The transgender and gender diverse (TGD) patient population consists of a diverse group of people with unique needs who have, unfortunately, been underserved by the medical community. These individuals share a disproportionate burden of discrimination and disease when compared to cisgender persons. However, despite this, they continue to receive inequitable treatment, and transgender health topics still comprise just a small portion of medical education training. While efforts to improve awareness and training regarding transgender health care needs are underway, these take time to gain traction. It also relies heavily on changing medical providers’ own biases. Telemedicine has been proposed as a way to potentially bridge the gap and increase the access and availability of quality, informed medical care to this community. Although telemedicine has demonstrated its ability to do this in other areas of medicine, the existing research on whether it has the capacity to do so for transgender health care delivery is scant. The majority of the existing literature on the topic consists of retrospective qualitative feedback provided during a time where telemedicine was still emerging as a commonplace medium through which medical care is provided. Therefore, this thesis proposes to perform a randomized controlled trial investigating whether instituting a hybrid telemedicine approach has the capability to expand the accessibility of specialty transgender health care services as compared to fully in person medical care while maintaining a high standard of health care quality and patient satisfaction. This study would have the capacity to help inform future health care policy and provide support for continued telemedicine offerings and reimbursement moving forward.

he purpose of the current study was to evaluate the use of behavior skills training via telehealth to teach job interview skills to emerging adults with ASD. Additionally, the study examined if following intervention, skills were able to generalize to new interviewers. 2 undergraduate and 1 graduate student with ASD participated in the study, and received intervention for 3 behaviors: (1) appropriately answering questions, (2) asking appropriate questions, and (3) engaging in appropriate body language. The current study used a multiple baseline design across behaviors. Results from the study indicated BST via telehealth was effective in teaching job interviews skills. Each participant remained at mastery during generalization and did not require a booster session. Social validity ratings completed by each participant indicated they found the intervention method to be fair, effective, and efficient for the identifed need. Limitations and directions for future research are discussed.

Effective patient-provider communication (PPC) involves conveying sufficient information to a patient such that the treatment is agreed upon and implemented accurately. Furthermore, a patient must feel adequately involved in the treatment process. With the advent of the COVID-19 pandemic, many clinical visits were shifted online. Although telemedicine was successful in meeting pandemic-specific goals, such as lowering personal contact, it changes the communicative context. Both patients and providers get less input from body language (nonverbal communication) and rely more on verbal communication. Furthermore, the number of telemedicine visits conducted remains elevated over pre-pandemic levels. Much of what is known about effective PPC is derived from studies in in-person contexts, with little information available in virtual contexts. Given that even occasional lapses in optimal PPC can have severe effects on patient outcomes, it is essential to understand PPC in various settings to optimize patient outcomes in the long run. This study was a secondary data analysis of the UCF Student Health Services Patient Satisfaction Questionnaire. A total of 6645 survey results from January 2021 to November 2022 were analyzed to compare patient perceptions of PPC variables and overall satisfaction with the clinical visit. The results indicated that there was no statistically significant difference in overall satisfaction and PPC variables between telemedicine and in-person visits. However, the results revealed that different PPC variables contributed to overall satisfaction with telemedicine and in-person visits. Keywords: patient-provider communication, telemedicine, telehealth, COVID-19, patient satisfaction, college

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This thesis investigates methods for remote collaboration and communication within a Mixed Reality (MR) rehabilitation environment. Based on the research on remote communication methods and an interview with an occupational therapist with previous experience in MR rehabilitation, a video and audio stream communication method was chosen to be implemented. The implementation consists of two applications, one patient application developed for HoloLens 2 and one therapist application for Android devices. The latter was tested on professional occupational therapists to investigate the feasibility of the method.  The result of the test indicated that the general attitude toward remote rehabilitation was positive. However, the chosen method did not allow the therapist to see the patient's face and surroundings which was a problem for a majority of the test participants. The cognitive workload for the therapist when communicating with the patient was in magnitude to similar tasks and the application was relatively easy to navigate.

Measurement Based Care (MBC) is considered to be an evidence-based practice. Despite its well-documented efficacy, it is underutilized in the clinical community for various reasons, including clinician and patient buy-in. A key component to the successful implementation of MBC is the routine administration of Patient Reported Outcome Measures (PROMs). There is a lack of research describing the utilization of MBC in a telehealth setting. As technological innovations continue, a greater number of clinics are offering telemental health services. Additionally, the COVID-19 pandemic caused a majority of underprepared clinics to begin implementing telehealth. The present study sought to evaluate patient compliance with PROMs in MBC after an abrupt shift to telehealth due to the COVID-19 pandemic. Participants were collected from a clinical population at a community based psychological training clinic. The participants were separated into groups: modality 1 (in-person services, n = 17), modality 2 (telehealth services, n = 17), and modality 3 (hybrid of modalities 1 and 2, n = 10), to assess the effect of modality on mean PROM compliance. The participants were separated into groups adult (≥18 years of age, n = 23) and child (<18 years of age, n = 17), to assess the effect of maturity on mean PROM compliance. Results showed that mean PROM compliance was significantly higher in the in-person modality than the telehealth modality. Results also showed that PROM compliance was significantly higher in adults than in children. There was not a significant interaction effect of modality and maturity on PROM compliance. Additionally, results showed that PROM compliance decreased significantly after the switch from in-person services to telehealth services in the hybrid modality. These findings show that clinics may face significant barriers to the implementation of MBC after a sudden shift to telehealth caused by an unforeseen stressful event. / M.S. / Measurement-Based Care (MBC) is an effective practice for the treatment of patients in psychological practices. It is a collaborative process that involves the clinician and patient tracking treatment progress and outcomes through the use of consistently administered measures known as Patient Reported Outcome Measures (PROMs). Although MBC has been shown to be effective, there is little literature regarding its use in a telehealth setting. As a greater number of clinics begin offering telehealth services, questions regarding patient adherence to interventions have arisen. Furthermore, the global COVID-19 pandemic forced a majority of underprepared clinics to offer telehealth services. The current study sought to better understand potential barriers to the implementation of MBC in a telehealth setting. Participants were collected from patients receiving therapy at a community based psychological training clinic. The participants were separated into the groups: in-person services (n = 17), telehealth services (n = 17), and hybrid of in-person and telehealth (n = 10), to assess the effect of modality on mean PROM compliance. The participants were separated into groups adult (≥18 years of age, n = 23) and child (<18 years of age, n = 17), to assess the effect of maturity on mean PROM compliance. Results showed that patients in the in-person therapy group were more likely to complete their measures than patients in the telehealth therapy group, regardless of their maturity. Additionally, adult patients were more likely to complete their measures than child patients, regardless of the modality. Results also showed that patients who experienced both in-person and telehealth services were more likely to complete their measures before the switch to telehealth. These findings show that clinics may face significant barriers to the implementation of MBC after a sudden shift to telehealth caused by an unforeseen stressful event.

