Health Care Professionals' and Patients' Perceptions and Experiences of Who Uses Video Consultations, and Why: Qualitative Study.

Background: Video consultations (VCs) are effective and beneficial, yet their use is being discontinued, and there is a preference for face-to-face consultations. Objective: This study investigates how patients and health care professionals (HCPs) perceive patients' introduction to VCs, who use them, and what drives their use in Swedish primary care. Methods: Six focus group interviews with 27 HCPs and 13 individual interviews with patients in primary care were conducted between August 2022 and May 2023. The interviews examined VC implementation and were analyzed using rapid assessment procedures. Results: A total of five themes were identified: (1) challenging start with unprepared users and immature technology; (2) users and nonusers are perceived to have different characteristics, needs, and circumstances; (3) patient-related drivers: based on patients' preferences and opportunities; (4) HCP-related drivers: clinical suitability, assessment of patient needs, and preferences; and (5) societal and organizational drivers: the pandemic, demographics, and infrastructure. Patients and HCPs described the introduction of VCs as rushed and confusing, with limited guidance and support (theme 1). HCPs struggled to assist patients due to a lack of training and limited access to the patient-facing interface (theme 1). VC users were typically perceived as younger, digitally literate, and motivated by convenience or urgency, while older adults and those with language or cognitive barriers were often assumed to be nonusers (theme 2). VC use was shaped by patient preferences, accessibility, and clinical urgency (theme 3), as well as by HCPs' professional judgment and convenience (theme 4). Assumptions held by HCPs about patients' digital skills and preferences influenced whether VCs were offered, while patients' own assumptions about complexity or suitability affected whether they accepted them. Broader factors, such as digital infrastructure, platform usability, reimbursement policies, and the COVID-19 pandemic, also significantly influenced use (theme 5). Conclusions: The rushed implementation potentially deterred some patients and HCPs from use. Misguided preconceptions and biases negatively influenced VC use and risked reinforcing existing disparities and contributing to digital exclusion. In addition, HCPs' and patients' preferences, which were related to their needs, waiting times, and different circumstances, and potentially misguided judgments of appropriateness, influenced VC use. Lastly, infrastructure, reimbursement, sociodemographics, and organizational type also drive VC use. To support more sustainable and equitable use of VC in primary care, developers should optimize VC applications' usability, implementers should deploy multiple strategies, health care providers should consider the potential of VC in care delivery, and policymakers should increase digital readiness. Further research should evaluate the effectiveness of different strategies for introducing patients to VCs, explore younger patients' and nonusers' perspectives, characteristics of HCP users, and differences between professional roles, as well as between consultation types.