TELEHEALTH COURSES: STUDENT COSTS AND SATISFACTION

TELEHEALTH COURSES: STUDENT COSTS AND SATISFACTION By Stephanie A. Ahens RN, BSN A eseach pape submitted in patial fulfillment of the equiements fo the degee of: MASTER OF NURSING Washington State Univesity-Spokane Intecollegiate College of Nusing May, 2001

11 To the faculty of Washington State Univesity: The membes of the Committee appointed to examine the poject of Stephanie A. Ahens find it satisfactoy and ecommend that it be accepted.

111 Acknowledgments To D. Michael Rice whom without all of you help and guidance I would have not made it though Gaduate school. You ae a mento to me and I appeciate all of you geneosity and vast clinical knowledge. To D. Elizabeth LeCuye-Maus and D. Anne Mealey, thank you fo being so suppotive and flexible while woking on my clinical poject. To Magaet Ruby, thank you fo always being helpful and kind. You definitely go "beyond the call of duty". To Dad, Ken, fo letting me move back home so I could affod to attend gaduate school and fo motivating me to always bette myself in you own unique way. I love you. To Mom, Bonne, fo always being a constant souce of suppot and encouagement. You ae a geat mothe and a wondeful fiend. Thank you fo eminding me that I can be anything I want to be. I love you. To K.C., my little bothe, whom I look up to and admie. I thank you fo always giving me wods of encouagement and fo believing in me. I love you. To my fiance, Mohammed, thank you fo emotionally and financially suppoting me tho~gh this challenging pocess. I love and appeciate you. To my fiends and family, thank you fo undestanding my absence at many paties and othe gatheings due to my school commitments. Finally thank you to my beautiful Pesian cat, Remington, fo always being by my side while I woked many late nights eading o on the compute.

IV TELEHEALTH COURSES: STUDENT COSTS AND SATISFACTION Chai: D. Michael Rice By Stephanie A. Ahens RN, BSN Washington State Univesity-Spokane May, 2001 Abstact Identifying cost effectiveness will help evaluate which populations need access and financial suppot to attend Gaduate nusing school. Education via telehealth modalities can povide educational access to students who ae unable to commute to univesities o move to lage cities. Yet, thee ae no studies that evaluate the students' indiect costs associated with televideo couses. The existing studies focus solely on the opeational costs associated with setting up potential couse sites. The pupose of this study was to examine student's indiect costs and satisfaction elated to attending gaduate school via telehealth connections. The items developed fo this suvey wee modified fom the Flashlight Poject and administeed to 30 students enolled in a psychiatic diffeential diagnosis couse. Analysis of the data indicated that the availability of convenient couse locations minimized the students' costs while attending school. The high satisfaction ating of the couse offeed via televideo suppots the benefits of telehealth education in ual settings. The data in this study encouages developing nlal televideo sites, which deceases indiect costs and aids in etaining students.. This study was patially suppoted by gant # DOg HP 00159-02 to Michael Rice fom HRSA

v TABLE OF CONTENTS Acknowledgments Abstact List of tables Intoduction Evaluation Famewok fo Telehealth Initiatives Studies on Telehealth Satisfaction Cost Analysis Studies Statement of Poblem Pupose of Study Pocedue Results of Study Discussion Nusing Implications Refeences Appendix 111 iv vi 2 3 4 7 8 8 9 9 16 18 19 21

vi LIST OF TABLES Table 1- Table 2- Table 3- Table 4- Table 5- Table 6- Table 7- Age of Respondents RacelEthnic Backgound of Respondents Sex of Respondents How fa do you live fom this couse delivey site? Costs of food pe week while at class o due to taveling to class site? Appoximate costs of childcae while at school? Appoximate costs of gas pe week taveling to and fom school-class site?

