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      Consumer preferences, experiences, and attitudes towards telehealth: Qualitative evidence from Australia

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          Abstract

          In Australia, telehealth is not new, with several telehealth specialist services being available for those living in rural and remote communities. However, prior to the COVID-19 pandemic, telehealth was not routinely available for primary care or urban specialist appointments. There has been an increased focus in the use of telehealth within primary care, and particularly general practice, but overall, there has been limited research to date to guide telehealth best-practice based on consumer experiences and preferences within these settings. We aimed to capture the consumer experience of telehealth during the COVID-19 pandemic, through a novel Kitchen Table Discussion (KTD) method. This increases access to a broader community consumer cohort, with consumer hosts leading discussions in a safe environment. The KTDs were conducted in May 2021, with 10 community members each hosting a group of up to 10 participants. A total of 90 participants took part from across Australia, with the majority living in major cities, although a significant proportion lived in inner and outer regional areas of Australia, or had experience living in rural, regional or remote areas. Seventy percent of participants reported using telehealth in the past. Data were analysed sequentially using thematic analysis and identified key themes: modality, convenience, access, wait time, existing relationship, communication, connectivity, cost, and privacy. Overall, the future of telehealth looks hopeful from the perspective of the consumer, but significant improvements are required to improve consumer engagement and experience. It is evident that ‘one size does not fit all’, with results suggesting consumers value the availability of telehealth and having choice and flexibility to use telehealth when appropriate, but do not want to see telehealth replacing face-to-face delivery. Participants tended to agree that telehealth was not a preferred method when physical examination was required but would suit certain points of the patient journey.

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          Using thematic analysis in psychology

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            What Is Value in Health Care?

            New England Journal of Medicine, 363(26), 2477-2481
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              Beyond Adoption: A New Framework for Theorizing and Evaluating Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies

              Background Many promising technological innovations in health and social care are characterized by nonadoption or abandonment by individuals or by failed attempts to scale up locally, spread distantly, or sustain the innovation long term at the organization or system level. Objective Our objective was to produce an evidence-based, theory-informed, and pragmatic framework to help predict and evaluate the success of a technology-supported health or social care program. Methods The study had 2 parallel components: (1) secondary research (hermeneutic systematic review) to identify key domains, and (2) empirical case studies of technology implementation to explore, test, and refine these domains. We studied 6 technology-supported programs—video outpatient consultations, global positioning system tracking for cognitive impairment, pendant alarm services, remote biomarker monitoring for heart failure, care organizing software, and integrated case management via data sharing—using longitudinal ethnography and action research for up to 3 years across more than 20 organizations. Data were collected at micro level (individual technology users), meso level (organizational processes and systems), and macro level (national policy and wider context). Analysis and synthesis was aided by sociotechnically informed theories of individual, organizational, and system change. The draft framework was shared with colleagues who were introducing or evaluating other technology-supported health or care programs and refined in response to feedback. Results The literature review identified 28 previous technology implementation frameworks, of which 14 had taken a dynamic systems approach (including 2 integrative reviews of previous work). Our empirical dataset consisted of over 400 hours of ethnographic observation, 165 semistructured interviews, and 200 documents. The final nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework included questions in 7 domains: the condition or illness, the technology, the value proposition, the adopter system (comprising professional staff, patient, and lay caregivers), the organization(s), the wider (institutional and societal) context, and the interaction and mutual adaptation between all these domains over time. Our empirical case studies raised a variety of challenges across all 7 domains, each classified as simple (straightforward, predictable, few components), complicated (multiple interacting components or issues), or complex (dynamic, unpredictable, not easily disaggregated into constituent components). Programs characterized by complicatedness proved difficult but not impossible to implement. Those characterized by complexity in multiple NASSS domains rarely, if ever, became mainstreamed. The framework showed promise when applied (both prospectively and retrospectively) to other programs. Conclusions Subject to further empirical testing, NASSS could be applied across a range of technological innovations in health and social care. It has several potential uses: (1) to inform the design of a new technology; (2) to identify technological solutions that (perhaps despite policy or industry enthusiasm) have a limited chance of achieving large-scale, sustained adoption; (3) to plan the implementation, scale-up, or rollout of a technology program; and (4) to explain and learn from program failures.
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                Author and article information

                Contributors
                Role: Project administrationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Writing – original draft
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: SupervisionRole: Writing – original draft
                Role: Project administrationRole: Visualization
                Role: ConceptualizationRole: ResourcesRole: Writing – review & editing
                Role: InvestigationRole: Project administrationRole: ResourcesRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: Project administrationRole: SupervisionRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                31 August 2022
                2022
                : 17
                : 8
                : e0273935
                Affiliations
                [1 ] School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
                [2 ] Consumers Health Forum of Australia, Canberra, Australian Capital Territory, Australia
                [3 ] Digital Health CRC Limited (DHCRC), Sydney, New South Wales, Australia
                [4 ] Deakin Health Economics, Deakin University, Burwood, Victoria, Australia
                King Abdulaziz University Faculty of Medicine, SAUDI ARABIA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                ‡ BN, SE, LW, JN and IF also contributed equally to this work.

                Author information
                https://orcid.org/0000-0002-4553-2188
                https://orcid.org/0000-0002-7783-6928
                Article
                PONE-D-22-09068
                10.1371/journal.pone.0273935
                9432716
                36044536
                af94398a-fbc7-4696-94f4-52cf80ae2216
                © 2022 Toll et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 28 March 2022
                : 17 August 2022
                Page count
                Figures: 2, Tables: 1, Pages: 21
                Funding
                Funded by: DHCRC
                Award ID: DHCRC0161
                Award Recipient :
                This research was part of a larger study supported by the Australian Government Department of Health, Health Economics and Research Division, and the Digital Health CRC Limited (DHCRC), funding number DHCRC0161. The DHCRC is funded under the Commonwealth’s Cooperative Research Centres (CRC) Program. The Department of Health had no role in study design, data collection and analysis, or preparation of the manuscript.
                Categories
                Research Article
                Earth Sciences
                Geography
                Human Geography
                Urban Geography
                Cities
                Social Sciences
                Human Geography
                Urban Geography
                Cities
                Medicine and Health Sciences
                Health Care
                Primary Care
                Medicine and Health Sciences
                Health Care
                Health Care Providers
                Physicians
                People and Places
                Population Groupings
                Professions
                Medical Personnel
                Physicians
                People and Places
                Geographical Locations
                Oceania
                Australia
                Medicine and Health Sciences
                Epidemiology
                Pandemics
                Medicine and Health Sciences
                Health Care
                Health Care Policy
                Medicine and Health Sciences
                Medical Conditions
                Infectious Diseases
                Viral Diseases
                Covid 19
                Medicine and Health Sciences
                Health Care
                Quality of Care
                Custom metadata
                We have provided demographic data within the manuscript. The KTD interview schedule are now provided as a supplementary information file to allow the study to be duplicated. Due to ethics and data governance policies, we are not able to provide the interview transcripts. Data are available from the Curtin University Ethics Committee (contact via hrec@ 123456curtin.edu.au ) for researchers who meet the criteria for access to confidential data.

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                Uncategorized

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