This study used a descriptive qualitative technique to investigate the perceptions of health stakeholders for managing the advantages of telemedicine and telenursing and to determine the weaknesses of 5M factors. In this study, we excluded market aspects and focused our evaluations on how workflows (methods), people, money, machines, and materials were executed.

The study results will provide recommendations for better telemedicine and telenursing implementation by conducting a synthesis that combines a literature review and descriptive qualitative analysis of focus group discussions (FGDs). We searched for journal articles using a convenience approach with the following keywords: benefits, advantages, disadvantages, 5M obstacles, and constraints of telenursing or telemedicine. We posed 4 questions regarding the use of telenursing and telemedicine during 2 data collection periods, namely during the final period of the COVID-19 pandemic (2022‐2023) and after the recovery period (2024).

We conducted 2 FGDs. The first was held in 2022, to represent the COVID-19 period (2020‐2022). The second FGD was conducted in 2024 to determine the implementation of telenursing and telemedicine during the recovery period (2023-2024). The FGDs were conducted via the online Zoom platform. Data collection was conducted twice to examine perspectives during and after the COVID-19 pandemic. After the COVID-19 pandemic, there was a tendency for patients to prefer direct care at health facilities.

The questions asked during the FGDs were almost the same, with the aim of understanding the perspectives, benefits, and potential challenges that arise during the implementation of telehealth. These questions were as follows: (1) Describe the telemedicine or telenursing services you have utilized. (2) What are the prospects for telemedicine and telenursing implementation? (3) Could you explain the shortcomings experienced and 5M factors when using telemedicine and telenursing? and (4) What do you hope to achieve by utilizing telemedicine or telenursing?

Data were gathered through semistructured FGD with policymakers, hospital organizations, medical doctors, nurses, and health care providers. Purposeful sampling was used to ensure representation across different occupations and demographic groups. Participants were invited by sending a letter of application to become a participant to hospitals, clinics, health centers and health worker associations. The organization then appointed the sections that would participate in the FGD according to the requested criteria, namely having experience in implementing digital health, including telemedicine or telenursing.

We selected 12 FGD participants in 2022 and 11 FGD participants in 2024 via purposive sampling. Ideally, the FGD participants would have been the same individuals, but this study had a weakness in that participants in the first FGD could not participate in the second FGD. Participants in 2022 and 2024 were different people because they were sent by the target organizations according to the research objectives. Some differences in the participants were due to changes in personnel and tasks of the organization during the COVID-19 period. The professions of the participants were diverse, namely nurses, midwives, doctors, lecturers, medical recorders, lawyers, and others. Additionally, involving a variety of stakeholders was expected to help identify potential and 5M barriers to telemedicine and to develop targeted recommendations to address them effectively.

Response bias was possible because the data were gathered through focus group conversations, where individuals might alter their answers in reaction to what other group members think. To reduce prejudice, the facilitator gave each participant information at the outset so they may voice their opinions independently of other participants’ experiences. At the conclusion of the conversation, each member had the opportunity to share personal experiences that had not been discussed. Saturation was reached when no new topics nor information surfaced from the focus groups. One way to reach data saturation is to ask whether there are any unresolved issues from the focus group.

The researcher’s online Zoom account was used to conduct the FGD. Participants who were not speaking were muted to reduce noise while someone was speaking. Participants were invited to repeat what was said when the signal was clear again if signal interference was present. The atmosphere could be managed during the FGDs, and there were no issues with internet connectivity.

Data analysis was conducted in 2 stages: (1) inductive method and (2) triangulation with the deductive method, which was verified and validated based on the reviewed literature.

In the first stage, the research team used an inductive content analysis on each communication from the FGD, which they verified without looking at the existing literature. Field comments were added to the transcribed audio data. To identify any writing errors and validate the comments made by the participants, the transcriptions were read twice. This methodical approach ensured that every facet of the data was carefully considered and comprehended, producing thorough and trustworthy results. The transcription stage was carried out immediately after the FGD was completed. The researcher re-examined all statements from participants in both FGDs. The transcription, transcribing, and coding processes in stages 1 and 2 were carried out in the same steps. The facilitator retrieved words by attaching parallel keywords, then grouped and compared all codes. From these grouped keywords, the principal researcher then discussed them with a research team consisting of 3 participants in the FGD who acted as field observers and research assistants. The keyword data were compared with the final field notes to gain consensus in order to obtain themes that ensured trustworthiness and transparency and were not biased toward only one researcher.

The researchers used a thematic approach to analyze qualitative data in 2022 and 2024. After obtaining initial codes, terms, and themes from the FGDs, we evaluated and reviewed these themes by comparing them with the entire dataset to ensure they accurately reflected the views of health care providers. During this stage, we analyzed the themes as they evolved across time periods, specifically comparing participants’ telemedicine implementation during the peak of the COVID-19 pandemic in 2020‐2022 with the subsequent postpandemic situation in 2023‐2024. We then clearly defined and named each theme to establish its specific meaning and scope in relation to the research questions.

