Ensuring full participation of people with disabilities in an era of telehealth

Establishing Best Practices in Telehealth Care for Adults with Developmental Disabilities in the United States: An e-Delphi Study

Background: Telehealth care is now a key element of mainstream health care since the COVID-19 pandemic, with all types of health care providers joining the digital revolution. As a population experiencing health care disparities, adults with developmental disabilities and their supporters have described variable experiences with telehealth care that contribute to overall care quality and health outcomes. Methods: This e-Delphi study established consensus on best practices in telehealth care for adults with developmental disabilities in the United States. Online surveys and videoconferencing interviews were conducted with 44 expert panelists with experience with telehealth care and developmental disabilities, including adults with developmental disabilities, family members, direct support professionals, nurses, and health care providers. Results: Three rounds of surveys resulted in a set of 9 guidelines consisting of 42 items. The guidelines addressed 1) appropriate situations for telehealth care, 2) communication needs and preferences, 3) support person collaboration, 4) education and anticipatory guidance, 5) reminders, 6) coordination of care, 7) equitable and fair access, 8) privacy and safety, and 9) evidence-based practice. Conclusion: Health care providers can adopt these best practice guidelines to ensure telehealth care is provided equitably and safely to adults with developmental disabilities. Policy advocacy is needed for the uptake of these guidelines and for health care providers and adults with developmental disabilities to access the resources needed for safe and effective telehealth care use.

Exploring the factors affecting home dialysis patients' participation in telehealth-assisted home visits: A mixed-methods study

BACKGROUND

Technology, such as telehealth, is increasingly used to support home dialysis patients. The challenges patients and carers face when home dialysis nursing visits are provided via telehealth have yet to be explored.

OBJECTIVES

To explore patients' and carers' perspectives as they transition to telehealth-assisted home visits and identify the factors influencing their engagement in this modality.

DESIGN

A mixed-methods approach, guideed by the behaviour change wheel using the capability, opportunity, motivation-behaviour model to explore individual's perceptions of telehealth.

PARTCIPANTS

Home dialysis patients and their carers.

MEASURUEMENTS

Suveys and qualitative interviews.

METHODS

A mixed-methods approach was undertaken, combining surveys and qualitative interviews. It was guided by the Behaviour Change Wheel using the Capability, Opportunity, Motivation- Behaviour model to explore individuals' perceptions of telehealth.

RESULTS

Thirty-four surveys and 21 interviews were completed. Of 34 survey participants, 24 (70%) preferred face-to-face home visits and 23 (68%) had previously engaged in telehealth. The main perceived barrier identified in the surveys was knowledge of telehealth, but participants believed there were opportunities for them to use telehealth. Interview results revealed that the convenience and flexibility of telehealth were perceived as the main advantages of telehealth. However, challenges such as the ability to conduct virtual assessments and to communicate effectively between clinicians and patients were identified. Patients from non-English speaking backgrounds and those with disabilities were particularly vulnerable because of the many barriers they faced. These challenges may further entrench the negative view regarding technology, as discussed by interview participants.

CONCLUSION

This study suggested that a blended model combining telehealth and face-to-face services would allow patient choice and is important to facilitate equity of care, particularly for those patients who were unwilling or had difficulty adopting technology.

Findings From a National Survey of Older US Adults on Patient Willingness to Use Telehealth Services: Cross-Sectional Survey

BACKGROUND

Telehealth (telemedicine and telepharmacy) services increase access to patient services and ensure continuity of care. However, few studies have assessed factors that influence patients' willingness to use telehealth services, and we sought to investigate this.

OBJECTIVE

This study aims to examine respondents' (aged between 45 and 75 years) willingness to use telehealth services (telepharmacy and telemedicine) and the correlates of the willingness to use telehealth services.

METHODS

We administered a cross-sectional national survey of 1045 noninstitutionalized US adults aged between 45 and 75 years in March and April 2021. Multiple logistic regression analyses were used to identify demographic and health service use correlates of self-reported willingness to use telehealth services.

RESULTS

Overall willingness to use telemedicine was high (674/1045, 64.5%). Adults aged 55 years and older were less willing to use telemedicine (aged between 55 and 64 years: odds ratio [OR] 0.61, 95% CI 0.42-0.86; aged 65 years or older: OR 0.33, 95% CI 0.22-0.49) than those younger than 55 years. Those with a regular provider (OR 1.01, 95% CI 1-1.02) and long travel times (OR 1.75, 95% CI 1.03-2.98) were more willing to use telemedicine compared to those without a regular provider and had shorter travel times, respectively. Willingness to use telemedicine services increased from 64.5% (674/1045) to 83% (867/1045) if the service was low-cost or insurance-covered, was with their existing health care provider, or was easy-to-use. Overall willingness to use telepharmacy was 76.7% (801/1045). Adults aged older than 55 years were less willing to use telepharmacy (aged between 55 and 64 years: OR 0.57, 95% CI 0.38-0.86; aged 65 years or older: OR 0.24, 95% CI 0.15-0.37) than those younger than 55 years. Those who rated pharmacy service quality higher were more willing to use telepharmacy (OR 1.06, 95% CI 1.03-1.09) than those who did not.

CONCLUSIONS

Respondents were generally willing to use telehealth (telemedicine and telepharmacy) services, but the likelihood of their being willing to use telehealth decreased as they were older. For those initially unwilling (aged 55 years or older) to use telemedicine services, inexpensive or insurance-covered services were acceptable.

Telehealth and delivery of alcohol use disorder treatment in the Veterans Health Administration

BACKGROUND

The use of telehealth treatment of alcohol use disorder (AUD) has increased since the start of the COVID-19 pandemic. However, it is unclear which patients are using telehealth and how telehealth visits are associated with treatment duration. This study examined characteristics associated with telehealth use among Veterans Health Administration patients receiving AUD treatment.

METHODS

Using a national retrospective cohort study, we examined data from March 01, 2020 to February 28, 2021 to: First, identify patient characteristics associated with (a) any telehealth versus only in-person care for AUD treatment, and (b) video (≥1 video visit) versus only telephone visits for AUD treatment (≥1 telephone visit, no video) among any telehealth users. This analysis used mixed-effects logistic regression models to adjust for potential correlation across patients treated at the same facility. Second, we assessed whether visit modality was associated with the amount of AUD treatment received (number of AUD psychotherapy visits or medication coverage days). This analysis used mixed-effects negative binomial regression models.

RESULTS

Among 138,619 patients who received AUD treatment, 52.8% had ≥1 video visit, 38.1% had ≥1 telephone but no video visits, and 9.1% had only in-person visits. In the regression analyses, patients who were male or had an opioid or stimulant use disorder (compared to having no non-AUD substance use disorder) were less likely to receive any telehealth-delivered AUD treatment compared to only in-person AUD treatment. Among patients who received any telehealth-delivered AUD treatment, those who were ≥45 years old (compared to 18-29 years old), Black (compared to White), diagnosed with a cannabis or stimulant use disorder, or diagnosed with a serious mental illness were less likely to receive a video visit than only telephone visits. Receiving any AUD telehealth was associated with receiving more psychotherapy visits and medication coverage days than only in-person care.

