Telehealth Education Research Articles

Postgraduate trainee views on eHealth at a distributed medical campus.

Purpose: e-Health is a rapidly evolving field that cuts across specialties however; there is a gap in development and evaluation of training for postgraduates in residency programs. This is a multicentre, collaborative effort among faculty from the departments of Psychiatry, Geriatrics and Internal Medicine in partnership with Ontario Telehealth Network to assess the needs of postgraduate residents in ehealth and build a pilot program to address identified learning gaps.
 Methodology: We conducted a needs assessment (Appendix A) through an online survey to investigate the self-perceived knowledge, gaps and barriers to eHealth of medical resident physicians at the McMaster University DeGroote School of Medicine Waterloo Regional Campus (WRC), Kitchener, Ontario, Canada
 Results: All respondents identified that they would be interested in education in telehealth and all of them felt that they would have to use telehealth in their future practices. However, 83.3% did not feel confident using telemedicine in clinical practice. Based on the results of the needs assessment, we have built a pilot rotation in which postgraduate trainees can practice telehealth skills in an interdisciplinary setting.

Development of an e-health education program at the workplace using formative research – Technologies for improving quality of life

Backgrounde-Learning, a means by which to expand people’s access to information can be effective in promoting health in the workplace. This study to present steps in the development of an e-health education program at the workplace. ObjectiveThis study aimed to present all steps of develop a telehealth education program for computer users using formative research to identify themes to health education for workers. MethodsA team of expert conducted focus groups with administrative workers (n = 36 participants) to identify thematic health to the development of program. Three meetings were audio video recorded, and notes. All data were based on constant analysis, classical content analysis and keywords in-context. ResultsThe content of the nine audio videos included four musculoskeletal health topics (Walking Program, Back School, Muscle Relaxation Techniques, and Work-related Musculoskeletal Diseases); three to healthy diet (Eating and Commensality, Ultra-processed Food and Food labeling, and Oil and Fat); two to mental health (Burnout Syndrome and the Meaning of work). ConclusionThe proposed steps in the development of a workplace e-health education program were successfully achieved. The engagement of the workers’ staged focus groups was fundamental to the choice of themes relevant to the population in question.

Measuring Self-Appraised Changes following Participation in an Intervention for Caregivers of Individuals with Dementia

ABSTRACTThis study examined the psychometric properties of the Self-Appraisal of Change Scale, a measure designed to capture domains that are subjectively relevant to caregivers, associated with overall well-being, and amenable to change upon engaging in an intervention. Data from 107 caregivers of veterans with dementia enrolled in a randomized controlled trial of a telephone-delivered caregiver psychoeducation and support group program (the Telehealth Education Program (TEP)) were analyzed. The TEP, which was delivered by master’s prepared social workers and a nurse dementia care manager, targeted caregivers’ dementia-related knowledge, attitudes, and self-management skills. Analyses were conducted to determine the factor structure, reliability, validity, and measurement invariance of the scale. Factor analyses yielded a single-factor solution for the scale’s nine items. The reliability and construct validity of the scale were also supported by the analyses. Multi-group analyses suggested that meaningful comparisons of scale items and total raw scores can be made across usual care (UC) and intervention groups. The findings offer preliminary support that the scale may represent a valid and reliable instrument that captures perceived changes in key domains (e.g. caregiving knowledge, attitudes, and skill) following participation in a psychoeducational and support intervention trial.

Nurses developing confidence and competence in telehealth: results of a descriptive qualitative study

Background: The widespread use of telehealth brings benefits to improve access to healthcare for rural and remote populations.Objective: This study explores what nurses considered important to confidently and competently participate in telehealth.Design: A descriptive qualitative approach was selected.Methods: Nine New Zealand Registered Nurses who worked in different clinical settings who use telehealth were identified through snowball sampling, and participated in single semi-structured interviews, which were thematically analysed using a general inductive approach.Findings: The nurses’ experience of using telehealth, from novice to becoming more proficient, was the main theme identified, with sub-themes of: Initial use of telehealth, hands-on training, specialty experience, mentorship and technological know-how. The confidence of nurses using telehealth in this study may reflect their clinical nursing experience.Conclusion: Recommendations include the need for more telehealth education and preparation, including incorporating telehealth in under and postgraduate nursing programmes. Additionally, specific telehealth nursing competencies are warranted.