The information was then classified, extracted to identify significant statements, and analyzed to create meanings. After categorization, themes were developed from the data in each FGD. These themes were eventually reduced to codes and incorporated into a comprehensive analysis of the studied situation. The researchers counted the communication from participants in each phase of the FGD, grouped them by the same theme, and described them in the 2022 and 2024 FGD stages. In the end, the data are presented as study findings in the form of tables and discussion points.

In order to assure the rigor of our telemedicine FGD in 2022 and 2024, we undertook member checks to ensure credibility. In this study, we clarified remarks made by participants over the phone on the decrease in telemedicine use following the COVID-19 pandemic. Additionally, we performed peer debriefing by triangulating data from articles and national policies and addressing all themes. Additionally, we maintained confirmability by exercising researcher reflexivity and closely following the FGD guidelines, and we established dependability by guaranteeing the lack of researcher bias. Our FGD topics were cross-referenced against reputable peer-reviewed articles as part of our second strategy to ensure rigor. The triangulation stage involved analysis using a deductive approach, validating the existing themes with several previously conducted studies. This method aimed to compare existing findings with those in other studies to provide a comprehensive picture both abroad and domestically. This method was expected to provide better recommendations and a more comprehensive implementation of telenursing and telemedicine.

In the assessment of the overall readiness for telemedicine implementation, this study used triangulation by combining the results of the FGDs and theoretical foundations from journal articles synthesized through the keywords readiness, telenursing, or telemedicine. All relevant articles available as full text were read and analyzed using the telemedicine readiness approach of the 5M elements. The 5M dimensions identified in this literature review were aligned with qualitative themes extracted from the FGDs. The articles were found from the year 2005 to 2025 and from the Ministry of Health regulations in Indonesia. The articles and national regulations provided basic indicators and best practices for the 5M components; meanwhile, the FGD data offered a localized, real-world context regarding stakeholder perceptions and challenges. By cross-verifying the 2 datasets, we were able to comprehensively conclude the strengths, gaps, and readiness levels of facilities for adopting telemedicine or telenursing.

The weakness in this study’s literature review is that it was not a systematic review but only used data from articles retrieved by searching research databases with the keywords telemedicine, telenursing, benefit, barrier, and COVID-19. We conducted a convenience search of journals through ProQuest and Google Scholar for articles published from 2005 through 2025. A total of 46 journal articles were analyzed and combined with the FGD results to obtain themes. Researchers reviewed the literature using unstructured (qualitative/narrative) and incidental data, involving the application of thematic and content analysis frameworks to synthesize diverse, nontraditional, and serendipitous sources. The steps included identifying core concepts through keyword extraction, underlying arguments, and key narratives. Coding was then performed, grouping insights into themes. Synthesis was then performed, connecting, comparing, and building themes. The Quality Rating System (QRS) consists of 21 explicit items covering study design, data collection, and analysis. It helps authors write better papers, assists reviewers with evaluation, and guides readers when appraising evidence, ensuring full clarity and trust in the study. Finally, the Standards for Reporting Qualitative Research (SRQR) checklist was used to improve the transparency of all aspects of the qualitative research [19].

All participants provided written informed consent, and the participants were aware of the research goals, advantages, and methods. The team members maintained anonymity throughout the completion of the FGD, guaranteed confidentiality, and discussed their experiences with digital implementation. The authors adhere to ethical norms when publishing the improvement study’s data by protecting both personal and organizational privacy and data confidentiality when implementing telemedicine and telenursing. This study was approved by the Ethical Board of the Faculty of Nursing, Universitas Indonesia: KET-138/UN2.F12.D1.2.1/PPM.00.02/2022 and KET 180/UN2.F12.D.1.2.1/PPM.00.02/2024.

This research explored the experiences of health care stakeholders using telemedicine and telenursing. We identified the following three themes: (1) health care providers have experience using telemedicine/telenursing, (2) telemedicine and telenursing have many benefits, and (3) telemedicine and telenursing have 5M factors that must be anticipated. The research results indicate that telemedicine has been implemented in Indonesia, and its use increased during the COVID-19 pandemic. Although some participants mentioned that the hospitals where they work had not yet implemented telemedicine, all participants were aware of the implementation of telemedicine. Telenursing is also one type of telemedicine that is widely used by nurses for follow-up care, monitoring, wound care consultations, and providing motivation.

The results of the research analysis describe many benefits of telemedicine, especially considering Indonesia’s archipelagic condition. Telemedicine itself is a health care service for remote examinations, diagnosis determination, and therapy administration remotely, aided by technology such as phones, video conferences, and other methods [2,7]. Differences in emphasis were observed: in 2022, the advantages of telenursing and telemedicine centered primarily on decreasing the transmission of COVID-19, whereas by 2024, the benefits of telemedicine had expanded to encompass access, education, and consultations. With the help of technology, access to services will be improved, and patients will be brought closer to health care services without having to go to hospitals or community health centers. This study supports the statement that telemedicine helps rural areas access health care services, in line with previous research [14,15,20,32].

The ability of technology to reach various rural areas means that telemedicine and telenursing can reduce both direct and indirect costs. This has also been conveyed by previous research, which states that, if consultations are conducted online, travel costs to the hospital can be saved; additionally, it will save indirect costs such as those caused by time inefficiency [14,21-23]. Another previous study also stated telestroke was a highly cost-effective strategy, which may enhance stroke care and improve favorable outcomes in patients in rural China [33].

