A multi-level qualitative analysis of Telehomecare in Ontario: challenges and opportunities

Abstract

BackgroundDespite research demonstrating the potential effectiveness of Telehomecare for people with Chronic Obstructive Pulmonary Disease and Heart Failure, broad-scale comprehensive evaluations are lacking. This article discusses the qualitative component of a mixed-method program evaluation of Telehomecare in Ontario, Canada. The objective of the qualitative component was to explore the multi-level factors and processes which facilitate or impede the implementation and adoption of the program across three regions where it was first implemented.MethodsThe study employs a multi-level framework as a conceptual guide to explore the facilitators and barriers to Telehomecare implementation and adoption across five levels: technology, patients, providers, organizations, and structures. In-depth semi-structured interviews and ethnographic observations with program stakeholders, as well as a Telehomecare document review were used to elicit key themes. Study participants (n = 89) included patients and/or informal caregivers (n = 39), health care providers (n = 23), technicians (n = 2), administrators (n = 12), and decision makers (n = 13) across three different Local Health Integration Networks in Ontario.ResultsKey facilitators to Telehomecare implementation and adoption at each level of the multi-level framework included: user-friendliness of Telehomecare technology, patient motivation to participate in the program, support for Telehomecare providers, the integration of Telehomecare into broader health service provision, and comprehensive program evaluation. Key barriers included: access-related issues to using the technology, patient language (if not English or French), Telehomecare provider time limitations, gaps in health care provision for patients, and structural barriers to patient participation related to geography and social location.ConclusionsThough Telehomecare has the potential to positively impact patient lives and strengthen models of health care provision, a number of key challenges remain. As such, further implementation and expansion of Telehomecare must involve continuous assessments of what is working and not working with all stakeholders. Increased dialogue, evaluation, and knowledge translation within and across regions to understand the contextual factors influencing Telehomecare implementation and adoption is required. This can inform decision-making that better reflects and addresses the needs of all program stakeholders.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-1196-2) contains supplementary material, which is available to authorized users.

Challenges encountered with the use of mobile phones to deliver public health services in the Greater Accra Region of Ghana- A qualitative study

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Factors Determining the Success and Failure of eHealth Interventions: Systematic Review of the Literature

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Family caregiving for persons with heart failure at the intersection of heart failure and palliative care: a state-of-the-science review

“…Qualitative studies [30, 36, 40, 42, 45, 48, 54, 61, 71, 72, 74, 77, 80, 83, 88, 104, 110, 117, 119, 131, 137, 138, 142] described a wide range of needs that caregivers felt underprepared for or in need of assistance with, including coping with and managing symptoms; understanding HF and prognosis; handling unplanned hospitalizations and other emergencies; managing medications and devices; providing and receiving emotional and spiritual support; partnering in patients’ self-care; balancing home and work; engaging in their own self-care; having difficult conversations; handing uncertainty about the future and the unpredictably of the disease; communication and care coordination; understanding palliative care services; managing the home; dealing with financial issues; knowing what to expect and how to care for patients at end of life; and leveraging and timely access to formal and informal social support and services. Two quantitative studies both identified handling emergencies as a situation that caregivers’ felt most unprepared for [127, 136].…”