TELEHEALTH COURSES: STUDENT COSTS AND SATISFACTION Stephanie A. Ahens RN, BSN Psychiatic Nuse Pactitione Gaduate Student Washington State Univesity Intecollegiate College of Nusing May, 2001

2 Intoduction Imagine a Registeed Nuse who lives 60+ miles away fom a majo hospital o college who wants to obtain he Maste's degee, but believes she cannot commute the 60+ miles. She is appoached by he supeviso inquiing if she would be inteested in taking a gaduate level couse at wok. She agees to take the couse and contacts the instucto. She is sent infomation about the gaduate pogam and given infomation about the couse. She egistes online and takes he couses at he cuent wok site via televideo. The class is offeed at a time which allows he to adjust he wok schedule at the community hospital. If someone wee unable to leave his/ he community due to pio obligations, then telehealth is a pefect solution. Telehealth is " The use of telecommunications and infomation technology to povide access to health assessment, diagnosis, intevention, consultation, supevision, education, and infomation acoss distance" (Nickelson, 1998, p527). Education via telehealth modalities can benefit filal students who ae unable to commute to univesities o move to lage cities. Bown (1999) defines telehealth as a linkage to egional, national and intenational makets in a live two-way audiovisual inteaction. Inteactive telecommunication is linking two o moe locations whee students paticipate in classes while inteacting simultaneously with one anothe. Robbins (1999) discusses the Remote Communities Sevices Telecente (RCST) poject, a model fo widespead implementation of wieless solutions fo woldwide ual communities. The concept of RCST is to povide a telecommunications esouce facility in small emote communities that have limited communications infastuctue. The intent

3 of ReST is to use the expeience of ual pactitiones in the teaching of students in the medical and nusing school at Memoial Univesity of Newfoundland. Recuitment and etention of qualified health pofessionals is a difficult obstacle to ovecome in ual and emote communities. Telehealth enables diect teaching and consultation in a eal time mode to communities and decease gaps in education and access to psychiatic cae. While thee is a polifeation of telehealth systems to addess ual health cae needs, thee has been limited wok on the evaluation of the cost effectiveness and satisfaction with the telehealth systems. Evaluation Famewok fo Telehealth Initiatives Field (1996) poposed a numbe of elevant telemedicine evaluation questions in ode to evaluate: 1) quality of cae and health outcomes 2) access to cae 3) health cae costs and cost-effectiveness 4) patient's oveall satisfaction and 5) staff and student's oveall satisfaction. Field emphasizes that evaluation should be undestood as a cumulative and fowad-looking pocess fo building useful knowledge and as a tool fo implementing pogam o policy impovements. Scott, Coates & McCathy (1999) epots that evaluation attempts have been hampeed by ual aeas being spasely populated, and telehealth pojects' inability to geneate sample sizes lage enough to waant statistical analysis. Yet, telehealth confeences o meetings ae deliveed evey couple of weeks in the United States. Legislative action egading telehealth is inceasing. Accoding to Nickelson, Kiby, and Hadesty (1998) in the 104 th Congess fom 1994-1996, 15 pieces of legislation wee intoduced that addessed telehealth system development and policy.

4 Telemedicine Infomation Exchange (TIE) epots that the online legislative Web contains eighty telemedicine bills. Of those eighty bills, only fouteen have been enacted into law (Wachte 2001). Washington State has no pending laws concening telehealth at this time. Studies on Telehealth Satisfaction West Geogia's distance leaning pogam is a pat of the Geogia Statewide Academic and Medical System (GSAMS), which is the lagest distance leaning and healthcae netwok in the wold. GSAMS has moe than 370 sites in Geogia, including K-12 schools, colleges, univesities, hospitals, pisons, and veteinay settings at Zoo Atlanta. Hill (1997) evaluated the cost effectiveness and quality analysis of distance leaning utilized by the College of Education at the State Univesity of West Geogia. Hill administeed suveys to faculty and students that measlled attitudes towad distance leaning, peceived class quality, student demogaphic infomation, and enollment infomation. Of 198 students, 129 students esponded to the suvey. Out of a possible 25 faculty, 21 completed suveys wee etuned. Hill's study measued the coelation between student satisfaction and satisfaction with the instucto, age of the student, distance of the student fom the home site, the numbe of total sites, and the total numbe of students enolled in a couse. "The fathe away the student was fom the main campus, the moe positive his o he attitude was towad distance leaning"(hill, 1997, p2). Olde students appeaed to epot a highe satisfaction with distance leaning couses than wee thei younge classmates. "Neithe

