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Current evidence-based literature regarding the experiences of siblings of children with disabilities acknowledges that siblings have diverse experiences and that it is unclear to what extent siblings are negatively impacted. (Emerson & Giallo, 2014; Giallo, Roberts, Emerson, Wood, & Gavidia-Payne, 2014; Goudie, Havercamp, Jamieson, & Sahr, 2013; Neely-Barnes & Graff, 2011). Yet the literature also emphasizes that a substantial portion of siblings experience emotional and social difficulties and are in need of clinical services that better address their challenges. The aim of this doctoral project is to create an evidence-based and theoretically grounded program that supports siblings through the use of telehealth. Telehealth has previously been used with youth, mostly to address chronic conditions, and demonstrated comparable, and sometimes superior, outcomes when using telehealth as opposed to face-to-face treatment (Dougherty, Lipman, Hyams, & Montgomery, 2014; Gettings, Franco, & Santosh, 2015; Letourneau et al., 2012). The objectives of Sib Kinnect, the proposed program, are to use telehealth to increase knowledge about disability, promote development of meaningful interests, improve coping and problem solving skills, and provide an enjoyable experience in which siblings can connect and learn from each other. The eight-week manual-guided program is designed for siblings, ages 10-12, of children with developmental disabilities and will include fun, age-appropriate activities and discussions that address the desired outcomes in a format that is enjoyable and engaging. In order for this program to be implemented, this project will also discuss important operational components such as the evaluation plan, information dissemination, staffing, and funding

All students have the right to education. Students with disabilities need support from health providers to achieve their potential at school. Barriers to health service provision exist including shortages of providers, waitlists for services, complexities of coordination between the health and education sectors, and more recently the COVID-19 pandemic. Given these barriers, some schools have been using telehealth to increase access to school-based health services; however, the literature is still emerging in this area. In this thesis, I used scoping review methods to explore the literature pertaining to telehealth use in schools. The first manuscript describes the characteristics of telehealth use in schools as depicted in 57 included articles. The findings elucidated who is providing services using telehealth and with whom, when they are using telehealth, how they are using telehealth, and why they are using telehealth in the schools. Based on the findings, I identified practice and research recommendations. The second manuscript delves into the factors that influence telehealth use in schools. We used diffusion of innovations theory to categorize statements in the 57 included articles to identify factors that influenced telehealth implementation in schools. These categories included the features of the telehealth itself (the innovation), the communication about telehealth, the process of deciding to use telehealth (time), and the social system. The findings pointed to at least four key factors that influence implementation of telehealth in schools. The final concluding chapter integrates the findings from the two studies with overarching ideas about technology complexity, access to services, and current knowledge. Additionally, implications for schools, health providers, and specifically occupational therapists are provided along with policy implications. / Thesis / Master of Science Rehabilitation Science (MSc) / School-based health providers experience barriers to servicing children and youth. These barriers reduce access to services. Telehealth is a way to provide services that may increase access to health services in schools. This thesis explored the current research about telehealth use in schools. The first study looked at the characteristics of use such as who is using telehealth, how are they using telehealth, and why are they using telehealth. The second study looked at what factors influence use of telehealth in the schools. The findings from these two studies describe what is currently known about telehealth use in schools. With this information, health providers can decide when, with whom, and how to provide telehealth in the schools. Researchers may use these studies to fill gaps in knowledge about how to best use telehealth in the school setting.

The implementation of telehealth applications is resource intensive and fraught with challenges unique to the people and places involved. The use of telehealth to provide clinical care to patients, educate patients and providers, and conduct research studies to advance medical science has been shown to positively affect issues of access and the quality of care. Previous research has focused on the use of specific technologies, known barriers to adoption and diffusion, and the general efficacy of these applications. Few studies have researched the role champions play in the deployment and operation of telehealth networks. The researcher proposed conducting an interpretative phenomenological analysis (IPA) of clinicians, educators and technical professionals within a successful telehealth network to determine the lived experiences that identify them as champions in the field. Three research questions were studied: 1) What do telehealth champions believe to be the human elements necessary to advance telehealth systems?; 2) How do these telehealth champions explain their empowerment during the creation and use of telehealth networks?; and 3) How do these champions use shared processes and experiences to help spur engagement? Semi-structured interviews with 16 champions from the three disciplines were conducted to explore their lived experiences as part of a telehealth network. Seven champion themes - modern pioneers; champion teams; agents of change; knowledge brokers; supported by management; advocates, not champions; and well-prepared visionaries - emerged from the iterative review and analysis of data. Findings suggest that telehealth champions are not born but instead created. They are modern pioneers who function as part of innovative telehealth teams. Champions also serve as agents of change who utilize their knowledge of disruptive technologies to advocate for improvement in established healthcare systems. They are problem solvers who serve as resources for their colleagues, organizations and collaborative networks. Telehealth champions channel the universal goals of improving patient care and expanding healthcare access to overcome adoption barriers. Applying the ideals of what it means to be champions and how they overcome barriers to new telehealth applications could prove to be very beneficial for those tasked with developing new networks.

