Telemedicine Adoption and Patient Satisfaction in Rural Healthcare facilities: The Moderating Role of Internet Connectivity at Selected Primary Health Centres in Abakaliki Metropolis, Ebonyi State, Nigeria

Telemedicine offers transformative potential for extending quality healthcare to underserved rural and peri-urban populations, yet its effectiveness in improving patient satisfaction is not uniform — it depends critically on the quality of internet connectivity that enables real-time clinical interaction. In Ebonyi State, Nigeria's third-poorest state, primary health centres serving the peri-urban communities of Abakaliki Metropolis operate under conditions of severe connectivity inequity, making the moderating role of internet connectivity in the telemedicine-patient satisfaction relationship a question of immediate clinical and policy importance. This study examined the relationship between telemedicine adoption and patient satisfaction, and the moderating effect of internet connectivity on this relationship, at selected primary health centres in Abakaliki Metropolis, Ebonyi State. Two specific objectives guided the study: (i) to examine the relationship between telemedicine adoption and patient satisfaction at selected primary health centres in Abakaliki Metropolis; and (ii) to determine whether internet connectivity significantly moderates the relationship between telemedicine adoption and patient satisfaction at selected primary health centres in Abakaliki Metropolis. A cross-sectional survey design was employed. Using Yamane's (1967) formula, 348 patients who had utilised telemedicine services at selected primary health centres in Abakaliki Metropolis were surveyed through a stratified random sampling technique. A validated structured questionnaire (Cronbach's α = 0.87) served as the data collection instrument. Moderated regression analysis using Hayes' (2018) PROCESS Macro (Model 1) with 5,000 bootstrap resamples tested the moderation hypothesis. Telemedicine adoption was significantly and positively correlated with patient satisfaction (r = 0.584, p < .001, r² = 0.341). Internet connectivity significantly moderated the relationship between telemedicine adoption and patient satisfaction (ΔR² = 0.063, F-change = 29.14, p < .001): the positive effect of telemedicine adoption on patient satisfaction was significantly stronger among patients experiencing high internet connectivity (simple slope: B = 0.741) than among those experiencing low connectivity (simple slope: B = 0.312). This study provides the first empirical test of internet connectivity as a moderator - rather than a direct determinant - of the telemedicine adoption–patient satisfaction relationship in Nigerian primary healthcare settings, generating evidence directly relevant to digital health infrastructure investment prioritisation and telemedicine programme design in resource-constrained sub-Saharan African health systems.