{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T19:18:27Z","timestamp":1788290307491,"version":"build-2803163510"},"reference-count":55,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Hum Factors"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Virtual clinics allow doctors to connect to patients in difficult-to-reach locations. While this can result in improved access to care, implementing existing virtual clinics in these locations is difficult due to their contextual constraints. To address these challenges, a virtual clinic system for remote, rural, and underserved areas was developed based on user-centered design principles. To complete the user-centered design cycle, the developed system was then implemented and evaluated in the target contexts.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aimed to conduct a pilot study with the developed user-centered virtual clinic system to evaluate its performance in resource-limited settings. Patient, doctor, and nurse feedback was collected to understand how the virtual clinic system and implementation strategy might be improved before long-term implementation.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A pilot study was conducted at 2 health care facilities in South Africa\u20141 underserved public primary health clinic in the city of Cape Town, and 1 remote occupational health clinic in the Northern Cape Province. Doctor and nurse dyads participated in using the system to consult with real patients in each clinic. Patients received both virtual and physical examinations by the same doctor, and these 2 consultations were compared with one another. Surveys were conducted to gather patient feedback pre\u2013 and post\u2013virtual clinic consult. Observations of system usage were collected, and doctor and nurse participant interviews were conducted at the conclusion of each day. Qualitative data were thematically analyzed to understand barriers and facilitators of virtual consultations, as well as patient satisfaction.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 12 patient consultations were conducted using the virtual clinic system across 2 health care facilities. Two doctors and 2 nurses participated in the study as users. Doctor and nurse confidence in using the system increased over time. Doctors were confident that the virtual consultation format could be used to diagnose patients remotely. Key indicators of patient satisfaction were being included in consultation communication and understanding the benefits virtual care could offer. Potential barriers to virtual consultations were infrastructure offered by the implementation environment and medical device limitations.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The results from this pilot study indicate that virtual clinic consultation is possible in low-resource settings using the developed virtual clinic system. This system can support patients in remote, rural, and underserved areas to receive certain health care services from a doctor without the doctor having to be physically present in the facility. The results encourage further scaling of the system to support long-term implementation in low-resource health clinics in South Africa and other sub-Saharan African countries.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/84272","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T19:01:45Z","timestamp":1788289305000},"page":"e84272-e84272","source":"Crossref","is-referenced-by-count":0,"title":["User-Centered Virtual Clinic Services for Remote, Rural, and Underserved Sub-Saharan Africa: Development and Usability Study"],"prefix":"10.2196","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9990-6221","authenticated-orcid":false,"given":"Abby","family":"Blocker","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6192-7809","authenticated-orcid":false,"given":"Ahmed","family":"Biyabani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5756-282X","authenticated-orcid":false,"given":"Joyce","family":"Mwangama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2757-6646","authenticated-orcid":false,"given":"Mohammed Ishaaq","family":"Datay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2146-5600","authenticated-orcid":false,"given":"Bessie","family":"Malila","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,9,1]]},"reference":[{"issue":"1","key":"R1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjoq-2020-001313","article-title":"Delivering outpatient virtual clinics during the COVID-19 pandemic: early evaluation of clinicians\u2019 experiences","volume":"11","author":"Vas","journal-title":"BMJ Open Qual"},{"issue":"3","key":"R2","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1258\/jtt.2012.SFT105","article-title":"Telehealth for nursing homes: the utilization of specialist services for residential care","volume":"18","author":"Gray","journal-title":"J Telemed Telecare"},{"issue":"5-6","key":"R3","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1080\/21678421.2018.1440408","article-title":"The TiM system: developing a novel telehealth service to improve access to specialist care in motor neurone disease using user-centered design","volume":"19","author":"Hobson","journal-title":"Amyotroph Lateral Scler Frontotemporal Degener"},{"issue":"6","key":"R4","doi-asserted-by":"publisher","first-page":"725","DOI":"10.1089\/tmj.2020.0084","article-title":"The application of mobile telehealth system to facilitate patient information presentation and case discussion","volume":"26","author":"Ren","journal-title":"Telemed J E Health"},{"key":"R5","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-publhealth-040218-044206","article-title":"The digitization of patient care: a review of the effects of electronic health records on health care quality and utilization","volume":"40","author":"Atasoy","journal-title":"Annu Rev Public Health"},{"issue":"12","key":"R6","doi-asserted-by":"publisher","first-page":"1154","DOI":"10.1089\/tmj.2018.0227","article-title":"Telehealth decreases rural emergency department wait times for behavioral health patients in a group of critical access hospitals","volume":"25","author":"Fairchild","journal-title":"Telemed J E Health"},{"issue":"1","key":"R7","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1016\/j.ijmedinf.2008.07.010","article-title":"Pulmonary telemedicine--a model to access the subspecialist services in underserved rural areas","volume":"78","author":"Raza","journal-title":"Int J Med Inform"},{"issue":"5","key":"R8","doi-asserted-by":"publisher","first-page":"890","DOI":"10.1016\/j.ajem.2018.08.017","article-title":"On-demand synchronous audio video telemedicine visits are cost effective","volume":"37","author":"Nord","journal-title":"Am J Emerg Med"},{"key":"R9","doi-asserted-by":"publisher","DOI":"10.1177\/2040622319891587","article-title":"Addressing cost and time barriers in chronic disease management through telemedicine: an exploratory research in select low- and middle-income countries","volume":"10","author":"Sayani","journal-title":"Ther Adv Chronic Dis"},{"issue":"1","key":"R10","doi-asserted-by":"publisher","DOI":"10.1186\/s41687-023-00659-8","article-title":"Patient-reported experiences and outcomes of virtual care during COVID-19: a systematic review","volume":"7","author":"Bajgain","journal-title":"J Patient Rep Outcomes"},{"key":"R11","unstructured":"Global fiber development index: 2020, a global index comparing fiber development on a country-by-country basis. 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