CONCLUSIONS

Telehealth, a common modality for AUD treatment, supported a greater number of psychotherapy visits and a longer duration of medication treatment for AUD. However, some groups were less likely to receive any video telehealth than telephone visits, suggesting that multiple treatment modalities should remain available to ensure treatment access.

Construction of the Digital Health Equity-Focused Implementation Research Conceptual Model - Bridging the Divide Between Equity-focused Digital Health and Implementation Research

Digital health implementations and investments continue to expand. As the reliance on digital health increases, it is imperative to implement technologies with inclusive and accessible approaches. A conceptual model can be used to guide equity-focused digital health implementations to improve suitability and uptake in diverse populations. The objective of this study is expand an implementation model with recommendations on the equitable implementation of new digital health technologies. The Digital Health Equity-Focused Implementation Research (DH-EquIR) conceptual model was developed based on a rigorous review of digital health implementation and health equity literature. The Equity-Focused Implementation Research for Health Programs (EquIR) model was used as a starting point and merged with digital equity and digital health implementation models. Existing theoretical frameworks and models were appraised as well as individual equity-sensitive implementation studies. Patient and program-related concepts related to digital equity, digital health implementation, and assessment of social/digital determinants of health were included. Sixty-two articles were analyzed to inform the adaption of the EquIR model for digital health. These articles included digital health equity models and frameworks, digital health implementation models and frameworks, research articles, guidelines, and concept analyses. Concepts were organized into EquIR conceptual groupings, including population health status, planning the program, designing the program, implementing the program, and equity-focused implementation outcomes. The adapted DH-EquIR conceptual model diagram was created as well as detailed tables displaying related equity concepts, evidence gaps in source articles, and analysis of existing equity-related models and tools. The DH-EquIR model serves to guide digital health developers and implementation specialists to promote the inclusion of health-equity planning in every phase of implementation. In addition, it can assist researchers and product developers to avoid repeating the mistakes that have led to inequities in the implementation of digital health across populations.

Changes in postpartum insurance and care use by disability status during the COVID-19 pandemic

BACKGROUND

People with disabilities face unique health needs and barriers to perinatal care. The pandemic may have worsened health care access disparities, while pandemic-era Medicaid provisions potentially improved access via increased insurance coverage.

OBJECTIVE

We assessed changes in postpartum insurance, visits, and reproductive health care during the COVID-19 public health emergency (PHE) and PHE Medicaid provisions among individuals with disabilities versus individuals without disabilities.

METHODS

We used the 2019-2020 Pregnancy Risk Assessment Monitoring System survey and Disability Supplement to compare changes in postpartum outcomes by disability status during COVID-19. Adjusted regression models included an interaction term between disability status and postpartum exposure to the PHE. Comparative differences were examined overall, among low-income respondents, and among respondents with Medicaid-paid deliveries.

RESULTS

During the PHE, there was a significant increase in postpartum Medicaid by 7.1% points (95 % CI: 0.6, 13.6) and a decrease in uninsurance by 5.2% points (95 % CI: -9.0, -1.4) among respondents with disabilities relative to those without. There was a significant increase in postpartum contraception during the PHE among respondents with disabilities relative to those without by 6.3% points (95 % CI: -0.1, 12.5). The PHE was associated with larger increases in postpartum Medicaid and larger decreases in postpartum uninsurance among low-income respondents, with similar estimates among respondents with Medicaid-insured deliveries.

CONCLUSIONS

During the COVID-19 PHE, individuals with disabilities saw increased postpartum insurance and improved contraceptive use. As PHE Medicaid provisions are rolled back, these differential improvements should be factored into decisions about postpartum Medicaid eligibility.

Gender Diversity, Disability, and Well-Being: Impact of Delayed and Foregone Care Because of COVID-19

Purpose: This study explored the impact of delayed and foregone care due to COVID-19 on well-being among disabled and gender diverse adults. Methods: Using data from the 2021 National Survey on Health and Disability and logistic regression modeling we assessed the impact of delayed or foregone care due to COVID-19 on well-being among disabled people (n = 1638), with comparisons between cisgender (n = 1538) and gender diverse (n = 100) people with disabilities. We report odds ratios (OR) and confidence intervals (CI). Results: Disabled people reported high rates of delayed (79.36%) and foregone (67.83%) care and subsequent negative effects on well-being (72.07%). Gender diverse disabled people were over four times more likely to have delayed any care (OR 4.45, 95% CI 1.86-10.77) and three times more likely to have foregone any care (OR 3.14, 95% CI 1.71-5.79) due to COVID-19 compared to cisgender disabled people. They were three times more likely to report any negative impact on their health and well-being because of delayed and foregone care (OR 2.78, 95% CI 1.43-5.39). Conclusion: The COVID-19 pandemic affected the health care utilization of disabled people, resulting in high rates of delayed care, foregone care, and negative impacts on well-being. These effects were intensified at the intersection of disability and marginalized gender identity, with gender diverse disabled people having higher odds of delayed and foregone care and negative effects on well-being, including physical health, mental health, pain levels, and overall level of functioning.

Can evidence drive health equity in the COVID-19 pandemic and beyond?

Using scoping review methods, we systematically searched multiple online databases for publications in the first year of the pandemic that proposed pragmatic population or health system-level solutions to health inequities. We found 77 publications with proposed solutions to pandemic-related health inequities. Most were commentaries, letters, or editorials from the USA, offering untested solutions, and no robust evidence on effectiveness. Some of the proposed solutions could unintentionally exacerbate health inequities. We call on health policymakers to co-create, co-design, and co-produce equity-focussed, evidence-based interventions with communities, focussing on those most at risk to protect the population as a whole. Epidemiologists collaborating with people from other relevant disciplines may provide methodological expertise for these processes. As epidemiologists, we must interrogate our own methods to avoid propagating any unscientific biases we may hold. Epidemiology must be used to address, and never exacerbate, health inequities-in the pandemic and beyond.

Adaptations to research within the intellectual disability population during the COVID-19 pandemic: Lessons learned from the CAREVIS study

The COVID-19 pandemic resulted in changes in all areas of clinical practice, including clinical research and within the intellectual disability population. While there have been some benefits from this rapid adoption of change, those involved in research have had to overcome a number of additional challenges. These adaptive changes, which have included the use of technology, closure of social spaces, working with specific groups who are more vulnerable to COVID-19, and mask use impairing communication, have had both positive and negative impacts on research. As the pandemic and related restrictions evolve, it is important to examine the changes that have occurred. In the future, the adoption of a hybrid model in research is likely to be a common approach, establishing a balance between technology and in-person interaction.

Telehealth as an Effective Care Delivery Method During the COVID-19 Pandemic for the Rhode Island Behavioral Health Population

In response to the COVID-19 pandemic, Rhode Island implemented a telehealth waiver allowing telehealth parity. This study investigated (1) if telehealth allowed for patients who seek mental health services to maintain visit frequency and (2) if subpopulations were less likely to utilize telehealth. We used descriptive statistics to analyze the change in total number of visits, in-person visits from pre-waiver to post-waiver, and a multivariate linear regression to identify relationships between demographics and telehealth utilization. Participants were able to maintain the frequency of visits during the COVID-19 pandemic. Race/ethnicity, age, gender, employment status, and housing status were all statistically significant predictors of telehealth utilization. Telehealth aids in the continuing of care when in-person visits are not a viable option. Access to telehealth is crucial during public health emergencies and aids in maintaining visit frequency. Further research should be done to evaluate subgroups who are less likely to utilize telehealth.