5 the numbe of sites no the numbe of students in a couse appeaed to have an impact on student satisfaction" (Hill, 1997, p2). Faculty also epoted an oveall satisfaction with teaching a couse though distance education. Eighty-seven pecent epoted that they had a positive attitude towad distance leaning at the end of teaching the couse. Faculty cited many easons fo wanting to use distance education such as the ability to each students who cannot commute to the main campus, the ability to utilize technologies not available in taditional classooms, eduction of tavel time, and the need to keep up with emeging technologies. Faculty epoted fustation about tanspoting mateials between sites, scheduling couses, helping students egiste, time spent on emailing students, and getting mateial fo couses deliveed on time to othe couse sites. "Moe telehealth pojects ae being implemented because they espond to community needs, athe than fom the need to test o justify new technologies" (The Telehealth Industy in Canada, 2000, pi5). Nesbitt, Hilty, Kuenneth, and Siefkin (2000) studied a total of 657 consecutive patients who consented to a telemedicine consultation, using telemedicine televideo units povided by DC Davis Health system. The DC Davis medical cente and seveal uban o sububan pimay cae clinics, ual hospitals, and clinic affiliates wee involved. Patients and physician satisfaction wee measued on a 5 point Liket scale. Patients and physicians epoted high levels of satisfaction. Rual clinics equested moe specialty consultations than uban o sububan clinics. "A diving foce behind the gowth and development of telemedicine pogams acoss the county has been the need to incease access to medical sevices in ual settings" (Nesbitt et ai., 2000, p169). Nesbitt et ai. found that in the aea of psychiatic cae whee acceptance

6 ates wee expected to be low, 29% of patients chose telemedicine fo the initial visit, wheeas 35% chose telemedicine fo follow-up cae. "South Austalia has a atio of psychiatists to population of 1:8500, but all psychiatists eside and wok in Adelaide except one" (Clake, 1997, pi2). Psychiatists tavel to distant towns once a month. Nuses and social wokes suppot the communities the est of the time. Televideo connections at Glenside Hospital began in 1994, in ode to link thee ual towns. The telemedicine was used to povide clinical consultations, staff taining, and community health activities. Afte the videoconfeence was completed geneal pactitiones and nuses wee asked to ate thei satisfaction. When asked the usefulness in claifying diagnosis, 52% of physicians and 82% of nuses epoted it was vey helpful. On the usefulness in developing a fomulation, 40% of physicians and 72% of nuses epoted the videoconfeence was vey helpful. The numbe of pofessionals inteviewed was not given. Foty-thee patients wee involved with this study. Fifty pecent of the patient goup etuned thei questionnaie. Eighty-eight pecent epoted they would use the sevice again. Ninety-thee pecent epoted no difficulty with the sound delay and 93% had no difficulty with the pictue bluing. Dunn (1999) pefomed an empiical study using televideo on 2200 pathology cases, which showed how inceasing use of televideo systems deceased case tunaound times fom 2.46 days to 1.5 days, without any dop in the level of accuacy. LaMendola (1997) identified 30 telemental health pogams opeating in fontie and ual aeas. The majoity of the pogams wee in Alaska, Coloado, Kansas, Montana, Nebaska, and South Dakota. The sevices povided though telemedicine wee education, consultation, theapy, and administation. Education sevices included continuing education and

7 taining. Consultation sevices included medication eviews, assessments, psychiatic supevision, case eview, and involuntay commitment appaisals. Meetings, ecod shaing, infomation tansfe, and utilization eview wee coveed in administation sevices. Ninety-thee pecent of the sites offeed consultative sevices, 70% offeed education sevices, 43% offeed administative sevices, and 17% offeed theapy sevices. Only 2 (7%) offeed all foll sevices. Scott et al. (1999) epot that in the past few yeas' gowth in ual telemedicine and telehealth netwok development has been apid. "Fo example, the Association of Telemedicine Sevice Povides (ATSP) data on 96 active telemedicine sites in ove 40 U.S. states indicates that the numbe of telemedicine consults in 1996 (21,000) tipled that of 1995, and in the fist quate of 1997 ove 11,000 consults in ove 40 specialties have been egisteed" (Scott et al. 1999, p40). Cost Analysis Studies Hill (1997) completed a cost analysis of The State Univesity of West Geogia's distance education couses. The benefit was detemined by multiplying the numbe of students, who said they would not have taken the couse if they had to commute to the main campus, by the amount of tuition paid pe student. The benefit was compaed to the ovehead costs of the distance leaning pogam and any additional costs elated to mailings, tavel etc. Ovehead costs include salay and benefits of the distance leaning coodinato, student facilitato wages, telecommunications chages, tavel expenses, and supplies. Based upon these calculations thee was a tuition gain fo the Univesity, which anged fom $3234 to $8764. Hill's study epoted an oveall satisfaction with distance