The perspectives of South African academics within the disciplines of health sciences regarding telehealth and its potential inclusion in student training

The professional training and development of healthcare professionals in the area of telehealth is important to ensure the sustainability of this service delivery model. Tertiary institutions are among the key constituents involved in telehealth education, training and development. Academics within the healthcare sciences should therefore have the necessary experience and knowledge in this area to support the education and training of students. The objectives of this study were to determine the perspectives, experiences and attitudes of South African academics within various disciplines of health sciences regarding telehealth, as well as their views on suitable content areas for a telehealth module. A descriptive survey design was implemented. Sixty-six fulltime employed academic staff from five universities participated. The majority of participants were familiar with the terms telehealth/electronic health (eHealth), while 59% were unfamiliar with terms such as synchronous and asynchronous services. Eighty percent of respondents felt it necessary to include telehealth in the curriculum. The majority (89%) did not conduct research in telehealth. Seventy-one percent felt positive that telehealth could benefit the profession, and 30% stated that lack of standards creates a negative attitude toward the area and its sustainability. The majority of participants (77%) felt that their final-year students knew very little about telehealth upon exiting their study programme. Almost half (45%) of the participants felt that ethical issues were the most important aspect that needed to be included in a telehealth module, while data management was ranked as being least important (49%). The correlation between the perspectives on ethical issues and limitations to telehealth was statistically significant ( p =0.007), implying that participants saw lack of ethical considerations as a limitation to the uptake of telehealth practice. While attitudes regarding telehealth were positive, concerns were raised around the lack of standards and guidelines. Opportunities for professional development in telehealth need to be created through continued professional development (CPD) workshops and training. This in turn may provide more skilled faculty to teach in this area, allowing students to receive better instruction on telehealth service delivery models.

The APN-PLACE Telehealth Education Network: Legal and Regulatory Considerations

Telehealth technology can enhance nursing clinical education by allowing for virtual site visits, preceptor support, preceptor education, and student oversight. The Advance Practice Nurse-Preceptor Link and Clinical Education (APN-PLACE) Telehealth Education Network is a new and innovative video communication system that connects schools of nursing to preceptors and clinical practice sites. Specific areas of focus include preceptor education and support, student assessment, and clinical experiences when implementing a telehealth education network. As with in-person, or traditional, clinical education, it is important to consider the legal and regulatory issues related to the use of telehealth programs in clinical education. This article presents a telehealth preceptor support network and provides an overview of the associated legal and regulatory issues surrounding its use in advanced practice registered nurse clinical education.

Internet-Generation Nursing Students' View of Technology-Based Health Care.

Today's nursing school applicants are considered "digital natives." This study investigated students' views of new health care technologies. In a cross-sectional survey among first-year nursing students, 23 common nursing activities and five telehealth nursing activities were presented along with three statements: "I consider this a core task of nursing," "I look forward to becoming trained in this task," and "I think I will do very well in performing this task." Internet-generation nursing students (n = 1,113) reported a significantly (p ⩽ .001) less positive view of telehealth activities than of common nursing activities. Median differences were 0.7 (effect size [ES], -0.54), 0.4 (ES, -0.48), and 0.3 (ES, -0.39), measured on a 7-point scale. Internet-generation nursing students do not naturally have a positive view of technology-based health care provision. The results emphasize that adequate technology and telehealth education is still needed for nursing students. [J Nurs Educ. 2017;56(12):717-724.].

