The Diffusion of Telehealth in Rural American Indian Communities: A Retrospective Survey of Key Stakeholders

Abstract

Objective: Mental health issues are a serious concern for many American Indian Veterans, especially for post-traumatic stress disorder and related psychiatric conditions. Yet, acquiring mental health treatment can be a challenge in Native communities where specialized services are largely unavailable. Consequently, telehealth is increasingly being suggested as a way to expand healthcare access on or near reservation lands. In this study, we wanted to understand the factors affecting the diffusion of telehealth clinics that provided mental health care to rural, American Indian Veterans. Materials and Methods: We surveyed 39 key personnel and stakeholders who were involved in the decision-making process, technological infrastructure, and implementation of three clinics. Using Roger Everett's Diffusion Theory as a framework, we gathered information about specific tasks, factors hindering progress, and personal reactions to telehealth both before and after implementation. Results: Many participants expressed initial concerns about using telehealth; however, most became positive over time. Factors that influenced participants' viewpoint largely included patient and staff feedback and witnessing the fulfillment of a community health need. The use of outside information to support the implementation of the clinics and personal champions also showed considerable influence in the clinics' success. Conclusion: The findings presented here address critical gaps in our understanding of telehealth diffusion and inform research strategies regarding the cultural issues and outcomes related to telemental health services. Information contained in this report serves as a long overdue guide for developing telemental health programs and policies among American Indians, specifically, and rural populations in general.

Barriers and Facilitators to eHealth Use in Daily Practice: Perspectives of Patients and Professionals in Dermatology

“…These barriers are in line with findings from current literature [ 18 - 21 , 23 , 31 - 33 ]. In different studies investigating the implementation and adoption of a variety of eHealth interventions in a range of settings, technological knowledge, and skills: financial aspects, social and organizational support, and the lack of education and training are the most frequently noted barriers [ 18 - 21 , 23 , 31 - 33 ]. Crucial factors leading to the successful implementation of teledermatology have been the focus on embedding the intervention in the existing health care infrastructure, the comprehensive support and training of future users, and the clear assignment of persons who took full responsibility for the entire process [ 34 ].…”

“…Interestingly, a lack of experience seemed not to negatively influence the acceptance of eHealth interventions. Compared with other studies assessing the attitude of patients towards the introduction of eHealth services [ 21 - 25 , 33 ], we found a relatively positive attitude towards the use of digital use in daily practice. This might be explained by the recruitment of a relatively small group of patients in a tertiary hospital and through an advertisement by the Dutch Association for People with Atopic Dermatitis (VMCE).…”

Posttraumatic stress disorder and symptoms among American Indians and Alaska Natives: a review of the literature

“…A renewed Memorandum of Understanding between the Veterans Health Administration and Indian Health Service (October 1, 2010) builds upon a previous agreement by deploying and coordinating new health information technologies to better meet the growing demand for trauma-informed care among Native people at highest risk of post-traumatic stress disorder. Several innovative approaches along these lines, including real-time interactive videoconferencing and remote monitoring, have proven effective with respect to both clinical as well as cost outcomes in treating American Indians and Alaska Natives who suffer from this chronic, debilitating condition [71-74]. Given such success, the questions now facing us need to be broadened to include how to promote the diffusion, adoption, and sustainability of these services, which lead naturally to understanding the structure, financing, and policies shaping related care.…”

Barriers to Use of Telepsychiatry: Clinicians as Gatekeepers

“…32 Even in resource scarce areas, some patients still voice a preference for in-person encounters. [33][34][35][36][37] Negative perceptions and expectations should not be ignored, as they may predict actual use and satisfaction. 38 Patients generally report increasing comfort and satisfaction once they have used telepsychiatry 27,39,40 after initial apprehension, discomfort, and fear.…”