Telehealth provides an alternative delivery form of parent training that allows practitioners to disseminate information and feedback at a distance. Telehealth can be as effective as in-person training (Wacker et al., 2013a; Wacker et al., 2013b; Vismara et al., 2009). Despite most telehealth studies indicating high satisfaction, research on patient satisfaction using telehealth has depended mostly on survey instruments, which limits definitive conclusions and may not translate into actual use or selection (Whitten & Love, 2005). The primary purpose of this study was to evaluate a procedure for identifying parent preference of in-person or telehealth training modalities. Secondary purposes were to evaluate and compare correspondence between preference as measured in a choice format and a social validity measure, determine if the procedures can be used to detect differences in acquisition from each modality, and to evaluate effects of parent training on child appropriate and inappropriate behavior. The results support previous research that telehealth can be as effective as in-person training. Participants overall chose telehealth 40.93% of the time. Parent choice on any particular occasion was jointly influenced by other variables. Reported preference results at the end of the study differed from the choice data, which suggests satisfaction may differ from preference or actual use. Future studies could use this method to evaluate preference on a larger scale, or for different kinds of interventions and training modalities.

The study examined the effectiveness of asynchronous video-otoscopy by a telehealth facilitator, for diagnosing ear disease in an underserved community at a primary health care clinic. Study I explored whether video-otoscopy images by a facilitator provided accurate asynchronous diagnosis. Onsite otoscopy was performed by an otolaryngologist on 61 adults. Video-otoscopy images were taken by the facilitator with no formal health care training, and by the otolaryngologist. Images were uploaded to secure server from which the otolaryngologist rated and made a diagnosis six weeks later. More otolaryngologist acquired images (83.6%) were graded as acceptable or better than facilitator images (75.4%). Moderate concordance was measured between asynchronous diagnosis from video-otoscopy images acquired by the otolaryngologist and facilitator (κ = 0.596). Lack of depth perception was considered a limitation of video-otoscopy images. Study II investigated asynchronous video-otoscopy recordings made by a facilitator in children at primary health care. Onsite otomicroscopy of 140 children (2-16 years) by an otologist was the gold standard. Video-otoscopy recordings were completed by a facilitator. Four and eight weeks later, an otologist and general practitioner asynchronously graded and made a diagnosis from online recordings. Video-otoscopy recording quality was acceptable or better in 87% of cases. Asynchronous diagnosis from recordings was not possible for 18% of ears. There was substantial agreement between asynchronous video-otoscopy and onsite diagnoses (κ = 0.679-0.745). Variability of asynchronous diagnosis accuracy was similar to inter- and intra-rater diagnostic variability. Study III examined the point prevalence of otitis media in the children from study II. Onsite otomicroscopy was completed by an otologist. Prevalence of otitis media was 24.8%, with OME the most prevalent (16.5%). Despite AOM prevalence of 1.7%, caregivers reported otalgia for 7.4% of children within two weeks of assessment. Caregivers did therefore not typically seek medical opinion for otalgia. Lack of medical opinion is problematic as the sample demonstrated high CSOM prevalence (6.6%). A telehealth facilitator with limited training was capable of acquiring good quality video-otoscopy measures in children and adults. Asynchronous video-otoscopy recordings may be used within a telehealth clinic in a primary health care clinic to reduce morbidity and mortality associated with CSOM. / Thesis (DPhil)--University of Pretoria, 2015. / Speech-Language Pathology and Audiology / DPhil / Unrestricted

