This evidence theme on the acceptance and use of telehealth in aged care settings summarises one of the key issues we identified as part of a scoping review on human factors and technology in aged care. We identified eight studies on this topic. [7, 9-15] If you need more information on this topic, try using one of our PubMed searches below.
Factors that may reduce telehealth acceptance
Our review found that major barriers to telehealth acceptance may include limited technical skills, staff uncertainty around when to use telehealth, confidence in relaying information to health professionals, and the useability of the technology.
Staff skills, knowledge, uncertainty or lack of confidence
The included studies reported that:
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Some staff lacked the technical confidence to conduct telehealth consultations and were more likely to use it with the support of more experienced team members. [9]
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Despite feeling professionally isolated and in need of clinical advice, residential aged care staff might hesitate to use telehealth for fear of disturbing external clinicians unnecessarily or being perceived as incompetent. [9] This was particularly evident when there was a power imbalance between the staff member and the consulting clinician.
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Some nurses expressed uncertainty in having to conduct physical assessments on behalf of remote health professionals and might lack confidence in relaying the information they needed to form a clinical judgement. These concerns might be reduced over time with greater experience in telehealth consultations and by becoming more familiar with the consulting clinician’s communication style. [7]
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Some aged care staff expressed uncertainty about their roles during telehealth consultations. For example, consulting doctors might expect enrolled nurses to relay information that goes beyond their scope of practice. [7]
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Some residents were less engaged in online consultations due to cognitive or sensory impairments. [7] Residents with dementia were at times confused by seeing their own faces on the computer screen. [7]
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In a home care study, staff felt they lacked the training and knowledge to use telehealth for managing the care of people with depression. [10] In this same US-based study, staff reported fearing for their health and safety when taking expensive telehealth equipment into the homes of people living in unhygienic conditions or insecure neighbourhoods. [10]
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The most significant barrier to home-based telehealth consultations in one US study was the lack of reimbursement under the fee-for-service Medicare system for providing care via telehealth. [10]
Technology-related issues
Some studies highlighted specific technology-related considerations that may impact how individuals engage with telehealth. They reported that:
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Some older adults and their families needed reassurance that the telehealth connection was private and secure, that consultations were not being recorded, and that their information remained confidential. [11, 12] Some people were concerned that they could not easily identify the clinician at the other end, perhaps due to bad lighting. [12]
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Health professionals reported issues relating to poor data and equipment integration and inconsistent documentation of telehealth sessions which impacted telehealth acceptance. [13] For example, a remote clinician might not be able to access locally stored clinical records, including lists of medications. This information would then have to be read aloud by staff. [7]
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Technical problems might reduce useability and acceptance. These included poor audio-visual quality, low volume, unstable internet connections (especially in rural and remote areas), and the burden of setting up and troubleshooting technical issues. [9, 13, 14] Poor visual quality could make it difficult to conduct appropriate visual assessments of certain conditions. [7]
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In one study, older people with cognitive decline or physical frailty found it difficult to engage with video-conferencing technology using iPads. They found the iPads ‘too heavy’ to hold independently, icons challenging to press, and calls were sometimes impacted by hearing impairments, despite the volume being at maximum level. [11]
Factors that may increase telehealth acceptance
Factors with the potential to increase telehealth acceptance include positive perceptions or beliefs in telehealth benefits and having strategies in place (e.g., staff training) to address potential barriers.
Positive perceptions about the use of telehealth technology
Across the included studies, aged care staff were more likely to support the use of telehealth when they could perceive its benefits for those in their care as well as for themselves. They reported that:
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For some residential aged care nurses, telehealth provided an opportunity for greater autonomy and responsibility as they became the ‘eyes, ears, and hands’ of the remote clinician. They reported feeling more empowered in their role when using this technology. [7, 14]
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Staff perceived a telehealth service linking residential aged care nursing staff and emergency department clinicians as creating better communication, trust, and care continuity for residents and their families. [14]
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Perceiving an advantage of telehealth over alternative approaches to accessing care was also important for acceptance. For example, staff who found telehealth improved the speed at which those in their care were seen by clinicians were shown to be more willing to engage with the technology. [9]
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Staff members who advocate for the benefits of telehealth can be effective in encouraging other staff to trial or use it. [9, 10]
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In the home care setting, visiting nurses were more willing to adopt telehealth consultations when there was adequate acceptance (or ‘buy-in’) from care recipients, family/informal caregivers, and general practitioners. [10]
Telehealth training and regular practice for staff
Aged care staff emphasised the importance of having training in telehealth to increase their skills and confidence. [9, 14, 15] Some staff reported that the more frequently they used videoconferencing technology for telehealth consultations, the more confident they became in running the sessions. This increase in confidence led to increased uptake of telehealth. [7, 9, 14]
Organisational support
Organisational support for telehealth could increase its acceptance. For example:
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Organisations providing infrastructure and essential equipment such as telehealth units or rooms, devices with good quality audiovisual properties, and stable network connections had better telehealth acceptance. [13, 14]
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Aged care workplaces with a supportive culture and technology leadership had a more successful uptake of telehealth services. This might also translate into positive and fulfilling workplace experiences for staff. [7, 9]
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