Perceived Barriers to Home-Based Telemedicine and Facilitators of Public Health Center-Based Telemedicine Among Digitally Capable Community-Dwelling Older Adults: A Cross-Sectional Scenario-Based Survey.

Background/Objectives: Home-based telemedicine requires patients to perform technical tasks independently, whereas assisted public health center (PHC)-based telemedicine transfers some of these tasks to on-site personnel. This study describes model-specific perceptions and estimates the difference in intention to use between the two scenarios among relatively digitally capable, community-dwelling older adults. Methods: A cross-sectional, fixed-order, scenario-based online survey was completed by 300 adults aged 65 years or older in South Korea. Home-based barriers and PHC-based facilitators were analyzed as non-equivalent descriptive domains. The primary paired comparison used three conceptually matched intention items. Internal consistency, exploratory factor evidence, 95% confidence intervals (CIs), Pearson and Spearman correlations, and multivariable linear regressions with HC3 robust standard errors were reported. Results: The seven-item home-based barrier score was 2.80 (SD 0.76; 95% CI 2.71-2.89), and the seven-item PHC facilitator score was 3.58 (SD 0.58; 95% CI 3.52-3.65). Intention scores were 3.91 (SD 0.64) for home-based and 3.88 (SD 0.66) for PHC-based telemedicine. The paired mean difference (PHC minus home) was -0.030 (95% CI -0.107 to 0.047; p = 0.441; Cohen's dz = -0.045, bootstrap 95% CI -0.155 to 0.071). Preferences were home-based 42.7% (95% CI 37.2-48.3%), PHC-based 41.3% (95% CI 35.9-47.0%), and unsure 16.0% (95% CI 12.3-20.6%). After adjustment, digital literacy remained positively associated with both intention outcomes. Conclusions: No statistically detectable difference in intention to use was observed between the two hypothetical scenarios; this finding does not establish equivalence. The item-level results generate a hypothesis that staff-supported PHC delivery may be useful for some older adults, but actual uptake, effectiveness, accessibility, and equity require evaluation in real-world studies that include less digitally capable and more vulnerable populations.