No sistema brasileiro de saúde, cabe aos Centros de Saúde o papel de órgão provedor de assistência médica primária. Para que esse papel seja cumprido com responsabilidade e eficácia, se mostrou fundamental a condução de programas públicos de atenção primária que envolvam visitas domiciliares aos pacientes. O objetivo desses programas, tais como o Estratégia de Saúde da Família (ESF), também conhecido como Programa de Saúde da Família (PSF), é o de melhorar a qualidade do serviço de saúde prestado à população por meio da aproximação entre equipes de saúde e a comunidade, permitindo, dessa forma, uma migração do paradigma de tratamento de doenças para o de promoção da saúde. No entanto, apesar da importância desses programas para a organização e articulação do sistema de atenção primária, as atividades de atenção domiciliar são normalmente conduzidas com pouco ou nenhum suporte de Tecnologia da Informação (TI). Esta pesquisa de mestrado tem por objetivo mostrar a definição e o desenvolvimento de um sistema móvel que auxilie os profissionais de saúde na coleta de informações dos pacientes que usufruem dos serviços de saúde citados acima. O projeto recebeu o nome de Projeto Borboleta e durante o tempo desta pesquisa várias versões do software foram desenvolvidas. Essas versões geraram protótipos do sistema que foram submetidos a testes em campo e, a partir da avaliação realizada pelos profissionais de saúde, surgiram alterações diversas. / In the Brazilian Health System, the healthcare centers have the role of primary health care providers. To successfully fulfill this responsibility with more dedication and effectiveness, the Brazil- ian government created public primary health programs of homecare where the health professionals visit the patient\'s homes. Those programs, as the Family Health Strategy (also known as Fam- ily Health Program), aim to raise the quality of health services provided by the centers to the neighboring community. This enables a new way of treatment of diseases and health care promo- tion. Nevertheless, those important programs have almost no Information Technology mechanisms helping them to manage the processes involved by the program. This master research objective is to present a definition and development of a mobile system that helps the healthcare providers to collect relevant data on the patient status on the site of the homecare treatment. The project was named as the Borboleta Project and during, the development of this research, several versions were released. Those versions were tested as prototypes on a real situation until a more stable version fitted the health professionals needs. Other objectives of this research were to analyze the solutions adopted by the development team, to describe the difficulties encountered by the team while working on this mobile system, and finally to show which were the feedbacks of the usage of the system on the field, during the test phase.

Background: Chronic obstructive pulmonary disease (COPD) is an important common chronic lung condition that is a leading cause of morbidity and mortality worldwide, resulting in a substantial and increasing economic and social burden to health care systems. Physical activity (PA) is the strongest predictor of mortality in this population, playing an important role determining the quality of life in COPD, with better outcomes being reported by those who have higher levels of PA. Therefore, improving PA levels has been considered a key component in the management of patients with COPD. Likewise, it is important to understand the mechanisms that lead to inactivity, as it is to develop accurate methods of measuring PA in this population. Aims of the thesis: 1) To identify and to summarize the interventions able to increase PA levels in patients with COPD; 2) To understand the longitudinal interaction between muscle mass and function and PA levels in COPD; 3) To study the acceptability and the suitability of a new activity monitor (TracMor D - Philips, the Netherlands) for home coaching in daily routine of patients with COPD; and 4) To investigate whether a PA enhancing programme with set targets and feedback would constitute a successful intervention to increase PA levels in patients with COPD attending pulmonary rehabilitation (PR). Methods: To achieve the first aim of the thesis I performed a systematic review summarizing interventional studies that assessed PA as an outcome in patients with COPD. For the second aim, I analysed some multicentric longitudinal data (one year follow-up) on PA and muscle mass/function in COPD. The third aim was achieved with a pilot study I conducted in Edinburgh, where patients with COPD wore three TracMor D in different body places simultaneously with the criterion method (Actigraph GT3x activity monitor) for a week. To accomplish the fourth and main aim of my PhD, I conducted a randomised controlled trial (RCT) where patients with COPD undergoing PR were randomised to either receive PR only or PR plus a PA coaching programme using the TracMor D activity monitor for 12 weeks. Main Results: Study 1: Sixty studies were considered for data extraction in the systematic review. Seven types of intervention with the potential to increase PA levels in patients with COPD were identified. PR programmes with more than 12 weeks of duration and PA coaching programmes with feedback of an activity monitor are promising interventions to increase activity levels in patients with COPD. Overall, the quality of evidence across interventional studies was graded as very low. Study 2: The longitudinal study showed that there were weak correlations between PA levels and muscle strength at baseline (0.19 ≤ r ≤ 0.33 p < 0.001 for all). No correlations were found between changes in PA and muscle strength (-509 [-1295-362] vs -0.4 [-3.5-2.6] - 12 months minus baseline - respectively) and future muscle mass (p > 0.05). Baseline PA levels are related to future muscle strength (0.30 ≤ r ≤ 0.41, p < .0001) but not with muscle mass. Study 3: This study showed that TracMor D had strong correlations with Actigraph GT3x in terms of Kcal consumption in all three positions (necklace, pocket and hip) (0.84 ≥ r < 0.86, p < 0.001 for all). TracMor D was considered comfortable and easy to use at home, receiving a mean usability score of 98 out of 100 maximum points. Study 4: My RCT showed that the proposed PA intervention was effective in changing steps/day (1251 ± 2408 vs control -410 ± 1118, p=0.01), time spent in light activities (21 ± 60 vs -37 ± 55, p=0.004), exercise capacity (99 ± 139 vs 3 ± 83 meters; 85 ± 114 vs 2 ± 62 seconds, p < 0.03 for both) and muscle strength (15 ± 20 vs -5 ± 18, p=0.01) among others when compared to the control group. Conclusions: Strategies focussing specifically on increasing PA and longer PR programmes may have greater impacts on PA levels in COPD. Well-designed clinical trials with objective assessment of PA in patients with COPD are needed. PA levels are not related to one-year changes in muscle mass and muscle strength in patients with COPD. However, higher PA levels at baseline are related to having higher muscle strength at one-year. TracMor D strongly correlated with the criterion method and was highly accepted by patients with COPD in their daily routine, being considered comfortable and easy to use at home. The combination of PR with a physical activity enhancing programme using a PA monitor to set targets and give feedback on activity levels significantly improves PA, exercise capacity, muscle strength, quality of life, and anxiety and depression levels in patients with COPD.

