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    Implementing solutions to improve and expand telehealth adoption: participatory action research in four community healthcare settings

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    Publication date
    2015-12-01
    Author
    Taylor, J.
    Coates, E.
    Wessels, B.
    Mountain, Gail
    Hawley, M.S.
    Keyword
    Technology; Telehealth; Adoption; Implementation; Action research; PDSA; Community nursing; Service improvement; Long-term conditions
    Rights
    © 2015 Taylor et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
    Peer-Reviewed
    Yes
    
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    Abstract
    Background: Adoption of telehealth has been slower than anticipated, and little is known about the service improvements that help to embed telehealth into routine practice or the role of frontline staff in improving adoption. This paper reports on participatory action research carried out in four community health settings using telehealth for patients with Chronic Obstructive Pulmonary Disease and Chronic Heart Failure. Methods: To inform the action research, in-depth case studies of each telehealth service were conducted (May 2012–June 2013). Each service was then supported by researchers through two cycles of action research to implement changes to increase adoption of telehealth, completed over a seven month period (July 2013–April 2014). The action research was studied via observation of multi-stakeholder workshops, analysis of implementation plans, and focus groups. Results: Action research participants included 57 staff and one patient, with between eight and 20 participants per site. The case study findings were identified as a key source of information for planning change, with sites addressing common challenges identified through this work. For example, refining referral criteria; standardizing how and when patients are monitored; improving data sharing; and establishing evaluation processes. Sites also focused on raising awareness of telehealth to increase adoption in other clinical teams and to help secure future financial investment for telehealth, which was required because of short-term funding arrangements. Specific solutions varied due to local infrastructures, resources, and opinion, as well as previous service developments. Local telehealth champions played an important role in engaging multiple stakeholders in the study. Conclusions: Action research enabled services to make planned changes to telehealth and share learning across multiple stakeholders about how and when to use telehealth. However, adoption was impeded by continual changes affecting telehealth and wider service provision, which also hindered implementation efforts and affected motivation of staff to engage with the action research, particularly where local decision-makers were not engaged in the study. Wider technological barriers also limited the potential for change, as did uncertainties about goals for telehealth investment, thereby making it difficult to identify outcomes for demonstrating the added value over existing practice.
    URI
    http://hdl.handle.net/10454/11028
    Version
    Published version
    Citation
    Taylor J, Coates E, Wessels B et al (2015) Implementing solutions to improve and expand telehealth adoption: participatory action research in four community healthcare settings. BMC Health Services Research. 15(1): 529.
    Link to publisher’s version
    http://dx.doi.org/10.1186/s12913-015-1195-3
    Type
    Article
    Collections
    Health Studies Publications

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