Enhancing Telehealth Education in Nursing: Applying King's Conceptual Framework and Theory of Goal Attainment.

Telehealth technologies are increasingly used in the provision of nursing care to clients and populations. The education of nurses must include content and practice with telehealth technologies. The authors of this article discuss how one school of nursing has infused telehealth content and resources into undergraduate and graduate curricula using King's conceptual system and theory of goal attainment as a guide.

Ubiquitous Technology in Healthcare and Teaching-Learning: Scourge or Blessing?

The author in this article introduces a discussion of one school of nursing's efforts integrating telehealth education into undergraduate and graduate curricula using King's theory of goal attainment as a guide. The introduction shares a story of loss in a rural setting without access to quality healthcare to highlight the blessing technology may be. However, challenges are discussed that arise through the ubiquitous use of technology in person-to-person communication and relationships.

Telehealth to Expand Community Health Nurse Education in Rural Guatemala: A Pilot Feasibility and Acceptability Evaluation.

Telehealth education has the potential to serve as an important, low-cost method of expanding healthcare worker education and support, especially in rural settings of low- and middle-income countries. We describe an innovative educational strategy to strengthen a long-term health professional capacity building partnership between Guatemalan and US-based partners. In this pilot evaluation, community health nurses in rural Guatemala received customized, interactive education via telehealth from faculty at the supporting US-based institution. Program evaluation of this 10 lecture series demonstrated high levels of satisfaction among learners and instructors as well as knowledge gain by learners. An average of 5.5 learners and 2 instructors attended the 10 lectures and completed surveys using a Likert scale to rate statements regarding lecture content, technology, and personal connection. Positive statements about lecture content and the applicability to daily work had 98% or greater agreement as did statements regarding ease of technology and convenience. The learners agreed with feeling connected to the instructors 100% of the time, while instructors had 86.4% agreement with connection related statements. Instructors, joining at their respective work locations, rated convenience statements at 100% agreement. This evaluation also demonstrated effectiveness with an average 10.7% increase in pre- to posttest knowledge scores by learners. As the global health community considers efficiency in time, money, and our environment, telehealth education is a critical method to consider and develop for health worker education. Our pilot program evaluation shows that telehealth may be an effective method of delivering education to frontline health workers in rural Guatemala. While larger studies are needed to quantify the duration and benefits of specific knowledge gains and to perform a cost-effectiveness analysis of the program, our initial pilot results are encouraging and show that a telehealth program between a US-based university and a rural community health program in a low- and middle-income country is both feasible and acceptable.

Feasibility of a Telehealth Educational Program on Self-Management of Pain and Fatigue in Adult Cancer Patients

ContextPain and fatigue are common symptoms among cancer patients and often lead to substantial distress. Innovative self-management programs for pain and fatigue are needed. ObjectivesThe primary objective was to assess the feasibility of a telehealth pain and fatigue self-management program among adult cancer patients. Secondary objectives included assessment of differences in patient characteristics, recruitment, and retention of patients based on two screening strategies: 1) navigator-collected, patient-reported pain or fatigue and 2) in-clinic, physician-identified pain or fatigue. MethodsThis prospective, nonrandomized, pre-post evaluation assessed feasibility, which was defined as 50% of eligible patients choosing to participate and completing the intervention. Patient demographics and patient-reported outcomes (patient activation, distress, symptoms, and quality of life) were collected at baseline and study completion. Differences in baseline characteristics were compared between cohorts and for patients who did vs. did not graduate from the program. ResultsThe program did not meet feasibility requirements because of only 34% of eligible patients choosing to participate. However, 50% of patients starting the program graduated. Differences in baseline characteristics and retention rates were noted by recruitment strategy. At baseline, 27.3% of navigated patients were at the highest activation level compared with 7.1% in the physician-referred, non-navigated patients (P = 0.17); more than 15% of non-completers were at the lowest activation level compared with 9% of completers (P = 0.85). ConclusionTelehealth self-management program for pain and fatigue may be better accepted among selected segments of cancer patients. Larger scale studies are needed to assess the efficacy of this program in a more selective activated population.

