Perceived knowledge, attitudes, and barriers toward telemedicine adoption Among adults in Mogadishu, Somalia: a cross-sectional study

Abstract

Telemedicine has emerged as an important strategy for improving access to healthcare, particularly in fragile health systems facing shortages of specialists and significant geographic barriers. Despite its potential, evidence on community readiness for telemedicine adoption in Somalia remains limited. A community-based cross-sectional study was conducted between February and April 2026 among 425 adults in Mogadishu. Participants were recruited using convenience and snowball sampling through social media platforms. Data were collected using a structured questionnaire assessing telemedicine knowledge, attitudes, and perceived barriers. Descriptive statistics summarized participant responses, while multivariable linear regression identified independent predictors of knowledge and attitude scores. The mean knowledge score indicated limited-to-moderate knowledge across the five-item measure. Although 60.9% had previously heard of telemedicine, fewer than half had observed (44.0%) or used (44.7%) telemedicine services. Attitudes toward telemedicine were generally favorable, with mean item scores ranging from 3.21 to 3.42 on a five-point scale. The most frequently perceived barriers were preference for face-to-face consultations, technological limitations, and patient resistance. Higher knowledge scores were independently associated with age, income, chronic illness, transportation-cost barriers, and social media use, whereas positive attitudes were independently associated with marital status, educational attainment, and smartphone ownership. Adults in Mogadishu demonstrate moderate knowledge and generally positive attitudes toward telemedicine despite persistent technological and behavioral barriers. Expanding digital literacy, strengthening digital infrastructure, and establishing supportive regulatory and implementation frameworks will be essential to facilitate equitable and sustainable telemedicine integration into Somalia's health system.