BACKGROUND: The COVID-19 pandemic has increased the demand for mental health services but has also imposed new barriers for those seeking care, creating a widespread shortage. As a result, providers are increasingly looking to incorporate technology into mental healthcare. Despite the increased focus on mental health technology in recent years, many new technologies are framed as products rather than clinical tools and fail to be effectively implemented. Digital clinics, hybrids of clinical care and technology, such as a smartphone app, offer a model of how technology can be implemented into mental healthcare. In addition to increasing the need for technology in mental healthcare, the COVID-19 pandemic has also lessened many historical barriers to successful implementation of a digital clinic including regularity restrictions, financial challenges, and the motivations of patients and providers in adding technology into healthcare. Objective: In order to better understand how technology can be incorporated into mental healthcare, the Technology Enabled Care Program (TECC), a digital clinic at Beth Israel Deaconess Medical Center, will be evaluated through the study of a case series. The integrated-Promoting Action on Research Implementation in Health Services (i-PARISH) framework, an implementation science model, will be applied to TECC in order to identify factors important to the larger scale implementation of this digital clinic. METHODS: The TECC program combines eight sessions of face-to-face therapy via telehealth with the use of a mindLAMP, a mental health smartphone app. The app is customizable for each use case and is supported by a 3-member care team containing technology specialists and a therapist. Quantitative data from this program will be investigated and discussed along with information on patients’ qualitative experiences in order to get a better understanding of the successes and areas for improvement in this first implementation of TECC. RESULTS: From the six initial patients who have completed TECC, four were selected to be represented in this case series. One patient was highly engaged with the app and used it on a daily basis throughout the program. Two patients use the app consistently at times but experienced periods of low engagement during their care. A fourth patient struggled with technical issues and their app use was intermittent. Most feedback on the program was positive, but exceptions will be detailed. CONCLUSION: Implementation of the TECC program and mindLAMP app into practice was successful in many regards and these early cases shed light on areas of potential improvement in future iterations of the digital clinic. Moving forward, these results will inform a focus on factors that can increase adoption by patients, clinicians, and healthcare systems.

Background: During the last century, closure in rural pharmacies has been increasing in Sweden resulting in unequal access to pharmaceutical services among the population. Telepharmacy is a provision of pharmaceutical care to patients at distance thereby increasing access to health care. Previous studies have shown promising results regarding various clinical outcomes, attitudes of patients and pharmacists in addition to high-quality drug counseling. As pharmaceutical care is essential for safe drug utilization, it is of importance to induce new approaches in Sweden to maintain pharmaceutical care in these areas. Aim: This study aimed to evaluate a telepharmacy system named Farmaceut på Distans at a local pharmacy in Sweden concerning; patient's and pharmacists’ attitudes, areas of improvements, and safety of the method. Methods: The study was performed between 26/4,-7/5 2021. The objectives of this study were evaluated through a questionnaire and short semi-structured interviews with patients, a semi-structured observation, a semi-structured interview with the project leader, and a focus group with included pharmacists. Additionally, a medicine dispensing error protocol was established.  Results: Eleven patients, three pharmacists, and the project leader were included in this study. This study shows that patients and pharmacists expressed optimistic attitudes towards Farmaceut på Distans. However, the method requires to be improved regarding technical aspects in advance of implementation. Further, no medicine dispensing errors were obtained.  Conclusions: Due to the small sample size, no conclusions can be drawn regarding the safety of the method. Farmaceut på Distans is a promising approach to maintain safe drug utilization in Sweden. However, further studies require to be performed regarding safety and attitudes among users.

