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1 A comparison between rural speech pathologists and rural residents access and attitudes towards the use of information technology and telecommunications for speech pathology service delivery.

2 Carolyn Dunkley, Bendigo Health Service Lydelle Pattie, SCOPE, Victoria Lindy McAllister & Linda Wilson, Speech Pathology Program, School of Community Health, Charles Sturt university - Albury

3 Outline Background for the research Purpose of the research Methodology Results Implications Summary & Conclusion

4 Literature Already identified inequities to health care in rural areas including speech pathology (Wilson, Lincoln, & Onslow, 2002; Dixon & Welch, 2000). Barriers to accessing health care (O Callaghan, 2003) Socioeconomical Geographical Service provision Physical & cultural Telehealth: a potential solution to problems of inequity (Hornsby & Hudson, 1997, PRCHIT, 1996)

5 Telehealth A method of providing clinical, educational and administrative services across distance utilising IT&T (Prerost, 1999). IT&T classified in two groups (Ash, 1997) Synchronous Asynchronous Telehealth is becoming more frequently used in some states (e.g., WA & Qld)

6 Our research questions What was the access of rural speech pathologists (SP) and rural residents (RR) in NSW and Victoria to IT&T? What did SPs & RRs use IT&T for? How often did SPs & RRs access IT&T? How confident were SPs & RRs in using IT&T? What were the attitudes of SPs & RRs towards IT&T? Did SPS and RRs attitudes towards IT&T potentially affect their use of IT&T for service delivery?

7 Method Mixed method approach Quantitative (questionnaire) Qualitative (interviews) Questionnaires: 1100 mailed to rural residents in NSW; mailed to 210 speech pathologists in NSW; Interviews: 10 interviews with rural residents and 4 with speech pathologists to elicit their views and personal experiences with IT&T

8 Data Analysis Questionnaires: descriptive statistics & some correlations. Interviews: content analysis to identify themes and patterns.

9 Questionnaire Respondents 43 Rural Residents Mode of years 41 females, 2 males Range of education levels, employment etc 49 Speech Pathologists Mode of years 47 females, 2 males 92% anglo-saxon/anglo-celtic background Mode professional experience of 0.5 years

10 IT&T Access Not at all easy Videoconferencing 49% Web Camera 49% Satellite phone 77% Video Camera 26% Web Camera 92% DVD 84% Video Camera 63% Rural Residents (N=43) Teleconferencing 31% Videoconferencing 31% Satellite phone 31% Computer 93% CD 88% Internet 88% 81% VCR/DVD 84% Video Camera 40% Computer 88% CD 65% Internet 65% VCR 65% 91% Very easy Speech Pathologists (N=49)

11 Uses of IT&T Education/school Business Accounting/finance Hobbies/entertainment Information/research Games Music Shopping Weather information Meetings Staying in touch Telehealth Guitar lessons Gambling Report writing PD Caseload mx Stats Resource access/dev. Prof. correspondence Research/info access Meetings/case conf. Networking SD (asynch only)

12 Frequency of IT&T use Rural residents (N=43) Never Videoconferencing 72% Teleconferencing 79% Satellite phone 86% Video Camera 49% Satellite phone 88% Web Camera 76% Video Camera 43% VCR/DVD 23% CD 46% VCR 22% Teleconferencing 60% Videoconferencing 30% Speech Pathologists (N=49) Computer 65% 44% Internet 40% CD 28% Computer 98% 94% Internet 38% Every day

13 Confidence using IT&T Not confident Satellite phone 74% Web Camera 72% Videoconferencing 67% Video Camera 33% Web Camera 88% Satellite phone 84% Videoconferencing 58% Rural residents (N=43) Speech Pathologists (N=49) VCR/DVD 56% Computer 49% CD 49% 49% Internet 42% Video Camera 19% 97% VCR 96% Computer 94% CD 84% DVD 75% Video Camera 67% Teleconferencing 49% Very confident

14 Identified Barriers for IT&T Servvice Delivery (SD) Personal Barriers Systemic Barriers

15 Personal barriers Speech pathologists ignorance regarding IT&T uses, clients access and skills SP: Clients in remote settings are often not in good financial situations and won t have IT&T RR: our access is about average, like everyone else we ve got a fax and a computer and the internet [satellite connection] and all that

16 Personal barriers cont. General unwillingness of SP to use IT&T SP: if you re not willing or wanting to use IT&T then that s a barrier as well SP: it s a total intrusion on my time as a clinican SP: Younger speech pathologists just accept IT&T as part of normal routine