Perceptions of Rural Emergency Department Providers regarding Telehealth-Based Care: Perceived Competency, Satisfaction with Care and Tele-ED Patient Disposition

Introduction: This study assesses rural providers’ perceptions of their ability to deliver high quality care via telehealth compared to usual care, and whether attending providers perceive that emergency department (ED) telehealth visits influence clinical reasoning in regard to patient disposition, specifically in tele-behavioral and tele-neurological cases. Methods: A cross-sectional survey was conducted of 134 ED providers (nurses [n = 126] and physicians [n = 8]) who were working in five Midwestern critical access hospitals (response rate 83%). Descriptive, correlational and stepwise regression analyses were employed to evaluate provider perceptions of 1) competency level in telehealth delivery, 2) patient health outcomes, 3) access to continuing education in telehealth, and 4) clinical influence of telehealth visit. Evaluation of preliminary set of N = 100 telehealth cases were assessed for influence of telehealth on clinical reasoning of attending physicians regarding patient disposition. Results: The majority (67%; n = 90) of participants had at least minimal experience with telehealth care delivery, with an average of 1 - 2 visits in teleneurology, and 3 - 4 visits in telebehavioral cases. Providers rated their overall mean competency level in telehealth care delivery as 3.01/5.00 based on a 5 point “novice (1) to expert” (5) scale. Mean scores for providers perceived competency level in 7 evidence-based sub-categories for telehealth care delivery were self-reported as relatively low to mid-range values, ranging from 2.64 - 3.57/5.00. Stepwise linear regression analysis of whether all providers “would recommend telehealth to their family and friends” revealed two predictors for model of best fit (n = 81; p 2 = 0.598): 1) their perceptions of telehealth experience compared to usual care; and 2) perceptions of patient health outcomes with telehealth compared to usual care. Providers rated “neutral” to “very unlikely” that they “would recommend telehealth to family and friends” (2.75/5.00; n = 122; 91%). Attending physicians reported that for a majority of cases, telehealth visits influenced patient disposition and transfer decision-making (58.4%), and the influence of telehealth visits on patient disposition was statistically significantly higher for behavioral health cases (p < 0.018). Discussion: This study will be followed on to inform administrators/policy makers about 1) perceived level of competency of providers who implement tele-emergency care, 2) potential importance of telehealth equipment used and teamwork between rural providers and distant specialist, and 3) how use of telehealth may enhance ability of rural ED providers to improve quality of care. Perceived influence of telehealth on patient disposition is reported to be highest for telebehavioral patients. Healthcare educators need to place a priority on addressing provider competencies in telehealth through health professions degree programs and continuing education. Further research is needed to promote application and testing of evidence-based provider competencies in telehealth, and potentially relevant health communication models, to increase providers’ perceived efficacy and competency in telehealth care delivery, thus supporting high quality patient health outcomes.

Education and training to support the use of clinical telehealth: A review of the literature

Introduction Despite a growing literature base, substantial investment, and policy changes within governments, the integration of telehealth into routine clinical care has been limited. The availability of appropriate systematic education and training for practitioners has been highlighted as necessary for strong adoption. However, the availability and nature of telehealth-related education and training for practitioners is not understood. By reviewing the literature, we aimed to describe the delivery of education and training in telehealth, with particular focus on content, modes of delivery, types of institutions, and target clinician groups. Methods We performed searches using PubMed, Scopus, Embase, Web of Science, PsycINFO, the Cochrane Library, and ERIC. We included studies that were focused on the delivery of telehealth-related academic or vocational education and training. We extracted information pertaining to country, programs and their participants, and tabulated the results. Results Altogether 388 articles were identified, of which nine studies were selected for final review. Programs from five countries were represented and articles were spread across telemedicine and clinically oriented journals. Education and training in telehealth has been provided as both university level and vocational courses using conventional classroom based delivery methods and e-learning. Reported curriculum items included terminology, clinical applications, the evidence-base, and technological aspects. Conclusions Published evidence in peer-reviewed literature on telehealth education and training is limited. According to this review, a number of topics relating to telehealth have been covered by existing education programs both within tertiary and professional development levels.

