Volume 33 Number 4

Background

The global burden of chronic wounds is substantial, contributing significantly to morbidity, disability, and healthcare costs worldwide.^1–3 Traditionally, wound care has required in-person visits to healthcare facilities, involving comprehensive assessments by multidisciplinary care teams.^4,5 However, barriers such as limited access to facilities, conflicting work time or caregiving responsibilities, mobility challenges, and transportation issues can impede timely wound care access, especially in regions with vast geographic distances and underserved areas.^6,7 In recent years, virtual wound care services have emerged as a promising solution to address these challenges, offering patients a convenient and accessible alternative to in-person care.^8–10

Virtual wound care services involve remote assessment, monitoring, and management of wound healing through digital health platforms, telemedicine, and other internet-enabled technologies.¹¹ These services enable healthcare providers to connect with patients virtually, offering support through video consultations, mobile applications and wearable technology that monitors wound progress.^12–14 A growing body of evidence suggests that virtual wound care services can reduce hospital admissions, lower healthcare costs, and improve patient outcomes, particularly in managing chronic wounds, diabetic foot ulcers, and post-surgical wound care.^15–17

In Saudi Arabia, geographical and infrastructural challenges limit access to timely healthcare, and virtual wound care services are gaining traction as an innovative model of healthcare delivery.¹⁸ The Saudi healthcare system has shown strong commitment to advancing digital healthcare solutions. Vision 2030 is a set of long-term goals that includes the aim to improve healthcare accessibility and efficiency in Saudi Arabia through telemedicine and e-health services.¹⁹ Several types of virtual wound care services are available to patients who live in Saudi Arabia. Video-based teleconsultations allow direct, real-time communication between patients and healthcare providers, enabling the assessment of wound status, personalised treatment guidance, immediate responses to patient inquiries and evaluating the wound care plan. Mobile health applications provide platforms for patients or caregivers to upload wound photos, document changes, and receive automated feedback on wound healing progress. Some virtual services integrate wearable sensors and monitoring devices, which transmit data on wound temperature, moisture levels, and other healing indicators to healthcare providers for continuous monitoring. These advancements allow providers to detect early signs of complications and adjust treatment plans promptly, enhancing the continuity and quality of wound care.²⁰

Despite the promising benefits of virtual wound care, patient and caregiver satisfaction remains a pivotal element in the successful adoption and sustainability of these services.²¹ Ensuring that virtual wound care aligns with patients’ needs and preferences, as satisfaction levels can directly impact adherence, engagement, involvement and ultimately outcomes. Yet, in Saudi Arabia, the experiences and satisfaction levels of patients and caregivers with virtual wound care have not been extensively studied, limiting insights into how to tailor these services be optimised to meet local healthcare needs effectively. The aim of this cross-sectional study was to assess patients and caregivers satisfaction with virtual wound care services in Saudi Arabia using a cross-sectional survey

Methods

Study design, setting and participants

The study used a cross-sectional design through an online survey to assess satisfaction with virtual wound care services among patients and caregivers in Saudi Arabia. The study targeted individuals who engaged with virtual wound care services,such as wound consultation, re-assessement and follow up treatment plan and prevention, including both patients and their caregivers, between 11 April and 10 December 2024, in Saudi Arabia. Inclusion criteria specified that patients, (or their care givers) aged 18 years or older, had at least one wound, had engaged with virtual wound care services within the past 12 months and had access to the internet via a personal computer or smartphone. Participants were recruited through purposive and snowball sampling. A total of 9200 participants registered in the virtual wound care system were contacted to participate in the study and to invite their caregivers to participate. Patients who did not agree to participate or who had not attended any virtual wound care services were excluded. We distributed the study invitation, including all relevant details, to all eligible participants. A total of 4190 respondents completed the survey, comprising 1890 caregivers (44.8%) and 2300 patients (54.5%).

Survey instrument, measures, and data collection

A structured questionnaire was developed based on existing telehealth satisfaction scales, notably the 10-Item Telehealth Satisfaction Scale (TSS),²² alongside additional items specific to the virtual wound care experience adapted from previous studies.²³ The survey consisted of three main sections:

Demographic Information: Age, gender, marital status, employment status, educational level, and self-perceived health status.

Telehealth Satisfaction: Questions on ease of use, perceived effectiveness, and satisfaction with various aspects of virtual wound care, including communication quality and privacy (Cronbach’s alpha: 0.78).

Service Experience: Items evaluating specific service dimensions such as personal comfort, response from the wound care professional, and overall service usability (Cronbach’s alpha: 0.75).

Data was collected from 11 April to 10 December 2024 using an online questionnaire distributed via Google Forms, shared through emails and text messages services. Participants were directed to the survey link, where they could review and agree to the consent form before proceeding with the survey. The survey responses were stored securely and only accessible to authorised research personnel.