8 education by the students and faculty. Economic benefits fo The State Univesity of West Geogia wee also obseved. "It must be noted that the geatest benefits of the distance leaning pogam, its fa-eaching effects on teaches eceiving highe education, the childen they teach and the entie educational system, ae simply not measuable"(hill, 1997, p4). Statement of Poblem Thee ae few studies that evaluate cost vs. effectiveness of telehealth couses. The existing studies focus on equipment, fibe optic wie cost, salaies fo technical suppot staff, and miscellaneous costs fo setting up potential couse sites. Thee wee no studies found that evaluated student costs fo commuting, food, gas, childcae, and othe costs elated to attending school. Pupose of Study The pupose of this study was to examine costs and satisfaction elated to attending gaduate school via distance televideo leaning methods. The suvey focused on the satisfaction and costs elated to the location of couse site and the use of the Intecollegiate College of Nusing (ICN), Medically Indigent Rual Aea (MIRA) Netwok fo televideo connections. The ICN MIRA Netwok is a system of newly developed Intenet Potocol (IP) televideo connections in Washington State used fo couse delivey. The system in this study included the Washington Highe Education Television System (WHETS) and IP connections. Student demogaphics, commuting

9 time, childcae costs, gas and food costs, and othe costs excluding tuition wee included in the suvey. Pocedue A suvey modified to telehealth systems was based on the Flashlight evaluation pogam. The Flashlight pogam is a computeized database of questions about electonic education. Initially funded by the Andebeg foundation, the Flashlight database has been validated in 251 national studies. The items developed fo this suvey wee modified and administeed to 30 students attending Intecollegiate College of Nusing (Appendix I). The modified suvey was appoved by IRB. A total of 32 students wee enolled in a couse entitled Medical Mimics (N544) duing the sping semeste of 2001. A total of 30 students (N=30) completed the suvey, one student withdew fom the couse and one student efused to answe the suvey. Results of Study Analysis of the data indicated that the suvey espondents had a mean age of 40 49 yeas of age with a ange of 20 to 59 yeas of age (Table # 1). The espondent's ethnic backgounds wee; Caucasian (86.7%), Hispanic (3.3%), Afican Ameican (3.3%), and 3.3% answeed othe (Table # 2). The majoity of the population wee female (86%) with 10 pecent male (Table # 3). Since, 60 % of the total sample wee unde the age of 49, they ae in an age backet most likely to have childen at home.

10 Table # 1: Age of Respondents Age Fequency Pecent Valid Cumulative Pecent Pecent 20-29 1 3.3 3.3 3.3 30-39 5 16.7 16.7 20.0 40-49 12 40.0 40.0 60.0 50-59 10 33.3 33.3 93.3 No Answe 2 6.7 6.7 100.0 Total 30 100.0 100.0 Table # 2: Race/Ethnic backgound Fequency Pecent Valid Cumulative Pecent Pecent Othe 1 3.3 3.3 3.3 Hispanic/ 1 3.3 3.3 6.7 Latino Caucasian 26 86.7 86.7 93.3 Afica.n- 1 3.3 3.3 96.7 Ameican/ Black Refused to 1 3.3 3.3 100.0 answe Total 30 100.0 100.0 Table # 3: Sex of Respondents Fequency Pecent Valid Cumulative Pecent Pecent Female 26 86.7 86.7 86.7 Male 3 10.0 10.0 96.7 Refused 1 3.3 3.3 100.0 Total 30 100.0 100.0

11 Fifty-thee pecent of the subjects lived moe than twenty-one miles fom thei couse delivey site. The data also indicated that with telehealth connections in place, less than 13.3% (n=4) lived moe than 50 miles fom a telehealth couse site (Table 4). This indicates that access to moe telehealth sites will continue to decease distance taveled by students. Table # 4: How fa do you live fom this couse delivey site? Fequency Pecent Valid Cumulative Pecent Pecent 0-5 miles 4 13.3 13.3 13.3 6-10 miles 8 26.7 26.7 40.0 11-20 2 6.7 6.7 46.7 miles 21-50 12 40.0 40.0 86.7 miles moe than 4 13.3 13.3 100.0 50 miles Total 30 100.0 100.0 Only 26.7% of espondents attend the main campus site fo thei couse wok. Sixtypecent of espondents attended class at a emote campus. Ten-pecent of the students taking the couse tavel to a community distance leaning site (Figue # 1). A community distance leaning site in this study is defined as an IP connection at a Community College o ual aea. A emote campus is defined as a banch campus using WHETS. In contast to the location of telehealth sites fo couse delivey, eighty-pecent of the espondents epoted that they lived moe than 51 miles fom the main campus.