OBJECTIVE: This study will explore the effects that an online support group can have on traumatic brain injury (TBI) caregiver burden. BACKGROUND: TBI is a public health concern that affects the lives of both patients and their caregivers. Caregivers often take responsibility for significant elements of TBI patients’ lives and, over time, this role takes a mental and physical toll on a caregiver’s own life. To date, there is limited research on the success of interventions, such as support groups and telehealth, in mitigating caregiver burden. There is much research that remains to be done. It is crucial that new and innovative support groups and telehealth interventions, such as the one outlined in this thesis, are trialed and analyzed by participants, in order to understand what methods are most effective in supporting these caregivers. DESIGN: One-group before-after non-randomized innovative intervention study. PARTICIPANTS: Eighty-five adult primary caregivers of TBI patients, recruited through the Brain Injury Association of America (BIAA). INTERVENTION: Sixteen sessions of mindfulness-based cognitive behavioral therapy (CBT) led by trained clinical psychologists and delivered via group videoconference. MAIN OUTCOME MEASURES: Zarit Interview Burden (ZBI); Brief Symptom Inventory (BSI). DATA ANALYSIS: Descriptive demographics. Unadjusted effect size and score descriptive for ZBI and BSI. Paired t-tests to compare mean ZBI and mean BSI at pre-intervention and post-intervention. Stratify by baseline BSI score to determine if baseline BSI score predicts decrease in ZBI score over the course of the intervention. CONCLUSIONS: The proposed study provides an innovative way to reduce burden on TBI caregivers and to analyze the feasibility and acceptance of the intervention. The study does, however, present limitations and, thus, outlines areas for future research. These limitations include the lack of a control group, the use of multiple clinical psychologists as group leaders, and the recruitment of only BIAA members who are comfortable using technology.

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Deficits in eye contact are a common feature of autism spectrum disorder (ASD). Previous research has shown shaping without prompting to be effective in teaching eye contact to children diagnosed with ASD. The purpose of the current study was to evaluate a shaping procedure, implemented by parents trained and supervised via telehealth, to teach two preschool-aged children with ASD to make eye contact in social play. A single-case, multiple baseline experimental design was used to evaluate the effects of the teaching protocol., Interobserver agreement and treatment integrity were measured. For each child, eye contact was taught in three different settings in their natural environment, each setting corresponding to a child-preferred play activity where the parent was a necessary component. The parents were instructed to engage in thea play activity, make a pause and wait for the child's eye contact before continuing the activity. The target behaviour, eye contact, was divided into five successive learning phases. Within the framework of the study, both children acquired sustained eye contact for a duration of between 1 and 2 seconds across several settings. Furthermore, in line with prevailing research, findings from this study confirm that telehealth can be used to train and supervise parents from a distance. A high degree of social validity, as measured by the participating parents' self-reports, as well as indices of happiness in the two children, adds to the results of this study. Challenges, solutions and benefits of telehealth are highlighted. Variability in outcome between settings and children are discussed as well as limitations and directions for future research. / Bristande ögonkontakt är vanligt förekommande vid autism (ASD). Tidigare forskning har visat att shaping utan prompting är effektiv för att lära barn diagnosticerade med ASD ögonkontakt. Föreliggande studies syfte var att utvärdera en shapingprocedur, implementerad av föräldrar som utbildades och handleddes via e-hälsa, för att lära två förskolebarn med ASD-diagnos att ge ögonkontakt vid social lek. En single-case experimentell design med multipel baslinje användes för att utvärdera effekterna av undervisningsprotokollet. I, inklusive mätning av interbedömarreliabilitet och behandlingstrohet mättes. För varje barn tränades övades ögonkontakt i tre olika sammanhang i desras naturliga miljö, därvarje sammanhang motsvarande en av barnet föredragen lekaktivitet i vilken föräldern var en nödvändig beståndsdel.Föräldrarna instruerades att inleda en aktivitet, göra en paus och vänta på barnets ögonkontakt innan de fortsatte aktiviteten. Målbeteendet, ögonkontakt, delades in i fem successiva inlärningsfaser. Inom ramen för studien tillägnade sig båda barnen ögonkontakt med en duration av mellan 1 och 2 sekunder, i flera sammanhang. Vidare bekräftar studiens resultat, i linje med i likhet med aktuell forskning, att e-hälsa kan användas för att utbilda och handleda föräldrar. En hög grad av social validitet, såsom mätt genom de deltagande föräldranrnas självskattningar, liksom tecken på glädje hos de två barnen, bidrar till studiens resultat. Utmaningar, lösningar och fördelar med e-hälsa belyses. Variationen i resultat mellan sammanhang och barn diskuteras liksom studiens begränsningar och inriktning för framtida studier.

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