Chronic obstructive pulmonary disease (COPD) is a collection of chronic conditions that results in irreparable lung damage and stress to patients. COPD also has considerable financial impacts on health care entities due to frequent hospital readmissions of COPD patients. The Centers for Medicare and Medicaid Services penalize care entities for 30-day hospital readmissions. Many rehospitalizations attributed to COPD are due to exacerbations, often preceded by physiologic and emotional changes that can be monitored, allowing action to be taken to prevent readmissions. The practice problem for this quality improvement project explored whether the use of remote home monitoring of COPD patients discharged to home health care, coupled with the use of a medication rescue pack, would reduce rehospitalizations within 30 days after discharge. The purpose of the project was to evaluate the effectiveness of telehealth remote monitoring and initiation of a medication rescue pack in decreasing 30-day readmissions of COPD patients. The self-efficacy model was used to encourage health-promoting actions that are necessary for chronic disease management. Data from the project agency's records of COPD patients were evaluated for readmission rates. Analysis of the data from 8 preintervention patients showed that 3 (38%) were readmitted. Postintervention data showed that of the 9 participants, only 1 was readmitted (11%). Comparison of the data showed a 27% decrease in readmissions because of the intervention. The results of this project have the potential to bring about positive social change by improving care management remotely in real time, thus decreasing rehospitalization in COPD patients.

The current study evaluated the effectiveness of delivering behavioral assessment and treatment to reduce challenging behavior shown by Korean children with ASD by using in-home telehealth from the U.S. The participants were five young children diagnosed with autism who lived in Korea and displayed challenging behavior. The children’s mothers, who had no previous experience in functional analysis (FA) and functional communication training (FCT) procedures, implemented all procedures with coaching provided by a behavior consultant during assessment and treatment sessions via telehealth. The results of the current study showed that functional analyses conducted via telehealth from the U.S. to the children’s homes in Korea were effective in identifying the function of challenging behavior for each participant. Furthermore, the results also showed that challenging behavior was reduced by 100% across all children by the end of treatment. These results suggest that telehealth can be an effective and efficient way to deliver behavior analytic services for underserved populations in countries like Korea.