Data analysis

Responses were analysed using SPSS statistical software. Descriptive statistics were used to summarise demographic data. The chi-square and correlation analyses were conducted to identify relationships between demographic variables and satisfaction levels with a significance threshold set at p<0.05.

Results

Respondents’ profile and overall satisfaction

A total of 4190 respondents completed the survey, comprising 1890 caregivers (44.8%) and 2300 patients (54.5%). The majority were female (61.1%) and held a bachelor’s degree (59.2%). Most respondents were married (59.0%), and nearly half (49.3%) were employed full-time. Self-rated health status was largely positive, with 39.3% rating their health as excellent. The mean overall satisfaction score was 51.29 (±8.91), with patients reporting significantly higher satisfaction than caregivers (Table 1). A total of 30 participants did not complete the survey, and their responses were considered missing data. Their data were deleted due to incomplete responses prevented measuring relationships between the assessment tools and demographic variables.

 

Table 1. Socio-demographic characteristics of participants.

 

Satisfaction levels and associated factors

The satisfaction distribution shows that 66.3% of patients reported high satisfaction compared to 33.3% of caregivers, whereas caregivers constituted the majority of those with low satisfaction (62.8%). Satisfaction also varied significantly with age, gender, educational attainment and employment status. Younger participants and those with technical diplomas exhibited higher satisfaction rates. Employed individuals, especially full-time, reported greater satisfaction than retired or unemployed participants. Self-perceived health also correlated positively with satisfaction, with those reporting lower health levels tending to be more satisfied (Table 2).

 

Table 2. Satisfaction levels and influential factors among participants

 

Satisfaction with virtual wound care system

Patients rated aspects of the telehealth system more favourably than caregivers across several domains. Notably, 73.5% (n=1690) of patients rated voice quality as excellent compared to 41.8% (n=790) of caregivers. Similarly, personal comfort and ease of access were rated highly by patients. The wound care team’s thoroughness, courtesy and respect for privacy were particularly well-rated among patients, with over 70% reporting excellent experiences in these areas (Table 3).

 

Table 3. Satisfaction with core domains of the virtual wound care System

 

Willingness to reuse and recommend

Patients demonstrated a higher willingness than caregivers to reuse and recommend telehealth services to others, with 42.2% (n=970) strongly agreeing they would participate again and 46.5% (n=1070) recommending it to others. Caregivers, though generally supportive, showed lower levels of strong agreement in both reuse and recommendation (Table 4).

 

Table 4. Willingness to reuse telehealth services and recommendation to others

 

Discussion

The present study examined satisfaction levels with virtual wound care services among patients and caregivers in Saudi Arabia, focusing on key demographic and experiential factors influencing perceptions of telehealth effectiveness. With the Kingdom’s healthcare sector rapidly adopting digital health solutions as part of Vision 2030, virtual wound care services provide an accessible and efficient approach for managing wounds.

Results from the current study indicate that younger individuals, males, and those with higher educational backgrounds reported greater satisfaction with virtual wound care services. This aligns with Saudi Arabia’s digital health transformation, which has primarily been driven by younger, tech-savvy demographics who are more comfortable engaging with online health platforms. Literature on telehealth supports this trend; recent studies show that younger patients generally report higher satisfaction with digital healthcare due to familiarity with technology and fewer accessibility barriers.^24–27 In contrast, caregivers reported lower satisfaction than patients, likely reflecting different priorities and concerns when overseeing patient care remotely. This finding is consistent with studies showing that caregivers often encounter unique challenges in telehealth contexts, particularly around communication and reassurance.^28–30

A key finding was the strong association between satisfaction levels and factors like employment status, educational attainment, and self-rated health status. Full-time employees and those with higher education, particularly technical diploma holders, were more satisfied with virtual wound care services. This may reflect the fact that educated individuals with stable employment are more likely to have access to reliable internet and the flexibility to engage with telehealth services and meeting their needs, essential for a seamless virtual care experience. Studies indicate that educational attainment and employment are significant predictors of telehealth satisfaction, as they influence users’ access to and confidence in using digital platforms.³¹ For Saudi Arabia, where telemedicine adoption is fast paced, these insights highlight the need for tailored digital literacy and support programs to improve access and satisfaction across varying demographic groups. Barakat-Jonhson et al³⁵ conducted a study to assess the viability and acceptability of using a digital app linked to a Virtual Wound Care Command Centre (eWCC). This new model of care could improve wound care for individuals in the community and improve patient wound outcomes in Australia. It enabled patients and other health professionals to access wound consultation remotely. The model was designed to offer remote access and timely interventions for wound treatment and prevention to enable continuity of care. In addition, virtual wound care services are capable of meeting patient needs, as in-person attendance was found to have no effect on care quality and patient satisfaction.³⁵

Another interesting randomised control trial (RCT) by Irgens et al found that videoconference consultations provided a satisfactory remote interaction compared to conventional in-person follow up. However, they indicated that their study lacked statistical power to provide conclusive evidence on the other comparisons they performed.