Telemedicine in the Himalayas: Operational Challenges-A Preliminary Report.

Nonavailability of quality healthcare in mountainous, isolated, inaccessible sparsely populated regions is a universal problem. In this project, remote virtual healthcare was provided at Keylong and Kaza in Himachal Pradesh (HP) in North India. This innovative public-private partnership (PPP) provides 24/7 affordable healthcare to an alpine community where people commute 20-50 km for primary and 250 km for secondary healthcare services. Following a need assessment study, an MoU was signed by Apollo Hospitals in January 2015 with the National Health Mission. The government paid for all services delivered, Capital Expenditure (CAPEX) and Operating Expenditure (OPEX). Noncompliance to auditable weekly and monthly program MIS would result in penalties. Apollo Telehealth Services customized a turnkey solution, end-to-end, on a program management approach with measurable milestones and monthly reports. Key health issues in the region were identified. Very Small Aperture Terminals were installed amidst landslides and subzero temperatures. In February and March 2015, staff recruited from the community and local government staff were trained in Chennai. A major cultural transformation had to be effected. Urban teleconsultants were sensitized for community interaction, while deploying cutting- edge technology. Case records were audited. In the first 42 weeks, 2,213 teleconsults were provided, including 171 emergencies. Telelaboratory services and telehealth education programs have also been added. Evaluation confirms that delivering remote healthcare in inhospitable terrains in a PPP mode is effective.

Competencies required for nursing telehealth activities: A Delphi-study

Telehealth is viewed as a major strategy to address the increasing demand for care and a shrinking care professional population. However, most nurses are not trained or are insufficiently trained to use these technologies effectively. Therefore, the potential of telehealth fails to reach full utilization. A better understanding of nursing telehealth entrustable professional activities (NT-EPAs) and the required competencies can contribute to the development of nursing telehealth education. In a four-round Delphi-study, a panel of experts discussed which NT-EPAs are relevant for nurses and which competencies nurses need to possess to execute these activities effectively. The 51 experts, including nurses, nursing faculty, clients and technicians all familiar with telehealth, were asked to select items from a list of 52 competencies based on the literature and on a previous study. Additionally, the panelists could add competencies based on their experience in practice. The threshold used for consensus was set at 80%. Consensus was achieved on the importance of fourteen NT-EPAs, requiring one or more of the following core competencies; coaching skills, the ability to combine clinical experience with telehealth, communication skills, clinical knowledge, ethical awareness, and a supportive attitude. Each NT-EPA requires a specific set of competencies (at least ten). In total, 52 competencies were identified as essential in telehealth. Many competencies for telehealth, including clinical knowledge and communication skills, are not novel competencies. They are fundamental to nursing care as a whole and therefore are also indispensable for telehealth. Additionally, the fourteen NT-EPAs appeared to require additional subject specific competencies, such as the ability to put patients at ease when they feel insecure about using technology. The NT-EPAs and related competencies presented in this study can be used by nursing schools that are considering including or expanding telehealth education in their curriculum.

