What Shapes Telehealth? The Role of Environment and Technology in Communication Quality

Abstract

Objective: This paper explores the role of patient–provider communication (PPC) in healthcare quality, examines how communication dynamics are influenced in telehealth settings, reviews physical environment factors affecting virtual interactions, and identifies research gaps to guide future improvements in telehealth services. Background: While PPC is a well-established determinant of healthcare quality, the telehealth context introduces new challenges due to the absence of a shared physical space. Communication dynamics are altered by the loss of nonverbal cues, technical disruptions, environmental design limitations, and changes in interaction structure. These factors collectively affect PPC in virtual settings. Methods: A scoping review was employed, focusing on peer-reviewed articles addressing PPC, telehealth communication, environmental factors, and technological influences. Thematic synthesis identified key environmental and technological variables impacting communication quality. Results: Findings reveal that physical environment factors and technology affect communication dynamics, patient engagement, and satisfaction in telehealth settings. Despite growing recognition of issues in these domains, physical environment and technology variables are still treated as secondary considerations rather than integral parts of the communication environment. A novel conceptual framework is proposed, identifying three interconnected environments: the local user's physical environment, the remote user's physical environment, and the digital environment—which, unlike the others, is directly moderated by technology. Conclusions: Physical environment and technology factors shape PPC in telehealth, influencing user perceptions and engagement. Greater attention to these elements is essential for optimizing telehealth service quality and improving patient outcomes. Future research should systematically investigate how physical environment and technology affect communication quality and healthcare delivery.