Remote participants' experiences with a group-based stroke self-management program using videoconference technology.
ABSTRACT Telehealth is an all-inclusive term for the provision of health services using information and communication technology. Videoconference delivery is one form of telehealth whereby a synchronous, two-way audio and visual connection is made between two or more sites. Videoconference is used in remote areas to improve access to healthcare, perform individual clinical assessments and deliver group education. Moving On after Stroke (MOST®) is a group-based, self-management program for stroke survivors and their caregivers, which consists of information sharing, facilitated discussion, goal-setting, and exercise. This program was delivered simultaneously to local participants onsite in Thunder Bay, Canada, and distant participants in smaller, remote communities in Northwestern Ontario using videoconferencing (MOST-Telehealth Remote). The objective of this study was to explore the experiences of remote participants, their perceptions regarding factors that enable or limit videoconference participation, and to obtain suggestions for enhanced delivery of videoconferenced group programs.
This qualitative study used an interpretive methodology. Semi-structured interviews were conducted in person with remote MOST-Telehealth Remote (MOST-TR) participants within one year post-program. Participants were recruited using purposive sampling and included both male and female stroke survivors and caregivers, those who participated alone and those who participated with others at the remote site. Twenty-seven people were approached, eight declined, and 19 agreed to participate. The average age of participants was 66.2 years (range 48-84). The interviews were transcribed and coded using NVivo v2.0 (www.gsrinternational.com). Data were analyzed for common categories using qualitative descriptive methods.
All participants valued access to the program without having to travel long distances. They felt safe in discussions and when exercising with the group across videoconference. Many reported 'feeling as if they were in the same room' but also acknowledged that there were limitations to participating via videoconference. Participants recognized a loss of subtleties in communication and the group facilitators found it difficult to discern whether participants were finding the exercises too difficult or too easy. The videoconference medium also limited participants' ability to privately or informally address concerns. Factors facilitating engagement and participation were similar to factors in face-to-face groups. Additionally, the importance of collaboration with onsite coordinators, volunteers, and other local participants was highlighted. Facilitators have the added responsibility of including all participants more explicitly, especially those offsite. Suggestions to improve group cohesion and participation included a preliminary face-to-face meeting with all participants, implementing technical strategies, and ongoing onsite support.
For MOST-TR participants, videoconference participation was valuable. Addressing the limitations of videoconference connection and enhanced local support may improve the experience for remote participants in small-group, videoconferenced, self-management programs. Using videoconference technology to participate in existing programs greatly increases accessibility for people living in remote areas.
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ABSTRACT: Background Given the increasing emphasis on the community management of spinal cord injury (SCI), strategies that could be developed and implemented in order to empower and engage individuals with SCI in promoting their health and minimizing the risk of health conditions are required. A self-management program could be one approach to address these complex needs, including secondary complications. Thus, the objective of this study was to determine the importance attributed to the components of a self-management program by individuals with traumatic SCI and explore their views/opinions about the delivery of such a program.Methods Individuals with SCI were recruited by email via the Rick Hansen Institute (Vancouver, British Columbia, Canada) as well as an outpatient hospital spinal clinic. Data were collected by self-report using an on-line survey.ResultsThe final sample size was 99 individuals with traumatic SCI. The components of a self-management program that were rated as ¿very important¿ by the greatest proportion of participants included: exercise (n=¿53; 53.5%), nutrition (n=¿51; 51.5%), pain management (n=¿44; 44.4%), information/education on aging with a SCI (n=¿42; 42.4%), communicating with health care professionals (n=¿40; 40.4%), problem solving (n=¿40; 40.4%), transitioning from rehabilitation to the community (n=¿40; 40.4%), and confidence (n=¿40; 40.4%). Overall, 74.7% (n=¿74) of the sample rated the overall importance of the development of a self-management program for individuals with traumatic SCI as ¿very important¿ or ¿important¿. Almost 40% (n=¿39) of the sample indicated that an internet-based self-management program would be the best delivery format. The highest proportion of participants indicated that the program should have individuals of a similar level of injury (n=¿74; 74.7%); having individuals of a similar age (n=¿40; 40.4%) was also noted. Over one-quarter of the sample (n=¿24) had a depression score consistent with significant symptoms of depression.Conclusions Future research is needed to further evaluate how the views of people with traumatic SCI change over time. Our findings could be used to develop and pilot test a self-management program for individuals with traumatic SCI.BMC Neurology 10/2014; 14(1):209. DOI:10.1186/s12883-014-0209-9 · 2.49 Impact Factor
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ABSTRACT: African Americans (AA) are more likely to develop and die from cancer than any other racial or ethnic group. The aims of this research were to (1) evaluate current education materials being implemented in a community-based prostate cancer education program for AA communities, (2) refine materials based on findings from aim 1, (3) share updated materials with participants from aim 1 for additional improvements, and (4) disseminate and evaluate the improved education program through a statewide videoconference with AA men and women. AA individuals evaluated the current education program through a mail survey (n = 32) and community forum (n = 38). Participants reported that the existing prostate cancer education program content could be understood by lay persons, but recommendations for improvement were identified. They included the following: defining unknown and/or scientific terminology, increasing readability by increasing font size and enlarging images, and including more recent and relevant statistics. Following refinement of the education materials based on survey and forum feedback, a statewide videoconference was implemented. Following the videoconference, participants (25 men; 3 women) reported that they would encourage others to learn more about prostate cancer, talk to their doctor about whether or not to get screened for prostate cancer, and recommend the conference to others. There is great potential for using this type of iterative approach to education program development with community and clinical partners for others conducting similar work.Journal of Cancer Education 12/2014; DOI:10.1007/s13187-014-0774-z · 1.05 Impact Factor
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ABSTRACT: Abstract Objective: This study aims to examine the technical quality of videoconferencing used in hospice to engage caregivers as "virtual" members of interdisciplinary team meetings and their impressions of telehealth. Furthermore, it aims to compare the quality of plain old telephone service (POTS) and Web-based videoconferencing and provide recommendations for assessing video quality for telehealth group interactions. Materials and Methods: Data were obtained from an ongoing randomized clinical trial exploring Web-based videoconferencing and a completed prospective study of POTS-based videoconferencing in hospice. For the assessment of the technical quality, an observation form was used. Exit interviews with caregivers assessed impressions with the use of telehealth. A retrospective analysis of video-recorded team meetings was conducted rating attributes essential for the quality of videoconferencing (e.g., video artifacts, sharpness). Results: In total, 200 hospice team meetings were analyzed, including 114 video-recorded team meetings using Web-based videoconferencing and 86 meetings using POTS videophones. A direct comparison between the two modalities indicates the superiority of Web-based video in image quality but less so in audio quality. Transcripts of 19 caregiver interviews were analyzed. Caregivers found the use of videoconferencing to be a positive experience and a useful and essential tool to communicating with the hospice team. Conclusions: This study highlights the potential of telehealth to improve communication in hospice and the need for new tools that capture the quality of video-mediated communication among multiple stakeholders and strategies to improve the ongoing documentation of telehealth group sessions' technical quality.Telemedicine and e-Health 03/2013; 19(4). DOI:10.1089/tmj.2012.0185 · 1.54 Impact Factor