Flexible Delivery Models Research Articles

Exploring the acceptability and experience of receiving diabetes and pregnancy care via telehealth during the COVID-19 pandemic: a qualitative study

BackgroundThe COVID-19 pandemic has significantly impacted the delivery of diabetes in pregnancy care and general maternity care. This study aimed to explore the experiences and acceptability of telehealth use in diabetes in pregnancy care during the COVID-19 pandemic, from the perspectives of pregnant women and their clinicians. The secondary aim was to explore the experiences of pregnant women receiving general maternity care via telehealth during the COVID-19 pandemic.MethodsIn-depth qualitative semi-structured interviews were undertaken and analysed via thematic inductive approaches. The Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies Framework (NASSS) was applied.ResultsEigthteen interviews were conducted with culturally and linguistically diverse pregnant women and 4 clinicians (endocrinologists and dietitians). All interviewees were satisfied with telehealth as a positive alternative to face-to-face consultations for diabetes care during the COVID-19 pandemic. Numerous benefits of delivering diabetes care via telehealth were discussed and themes centred around greater access to care, economic benefits and improved safety. Most barriers concerned the adopters (clinicians), yet, feasible and realistic suggestions to overcome barriers were voiced. The scope for technology adaptation and ongoing embedment into routine diabetes care was described. Overall, a hybrid flexible delivery model, predominantly consisting of telephone consultations, with some face-to-face consultations for initial diabetes appointments was recommended for future care. The use of telehealth in replacement of face-to-face appointments for general maternity care was perceived as reducing care quality.ConclusionIn this study, telehealth was viewed as acceptable to women and clinicians for diabetes in pregnancy care, supporting the ongoing delivery of a hybrid service model of telehealth and face-to-face care. These findings provide valuable information to improve diabetes in pregnancy services to meet the needs of women during the COVID-19 pandemic and beyond.

Menopause care delivery in the time of COVID-19: evaluating the acceptability of telehealth services for women with early and usual age menopause

Objectives This study aimed to explore women’s and clinician’s experiences and acceptability of telehealth use within a specialized multidisciplinary menopause service during the COVID-19 pandemic. Methods In-depth qualitative semi-structured interviews were analyzed via thematic inductive approaches. Telehealth acceptability was guided by the Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies (NASSS) framework. Results A heterogeneous group of 18 women who had attended the menopause service and six clinicians (gynecologists and endocrinologists) were interviewed. The majority of women and clinicians perceived telehealth as an acceptable way to deliver menopause care. Benefits of telehealth delivery were identified; themes centered around convenience, greater access to care and improved safety. Telehealth challenges included perceived impacts on personalized quality of care, patient-related logistical issues and system/organizational-related issues. A hybrid flexible delivery model combining telehealth and face-to-face care was recommended, following the easing of COVID-19 restrictions. Improvements to support embedding and adaptation of telehealth into routine care were described. Conclusion In this study, telehealth was viewed as acceptable, supporting the ongoing delivery of a hybrid service model of telehealth and face-to-face menopause care. The findings provide valuable information to improve the menopause service to meet the needs of women during the ongoing current pandemic and beyond.

Abstract 9490: Home-Based Cardiac Rehabilitation During COVID-19

Introduction: Cardiac rehabilitation (CR) reduces morbidity, hospitalizations, and mortality. Increasingly, digital tools have augmented the ease of delivering programs outside of the traditional rehabilitation center setting. Because of the need for distancing during the COVID-19 pandemic, many cardiac rehabilitation (CR) centers suspended in-person services and pivoted to home-based CR (HBCR). Hypothesis: In this study, we qualitatively evaluated the implementation of HBCR, which included weekly phone or video visits for individualized exercise plans, nutrition and health education counseling, wellness sessions, and optional mobile phone applications. Methods: Patient participants and staff members (physician, nurses, exercise physiologists, dietician, administrative staff) participated in semi-structured interviews. Two independent reviewers coded interview transcripts for emergent themes and pre-specified themes from the Theory of Planned Behavior, Unified Theory of Acceptance and Use of Technology, and the Consolidated Framework for Implementation Research. Results: A total of 12 patients and 7 staff were interviewed. Narrative descriptions highlighted the isolation, fear, and disruption of life activities during COVID-19. Key facilitators of the HBCR patient experience included strong relationships with staff who served as coaches and sources of accountability and the ability of HBCR to deliver an individually tailored experience within a patient’s home. Important organizational factors for implementation included leadership buy-in, culture of change, and support for staff. Though technology tools facilitated communication and accountability, not all participants embraced technology and some reported challenges with use. Participants in the modified program (N=57) experience 60.4m (+/- 50.4 SD) improvement in 6 minute walk distance. At the conclusion of the program, 45/62 (72.6%) achieved BP control <130/80. Conclusions: Individually tailored HBCR can facilitate access for patients to participate outside of a CR center. Ongoing research is needed to understand the long-term outcomes of flexible delivery models that may include both in-person and remote visits, and the role of technology in these models.