Telehealth and the Psychiatric Mental Health Nurse Practitioner: Beyond the COVID-19 Pandemic

OBJECTIVE

Examine the advantages, disadvantages, and challenges of telehealth for the psychiatric mental health nurse practitioner (PMHNP) in practice and student education. Describe areas for future research and policy development regarding telehealth in PMHNP practice and training during and beyond the COVID-19 pandemic.

METHODS

Review current evidence, standards of practice, and education for the PMHNP.

RESULTS

Recent rapid pandemic-related shifts in utilization of telehealth for clinical practice and student education have highlighted the advantages, disadvantages, and areas in need of additional study.

CONCLUSIONS

Postpandemic telehealth care delivery will likely persist or expand. PMHNPs must advocate for high practice and education standards.

Telehealth follow-up consultations for melanoma patients during the COVID-19 pandemic: Patient and clinician satisfaction

INTRODUCTION

The COVID-19 pandemic caused rapid implementation of telehealth for melanoma follow-up care in Australia. This study explores Australian melanoma patients and clinicians' level of satisfaction with telehealth.

METHODS

A cross-sectional study was conducted across three specialist melanoma centres in Sydney, Australia. Melanoma patients (all stages) and clinicians completed mixed methods surveys seeking socio-demographic and clinical information and questionnaires to assess satisfaction with telehealth. Additionally, patients completed measures of quality of life, fear of cancer recurrence and trust in their oncologist. Patients and clinicians provided open-ended responses to qualitative questions about their perceptions of telehealth.

RESULTS

One hundred and fifteen patients and 13 clinicians responded to surveys. Telephone was used by 109 (95%) patients and 11 (85%) clinicians. Fifty-seven (50%) patients and nine (69%) clinicians preferred face-to-face consultations, 38 (33%) patients and 3 (23%) clinicians preferred a combination of face-to-face and telehealth consultations. Five (4%) patients and nil clinicians preferred telehealth consultations. Patients diagnosed with early-stage melanoma, using telehealth for the first time, who have lower trust in their oncologist, and having higher care delivery, communication and supportive care concerns were likely to report lower satisfaction with telehealth. Open-ended responses were consistent between patients and clinicians, who reported safety, convenience and improved access to care as major benefits, while identifying personal, interpersonal, clinical and system-related disadvantages.

DISCUSSION

While telehealth has been widely implemented during COVID-19, the benefits identified by patients and clinicians may extend past the pandemic. Telehealth may be considered for use in conjunction with face-to-face consultations to provide melanoma follow-up care.

Telehealth and digital health innovations: A mixed landscape of access

In the wake of emergent natural and anthropogenic disasters, telehealth presents opportunities to improve access to healthcare when physical access is not possible. Yet, since the beginning of the COVID pandemic, lessons learned reveal that various populations in the United States do not or cannot adopt telehealth due to inequitable access. We explored the Digital Determinants of Health (DDoHs) for telehealth, characterizing the role of accessibility, broadband connectivity and electrical grids, and patient intersectionality. In addition to its role as an existing Social Determinant of Health, Policies and Laws directly and indirectly affect these DDoHs, making access more complex for marginalized populations. Digital systems lack the flexibility, accessibility, and usability to inclusively provide the essential services patients need in telehealth. We propose the following recommendations: (1) design technology and systems using accessibility and value sensitive design principles; (2) support a range of technologies and settings; (3) support multiple and diverse users; and (4) support clear paths for repair when technical systems fail to meet users' needs. Addressing these requires change not only from providers but also from the institutions providing these systems.

Artificial intelligence in physical rehabilitation: A systematic review

BACKGROUND

Physical disabilities become more common with advancing age. Rehabilitation restores function, maintaining independence for longer. However, the poor availability and accessibility of rehabilitation limits its clinical impact. Artificial Intelligence (AI) guided interventions have improved many domains of healthcare, but whether rehabilitation can benefit from AI remains unclear.

METHODS

We conducted a systematic review of AI-supported physical rehabilitation technology tested in the clinical setting to understand: 1) availability of AI-supported physical rehabilitation technology; 2) its clinical effect; 3) and the barriers and facilitators to implementation. We searched in MEDLINE, EMBASE, CINAHL, Science Citation Index (Web of Science), CIRRIE (now NARIC), and OpenGrey.

RESULTS

We identified 9054 articles and included 28 projects. AI solutions spanned five categories: App-based systems, robotic devices that replace function, robotic devices that restore function, gaming systems and wearables. We identified five randomised controlled trials (RCTs), which evaluated outcomes relating to physical function, activity, pain, and health-related quality of life. The clinical effects were inconsistent. Implementation barriers included technology literacy, reliability, and user fatigue. Enablers included greater access to rehabilitation programmes, remote monitoring of progress, reduction in manpower requirements and lower cost.

CONCLUSION

Application of AI in physical rehabilitation is a growing field, but clinical effects have yet to be studied rigorously. Developers must strive to conduct robust clinical evaluations in the real-world setting and appraise post implementation experiences.

Telehealth Utilization During the COVID-19 Pandemic Among People With Functional Disabilities in the U.S.: A Preliminary Analysis of National Health Interview Survey 2020 Data

Introduction

Telehealth has been widely promoted and adopted at multiple levels in the U.S. healthcare system during the COVID-19 pandemic. However, this rapid expansion of telehealth services may have further exacerbated health inequities among marginalized groups.

Methods

Using the 2020 National Health Interview Survey, this study compared patterns of telehealth use between people with functional disabilities and people without disabilities during the first year of the pandemic.

Results

In the multivariable-adjusted logistic regression models, respondents with moderate disabilities were significantly more likely to report telehealth use, not pandemic related (OR=1.25, 95% CI=1.03, 1.52) and telehealth use, pandemic related (OR=1.43, 95% CI=1.28, 1.60) than people without disabilities. Similarly, respondents with severe disabilities were significantly more likely to report telehealth use, not pandemic related (OR=1.46, 95% CI=1.07, 2.00) and telehealth use, pandemic related (OR=2.06, 95% CI=1.72, 2.46). In addition, telehealth use varied by the number of limitations and disability type.

Conclusions

People with functional disabilities were more likely to report telehealth use than people without disabilities. Furthermore, these associations strengthened with increasing disability severity and number of limitations while varying by disability type. Additional studies are warranted to explore ways of providing patient-centered telehealth to responsively meet various healthcare needs of people with functional disabilities and improve their health outcomes.

Establishing the Need for Anticipatory Symptom Guidance and Networked Models of Disease in Adaptive Family Management Among Children With Medical Complexity: Qualitative Study

BACKGROUND

Caregivers of children with medical complexity navigate complex family management tasks for their child both in the hospital and home-based setting. The roles and relationships of members of their social network and the dynamic evolution of these family management tasks have been underexamined.

OBJECTIVE

The purpose of this study was to explore the structures and processes of family management among caregivers of children with medical complexity, with a focus on the underlying dynamic nature of family management practices and the role of members of their social network.

