BACKGROUND:
Telemedicine is widely promoted to address critical gaps in healthcare access in conflict-affected settings, where fragile infrastructure and constrained service delivery(1,2). However, there is no evidence-based framework for systematically assessing when, where, and how telemedicine is feasible in such contexts. This mixed-methods assessment framework is intended as a practical guide for evaluating telemedicine feasibility in low-resource, conflict-affected health systems, demonstrated through its use in contexts similar to Yemen.

METHODS:
A convergent parallel mixed-methods design is used to integrate facility-level, provider-level, system-level, and community perspectives. Quantitatively, a situational analysis of hospitals is conducted using the telemedicine maturity checklist to assess organizational readiness, digital infrastructure, human resources, and regulatory environment(3). In parallel, a structured survey adapted from a validated Awareness, Knowledge, Attitudes, and Skills (AKAS) questionnaire is administered to quantify healthcare provider readiness(4). To assess the community's acceptability and awareness, a structured, interview-based questionnaire(5) was designed to include potential patients who require telemedicine as part of their healthcare. Qualitatively, semi-structured interviews with health system leaders and decision-makers explore perceived needs, operational constraints, cultural and ethical issues, and financing and governance considerations. A two-round Delphi process with national and international experts is used to build consensus on essential requirements and context-appropriate implementation strategies. To contextualize the community standpoint, a focus group discussion (FGD) was proposed with community leaders using semi-structured interviews.

RESULTS:
The framework yields quantified maturity scores for facilities, provider readiness profiles, and community acceptance indicators; a thematically organized mapping of barriers, enablers, and contextual risks; and an expert-informed consensus on minimum requirements, priority services, and phased implementation options.

CONCLUSIONS:
This mixed-methods framework forms a reproducible feasibility profile for telemedicine and provides an evidence-based approach for assessing its feasibility in resource-limited and conflict-affected settings, supporting policymakers and implementers in making informed decisions on investment, design, and scale-up of telemedicine services.