17 Personal barriers cont. Belief that face to face service delivery is better than IT&T SD SP: To treat a client properly you need to be face to face RR: I don t think my son could cope with high tech link ups but it might be ok for other kids SP: Nobody wants to give up their face to face visits RR: I don t think the electronic system will ever, ever replace a heart to heart, face to face, eyeball each other across the table type approach to it [healthcare]

18 Systemic barriers Infrastructure Availability Cost SP: Anything that costs money the department won t come at RR: It would be too expensive for me to buy the high tech stuff RR: This is a low income area. As long as the government subsidises it [telehealth], like Telstra or the health department subsidise it, I think it would be great.

19 Systemic barriers Provision of appropriate IT&T support Managerial Technical support SP: Management are forgetting that if you want SP to continue what they re already doing and use technology you need to give them more time and more resources to do that. SP SP don t have the technical know-how for using IT SD and there is a need for better supports in place to use this technology SP: having a helpdesk available knowing that it s there is more comforting RR: as long as there s a hotline or something, I d give it [new technology] a go.

20 Systemic barriers Already recognised limitations of IT&T for SP SP: because of the nature of people I work with we need to be a lot more hands on. Especially with feeding you can t exactly just do that over the phone or by a videoconference.

21 Discussion points RRs had greater IT&T access and confidence SPs had less access and confidence SPs beliefs that RRs did not have access to technology and were unwilling to use it were not supported by the data Both personal and systemic barriers for using IT&T for SD exist for both SPs & RRs Proposed barrier solutions Perceived positive impacts

22 Where to now? Telehealth is viewed as a possible solution to healthcare inequities in rural areas by both SPs and RRs However, RRs are more positive about it than SPs Need for more telehealth infrastructure Need for funded training for SPs to use telehealth Need for attitude shift in SPs to catch up with those of RRs Need for improved communication between RRs and SPs Need for future research into efficacy of telehealth in SP (Hill, Theodoros, Russell et al., 2006; Wilson, McAllister, Atkinson & Sefton, 2006)

23 References Ash, A. (1997). Telemedicine: why now? Enabling new models of healthcare delivery. Proceedings of the 4 th National Rural Health Conference. Australia: National Rural Health Alliance. Dixon, J., & Welch, M. (2000). Researching the rural-metropolitan health differential using the social determinants of health. Aust. J. Rural Health. 8, Hill, A., Theodoros, D., Russell, T., Cahill, L., Ward, E., & Clark, K. (2006). An internet-based telerehabilitation system for the assessment of motor speech disorders: A pilot study. Am. J. Speech-Language Pathology, 15, Minichiello, V., Aroni, R., Timewell, E., & Alexander, L. (1995) Indepth interviewing: Principles, techniques, analysis. (2 nd ed.) South Melbourne: Longman Australia. O Callaghan, A. (2003). The perceived needs and barriers experienced by isolated families when accessing speech pathology services in rural and remote NSW. Unpublished honours dissertation, Charles Sturt University: Albury, NSW, Australia. Portney, L., & Watkins, M. (2000). Foundations of clinical research: Applications to practice (2 nd ed.). Newbury Park, CA: Sage.

24 References cont. Prerost, S. (1999). Executive summary, the evaluation of the cost effectiveness of telemedicine: G8 global health care applications programme subproject 4, 3 rd forum meeting, Melbourne, Vic Australia. Retrieved June 21, 2002 from Project for rural health communication & information technologies (PRHCIT). (1996). Telehealth in rural and remote Australia. Moe, Vic. Australia: Monash University, Australia Rural Health Research Institute. Wilson, L., Lincoln, M., & Onslow, M. (2002). Availability, access, and quality of care: Inequities in rural speech pathology services for children and a model for redress. Advances in Speech Language Pathology, 1 (4) Wilson, L., McAllister, L., Atkinson, J., & Sefton, P. (2006). Internet based telehealth in speech pathology: Results of preliminary trials. In F. Pinciroli (Ed.), Proceedings of the Second IASTED International Conference on Telehealth, CD ROM, (pp ). Calgary, Alberta, Canada: ACTA Press. World Health Organisation. (1998). Health for all in the 21 st Century. Retrieved on April 20, 2000, from

25 People are leaving the bush and [lack of health services] is one of the reasons, and if this telehealth is going to help that then bring it on I say! (Rural NSW Resident)

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