider a good OH practice [20] and professional ethical regulations [4]. Therefore, it is recommended that professionals have prior work experience in face-to-face client work in OH before adopting telehealth services.

We also investigated factors related to the perceived usefulness and perceived ease of use of telehealth services by OH care professionals. Professional group, work experience and ICT knowledge were related to the experience of the usefulness of telehealth services, while only ICT skills were related to the ease of use of telehealth services. However, the number of employer or employee clients appeared to not have a significant role in the perceived usefulness or ease of use of telehealth services.

The study showed that OH nurses had more positive experiences regarding the usefulness and ease of use of telehealth services. In addition, the results showed that those with less than two years of experience in OH perceived telehealth services as more useful than those with over 10–20 years of experience. Our assumption is that respondents with less work experience were younger and therefore more accustomed to using technology than their older colleagues [39]. Good ICT skills were also found to be associated with perceived usefulness and ease of use. However, it has been noted that it is not age but those who rate their ICT skills highly who are more likely to use telehealth services [2].

4.1 Strengths and weaknesses of the study

This study has both strengths and weaknesses. The strength of the study lies in its timeliness, considering the rapid growth of telehealth services utilization since 2020. Another strength is that we have provided a cross-sectional snapshot of the use of electronic OH services and the factors associated with their perceived usefulness and ease of use. The third strength of the study is the widely used TAM model [26], which allows for comparability of the research findings with other similar studies.

The weakness of the study can be seen in the fact that, although it can identify general trends in the use of remote services, it does not consider individual factors that affect the participation of professionals. When examining the results, it should be noted that the different roles and responsibilities of OH professionals vary. For example, OH physicians play a central role in diagnosing diseases, while OH nurses focus more on preventive work and OH physiotherapists and OH psychologists on guidance.

A low response rate is common for web-based surveys [40]. Thus, the weakness of this study is also that generalizations derived from this study could be biased due to low response rate and should therefore be made with caution. However, considering only those who opened the survey, the response rate was quite reasonable. The third weakness of this study is that the study is based on self-assessments. However, some valuable information can only be collected using a questionnaire as was done in this study. Also, the weakness is that it was not possible to collect information on the non-respondents.

Although the study focused on a small group of OH professionals, the findings of the study may have applicability to the other practical telehealth services as well. However, the questionnaire used in this study did not include more detailed questions about how OH professionals use and experience telehealth services concerning the goal of their work. This issue is important for future studies. Moreover, all the other limitations of this study may reveal opportunities for future academic research on the use of telehealth services among health professionals.

5 Conclusions

There was a consensus among OH professionals regarding the usefulness and ease of use of telehealth services in client work. While telehealth services are generally expected to speed up and streamline work, this is not always the case in OH care according to this study. The use of telehealth services was found to be easy in OH care, but it requires users to be attentive. The results also revealed that in OH profession, work experience and ICT skills defined the perceived usefulness of telehealth services, while perceived ease of use was only related to the professional’s ICT skills. We conclude that when developing and implementing occupational telehealth services, it is important to ensure that OH professionals using telehealth services have good skills with the available digital working tools, as well as experience with face-to-face client work in OH care. In addition, we recommend that training should not only emphasize the benefits of telehealth services but also the factors that may make their work more complicated.