Patient intention to use and recommend teleconsultation platforms: the role of perceived platform governance and design

Purpose This study reframes teleconsultation adoption as a platform governance and design problem rather than treating it exclusively as an individual technology acceptance issue. It examines how patients' perceptions of multisided platform governance and design shape their behavioral intentions to use and recommend teleconsultation platforms. Design/methodology/approach A quantitative study was conducted with 503 teleconsultation users. The research integrates behavioral intention constructs with multisided platform governance dimensions and governance-derived patient perceptions. Data were analyzed using partial least squares structural equation modeling (PLS-SEM) to assess sufficiency relationships and necessary condition analysis (NCA) to identify minimum conditions required for high levels of patient recommendation. Findings The results show that while perceived usefulness and ease of use remain important, governance-related dimensions such as platform-side diversity and monetization logic play differentiated constraining and enabling roles in shaping patient behavior. Some platform attributes do not directly increase intention to recommend but emerge as necessary conditions that must be met before high recommendation can occur, highlighting the distinction between enabling and constraining factors in teleconsultation platforms. Practical implications The findings show that patient engagement and recommendation rely on essential governance and design conditions. Beyond feature improvement, platform sustainability depends on meeting minimum governance thresholds perceived by patients. Originality/value This study advances digital health and teleconsultation research through a governance-first lens. It reframes perceived usefulness, ease of use, and technology risk as patient-facing evaluations of platform governance and design. By combining sufficiency and necessity logics, it provides a more nuanced explanation of how multisided teleconsultation platforms shape patient use and recommendation intentions.