METHODS

This study used a qualitative approach to interview caregivers of children with medical complexity and members of their social network. Caregivers of children with medical complexity were recruited through an academic Children's Hospital Complex Care Clinic in the mid-Atlantic region and interviewed over a period of 1 to 3 days. Responses were analyzed using constructivist grounded theory and situational analysis to construct a new conceptual model. Only caregiver responses are reported here.

RESULTS

In total, 20 caregivers were included in this analysis. Caregiver perspectives revealed the contextual processes that allowed for practices of family management within the setting of rapidly evolving symptoms and health concerns. The dynamic and adaptive nature of this process is a key underlying action supporting this novel conceptual model. The central themes underpinning the adaptive family management model include symptom cues, ongoing surveillance, information gathering, and acute on chronic health concerns. The model also highlights facilitators and threats to successful family management among children with medical complexity and the networked relationship among the structures and processes.

CONCLUSIONS

The adaptive family management model provides a basis for further quantitative operationalization and study. Previously described self- or family management frameworks do not account for the underlying dynamic nature of the disease trajectory and the developmental stage progression of the child or adolescent, and our work extends existing work. For future work, there is a defined role for technology-enhanced personalized approaches to home-based monitoring. Due to the disparities caregivers and the children in this population already experience, technology-enhanced approaches must be built alongside key stakeholders with an equity orientation to technology co-development.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/14810.

People with Disabilities' Access to Medical Care During the COVID-19 Pandemic

Delaying and forgoing medical care intensifies the health disparities and unmet needs people with disabilities already face. While many people with disabilities were at high risk for COVID-19, less is known about their access to medical care during the pandemic. This study explored people with disabilities' access to medical care during the COVID-19 pandemic. We analyzed United States Census Bureau COVID-19 Household Pulse Survey data from the second year of the pandemic (April-July 2021) from people with (n = 38,512) and without (n = 296,260) disabilities. During the second year of the pandemic, 30.8% of people with disabilities delayed getting medical care and 28.9% forwent needed care. People with disabilities were also significantly more likely to delay and forgo medical care than people without disabilities. Attention must be drawn to the unmet needs of people with disabilities and efforts must be made to expand their access to health care.

Evaluating Telehealth Uptake Among North Carolina Medicaid Beneficiaries With Musculoskeletal Conditions: Insights From the COVID-19 Pandemic

BACKGROUND

The shift from in-person to virtual visits, known as telehealth (TH), during the COVID-19 pandemic was a significant change for North Carolina (NC) Medicaid beneficiaries seeking treatment for musculoskeletal (MSK) conditions, as remote care for these conditions was previously unavailable. We used this policy change to investigate factors associated with TH uptake and whether TH availability mitigated disparities in access to care or affected emergency department (ED) visits among these beneficiaries.

RESEARCH DESIGN

Using 2019-2021 NC Medicaid claims, we identified beneficiaries receiving treatment for MSK conditions before COVID-19 (March 2019-February 2020) and analyzed uptake of newly available TH during COVID-19 (April 2020-March 2021). We used descriptive analysis and Poisson generalized estimating equations to quantify TH uptake, factors associated with TH uptake, and the association with ED visits during COVID-19.

RESULTS

Black and Hispanic beneficiaries were less likely to use TH compared with White and non-Hispanic counterparts (10%, P <0.001 and 20%, P =0.03, respectively). Adults eligible for Tailored Plans, specialized NC Medicaid plans for those with significant behavioral health needs or intellectual/developmental disabilities, were less likely to use TH [adjusted risk ratio (ARR):0.83, 95% CI (0.78, 0.87)]; youth eligible for Tailored Plans were more likely to use TH [ARR:1.28, 95% CI (1.16, 1.42)]. Lower county-level internet access was associated with lower TH use [ARR: 0.85, 95% CI (0.82, 0.99)]. No statistical difference in ED utilization was observed between TH users and non-users.

CONCLUSIONS

TH has the potential to deliver convenient care to beneficiaries with MSK conditions who can access it. Further research and policy changes should explore and address underlying factors driving disparities and improve equitable access to care for this population.

Telehealth Use Among Older Adults With Sensory, Cognitive, and Physical Impairments: A Substitute or Supplement to Traditional Care?

OBJECTIVES

Telehealth use flourished during the COVID-19 pandemic, as older patients faced obstacles to seeking in-person care. Heavy reliance on telehealth may continue postpandemic, due to increased Medicare investments in its use. However, it is unclear if older adults with disabilities face obstacles to effective telehealth use. We evaluate (a) how sensory, physical, and cognitive impairments affect older adults' use of telehealth only, traditional in-person care only, neither, or both (i.e., combined care); and (b) whether these patterns differ on the basis of socioeconomic and social resources that may facilitate telehealth use.

METHOD

Data are from the Self-Administered Questionnaire in the 2020 wave of the Health and Retirement Study (n = 4,453). We estimated multinomial logistic regression models to evaluate associations between impairments and health care service use and tested 2-way interaction terms to evaluate moderation effects.

RESULTS

Persons without impairments were most likely to use combined care, considered the optimal form of care. Persons with vision or cognitive impairment were more likely to use telehealth or traditional care only, whereas persons with 3 or more physical limitations were least likely to use telehealth alone, relative to combined care. Patterns did not differ significantly on the basis of any of the potential moderators.

DISCUSSION

We discuss implications for health care policy and practice, in light of reimbursement changes proposed by the Centers for Medicare and Medicaid Services for telehealth services. These proposals include the elimination of voice-only services which may be particularly beneficial to vision-impaired older adults.

Older Adults With Functional Limitations and Their Use of Telehealth During COVID-19

We investigated the association between functional limitations and telehealth use among older Medicare beneficiaries in 2020. We use logistic regression models to estimate associations between functional limitations and the use of technological tools (i.e., computers, Internet, telehealth). We consider Internet use and informal technological support as moderators for telehealth use. Respondents (N = 3151; Mage = 78.31) with more functional limitations were more likely to use video-based telehealth. Net of functional limitations, those with a consistent Internet use were more likely to use emails/texts/portal messages to communicate with a healthcare provider. Further, more functional limitations were associated with a higher probability of using emails/texts/portal messages, but only among respondents who received informal technological support. Healthcare access may have been more difficult for older adults with functional limitations during the COVID-19 pandemic, especially for those with little prior experience with the Internet, or those without friends/family to provide technological support.

Strategies and solutions to address Digital Determinants of Health (DDOH) across underinvested communities

Healthcare has long struggled to improve services through technology without further widening health disparities. With the significant expansion of digital health, a group of healthcare professionals and scholars from across the globe are proposing the official usage of the term "Digital Determinants of Health" (DDOH) to explicitly call out the relationship between technology, healthcare, and equity. This is the final paper in a series published in PLOS Digital Health that seeks to understand and summarize current knowledge of the strategies and solutions that help to mitigate the negative effects of DDOH for underinvested communities. Through a search of English-language Medline, Scopus, and Google Scholar articles published since 2010, 345 articles were identified that discussed the application of digital health technology among underinvested communities. A group of 8 reviewers assessed 132 articles selected at random for the mention of solutions that minimize differences in DDOH. Solutions were then organized by categories of policy; design and development; implementation and adoption; and evaluation and ongoing monitoring. The data were then assessed by category and the findings summarized. The reviewers also looked for common themes across the solutions and evidence of effectiveness. From this limited scoping review, the authors found numerous solutions mentioned across the papers for addressing DDOH and many common themes emerged regardless of the specific community or digital health technology under review. There was notably less information on solutions regarding ongoing evaluation and monitoring which corresponded with a lack of research evidence regarding effectiveness. The findings directionally suggest that universal strategies and solutions can be developed to address DDOH independent of the specific community under focus. With the need for the further development of DDOH measures, we also provide a framework for DDOH assessment.

