Assessment of Perceptions, Usability, and Barriers to Telemedicine Implementation among Healthcare Workers in Kazakhstan: Results of the TUQ-MAST-KZ Questionnaire Pilot (Preprint)

BACKGROUND Telemedicine has become an essential component of modern healthcare systems, particularly in managing chronic diseases and advancing digital health. Its effective implementation requires overcoming barriers related to infrastructure, regulation, training, and provider acceptance. While international studies highlight numerous obstacles and success factors, evidence from Central Asia remains scarce. Kazakhstan is at an early stage of digital transformation, and systematic tools are needed to assess readiness and adoption. OBJECTIVE This study aimed to evaluate physicians’ perceptions of telemedicine implementation in Kazakhstan using the TUQ-MAST-KZ questionnaire, an adapted tool based on the Telehealth Usability Questionnaire (TUQ) and the Model for Assessment of Telemedicine (MAST). Findings were compared with international literature to identify common barriers, context-specific features, and provide recommendations for digital health development. METHODS A cross-sectional survey was conducted among 156 physicians from different regions of Kazakhstan. The TUQ-MAST-KZ instrument covered domains related to infrastructure, protocols, responsibilities, training, and user perceptions. Descriptive statistics were applied, and comparative analysis was performed against international systematic reviews and empirical studies published between 2020 and 2024, following PRISMA principles for literature mapping and thematic comparison. RESULTS Survey findings revealed three major categories of barriers: 1. Infrastructure and organizational deficits: limited internet connectivity, lack of standardized protocols (available in only 33.3% of healthcare organizations), and absence of formally assigned responsibilities (36.5%). 2. Training gaps: 70.5% of physicians reported a strong need for additional education and professional support in using telemedicine. 3. Trust and regulation: concerns about patient data confidentiality and lack of institutional guidelines. Comparative analysis showed strong alignment with international findings. Global studies similarly emphasize technical limitations, resource shortages, and the importance of staff training. At the disciplinary level, challenges confirmed include confidentiality and parental trust in pediatrics, interdisciplinary cooperation in mental health and telerehabilitation, and concerns about diagnostic accuracy in physiotherapy and rehabilitation. Privacy and data protection issues were identified as universal barriers. Success factors recognized both in Kazakhstan and internationally include administrative support, clear protocols, training, and staff engagement. In addition, international studies and our results highlight the need to adapt telemedicine solutions to patient-specific, clinical, and local contexts. CONCLUSIONS This study provides the first systematic evaluation of telemedicine implementation in Kazakhstan using the TUQ-MAST-KZ instrument. The findings confirm that national challenges largely mirror international trends while reflecting local infrastructural and institutional gaps. The results highlight the importance of standardized protocols, enhanced digital literacy, and formal responsibility within healthcare organizations. Adapting telemedicine to patient needs and local conditions will be crucial for successful integration. These insights offer practical guidance for policymakers, healthcare leaders, and educators seeking to strengthen digital health maturity in Kazakhstan and similar settings. CLINICALTRIAL Not applicable