The Concerns-Based Adoption Model (C-BAM) was developed in education for the purpose of implementing innovations and change within the school/college system. This study used the principles of the C-BAM and, for the first time, applied them to the process (implementation/training) and product (computer) of the telemedicine technologies in a rural nursing home setting in Missouri. Three rural counties of the 23 Missouri Telemedicine Network sites were chosen to pilot implementation of the computer as one mode of telemedicine technology. One rural nursing home was enlisted for an in-depth study to examine how telemedicine would affect communication between and among community health professionals. Methodological triangulation was used to study individuals' concerns about and utilization of telemedicine through interviews, participant observations, chart reviews, and the Stages of Concern (SOC) survey. Responses to the SOC over time are reported here. The participants consisted of nursing home employees: administration, nursing, housekeeping, and dietary. Forty-three of 52 employees participated in the SOC survey at Time 1 (preimplementation). Twelve months later, 40 participated in the SOC survey at Time 2. While the majority of respondents expressed awareness of the technology, they also expressed a high concern for informational and personal implications. Concern scores in all subscales decreased at Time 2. Findings from this study provided feedback for the implementation and training phases of the project. Most importantly, findings support the appropriateness of this educational model to the healthcare setting.
This study investigated predictors of utilization of the computer-based telemedicine in three rural Missouri counties. Participating health care agencies were given computers and access to an Internet-based workstation that provided e-mail and World Wide Web (WWW) services. Utilization data for e-mail messages sent and WWW pages accessed were collected through proxy servers. A survey was distributed to those employees who are enrolled in the Rural Telemedicine Evaluation Project (RTEP), which addressed perceptions of the Internet-based RTEP workstation. The results of the survey were analyzed to see how perceptions and demographic variables predicted actual utilization. The findings of the study revealed that for e-mail, behavioral intentions/attitude, age, organizational support, and time were the most significant predictors. For WWW, only the behavioral intentions/attitude subscale predicted utilization. The majority of respondents did not utilize the e-mail technology. Strategies need to be developed through training interventions and organizational policies to address non-utilization.
This study investigated predictors of utilization of the computer-based telemedicine in three rural Missouri counties. Participating health care agencies were given computers and access to an Internet-based workstation that provided e-mail and World Wide Web (WWW) services. Utilization data for e-mail messages sent and WWW pages accessed were collected through proxy servers. A survey was distributed to those employees who are enrolled in the Rural Telemedicine Evaluation Project (RTEP), which addressed perceptions of the Internet-based RTEP workstation. The results of the survey were analyzed to see how perceptions and demographic variables predicted actual utilization. The findings of the study revealed that for e-mail, behavioral intentions/attitude, age, organizational support, and time were the most significant predictors. For WWW, only the behavioral intentions/attitude subscale predicted utilization. The majority of respondents did not utilize the e-mail technology. Strategies need to be developed through training interventions and organizational policies to address non-utilization.
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