A review of the utilization of digital health technologies for college students with disabilities

OBJECTIVES

The purpose of this study was to understand current research on the utilization of mobile health (mHealth) technologies for college students with disabilities.

METHODS

We conducted a bibliometric analysis to understand the longitudinal research trends and dominant topics in mHealth research for college students. Next, we performed a scoping review to gain a more in-depth understanding of the current research on the use of mobile technologies for college students with disabilities.

RESULTS

Despite the increasing number of publications on the development of mobile health applications and mHealth interventions for college students, we found only five studies on disabilities. Most previous studies discussed mental health problems, and we could not find any research utilizing mHealth technologies for college students with physical disabilities.

CONCLUSION

Due to a lack of scientific evidence on the digitalized self-care of college students with disabilities, future studies focusing on this minority population are needed.

Telehealth in PM&R: Past, present, and future in clinical practice and opportunities for translational research

Telehealth refers to the use of telecommunication devices and other forms of technology to provide services outside of the traditional in-person health care delivery system. Growth in the use of telehealth creates new challenges and opportunities for implementation in clinical practice. The American Academy of Physical Medicine and Rehabilitation (AAPM&R) assembled an expert group to develop a white paper to examine telehealth innovation in Physical Medicine and Rehabilitation (PM&R). The resultant white paper summarizes how telehealth is best used in the field of PM&R while highlighting current knowledge deficits and technological limitations. The report identifies new and transformative opportunities for PM&R to advance translational research related to telehealth and enhance patient care.

Recommendations for the Use of Telepsychology in Psychology-Law Practice and Research: A Statement by American Psychology-Law Society (APA Division 41)

In response to the COVID-19 pandemic and subsequent impact on psychological work, Division 41 of the American Psychological Association convened a taskforce to provide guidance to its membership regarding the use of technology for practice and research at the intersection of psychology and law. Drawing from existing research in psychology-law and beyond, as well as the first-hand experience of taskforce members, this document outlines foundational guidance to apply technology to forensic and correctional work while acknowledging these settings provide unique challenges to ethical practice. The recommendations provide support for psychologists involved in assessment, treatment, training, and research. However, these recommendations may not exhaustively apply to all areas of psycholegal practice or all forms of technology. Further, these recommendations are intended to be consulted in conjunction with other professional practice guidelines, emerging research, and policy changes that impact the integration of technologies into this work.

Patient and caregiver experience with telehealth for surgical cancer care: A qualitative study

INTRODUCTION

The COVID-19 pandemic led to telemedicine adoption for many medical specialties, including surgical cancer care. To date, the evidence for patient experience of telemedicine among patients with cancer undergoing surgery is limited to quantitative surveys. Thus, this study qualitatively assessed the patient and caregiver experience of telehealth visits for surgical cancer care.

METHODS

We conducted semistructured interviews with 25 patients with cancer and three caregivers who had completed a telehealth visit for preanesthesia or postoperative visits. Interviews covered visit descriptions, overall satisfaction, system experience, visit quality, what roles caregivers had, and thoughts on what types of surgery-related visits would be appropriate through telehealth versus in-person.

RESULTS

Telehealth delivery for surgical cancer care was generally viewed positively. Multiple factors influenced the patient experience, including prior experience with telemedicine, ease of scheduling visits, smooth connection experiences, having access to technical support, high communication quality, and visit thoroughness. Participants identified use cases on telehealth for surgical cancer care, including postoperative visits for uncomplicated surgical procedures and educational visits.

CONCLUSIONS

Patient experiences with telehealth for surgical care are influenced by smooth system experiences, high-quality patient-clinician communications, and a patient-centered focus. Interventions are needed to optimize telehealth delivery (e.g., improve telemedicine platform usability).

Telehealth Palliative Care in Nursing Homes: A Scoping Review

OBJECTIVES

Many adults older than 65 spend time in a nursing home (NH) at the end of life where specialist palliative care is limited. However, telehealth may improve access to palliative care services. A review of the literature was conducted to synthesize the evidence for telehealth palliative care in NHs to provide recommendations for practice, research, and policy.

DESIGN

Joanna Briggs Institute guidance for scoping reviews, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews frameworks were used to guide this literature review.

SETTINGS AND PARTICIPANTS

Reviewed articles focused on residents in NHs with telehealth palliative care interventionists operating remotely. Participants included NH residents, care partner(s), and NH staff/clinicians.

METHODS

We searched Medline (Ovid), Embase (Elsevier), Cochrane Library (WileyOnline), Scopus (Elsevier), CINHAL (EBSCOhost), Trip PRO, and Dissertations & Theses Global (ProQuest) in June 2021, with an update in January 2022. We included observational and qualitative studies, clinical trials, quality improvement projects, and case and clinical reports that self-identified as telehealth palliative care for NH residents.

RESULTS

The review yielded 11 eligible articles published in the United States and internationally from 2008 to 2020. Articles described live video as the preferred telehealth delivery modality with goals of care and physical aspects of care being most commonly addressed. Findings in the articles focused on 5 patient and family-centered outcomes: symptom management, quality of life, advance care planning, health care use, and evaluation of care. Consistent benefits of telehealth palliative care included increased documentation of goals of care and decrease in acute care use. Disadvantages included technological difficulties and increased NH financial burden.

CONCLUSIONS AND IMPLICATIONS

Although limited in scope and quality, the current evidence for telehealth palliative care interventions shows promise for improving quality and outcomes of serious illness care in NHs. Future empirical studies should focus on intervention effectiveness, implementation outcomes (eg, managing technology), stakeholders' experience, and costs.

'The key to this is not so much the technology. It's the individual who is using the technology': Perspectives on telehealth delivery for autistic adults during the COVID-19 pandemic

LAY ABSTRACT

The COVID-19 pandemic meant that a lot of healthcare services had to move online, such as to video-calls, or to telephone. However, not many studies have looked at how autistic adults feel about this kind of service delivery. It is important to know this, as autistic people may have poorer health than non-autistic people, and they may also struggle to access services more than non-autistic people. This study asked 11 autistic adults (aged 27-67 years), seven family members/carers (aged 44-75) reporting about autistic adults and six service providers about their experiences of accessing or providing a telehealth service. These experiences were collected through interviews, which were then analysed through thematic analysis. Two main themes were: technology aids communication and access - except when it doesn't, and in/flexibility. The themes pointed out some positive aspects of telehealth delivery, including improved communication and decreased stress. The themes also pointed out negative aspects of telehealth, such as increased rigidity of the healthcare system, amplifying pre-existing barriers. Because autistic people have many barriers to accessing healthcare, this study encourages researchers and healthcare providers to think about how such barriers could be addressed through telehealth, and about the possible limitations of telehealth for some autistic people.