Unbundling teaching and learning in a flipped thermal physics classroom in higher education powered by emerging innovative technology

The emergence of open online courses and flipped classrooms has brought new opportunities to unbundle the traditional university. This study aimed to investigate a thermal physics classroom integrated with an open online learning mode to afford various learning strategies for students in Taiwan. Moreover, we examined students' preferred learning modes by adopting a quasi-experimental design with questionnaires, pre-test and post-test scores, self-reported journals and interviews. A total of 89 students participated in the study. The instructor allowed all students enrolled in the class to choose their own preferred learning modes. All students had full access to all course materials in both open online course and traditional face-to-face learning contexts throughout the whole semester. We examined the learners' academic performance in each learning mode and surveyed their perceptions of the course. The findings of this study indicate that information technology can transform teaching and learning in a thermal physics classroom and challenge the instructor to tailor the course to meet students' diverse needs. Significantly, students adopted five learning modes, consisting of face-to-face, web facilitated, alternative blended, online learning and flipped learning. This study provides a valuable reference on how traditional on-campus higher education institutions could be unbundled to create student-centred learning approaches.
 
 Implications for practice or policy:
 
 Educators could design a flexible delivery model, allowing students to choose five learning modes, consisting of face-to-face, web facilitated, alternative blended, online learning and flipped learning in terms of their learning style and time management.
 For students with sufficient background knowledge, the flipped learning mode provides the best learning performance.
 This study could provide administrators, educators and instructors with insights and new approaches in science, technology, engineering and mathematics education and improvements in their course policies.

Implementing trauma-focused CBT for children of veterans in the VA: Providing comprehensive services to veterans and their families.

Military families experience unique stressful circumstances such as frequent moves, service-related physical and mental health difficulties, and separation from support. Although many families exhibit high resilience in response to these stressors, military children are at an increased risk for emotional and behavioral difficulties, exposure to intimate partner violence, and child maltreatment. These potential problems not only affect child functioning, but often also negatively impact family and veteran outcomes. Although the Department of Defense has enhanced efforts to address child and family trauma among military families, many veterans' families are still not receiving timely, evidence-based treatment. With many veterans receiving care through Veterans Affairs (VA) medical centers, incorporating family treatment into VA services is important for promoting optimal veteran outcomes. Trauma-focused cognitive-behavioral therapy (TF-CBT) has been used successfully for civilian and military children exposed to trauma including child maltreatment, intimate partner violence, and traumatic grief. This article reviews research regarding veterans' mental health, child and family functioning, and parenting, and highlights the value of implementing TF-CBT in the VA given its family and-resilience-focused structure, strong empirical support, and flexible delivery model. Strengths of delivering TF-CBT in the VA (e.g., provision of trauma services for families where veterans are already receiving care, family education about trauma), as well as implementation barriers (e.g., VA policy regarding veteran-focused treatment, reduced facility resources) are discussed. Finally, future research directions are proposed, including mixed-methods research with veterans' families to investigate the effectiveness and feasibility of TF-CBT dissemination within VA facilities. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Getting to the Heart of the Matter: What is the Landscape of Exercise Rehabilitation for People With Heart Failure in Australia?

The benefits of exercise rehabilitation for people with heart failure (HF) are well established. In Australia, little is known about how the guidelines around exercise rehabilitation for people with HF are being implemented in clinical practice. Furthermore, it is unknown what organisational barriers are faced in providing exercise rehabilitation programs for this population. The aim of this study is to provide an updated review of exercise rehabilitation services for people with HF in Australia and to identify perceived organisational barriers to providing these services. A cross-sectional survey of cardiac rehabilitation centres in Australia, investigating the number and characteristics of services providing exercise rehabilitation for people with HF. A total of 334 of 457 identified services responded to the survey. Of these, 251 reported providing a supervised group-based exercise rehabilitation program for people with HF. These services were mapped, showing their distribution across Australia. Services which were unable to provide group-based exercise training for HF patients reported organisational barriers including insufficient funding (60%), staffing (56%) and clinical resources (53%). Of the 78 services that reported patients in their local area were unable to access appropriate exercise guidance, 81% were located in regional or remote areas. We found that reported exercise practices align with current best-practice guidelines with 99% of group based exercise programs reportedly including endurance training and 89% including resistance training. In Australia, exercise practices for people with HF align with current best-practice guidelines for this condition. Limited resources, funding and geographic isolation are reported as the major organisational barriers to providing these programs. Future endeavours should include the development of alternative and flexible delivery models such as telerehabilitation and other home-based therapies to improve access for these individuals to such services.

Characteristics of clients currently accessing a national online alcohol and drug counselling service.

Multiple barriers contribute to low rates of help-seeking for problematic alcohol and other drug (AOD) use in Australia, and highlight the importance of flexible delivery models. This study explored the characteristics of clients accessing a national AOD online counselling service (Counselling Online) over time and across jurisdictions. 2003 clients completed a brief demographics questionnaire before commencing their Counselling Online session. Demographic (e.g. gender, primary drug of concern) and service provision (timing of session, length of session) characteristics were explored to build a profile of individuals accessing online support for AOD concerns. Service provision and client characteristics remained relatively stable over time; alcohol remained the most common drug of concern, but methamphetamines overtook cannabis as the second most common drug of concern. Consistency in characteristics was also observed across states and territories, except for clients in the Northern Territory, where amphetamines were the most common primary drug of concern, and counselling sessions were significantly longer. Counselling Online continues to be a wide-reaching, easily accessible service for those concerned about their or others substance use. The characteristics of clients who access the service also suggest that it is responsive to contemporary needs and concerns.

