Exploring Underutilization of Videophones in Hospice Settings

Abstract

The aim of this study was to evaluate hospice providers' attitudes and perceptions regarding videophone technology in settings where the technology was introduced but underutilized. Specifically, the project seeks to provide an in-depth understanding of attitudes and perceptions that may lead to failure of a telehealth implementation in the hospice setting in the context of the technology acceptance model. Two hospice agencies were selected as a purposive sample. Both agencies had acquired videophones that were meant to be integrated into care delivery but ultimately were underutilized or never used. Interviews with staff were conducted over the telephone. The interview guide was constructed to capture staff perceptions and attitudes concerning videophone technology. Interviews were audiotaped and transcribed for content analysis. A total of 17 (n = 17) participants (2 hospice administrators, 1 hospice management staff, 10 nurse case managers, and 4 social workers) were interviewed. Participants found videophones to be useful in hospice care but expressed specific practical challenges, such as lack of equipment reliability, lack of human resources, and lack of clarity pertaining to caregiver eligibility criteria. While perceived usefulness of videophones was high among respondents, practical concerns can be interpreted as lack of perceived ease of use. Findings indicate that the Technology Acceptance Model (TAM) provides a good framework for an understanding of telehealth underutilization. Staff perceived that videophones were useful, but they were discouraged by their perception that the videophones were not reliable or easy to use and by their uncertainty about the cases that they were best suited for. Lessons learned are integrated into a randomized clinical trial currently under development.

Evaluation of Home Telehealth Following Hospitalization for Heart Failure: A Randomized Trial

“…19 Issues to address include technical difficulty, perceived expense, and acceptance by providers and patients. 20,21 The image quality of current videophones using commercial telephone lines may not offer adequate resolution to detect important clinical changes. To overcome this and the lack Higher scores indicate worse quality of life.…”

The Technology Acceptance Model: Its past and its future in health care

“…They had to quantitatively test relationships between variables specified by TAM. This criterion excluded studies that measured TAM variables but not the relationships between them [64-71] and qualitative studies that used TAM as a framework [72, 73]. Unlike Yarbrough and Smith [30], who reviewed qualitative studies of TAM, we were interested specifically in studies of TAM, a model of quantitative relationships between variables.…”

“…Nevertheless, qualitative TAM studies can be informative. Day et al’s qualitative interview study of hospice providers’ use of videophones showed that providers perceive videophone technology as useful (improved communication, better access to care) but not easy to use (low technical quality, difficult to use for patients), and that ease of use appeared to be a more dominant contributor to intentions to use [73]. Karsh et al’s study of primary care physicians’ and nurses’ perceptions of using error reporting systems revealed perceptions of usefulness (improved care, suggestions for improvement) and ease of use (easy and quick to use, minimal extra workload, good instructions), as well as subjective norms (colleagues, supervisors, internal and external organizations) [72].…”

Comparison of Two User Interfaces for Accessing Context-Specific Information Resources Related to Hazards and Near Misses

“…The model suggests that perceived usefulness and perceived ease of use influence users’ attitudes toward using the technology and contribute to their behavioral intention to use the technology. TAM has been applied in healthcare to understand clinicians’ technology adaptation in healthcare environment and evidence regarding its usefulness to predict clinicians’ acceptance of a new technology is mounting 14–18…”