An evidence-based practice guideline of the National Society of Genetic Counselors for telehealth genetic counseling

There are currently no practice guidelines available for genetic counseling using telehealth modalities. This evidence-based practice guideline was developed in response to increasing use of alternative service delivery models for genetic counseling, specifically telephone and video-based genetic counseling (telehealth genetic counseling or THGC). A recent systematic evidence review (SER) compared outcomes of THGC with in-person genetic counseling and found that for the majority of studied outcomes, THGC was a non-inferior and comparable service delivery model. The SER results were used to develop this guideline. The current and anticipated future use of THGC, including the influence of the COVID-19 pandemic, provides the context for this guideline. Recommendation: The Telehealth Practice Guideline author workgroup conditionally recommends telehealth genetic counseling, either via telephone or video, as a delivery method for genetic counseling. Depending on factors unique to individual healthcare systems and provider and patient populations, THGC may be the only service delivery model available or may be utilized in addition to other service delivery models including in-person genetic counseling. The evidence shows large desirable effects, minor undesirable effects, and increased equity for patients when THGC is available. THGC may reduce or remove existing barriers to patient access to genetic counseling, such as medical conditions and/or disabilities that may affect a patient's ability to travel, inflexible work or school schedules, and lack of reliable transportation, finances, or dependent care. THGC is likely acceptable to key groups impacted by its use and is feasible to implement. Certain patient populations may require additional resources or encounter more barriers in using telemedicine services in general. For these populations, THGC can still be a valuable option if solutions are available.

Designing for patient decision-making: Design challenges generated by patients with atrial fibrillation during evaluation of a decision aid prototype

Shared decision-making (SDM) empowers patients and care teams to determine the best treatment plan in alignment with the patient's preferences and goals. Decision aids are proven tools to support high quality SDM. Patients with atrial fibrillation (AF), the most common cardiac arrhythmia, struggle to identify optimal rhythm and symptom management strategies and could benefit from a decision aid. In this Brief Research Report, we describe the development and preliminary evaluation of an interactive decision-making aid for patients with AF. We employed an iterative, user-centered design method to develop prototypes of the decision aid. Here, we describe multiple iterations of the decision aid, informed by the literature, expert feedback, and mixed-methods design sessions with AF patients. Results highlight unique design requirements for this population, but overall indicate that an interactive decision aid with visualizations has the potential to assist patients in making AF treatment decisions. Future work can build upon these design requirements to create and evaluate a decision aid for AF rhythm and symptom management.

Equitable Access to Telehealth and Other Services for Deaf People During the COVID-19 Pandemic

Introduction

Deaf people who use American Sign Language (ASL) with low self-perceived ability to understand spoken information face inequitable access to health care due to systemic barriers.

Methods

We conducted interviews with 266 deaf ASL users at baseline (May-Aug 2020) and 244 deaf ASL users at follow-up (3 months). Questions addressed (1) access to interpretation during in-person visits; (2) whether they visited clinics (3) or emergency departments (EDs); and (4) telehealth use. Analyses involved univariate and multivariable logistic regressions across levels of perceived ability to understand spoken language.

Results

Less than a third were aged >65 (22.8%); Black, Indigenous, People of Color (28.6%), or LGBTQ+ (31.1%); and had no college degree (30.6%). More respondents reported outpatient visits at follow-up (63.9%) than at baseline (42.3%). Ten more respondents reported going to urgent care or an ED at follow-up than at baseline. At follow-up interviews, 57% of deaf ASL respondents with high perceived ability to understand spoken language reported receiving interpretation at clinic visits compared to 32% of ASL respondents with low perceived ability to understand spoken language (p<0.01). Telehealth and ED visits showed no between-group differences for low versus high perceived ability to understand spoken language.

Discussion

Our study is the first to explore deaf ASL users' access to telehealth and outpatient encounters over time during the pandemic. The U.S. health care system is designed for people who have high perceived ability to understand spoken information. Systemic access to health care, including telehealth and clinics, must be made consistently equitable for deaf people who require accessible communication.

Use of Teletherapy for allied health interventions in community-based disability services: A scoping review of user perspectives

Understanding the experiences and perspectives of users of teletherapy living with a disability and working with them, offers the potential to improve its capacity to meet their requirements. Literature examining the effectiveness of interventions delivered via teletherapy often fail to explore the motivators and implementation needs of the users. The scoping review aimed to examine the research evidence addressing user perspectives of teletherapy in delivery of allied health interventions to the disability community. The Joanna Briggs scoping review protocol methodology was employed with searches completed across five databases (ProQuest, CINAHL (EBSCO), Medline (OVID), Scopus, Google Scholar) in September 2021. The search yielded a total of 1365 results, 147 progressed to full text screening and 22 articles included in thematic analysis. Findings were split into themes addressing organisational and implementation based considerations for teletherapy, and secondly the social and contextual considerations of the Target Participants. The two areas of interest were addressed under each theme some of which include resourcing and upskilling, financial, challenging the status quo, moving from hands on to coaching and the utilisation of a hybrid model of intervention delivery. Teletherapy is viewed as creating a distinct set of benefits and challenges compared to in person service delivery, which impact individual members of the disability community differently. The scoping review identifies a strong need from recipients to trial teletherapy and experience it personally to facilitate understanding of how it can best suit an individual. More than being viewed as an alternative to in person services, teletherapy is viewed by users as better suited as a complementary service with flexibility of hybrid model opportunities valued above exclusive use of one over the other.

Engaging the disability community in informatics research: rationales and practical steps

As the informatics community grows in its ability to address health disparities, there is an opportunity to expand our impact by focusing on the disability community as a health disparity population. Although informaticians have primarily catered design efforts to one disability at a time, digital health technologies can be enhanced by approaching disability from a more holistic framework, simultaneously accounting for multiple forms of disability and the ways disability intersects with other forms of identity. The urgency of moving toward this more holistic approach is grounded in ethical, legal, and design-related rationales. Shaped by our research and advocacy with the disability community, we offer a set of guidelines for effective engagement. We argue that such engagement is critical to creating digital health technologies which more fully meet the needs of all disabled individuals.

Consumer perspectives of telehealth in ambulatory care in an Australian health network

We aimed to explore consumer experiences of ambulatory telehealth services and whether consumer experiences differed according to whether they received their consultation using telephone or video technology. We conducted structured telephone interviews with patient consumers who had received a recent remote consultation by telephone or video call, at local ambulatory allied health or multidisciplinary services within a large public metropolitan public health network. Respondents were asked about their recent experience and future choices in relation to telehealth. Responses from consumers who received telephone and video consultations were compared. Consumers from community rehabilitation, community health, allied health outpatients, multidisciplinary specialist clinics and mental health services participated (n = 379), of whom 245 received a telephone consultation (65%) and 134 a video consultation (35%). Almost half of respondents (49%) expressed preference for future face-to-face care and 29% reported they would choose to use telehealth over face-to-face consultation for a similar appointment again. Many commented that they would be influenced by the type of consultation required and expressed a desire to have a choice. Approximately 80% of both groups reported they had achieved the desired outcome from their telehealth consultation. Consumers using video were more likely to experience technical issues. Telehealth met the needs of most consumers, and responses were similar for telephone and video consultations.