Technology support to a telehealth in the home service: Qualitative observations

Introduction The Flinders University Telehealth in the Home (FTH) trial was an action research initiative that introduced and evaluated the impact of telehealth services on palliative care patients living in the community, home-based rehabilitation services for the elderly, and services to the elderly in residential aged care. The aim of this study was to understand the issues encountered during the provision of technology services that supported this trial. Methods A mixed methods approach was undertaken to analyse the roles of information and communication technology (ICT) and clinical staff in design, technology management and training. The data sources were staff observations and documents including job logs, meetings, emails and technology descriptions. Results Use of consumer technology for telehealth required customisation of applications and services. Clinicians played a key role in definition of applications and the embedding of workflow into applications. Usability of applications was key to their subsequent use. Management of design creep and technology services, coupled with support and training for clinicians were important to maintenance of a telehealth service. Discussion In the setting described, an iterative approach to the development of telehealth services to the home using consumer technologies was needed. The efficient management of consumer devices in multiple settings will become critical as telehealth services grow in scale. Effective collaboration between clinical and technical stakeholders and further workforce education in telehealth can be key enablers for the transition of face-to-face care to a telehealth mode of delivery.

Telehealth Education in Nursing Curricula.

Telehealth care is a fast-growing avenue of providing health care services at a distance. A descriptive study was conducted to identify trends of telehealth education in 43 schools of nursing. Findings reflected inadequate integration of telehealth in classroom content, simulation, and clinical experiences. Interviews with 4 nursing leaders of telehealth provided some recommendations on how to integrate telehealth education in nursing curricula.

A Parkinson's disease tele-education program for health care providers in Cameroon

BackgroundIn Sub-Saharan countries, most patients with Parkinson's disease are underdiagnosed and untreated, with a marked shortage of qualified personnel. ObjectivesTo develop a tele-education Parkison's disease program for health providers in Douala (Cameroon). MethodsFeasibility, satisfaction, pre-post course medical knowledge improvement and patients' access were analyzed. ResultsTwenty lectures over the course of a year which connected participants with movement disorder experts using live, synchronous video conferences, and teaching materials were given. Thirty-three health professionals (52.4% women) including 16 doctors, and 17 allied health professionals and 18 speakers participated. Videoconferences were successfully completed in 80%, participation ranged from 20% to 70%, and satisfaction was at least above average in 70% of the participants. Whereas medical knowledge was dramatically improved, post-course patient access was not changed. ConclusionTele-education for movement disorders in low-income countries is feasible. However, better access and patient care should be ensured as the final outcome for tele-health education. A sustainability plan is crucial to continue with this important need.

Integrated Telehealth Care for Chronic Illness and Depression in Geriatric Home Care Patients: The Integrated Telehealth Education and Activation of Mood (I‐TEAM) Study

To evaluate an integrated telehealth intervention (Integrated Telehealth Education and Activation of Mood (I-TEAM)) to improve chronic illness (congestive heart failure, chronic obstructive pulmonary disease) and comorbid depression in the home healthcare setting. Randomized controlled trial. Hospital-affiliated home healthcare setting. Medically frail older homebound individuals (N = 102). The 3-month intervention consisted of integrated telehealth chronic illness and depression care, with a telehealth nurse conducting daily telemonitoring of symptoms, body weight, and medication use; providing eight weekly sessions of problem-solving treatment for depression; and providing for communication with participants' primary care physicians, who also prescribed antidepressants. Control participants were allocated to usual care with in-home nursing plus psychoeducation (UC+P). The two groups were compared at baseline and 3 and 6 months after baseline on clinical measures (depression, health, problem-solving) and 12 months after baseline on health utilization (readmission, episodes of care, and emergency department (ED) visits). Depression scores were 50% lower in the I-TEAM group than in the UC+P group at 3 and 6 months. Those who received the I-TEAM intervention significantly improved their problem-solving skills and self-efficacy in managing their medical condition. The I-TEAM group had significantly fewer ED visits (P = .01) but did not have significantly fewer days in the hospital at 12 months after baseline. Integrated telehealth care for older adults with chronic illness and comorbid depression can reduce symptoms and postdischarge ED use in home health settings.

Evaluating the Role of Key Learning Theories in ECHO: A Telehealth Educational Program for Primary Care Providers

Evaluating the Role of Key Learning Theories in ECHO: A Telehealth Educational Program for Primary Care Providers