12 Figue #1: Couse Site Rual Hospital Site 3.3% Main Campus 26.7% Remote campus 60.0% Dis!. Leaming Site 10.0% The espondents indicated that 70 % lived moe than 100 miles fom the site whee the couse oiginated (Figue #2). Figue #2: Distance fom Spokane Campus Moe than 100 miles 70.0% 0-5 miles 3.3% 6-10 miles 10.0% 11-20 miles 3.3% 21-50 miles 3.3% 51-100 miles 10.0% The espondents indicated that 86.7 % of the sample spent less than ten dollas a week fo food costs because of thei convenient site location. (Table # 5).

13 Table # 5: Costs of food pe week while at class o due to taveling to class site? Fequency Pecent Valid Cumulative Pecent Pecent 0 9 30.0 30.0 30.0 $1-5 9 30.0 30.0 60.0 $6-10 8 26.7 26.7 86.7 $11-15 1 3.3 3.3 90.0 $16-25 3 10.0 10.0 100.0 Total 30 100.0 100.0 The espondents also indicated that the availability of convenient couse locations minimized the costs of childcae while attending school. The poximity of ual based couse sites allowed many of the espondents to use spouses, paents, gandpaents and othe elatives to povide childcae. This esulted in a vey low cost of childcae while attending school (Table # 6). The data indicates that 93 % of the espondents had no childcae costs associated with taking classes. Table # 6: Appoximate costs of childcae while at school? Fequency Pecent Valid Cumulative Pecent Pecent 0 28 93.3 93.3 93.3 $1-50 1 3.3 3.3 96.7 $51-100 1 3.3 3.3 100.0 Total 30 100.0 100.0 The students epoted that the costs of gas fo taveling to and fom class wee minimized by the availability of telehealth couses. The espondents epoted that ove 76% spent less than ten dollas a week to tavel to and fom the couse. A total of 93% spent less than twenty- five dollas a week fo gas (Table # 7).

14 Table # 7: Appoximate costs of gas pe week taveling to and fom school-class site? Fequency Pecen Valid Cumulative Pecen Pecen 0 3 10.0 10.0 10.0 $1-5 11 36.7 36.7 46.7 $6-10 9 30.0 30.0 76.7 $11-16 1 3.3 3.3 80.0 $17-25 4 13.3 13.3 93.3 $26-32 1 3.3 3.3 96.7 $33-40 1 3.3 3.3 100.0 Total 30 100.0 100.0 This low cost fo gas was associated with the minimal time spent commuting to and fom the couse sites. Commuting and couse activities included hous pe week spent commuting to and fom campus to attend a lectue, discussion o study session, to study in the libay, compute lab, etc. (Figue #3). Figue #3: Commuting and Couse Activities: Hous pe week 3.5 hous-5 hous 13.3% No answe 3.3% 30minutes-1 hou 33.3% 1.5 hous-3 hous 50.0% Oveall, 90% of espondents wee satisfied with the Medical Mimics couse offeed via televideo (Figue # 4).

15 Figue # 4- Oveall Satisfaction with couse Dissatisfied 10.0% Satisfied Vey satisfied 36.7% 53.3% Sixty-six pecent of students epoted that due to the way Medical Mimics (N544) was offeed via televideo they wee able to take the couse (Figue # 5). Figue #5: Able to take couse via televideo N.A. 20.0% Stongly Disagee Stongly Agee 53.3% 3.3% Disagee 10.0% Agee 13.3%