Telehealth Assessment in Rehabilitation Counseling During the COVID-19 Pandemic

Research has shown that using telehealth for rehabilitation assessment can be an effective approach. The COVID-19 pandemic and subsequent lockdowns led to many rehabilitation counselors pivoting to telehealth assessment with their clients. This study explores rehabilitation counselors’ use of rehabilitation assessments and telehealth since the beginning of the COVID-19 pandemic. Using a mixed-methods approach, data from 41 rehabilitation counselors across Australia were analyzed. Participants were asked which measures they used prior to the pandemic, how their use of the measures changed during telehealth, and how their work changed due to the COVID-19 pandemic. The Depression Anxiety Stress Scales and the Occupational Search Inventory were the most commonly used tests. Theoretical analysis demonstrated that participants utilized tests based on their usefulness in comprehensive assessment and rehabilitation planning, for engaging the client in the assessment process, out of necessity (mandated tests), and due to attributes of the test the counselor valued. Participants described the impact of COVID-19 on assessment practice demonstrating that despite challenges to telehealth, there were also benefits and that assessment measures could be altered for use in telehealth. Although telehealth had an impact on how rehabilitation counselors provided assessments, many found ways to make it work at a distance.

Factors associated with telehealth use among adults in the United States: Findings from the 2020 National Health Interview Survey

INTRODUCTION

During the COVID-19 pandemic, health care shifted to virtual interactions with health professionals. The aim of this study was to examine the determinants of telehealth use in a nationally representative sample of the United States adult population.

METHODS

The study used data from the 2020 National Health Interview Survey of 17,582 respondents aged ≥18. Andersen's model of health services utilization was employed to examine predisposing, enabling, and needs factors associated with past-year telehealth use. Multivariable logistic regression was conducted to examine statistical associations.

RESULTS

32.5% of adults (n = 6402; mean age 51.6, SE = 0.4) reported telehealth use. Predisposing factors: Women and married/partnered adults and those with higher levels of education had greater odds of using telehealth. Adults living in Midwest and South and adults living in medium-small and non-metropolitan areas had decreased odds of using telehealth. Enabling factors: Income and having a usual source of care were positively associated with telehealth use. A negative association was found for those with no insurance and telehealth use, whereas a positive association was found for military insurance. Needs factors: Odds of using telehealth were increased for adults who had well-visits and ER visits in the past 12 months. Mental health services quadrupled the odds of telehealth use. Odds of using telehealth increased with each additional chronic disease, including COVID-19.

CONCLUSION

There are disparities in telehealth use according to sex, education, rurality, access to care, and health needs. Tackling these disparities is pivotal to ensure barriers to telehealth use are not exacerbated post-pandemic.

Starting with us: Imagining relational, co-designed policy approaches to improve healthcare access for rural people with disability

CONTEXT

Access to healthcare for rural Australians is a wicked problem, particularly for rural people with disability. Contemporary healthcare access frameworks in Australia tend to overlook geography, use a 'one-size-fits-all approach', and disregard the valuable relationships between key rural healthcare stakeholders, including rural people with disability, rural health services and health professionals. The United Nation's Convention on the Rights of Persons with Disabilities requires the Australian Government to engage people with disability in the design of policies that will shape their day-to-day lives, including their access to healthcare. However, the nature and extent to which rural people with disability, rural health professionals and other key rural stakeholders are involved in the design of Australian policies impacting the health of rural people with disability are unknown.

AIM

This paper examines approaches taken to engage rural people with disability and health professionals in the design of Australian disability policy impacting healthcare access, and reimagines future processes which can improve healthcare access for rural people with disability.

APPROACH

Co-design and ethics of care lenses are applied to policy design approaches in this paper. We approach this work as rural disability and health academics, rural health professionals, and as rural people with disability, neurodivergence and family members of people with disability.

CONCLUSION

We argue future co-designed policy approaches could focus on driving change towards equity in healthcare access for rural people with disability by harnessing the relational nature of rural healthcare.

Study on the mechanism of public attention to a major event: The outbreak of COVID-19 in China

This study focuses on public attention to major events, which has become an important topic in the context of the COVID-19 pandemic. In the background of the global transmission of COVID-19, this study discusses the relationship between information shock and sustainable development, which is rarely mentioned before. By developing an appropriate theoretical model, we discuss how the level of public attention changes over time and with the severity of events. Then we use data on the daily clicks on a popular Chinese medical website to indicate public attention to the pandemic. Our analysis shows that, in the first half of 2020, the level of public attention is closely related to the scale of domestic transmission. The marginal effect of the domestic cases in the first wave is 1% to 0.217%. After the pandemic was largely under control in China, people still followed the latest news, but the scale of public attention to regional transmission diminished. And when the pandemic quickly and severely worsened in other countries, people in China were very attentive, that is, public attention increased. The time interval of social reaction we calculate is fairly stable, with a value of between 0 and 5 most of the time. The average time interval from January 2020 to May 2021 ranges from 1.76 days to 1.94 days, depending on the choice of models and parameters. This study suggests that raising public participation in dealing with the crisis over the long term would be enhanced in China by media encouragement to pay more attention to small-scale regional transmission and the course of the pandemic in other countries. The goal of sustainable development requires dealing with health and economic crises much better in the long term. Thus, the model and method used in the paper serve to enhance general interest.

Is Telemedicine in Primary Care a Good Option for Polish Patients with Visual Impairments Outside of a Pandemic?

With the proliferation of telemedicine during the COVID-19 pandemic, attention began to turn to the risk of health disparities associated with its use among people with disabilities. Therefore, the present study investigates the level of interest in using teleconsultations (TCs) in primary healthcare among people with visual impairments (PVIs) and identifies their motivations and needs. A total of 219 Polish PVIs were surveyed using a combination of closed and open questions. About 50% of the respondents expressed interest in using TCs. The factor most closely related to the willingness to use TCs was age. The predominant reason for using TCs was to obtain a prescription or referral, and the most highlighted need was the possibility to choose between a TC and an in-person visit. The blind and poor-sighted participants differed in some regards. Our study indicates that TCs, under some conditions, may be a beneficial option for PVIs, and provides some directions for its effective implementation.

Mitigating the Impact of the COVID-19 Pandemic on Adult Cancer Patients through Telehealth Adoption: A Systematic Review

During the first wave of the COVID-19 pandemic, the delivery of life-saving and life-prolonging health services for oncology care and supporting services was delayed and, in some cases, completely halted, as national health services globally shifted their attention and resources towards the pandemic response. Prior to March 2020, telehealth was starting to change access to health services. However, the onset of the global pandemic may mark a tipping point for telehealth adoption in healthcare delivery. We conducted a systematic review of literature published between January 2020 and March 2021 examining the impact of the COVID-19 pandemic on adult cancer patients. The review's inclusion criteria focused on the economic, social, health, and psychological implications of COVID-19 on cancer patients and the availability of telehealth services emerged as a key theme. The studies reviewed revealed that the introduction of new telehealth services or the expansion of existing telehealth occurred to support and enable the continuity of oncology and related services during this extraordinary period. Our analysis points to several strengths and weaknesses associated with telehealth adoption and use amongst this cohort. Evidence indicates that while telehealth is not a panacea, it can offer a "bolstering" solution during a time of disruption to patients' access to essential cancer diagnostic, treatment, and aftercare services. The innovative use of telehealth has created opportunities to reimagine the delivery of healthcare services beyond COVID-19.

