WHY IDENTICAL CARE FEELS LESS TRUSTWORTHY ON A SCREEN: PERCEIVED SOCIAL PRESENCE AND TRUST AS THE MECHANISM BEHIND THE TELEMEDICINE ADOPTION DEFICIT
Author(s)
Edgar José Pereira Dias, Doctor of Administration1, Everaldo Marcelo Souza da Costa, Doctor of Administration1, Jorge Brantes Ferreira, Ph.D.2, Marcia Athayde Moreira, Doctor of Controllership and Accounting3, Larissa Hellen de Sousa Carvalho, Bachelor in Administration1, Larissa Cristina Gondim Mira, Bachelor in Administration1, Natalha da Costa Marques, Bachelor in Administration1, Fernanda Leao Ramos, Ph.D.4.
1Master's and Doctorate Program in Administration, University of the Amazon, Belém, Brazil, 2Business Administration, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil, 3Master's Program in Accounting, Federal University of Pará, Belém, Brazil, 4Business Administrarion, FGV EBAPE, Rio de Janeiro, Brazil.
1Master's and Doctorate Program in Administration, University of the Amazon, Belém, Brazil, 2Business Administration, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil, 3Master's Program in Accounting, Federal University of Pará, Belém, Brazil, 4Business Administrarion, FGV EBAPE, Rio de Janeiro, Brazil.
OBJECTIVES: Telemedicine removes interpersonal cues through which patients form trust, but the resulting adoption deficit, and the mechanism producing it, remain poorly quantified. Establishing both is decisive for value assessment, since it identifies whether the deficit can be reversed. This experiment isolated the causal effect of consultation channel on trust and use intention and tested whether perceived social presence and trust transmit that effect.
METHODS: A between-subjects experiment randomly assigned 74 Brazilian adults to a vignette describing the same consultation delivered in person or by synchronous video (n=38 and n=36; 57% female; 65% aged 31 or younger). Validated seven-point scales measured perceived social presence, trust, and use intention (α=0.939 to 0.963). With clinical content held constant, ANOVA was utilized to compare conditions, and bootstrapped mediation (5,000 resamples) estimated the channel-to-intention pathway.
RESULTS: Holding care content constant, trust was lower under video (M=4.28 versus 5.80 in person) and so was use intention (M=3.82 versus 5.81), the channel explaining about a third of the variance in each (η²=0.325 and 0.311; p<0.001). The deficit ran through perception: video lowered perceived social presence, which raised trust (β=0.527) and, in turn, use intention (β=0.613); the total effect of social presence on intention was large (0.797), partly transmitted through trust (indirect 0.323; 95% CI 0.149 to 0.495).
CONCLUSIONS: Moving an identical consultation to a screen imposes a trust and adoption penalty that is not intrinsic to the medium but reflects how much human presence patients perceive. Because perceived social presence is modifiable, the penalty is recoverable by design: clinician communication that signals undivided attention (camera eye contact, naming the patient, acknowledging concerns aloud) and platform features that preserve co-presence (reliable video, visible clinician identity, minimal lag). For systems weighing virtual-first against hybrid pathways, this trust cost is addressable, and its effect on usage warrants inclusion in telemedicine cost-effectiveness models.
METHODS: A between-subjects experiment randomly assigned 74 Brazilian adults to a vignette describing the same consultation delivered in person or by synchronous video (n=38 and n=36; 57% female; 65% aged 31 or younger). Validated seven-point scales measured perceived social presence, trust, and use intention (α=0.939 to 0.963). With clinical content held constant, ANOVA was utilized to compare conditions, and bootstrapped mediation (5,000 resamples) estimated the channel-to-intention pathway.
RESULTS: Holding care content constant, trust was lower under video (M=4.28 versus 5.80 in person) and so was use intention (M=3.82 versus 5.81), the channel explaining about a third of the variance in each (η²=0.325 and 0.311; p<0.001). The deficit ran through perception: video lowered perceived social presence, which raised trust (β=0.527) and, in turn, use intention (β=0.613); the total effect of social presence on intention was large (0.797), partly transmitted through trust (indirect 0.323; 95% CI 0.149 to 0.495).
CONCLUSIONS: Moving an identical consultation to a screen imposes a trust and adoption penalty that is not intrinsic to the medium but reflects how much human presence patients perceive. Because perceived social presence is modifiable, the penalty is recoverable by design: clinician communication that signals undivided attention (camera eye contact, naming the patient, acknowledging concerns aloud) and platform features that preserve co-presence (reliable video, visible clinician identity, minimal lag). For systems weighing virtual-first against hybrid pathways, this trust cost is addressable, and its effect on usage warrants inclusion in telemedicine cost-effectiveness models.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
MT36
Topic
Medical Technologies
Topic Subcategory
Digital Health
Disease
No Additional Disease & Conditions/Specialized Treatment Areas