Early detection and intervention are crucial for optimal outcomes in autism spectrum disorder (ASD), but access to services is often lacking in rural communities. In fact, the average age of ASD diagnosis in rural communities is later than elsewhere, increasing the risk of missed early intervention and subsequently poorer outcomes. Caregivers in Southwest Virginia report that major barriers to ASD services include few providers with expertise in ASD, unaffordability of services, and geographic isolation; limited parent training or education about ASD emerges as a particular paucity in this region. To address these barriers, the current pilot study assessed the feasibility of delivering ASD assessment through a mobile clinic (n = 15). During COVID-19, the study shifted to pilot an ASD teleassessment protocol (n = 15). Participants included 30 children between 1.7 and 14.9 years of age and one or both caregivers. Following a diagnostic feedback session, caregivers of children who received an ASD diagnosis (n = 28) were randomized to either attend psychoeducation sessions or receive comparable materials about ASD, with the goal of improving caregiver ASD knowledge and empowerment to seek and provide care for their child. Although flexibility in scheduling was necessary to accommodate families’ schedules, both delivery formats exhibited high feasibility and strong caregiver satisfaction. The primary reason for rescheduling mobile assessments was weather-related, whereas teleassessments were rescheduled due to family emergencies and work-related conflicts. Caregiver empowerment in the domains of family and the community improved after receiving assessment and psychoeducation services, as did total ASD knowledge (η2 = .114–.235, p < .05). / M.S. / Children with autism spectrum disorder (ASD) tend to achieve better outcomes with early intervention, which requires early assessment and diagnosis. However, families in rural areas typically have greater difficulty accessing such services, due to limited providers, high cost of services, and geographic distance from provider offices. This often results in children from rural regions being diagnosed with ASD at a later age than elsewhere, thereby missing opportunities for effective and timely treatment. To overcome these barriers, the current pilot study evaluated two novel service delivery formats: (1) mobile assessment through the Mobile Autism Clinic prior to the COVID-19 pandemic (n = 15); and (2) tele-assessment via a secure video platform during the pandemic (n = 15). Participants included 30 children between 1.7 and 14.9 years of age and one or both caregivers. After completing an assessment, caregivers attended a feedback session to review diagnoses and recommendations. If their child received an ASD diagnosis (n = 28), caregivers then either completed additional educational sessions about ASD or received similar informational materials, with the goal of improving caregiver knowledge and empowerment. Although flexibility in scheduling was necessary to accommodate families’ schedules, both delivery formats demonstrated high feasibility and strong caregiver satisfaction. The primary reason for rescheduling mobile assessments was weather-related, whereas teleassessments were rescheduled due to family emergencies and work-related conflicts. Caregiver empowerment within their family and community improved after receiving assessment and psychoeducation services, as did total ASD knowledge.

Adults aged 65 years and above have grown substantially over with past decade. However, the chance of developing multiple comorbidities only increases with age. Because elderly residents of rural Appalachia often encounter barriers to healthcare, rural nurses, providers, and policy makers must overcome physical and structural barriers, but also gain a more in-depth understanding of the personal and cultural attitudes impacting the use of new and innovative forms of healthcare delivery. With a slow and variable uptake of telehealth adoption in rural Appalachia, and in the presence of well-documented medical mistrust, this study was designed to better understand the degree of medical mistrust existing in the elderly of rural Appalachia and to assess if medical mistrust may be inhibiting efforts related to telehealth acceptance. A correlational design was utilized administering the Medical Mistrust Index (MMI) and Technology Acceptance Model (TAM) questionnaire via electronic survey to those age 65 years and above living in rural Appalachia. Deemed well-established and validated, the MMI measures medical mistrust from a broader perspective, while TAM assesses telehealth acceptance in terms of perceived usefulness, perceived ease of use, and overall attitude towards telehealth as a technology. Demographics of gender, income, education, and previous telehealth experience were compared to MMI and TAM scores. The study revealed a moderate level of medical mistrust and telehealth acceptance among the elderly of rural Appalachia. A statistically significant negative relationship was found between MMI and TAM for those reporting previous telehealth experience, and among all demographics, with the strongest correlations found among females and participants of lower education. Elderly rural Appalachians have a rich social and cultural history, but past experiences and long-held beliefs have resulted in medical mistrust and slow telehealth uptake. Stakeholders have a responsibility to meet individuals where they are understanding that elderly residents of rural Appalachia may not be ready or fully prepared to incorporate telehealth into their management of care. However, quality rural nursing practice and continued research has the ability to evolve to meet the needs that exist among those of advancing age with limited healthcare resources such as those found in rural Appalachia.