Comparison of innovative communication approaches in nutrition to promote and improve health literacy

The translation of scientific evidence into guidelines and advice is a fundamental aspect of scientific communication within nutrition and dietetics. For communication to be effective for all patients, health literacy (HL) must be considered, i.e. an individual's capacity to obtain, comprehend and utilise information to empower decision-making and promote their own health. HL levels are varied and difficult to judge on an individual basis and have not been quantified, thus not giving a population mean HL competency indication. It has been evidenced that most of the working age population in England cannot comprehend healthcare materials due to complexity, thereby promoting a need for agreed readability thresholds for written healthcare information. A wide range of modalities within dietetics are used to communicate to a varied audience with the primary form written, e.g. journal articles, plain language summaries and leaflets. Audio/visual and digital communications are increasing in dietetic care and welcomed by patients; however, the effectiveness of such approaches has not been studied thoroughly and digital exclusion remains a concern. Communication considering a patient's HL level leads to empowerment which is key to effective management of chronic diseases with a high treatment burden. Therefore; this review will focus on the importance of modalities used to communicate science in nutrition to ensure they are appropriate in relation to Health Literacy.

Investigating the Challenges and Benefits of Engaging in Peer Support via Videoconferencing for People with Spinal Cord Injury

Background: One of the greatest challenges faced by people following a spinal cord injury is reintegrating into the community. Peer mentors are people who have had shared experiences of disadvantage and distress and have successfully navigated their way through the associated challenges to lead meaningful lives. Historically, peer mentoring services have been predominantly delivered via face-to-face interactions. Little is known about the experience of people with spinal cord injury engaging in online peer support services, and what the challenges and benefits are of this mode of delivery. Methods: An anonymous online survey consisting of closed and open response questions was used to collect data. Quantitative data were analysed descriptively and qualitative data were analysed using inductive content analysis. Results: Positive benefits of engaging in peer support via videoconferencing included convenience and social connectedness. The main barriers were problems with Wi-Fi and internet connections, inconsistencies between platforms and having to learn new platforms. Even though responses were mixed when comparing videoconferencing to face-to-face peer support, most participants felt socially connected. Conclusions: Addressing barriers through the provision of appropriate technology, and targeted and individualised assistance, is important to facilitate uptake of online peer support for people with spinal cord injury.

The Effect of Digital Literacy on Participation in Social Media Clinical Trials in Cancer: Tailoring an Informed Consent Process

Introduction: This study asked: (1) How does digital literacy influence one's decision to consent to a social media intervention study? (2) What is a brief way to assess individual digital literacy before an individual's decision to participate in a trial? and (3) How can a consent process be tailored around an individual's digital literacy level? Methods: We used an assessment tool to investigate digital literacy of those who chose to consent to a clinical trial and those who did not consent to the clinical trial but agreed to participate in a digital literacy study. Results A total of 161 hospice caregivers completed the digital literacy assessment. Older individuals and those who rated themselves as more proficient in the use of technology and social media were more likely to consent to the social media clinical trial. Conclusions: We found that asking participants to rate their technology skills and social media skills allows researchers to tailor a consent process. For those who are comfortable with technology and social media the traditional process is appropriate. For individuals that rate themselves with weaker technology and social media skills it is important that the consent process includes assurance they will receive adequate support in the use of the technology and the media. The next step is to test the assessment and tailoring of consent processes for a social media clinical trial. Clinical Trial # NCT02929108.

Children's Designs for the Future of Telehealth

Telehealth has increased dramatically with COVID-19. However, current telehealth systems are designed for able-bodied adults, rather than for pediatric populations or for people with disabilities. Using a design scenario of a child with a communication disability who needs to access telehealth services, we explore children's ideas of the future of telehealth technology. We analyzed designs generated by six children and found three provocative over-arching design themes. The designs highlight how improving accessibility, accommodating communication preferences, and incorporating home based sensor technologies have the potential to improve telehealth for both pediatric patients and their physicians. We discuss how these themes can be incorporated into practical telehealth designs to serve a variety of patient populations-including adults, children, and people with disabilities.

Workplace health surveillance and COVID-19: algorithmic health discrimination and cancer survivors

PURPOSE

This article examines ways COVID-19 health surveillance and algorithmic decision-making ("ADM") are creating and exacerbating workplace inequalities that impact post-treatment cancer survivors. Cancer survivors' ability to exercise their right to work often is limited by prejudice and health concerns. While cancer survivors can ostensibly elect not to disclose to their employers when they are receiving treatments or if they have a history of treatment, the use of ADM increases the chances that employers will learn of their situation regardless of their preferences. Moreover, absent significant change, inequalities may persist or even expand.

METHODS

We analyze how COVID-19 health surveillance is creating an unprecedented amount of health data on all people. These data are increasingly collected and used by employers as part of COVID-19 regulatory interventions.

RESULTS

The increase in data, combined with the health and economic crisis, means algorithm-driven health inequalities will be experienced by a larger percentage of the population. Post-treatment cancer survivors, as for people with disabilities generally, are at greater risk of experiencing negative outcomes from algorithmic health discrimination.

CONCLUSIONS

Updated and revised workplace policy and practice requirements, as well as collaboration across impacted groups, are critical in helping to control the inequalities that flow from the interaction between COVID-19, ADM, and the experience of cancer survivorship in the workplace.

IMPLICATIONS FOR CANCER SURVIVORS

The interaction among COVID-19, health surveillance, and ADM increases exposure to algorithmic health discrimination in the workplace.

Telehealth experiences of providers and patients who use augmentative and alternative communication

OBJECTIVE

We explore the telehealth experiences of adults who use augmentative and alternative communication (AAC) and clinicians who work with people using AAC.

MATERIALS AND METHODS

We conducted semistructured, online interviews with 6 adults who use AAC and 8 clinicians who provide telehealth services to people who use AAC between July and September 2020. Participants were located in the United States and the United Kingdom. All participants had engaged in 2 or more telehealth visits in the past 6 months. We used an inductive, thematic approach to analyze the interview data.

RESULTS

Our findings reveal that (1) telehealth is an essential service, (2) technology causes barriers, (3) policies meant to protect actually inhibit, and (4) remote monitoring devices have the potential to mitigate risks.

DISCUSSION

Telehealth systems created for persons without disabilities do not provide equitable access to everyone. Telehealth should be flexible enough to allow patients to use the communication modality that best meets their needs. We suggest that healthcare systems think of the healthcare ecosystem as one which includes a variety of telehealth options in addition to traditional in-person clinical visits.

CONCLUSIONS

The benefits of telehealth for people who use AAC are substantial and should be an option for ongoing health care. However, the accessibility of telehealth technologies needs to be improved. Designers should view telehealth as part of a broad healthcare ecosystem, which includes in-person, telehealth, and remote health monitoring technologies. Designers should also include AAC users in the design and development process. Telehealth policies should encourage multimodality access to health care and address funding concerns.