In addition to the benefits, telemedicine also faces challenges in its implementation. The participants provided many recommendations to anticipate the 5M barriers to implementation. The obstacle of implementation failure must be addressed by creating national regulations related to telemedicine and telenursing [14]. In 2023, Indonesia started requiring the use of EMRs, which aims for data integration and interoperability toward one data called SATU SEHAT (ONE HEALTH) Indonesia [34]. Telemedicine and telenursing must also begin to be integrated into SATU SEHAT and become part of the digital transformation in the health sector. Policies ensuring the security and confidentiality of EMR data must be enforced. This is in accordance with the synthesis of studies stating that medical records must document telemedicine-based service results and that data security must be maintained [34,35].

Another recommendation regarding policy is that credentialing requirements must be established for telemedicine providers. Only institutions with permits are allowed to conduct telemedicine or telenursing. In Indonesia, a regulatory sandbox was required, and all electronic-based health care service providers should be registered and assessed for feasibility before implementing telemedicine [35]. So this policy can be implemented, the government must be encouraged to apply it according to the regulations [14,17,35]. In addition to the organizing bodies that must have permits, the human resources providing care must be credentialed and licensed to practice telemedicine or telenursing. Nurses and doctors who use technology must receive training to improve digital literacy [8,16,36]. This digital literacy is essential for optimal telenursing performance.

Barriers that need to be anticipated are also related to telemedicine facilities. Text, video, telephone, and AI-based consultation media must be developed thoroughly [21,37,38]. The use of video facilitates the interaction between nurses and patients. The use of video also allows health care workers to monitor patients’ conditions, and decisions will be faster with the help of AI [5,39,40]. Unfortunately, sophisticated technology often becomes a barrier for patients who lack digital literacy. Many older adult patients and vulnerable individuals do not have the tools for telemedicine, which can hinder the development of telemedicine and telenursing [10,27,41]. In addition to the tools, network connections are not evenly distributed in every region. Therefore, previous research recommends that the government strengthen the network connections to ensure the successful implementation of telemedicine [12-14,42].

Not all care can be perfectly delivered through telemedicine. Some participants stated that they had to choose the type of service that could be provided through telenursing but still used a dual approach, namely face-to-face consultation followed by telenursing. Nurses, whose core responsibility is caring, must continue to prioritize care that consistently enhances satisfaction and comfort [8,29,43].

Patient and family preferences also significantly influence the success of telenursing. The paradox of telenursing and telemedicine, where there is no direct contact with health care personnel, means there is no physical touch, and the fear of misassessment often leads to hesitation in choosing the telemedicine method [18,26]. Therefore, it is recommended to maintain deep interactions [29] and enhance the sophistication of tools that can monitor patient conditions such as vital signs, for example, with heart rate monitors that automatically connect to servers [33,44]. Digital literacy education for the community must also be continuously strengthened so that the community increasingly understands the benefits of telenursing or telemedicine [24,28]. Improving digital literacy for the community can help them choose telemedicine and telenursing as an alternative support option for health care services [25]. Enhancing social impact is another recommendation for telemedicine success, as it can lessen apprehension about using new technology, particularly if the patient and health care practitioner have had favorable experiences with telemedicine [30]. The role of manager in encouraging the use of telemedicine is also very important, such as how managers controlled infections during COVID-19 by modifying services using technology. They must also be innovative and be role models in implementing telemedicine.

This study used a mixed approach to analyze the qualitative descriptive results from the FGDs and journal articles. The weakness of this study is that the journal search used a convenience approach and was not part of a systematic review. The FGD participants in 2022 and 2024 were not the same people, so follow-up on the development of telenursing and telemedicine was not possible. Although it has weaknesses, the results of this study can be used as initial findings to improve the implementation of telemedicine in Indonesia and other countries that have facilities, resources, and management that are almost the same as Indonesia. In future research, a systematic review and an in-depth interview method should be conducted.

These findings highlight the advantages and disadvantages of telemedicine and telenursing. We identified the following three themes from the study results: (1) health care providers have experience using telemedicine/telenursing, (2) telemedicine and telenursing have many benefits, and (3) telemedicine and telenursing have 5M factors that must be anticipated. The study’s findings suggest that 5M factors should be prepared to implement telemedicine. These include procedures like payment plans, human resource credentials, and licensing rules for organizers. Enhancing digital literacy for the community and health professionals is also recommended, as well as creating a budget that focuses on infrastructure improvements and training for technology use and digital literacy. For telemedicine to function well, upgrading facilities and adding internet access are required. A service type must be selected to generate a service recommendation, which may involve a combination of telemedicine and in-person care, such as an initial in-person visit to a health care facility followed by monitoring via telenursing. Telenursing and telemedicine can help with activity monitoring, follow-up treatment, patient and family education and consultation, and incentive building. Enhancing patient satisfaction and care must be a priority when providing nursing care via telenursing. There are implications for governance; operational rules for telemedicine and telenursing must be developed, and health care providers must increase their digital literacy.