Outpatient consultations form a large part of the healthcare of patients at tertiary hospitals, both as a precursor to in-patient treatment and for the management of on-going health conditions or long-term rehabilitation and monitoring after treatment. These outpatient consultations are generally conducted at the hospitals, most often located in large cities. Patients who live outside these cities face extensive travel to attend these consultations, placing a burden on themselves and on their families or carers. An ability of a tertiary hospital to deliver outpatient consultations in a telehealth mode to regional or remote locations closer to the patients’ homes would potentially relieve much of this burden of travel. Tertiary healthcare is highly complex. It can involve multiple clinicians, can require long time periods for its completion and often includes the patients and their families in the management of the healthcare situation. Outpatient consultations typically involve high levels of interpersonal discussion supported by access to data about the patient. Telehealth methods of delivering these outpatient consultations will be very demanding on the network connection between hospital and remote telehealth nodes. The next generation of Internet or intranet, often referred to as “broadband”, will have the capacity to deliver multiple high-quality, low-latency video streams and to provide shared access to large data sets. The prospective match of the capabilities of broadband networks and the needs of tertiary-level telehealth opens the possibility of effective, tertiary-level outpatient consultations in a telehealth mode of delivery. In this thesis I use a case-study-based approach to evaluate the development and pilot trial of a broadband telehealth system in a tertiary paediatric context. I use the data from these case studies to explore the way that a human-centred approach can be used to evaluate outpatient telehealth trials at a tertiary level of healthcare. My results show that human-centred evaluation for this level of telehealth must take a broad approach; that the telehealth activities must take place in a realistic setting; that qualitative and quantitative responses from participants must be complemented by observational data; that data must be gathered from all the participants; and that their competence to give meaningful responses must be recognised and their multiple, and possibly differing, points of view must be taken into account. Finally, my results show that the researchers must take into account the wider clinical and hospital contexts and in particular the participants’ view of these contexts, when interpreting evaluation data. My overall prediction is that telehealth applications for tertiary-level outpatient consultations will have important, transient phases in their development, and that a human-centred evaluation approach is the appropriate way to evaluate telehealth applications during these phases. These transient phases are not reported in conventional telehealth literature but my analysis of my case studies suggests that they are central to this class of tertiary level telehealth delivery.

Η τεχνολογία τηλεπικοινωνιών αλλάζει ριζικά το σύστημα παράδοσης υγειονομικής περίθαλψης στην χώρα μας. Η Τηλενοσηλευτική, ως υποσύνολο της Τηλεϋγείας, παρουσιάζει τα μοναδικά νομικά, ρυθμιστικά, και επαγγελματικά ζητήματα για το επάγγελμα της νοσηλευτικής. Συγχρόνως, παρουσιάζει τις νέες προκλήσεις και τις γρήγορα επεκτάσιμες ευκαιρίες για τις νοσηλεύτες/τριες στην εφαρμογή της Τηλενοσηλευτικής. Η εστίαση αυτής της διπλωματικής είναι η εφαρμογή της Τηλενοσηλευτικής στην παροχή νοσηλείας για τους ασθενείς που βρίσκονται σε απομακρυσμένες περιοχές μακρυά από τον παροχέα. Δεν είναι μια διπλωματική που να απευθύνεται στην τεχνολογία - υλικό των υπολογιστών, το λογισμικό, τα συστήματα. Η διπλωματική αυτή είναι μια επιτομή των ερευνητικών συμπερασμάτων των ευρύτατα αναγνωρισμένων αρχών στον τομέα της Τηλευγείας. Γράφτηκε ως αναφορά για τους νοσηλευτές/τριες σπουδαστές, για τις ήδη εργαζόμενους νοσηλευτές/τριες που μπορεί να αποβλέπουν σε μια σταδιοδρομία στην εφαρμογή της Τηλεπρακτικής μέσα στον κλάδο του επαγγέλματός τους, και ωθεί τους εργαζόμενους νοσηλευτές/τριες στην συμμετοχή της Τηλενοσηλευτικής.. Παρέχει τις νομικές και πρακτικές οδηγίες για τους νοσηλευτές/ τριες στην παροχή της ασφαλέστερης και πιο αποτελεσματικής θεραπευτικής φροντίδας του ασθενή. Η Τηλενοσηλευτική είναι ένας αναδυόμενος και ραγδαία επεκταμένος ρόλος για το επάγγελμα του νοσηλευτή/τριας, και προσφέρει απεριόριστες ευκαιρίες για τα μέλη του επαγγέλματος. / Telecommunications technology is radically changing the health care delivery system in our country. Telenursing, as a subset of telehealth, presents unique legal, regulatory, and professional issues for the nursing profession. At the same time, it presents new challenges and rapidly expanding opportunities for nurses in Telenursing practices. The focus of this paper is the application of Telenursing in the provision of nursing care for patients at sites remote from the provider. It is not a paper about computer technology – hardware, software, systems. This paper is a compendium of the research findings of the most widely recognized authorities in the field of telehealth. It was written as a reference for student nurses, nurses in clinical practice who may be considering a career in telepractactice, and advanced practice nurses, who are most likely to be involved in Telenursing. It provides legal and practice guidelines for nurses in the delivery of the safest and most therapeutic patient care. Telenursing is an emerging and rapidly expanding role for the nursing profession, and offers unlimited opportunities for members of the profession.