BACKGROUND: This doctoral project describes an occupational therapy clinic created by this author within an outpatient health center located on a rural reservation serving the Navajo Native-American community residents. This was the center’s first occupational therapy program. Occupational therapy services included community outreach activities and innovative approaches that were inclusive, culturally appropriate, and client-centered. PROBLEM: Some challenges occurred during the implementation of the occupational therapy program such as: client resistance, cultural differences, lack of public transportation to the reservation, little to no awareness of occupational therapy, and limited funds and resources. METHODOLOGY: A thorough literature review on developing healthcare programs in rural areas was performed to collect relevant information on current methods and approaches. Moreover, programs that incorporated cultural orientation programs and awareness was taken into consideration to develop the occupational therapy program and its activities. This facilitated building a positive rapport and relationship with the Navajo community residents. RESULTS: Innovative approaches were developed to help reduce some of the barriers. Four key program elements were chosen to focus on developing a sustainable and culturally appropriate operating occupational therapy clinic to serve the Navajo Native Americans living on a rural reservation community. Collaboration with pertinent stakeholders, integration of some of the population’s cultural values, conveying cultural respect, and including community outreach events helped the development and operation of the new occupational therapy program. IMPLICATIONS: The development of the new occupational therapy clinic provided several occasions for the clinician to integrate culturally-based activities when providing services to an underserved community. It was able to set an example for future occupational therapy practitioners to create an academic course (and/or internship) to educate students about providing occupational therapy services to an indigenous population.

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To address emerging challenges in empowering patients through telehealth, this dissertation has the following objectives: (a) find the key characteristics that enable patient empowerment [PE], (b) determining when will PE work as a solution, (c) find the optimal telehealth care method that enables PE, and (d) evaluate the impact of telehealth on health care outcomes (such as, patient satisfaction, patient trust with primary care providers, etc.) that ultimately enhances PE. These objectives are addressed in three studies presented here as three essays. Collectively, these essays contribute to the knowledge on PE, patient trust, and telehealth by providing insights on leveraging PE towards better health care services and delivery systems. Essay 1 aims to systemically map the concept of PE using principles of systems thinking with the Boardman soft systems methodology that enables a graphical visualization (i.e., systemigrams). Essay 2 investigates the practical and theoretical implications of connecting patients to empowerment care plans and minimizing wait times in healthcare service delivery using electronic prescriptions (s-scripts), phone calls, and video calls. In Essay 3, the mediating role of telehealth services between patient empowerment and patient satisfaction was analyzed, along with patient trust was assessed as a moderator between telehealth usability and patient satisfaction. Two hundred sixty-two responses from patients in North America with chronic illnesses were collected through an online survey questionnaire were analyzed using partial least squares-structural equation modeling (PLS-SEM). The findings of the research show that patients with chronic illnesses in North America feel empowered by using telehealth as they can get diagnosis of the illness even in remote areas and face no obstacle.