Application of the Concerns-Based Adoption Model to the Installation of Telemedicine in a Rural Missouri Nursing Home

Abstract

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.

Using telemedicine in nursing homes during the COVID‐19 pandemic: A multi‐perspective view on the implementation process

“…We found that nurses still felt residual unease about the way in which a nursing documentation system had been brought into their daily work routine. The same held true for the telemedical tool: It was chosen quickly by management using a top‐down approach due to pandemic time constraints, without involving nurses and using their extensive (tacit) knowledge on their own work processes (Armer et al., 2004 ). Hence, despite the two technologies (the nursing documentation system versus the new telemedical tool) being vastly different in both design and application, the way in which telemedicine was implemented brought up connections and associations between the two tools.…”

Clinician Telemedicine Perceptions During the COVID-19 Pandemic

“…Yet the potential benefits of telemedicine include improved access, more equitable care, and lower costs. [10][11][12][13][14][15] Additionally, advances in technology and access to smart phones and internet access have made telemedicine more accessible.…”

The clinical adoption meta-model: a temporal meta-model describing the clinical adoption of health information systems

“…An extensive review of diffusion of innovation in healthcare [23] recommends we seek to better understand why innovations are rejected (discontinued) once adopted. The CBAM has been applied to telemedicine [24]. TAM has been used in over 20 studies in healthcare to inform use acceptance and adoption [25].…”