Thermotolerance of an inactivated rabies vaccine for dogs

This study provides the first robust data that the antibody response of dogs vaccinated with Nobivac® Rabies vaccine stored for several months at high temperatures (up to 30°C) is not inferior to that of dogs vaccinated with vaccine stored under recommended cold-chain conditions (2–8°C). A controlled and randomized non-inferiority study was carried out comparing the four-week post vaccination serological responses of Tanzanian village dogs inoculated with vaccine which had been stored at elevated temperatures for different periods of time with those of dogs vaccinated with the same product stored according to label recommendations. Specifically, the neutralizing antibody response following the use of vaccine which had been stored for up to six months at 25°C or for three months at 30°C was not inferior to that following the use of cold-chain stored vaccine. These findings provide reassurance that the vaccine is likely to remain efficacious even if exposed to elevated temperatures for limited periods of time and, under these circumstances, it can safely be used and not necessarily destroyed or discarded. The availability of thermotolerant vaccines has been an important factor in the success of several disease control and elimination programs and could greatly increase the capacity of rabies vaccination campaigns to access hard to reach communities in Africa and Asia. We have not confirmed a 3-year duration of immunity for the high temperature stored vaccine, however because annual re-vaccination is usually practiced for dogs presented for vaccination during campaigns in Africa and Asia this should not be a cause for concern. These findings will provide confidence that, for rabies control and elimination programs using this vaccine in low-income settings, more flexible delivery models could be explored, including those that involve limited periods of transportation and storage at temperatures higher than that currently recommended.

Teaching Compressed-Format Courses: Teacher-Based Best Practices

This study provides insight into how highly rated instructors approached teaching compressed summer session courses, and offers a set of best practices that others might use when teaching in similar settings. Top-rated instructors indicated differences in the way they taught compressed-format summer session courses, with respect to course planning, classroom instruction, student assessment, and interaction with students. The study is of value to continuing educators, as universities are increasingly challenged to think about flexible delivery models, including teaching and learning in compressed formats.

Self‐determined blended learning: a case study of blended learning design

Higher education has been actively encouraged to find more effective and flexible delivery models to provide all students with access to quality learning experiences yet also meet institutional imperatives for efficiency and accountability. Blended learning, commonly defined as an integration of traditional face‐to‐face and online approaches to instruction (Garrison & Kanuka, 2004; Graham, 2006; Macdonald, 2008), is now proposed as one solution that addresses both student learning and higher education organisational needs. Successful blended learning, however, is more than a simple integration of information and communication technologies with face‐to‐face approaches. This paper proposes, describes and evaluates a pedagogical approach to blended learning focused on learners and learning. First, we interrogate the literature related to blended learning to show how various constructions of blended learning may be driven by teacher‐centric or learner‐centric conceptions. Next, planning a learner‐centric blended learning design for a core unit in a first year higher education course is described. The design is then evaluated using a mixed methodology in which the students’ voices illuminate their experiences of blended learning unit design with regards to engagement, learning and self‐determination.

Using IT Industry Practices to Modernize University Education

Incorporating industry training into university courses is not in itself a radically new concept. Many examples in a variety of professions have demonstrated the value of industry input into university curricula. The information technology (IT) profession is different from many others in that it has high volatility and a short shelf-life of information and skills. Incorporating IT industry certification within the curriculum of university Masters courses has solved a number of problems associated with the relevance and currency of the content. However, there are other factors that have led to the approach used at Charles Sturt University in Australia, which has made it a world leader in this area. This paper discusses the factors that have been integral to the process. Among the most significant of these are a flexible delivery model that makes use of a long tradition in distance education, a well-developed university infrastructure to produce and deliver materials on a global scale, extensive experience in the use of information and communications technologies, the use of online examinations that borrow from the model used by IT industry certification and, most significantly, the support of commercial IT training organizations. The result has been an outstanding success, with record enrolments in a period of global and domestic downturn in students taking up IT courses at universities.

Do hybrid flexible delivery teaching methods improve accounting students' learning outcomes?

This study investigates the association between the learning outcomes of students and two teaching models: a traditional face-to-face lecture/tutorial teaching model and a hybrid flexible delivery model. The hybrid flexible model is delivered using a combination of face-to-face seminars and electronic delivery and communication tools. It is found that academic performance is higher for students who studied under the flexible delivery model, achieved higher marks in prerequisite units, were female, or were younger. Evidence is provided that flexible delivery teaching models utilizing electronic delivery media can be used to achieve the benefits of small class sizes when teaching large student numbers. The results should be of interest to administrators and educators as they attempt to address the challenges of supplying tertiary education to an increasing number of students as well as meeting the perceived demand for flexible course delivery in a manner that can enhance students' learning outcomes. §Carlin Dowling and Jayne Godfrey were staff members at the University of Tasmania when most of this research was completed.