Abstract
Teledelivery of rehabilitation services has been proposed as a cost-effective option for supporting children with neurodisability and their families. However, little is understood of the conditions that support uptake of telehealth in paediatric rehabilitation, what is delivered during telehealth or perceptions of its outcomes. The aim of this study was to identify the context, process and outcomes of telehealth for children with neurodisability and their families. A secondary objective was to identify if variations in these aspects of telehealth occurred for Māori, the indigenous people of New Zealand.
METHOD
A mixed methods, three phase, realist evaluation identified context-mechanism-outcome configurations (CMOc) of telehealth. In phase one, the Determinants of Implementation Behaviour Questionnaire indicated factors affecting practitioner uptake of telehealth (Context). In phase two a casenote audit identified ‘practitioner input’ during telehealth (Mechanism). Phase three interviews with practitioners and parents explored ‘parent response’ to telehealth and, practitioner and parent perceptions of its value (Mechanism and Outcomes). Subgroup analyses for Māori were planned.
RESULTS
From phase one,practitioners (29/37, 78%) intended to use telehealth however few did so regularly (7/37, 22%). Positive experiences of telehealth were described by all practitioners (n=5) and families (n=7) in phase three. CMOc’s explained that practitioners’ offering of telehealth occurred when practitioners were confident, valued access to therapy over the familiarity of in-person delivery, and when practitioners used coaching-style communication. Parents were receptive to telehealth when they trusted practitioners, felt listened to and were offered telehealth as a choice. When telehealth occurred, access to therapy was timely, and more consistent than in-person delivery. Child outcomes appeared to be positive. Confidence in offering telehealth to Māori was low.
CONCLUSIONS
Initiatives to improve uptake of telehealth in paediatric rehabilitation should focus on creating conditions for practitioner implementation. Training in telehealth should include engagement with Māori. Adequate workspace and workplace culture change are required if telehealth is to be offered beyond the current ‘early adopters’.