Barriers and Facilitators to Video Telehealth with Geriatric Veterans
Gately, Megan.
2020
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Thesis (Ph.D.)--Tufts University, 2020.
Submitted to the Dept. of Interdisciplinary.
Advisor: Linda Tickle-Degnen.
Committee: Keren Ladin, Nathan Ward, and Lauren Moo.
Keywords: Occupational therapy, Public health, and Psychology.
This dissertation examines barriers and facilitators to implementation of video telehealth at Veterans Health Administration ... read more(VHA) through the lenses of occupational therapy (OT) practitioners and caregivers of geriatric Veterans. This dissertation employs concepts from the Promoting Action on Research Implementation in Health Services (PARIHS) framework, Technology Adoption factors developed by gerontology researchers, and the Person-Environment-Occupation (PEO) model. Findings highlight considerations for developing video telehealth for OT practitioners, older adults and their caregivers, outlining strategies to optimize implementation. Paper One utilizes PARIHS implementation science concepts to examine VHA OT practitioners' (N=322, 22% response rate) clinical experiences with and perspectives about video telehealth to deliver OT services to older Veterans. Analysis of data from a national web-based survey revealed that while users and non-users of video telehealth were similar demographically, those with fewer years of practice tended to use video telehealth less. Respondent attitudes towards video telehealth for specific interventions revealed some difference by use of video telehealth that warrant further study. Practitioners' perceived barriers and facilitators highlight several ways that OT-delivered video telehealth can be optimized to meet clinician and older Veterans' needs. Paper Two employs Technology Adoption factors found to influence older adults' decision-making around technology to examine perspectives of caregivers (N=24) of persons with dementia about video telehealth. One-to-one semi-structured phone interviews revealed that, while all the caregivers had technological capacity for video telehealth, perceived barriers differed by caregiver age and role. Advanced caregiver age, perceived limitations of video, and person with dementia difficulty operating technology or engaging due to dementia symptoms were key barriers. Paper Three examines caregiver (N=10) satisfaction with a video telehealth home safety evaluation for dementia, comparing satisfaction ratings with diverse person and environment factors. Multiple-case study analysis revealed that while caregiver satisfaction ratings were mostly high, lower Veteran cognitive status appeared to relate to positive caregiver visit satisfaction. Environmental parameters that appeared to negatively influence caregiver ratings included technological glitches and the presence of the Veteran with dementia during the visit. Findings elucidate opportunities for optimizations to video telehealth home safety evaluations for dementia, including the need for strong communication between caregiver and practitioner.read less - ID:
- 8910k767r
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