**4. Discussion**

The validation of the telemedicine questionnaire for healthcare professionals showed good reliability and an acceptable level of validity. Two questions su ffered from the ceiling e ffect which limit the validity, but all the questions had discriminative rates above zero, higher for the first four questions, showing that all the questions had a discriminative capacity. We could increase the response options to the items to help optimize their discriminative power, but this would reduce the comparability of the scores with the original questionnaire.

The internal consistency was good, with Cronbach's alpha coe fficients for the overall questionnaire and Factor 1 above 0.80. The Cronbach's alpha coe fficient was slightly below the acceptable cut-o ff for Factor 2 (0.67). The low number of items included in the second factor may contribute to this finding. These results are slightly worse than the one reported by Argimon et al. using a similar methodology [24]. The ceiling e ffect was found in two questions, though this was not measured in the English original version, meaning that we are unable to conclude that it is an intrinsic characteristic of the questionnaire or a weakness in the Catalan translation.

Our results show that the Catalan version of the Health Optimum questionnaire is a robust tool for assessing healthcare professional's satisfaction with a telemedicine program. All the questions presented a positive discrimination rate, especially Item 3, "Clinical quality". This means that the questionnaire is clearly able to distinguish the clinical quality of a telemedicine program.

The results show that it was adequate to perform the factor analysis and showed that the questionnaire had two dimensions, which accounts for 61.2% of the total variance: one concerning the quality of the telemedicine technology and another about technical di fficulties relating to telemedicine.

The questionnaire will be useful to evaluate healthcare professionals' perceptions of the growing number of di fferent asynchronous telemedicine programs available in Catalonia as well as allowing comparisons between them to inform which characteristics make them more accepted by professionals [25].