Pertaining to satisfaction on virtual wound care system dimensions, patients in the present study rated domains such as voice and visual quality, personal comfort, and courtesy from wound care providers significantly higher than caregivers. This discrepancy could be due to patients’ direct interaction with healthcare providers, where they receive reassurance and guidance, thereby enhancing satisfaction. Caregivers, on the other hand, may have felt disengaged or excluded from the direct care experience, affecting their perception of service quality. Systematic reviews conducted in other regions corroborate this finding, indicating that satisfaction with telehealth is higher among direct recipients of care due to their active role in consultations and decision-making.^32,33

The high willingness to reuse and recommend virtual wound care among patients reflects the acceptance of telehealth as a valuable component of wound care services. With 42.2% of patients strongly agreeing that they would reuse the service and 46.5% recommending it to others, the findings highlight growing trust in telehealth’s effectiveness. In support of these findings, previous research demonstrates that satisfaction with telehealth encourages patient retention and word-of-mouth advocacy​.³⁴ In Saudi Arabia, telehealth is relatively new but rapidly expanding and these findings reflect well on the sustainability of virtual wound care services and the commendable efforts made in transformation of digital health in the country.¹⁸ The alignment with Saudi Vision 2030’s goals to enhance healthcare accessibility and quality suggests that patient advocacy may further drive the adoption of telehealth services, provided there is continued attention to service quality and patient engagement.

Conclusion

This study examined the satisfaction of patients and caregivers with the use of virtual wound care services in Saudi Arabia. This study highlights higher satisfaction levels among patients compared to caregivers regarding virtual wound care services in Saudi Arabia, particularly in areas like voice quality, personal comfort, and team professionalism. Satisfaction was correlated with factors such as age, education, employment and self-reported health. While patients showed a greater willingness to reuse and recommend telehealth services, caregivers expressed concerns about accessibility and communication. The findings suggest that telehealth can be an effective option for wound care, but addressing caregiver concerns is crucial for improving satisfaction. Future research should focus on long-term outcomes and the development of policies to enhance virtual care services, ensuring they meet the needs of both patients and caregivers.

Limitations and future directions

While this study provides valuable insights into virtual wound care satisfaction, it is limited by its cross-sectional design and sample size, and hence the results could not be generalised to all patients and their caregivers in the region. Additionally, self-reported satisfaction measures may be subject to recall bias and social desirability bias, which could influence participants’ responses. Future research should consider longitudinal approaches to track satisfaction over time, especially as telehealth services evolve. Moreover, qualitative research could provide deeper insights into the unique challenges that caregivers face in the telehealth context. Expanding such studies within Saudi Arabia can offer targeted strategies for optimising telehealth services to meet the diverse needs of both patients and caregivers. In addition, the findings of this study have important policy implications for healthcare policy, telemedicine legislation, and future virtual care implementations. Policymakers should consider using these insights to inform regulations and guidelines that ensure the effective and equitable delivery of telehealth services. Future virtual care initiatives should be tailored to address specific needs in different regions, ensuring accessibility, quality, and satisfaction for both patients and caregivers.

Reflective questions

1. How might demographic factors, such as age, education, and employment status, influence individuals’ experiences, acceptance and satisfaction on virtual wound care services? What strategies could be implemented to address these differences and promote equitable appropriate access?
2. In what ways can healthcare providers better support caregivers involvement in delivering virtual wound care, given their lower satisfaction levels compared to patients in this study? In other words what specific challenges might caregivers face that differ from those of patients?
3. Considering the rapid adoption of telehealth globally and in Saudi Arabia, what future innovations, initiatives or enhancements could further improve the effectiveness and accessibility of virtual wound care services, particularly for remote area?

Conflict of interest

The authors declare no conflicts of interest.

Ethics statement

The study received an Institutional Review Board (IRB) approval numbered 24-136, ensuring adherence to ethical guidelines. Informed consent was obtained from all participants prior to survey participation, and anonymity and confidentiality were strictly maintained. The authors had no direct relationship with the participants or caregivers. The authors only received deidentified data. All eligible participants were invited to the study through an external member who was the only person to send the invitation to the participants and their responses were collected through an online survey. The data were fully anonymised.

Funding

The authors received no funding for this study.

Author(s)

Abdulaziz Binkanan¹*, Abeer Alanazi², Esiah Maqboul Abbas³, Fahad Zeed Alanezi⁴, Hawra Alqassab^5
1Senior Specialist, Wound Care Manager, Riyadh First Health Cluster, King Saud Medical City, Saudi Arabia
²Senior Podiatrist, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
³Senior Specialist, King Faisal Specialist Hospital and Research Centre
⁴Assistant Professor, Department of Adult Health Nursing, Dr. Sulaiman Al Habib College for Knowledge, Riyadh, Saudi Arabia
⁵Wound Care Nurse Specialist, Prince Saud Bin Jalawi Hospital, Saudi Arabia

*Corresponding author email Binkanan-az@hotmail.com

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