16 Discussion The data indicates that education via telehealth modalities benefit ual students who ae place bound by jobs, geogaphical baies and family obligations. Linkage to egional educational settings povides an invaluable sevice in small emote communities with limited commllnications infastuctue. The data indicates that ecuitment and etention of qualified health pofessionals can be ovecome in ual and emote communities using telehealth connections. The len MIRA Netwok enabled diect teaching in a synchonous eal time mode to isolated communities. The data povides a clea pictue on the cost of telehealth education fom the student's pespective. Data was not collected to actually allow compaisons of costs between synchonous and asynchonous classes. The data indicated that the student's indiect costs associated with obtaining advanced education wee limited by the use of telehealth connections. The data indicates that costs associated with tavel, food, and childcae had a diect impact on the student's ability to access advanced education. The data fom this study show that these costs ae minimized and facilitate the student's enollment in gaduate education. Sixty-pecent of the espondents attended class at a emote campus eflecting that access has impoved by developing emote sites and offeing couses via televideo. Ove 70% of the students lived moe than 100 miles fom the main campus whee the couse oiginated. While the televideo couse delivey sites wee emotely located in espect to the main campus, the students wee able to spend little on ca maintenance and fuel. Sixty- seven pecent of espondents spent less than $10 on gas costs commuting to thei

17 couse site. This is emakable given the ecent inceases in the costs associated with fossil fuels and the distance to the pimay campus. Typical of most gaduate education, 60% of the students wee between the ages of 20-49 yeas of age. Most had majo childcae esponsibilities o wee within the age ange duing which childeaing occued. The data fom this study indicated that the ability to access local televideo connections fo gaduate education esulted in minimal childcae costs. In many instances, the students wee able to utilize spouses, gandpaents and othe elatives who also lived in the aea. Foty-pecent of students live less than 11 miles fom thei paticula couse delivey site. The convenience of having a couse site located close to home deceased the student's financial buden by allowing students to continue to wok and attend school. The majoity of students wok an aveage of 32 hous a week. In ode to affod gaduate school and household expenses students need to wok and attend school at the same time. Developing televideo couses at wok settings o at home would incease the availability and access to education to individuals that ae in emote aeas who have family and/o wok obligations. The televideo connections did not affect the students' level of satisfaction. The data indicates that thee was a high level of satisfaction with the couse. The espondents noted that thee was satisfaction with the couse egadless of whethe they took the couse at the main campus o a emotely connected site. The majoity of espondents ageed that they wee able to take this couse due to the way the couse was offeed via televideo connections. This suppots poviding sites close to students, which may help decease commuting costs and etains students in the pogam.

18 Nusing Implications Due to Washington State having many ual and fontie aeas, telehealth is the solution to decease both indiect and diect costs associated with advanced ual health education. The televideo connection also allows the ual communities access to education that will povide advanced health cae. The use of telehealth povides an avenue fo solving the poblem of lack of access by poviding cae and clinical sites fo ual individuals. The nusing shotage in the United States is inceasing and indicates the need fo inceased enollment in nusing schools. Identifying cost-effective appoaches will help bidge the educational baies to populations that need viable outes of access to nusing education.

19 Refeences Bown, G. (1999). Technology in nuse education: A communication teaching stategy. Reteived Octobe 5,2000, fom Wold Wide Web: http://poquest.umi.com Clake, J. (1997). A efee and patient evaluation of a telepsychiaty consultation-liason sevice in South Austalia. Jounal of telemedicine and telecae, 3, supplement 1, 12-14. Dunn, B. (1999). Telepathology in the depatment of vetean's affais: Expeience elated impovements in pathological pefomance in 2200 cases. Telemedicine Jounal, 5(4),323-337. Field, M J. (1996). Telemedicine: A guide to assessing telecommunications in health cae. Washington D.C.: National Academy Pess. Hill, M. (1997). Teache education though distance leaning: Cost effectiveness and quality analysis. Retieved Octobe 30, 2000, fom Wold Wide Web: http://www.coe.uh.edu/insite/elec pub/html1997ide hill.htul. La Mendola, W. (1997). Telemental health sevices in U.S. Fontie aeas; lette to the field numbe 3. Retieved Novembe 26,2000, fom Wold Wide Web: http://www.du.edu/fontie-mhllette3.html. Nesbitt, T., Hilty, D., Kuenneth, C. & Siefkin, A. (2000). Development of a telemedicine pogam. Westen Jounal of Medicine, 173, 169-174. Nickelson, D. (1998). Telehealth and the evolving health cae system: Stategic oppotunities fo pofessional psychology. Pofessional Psychology: Reseach and Pactice, 29(6), 527-535.

20 Robbins, C.W. (1999). Remote communities sevice telecente poject. In M. Nelich & R. Ketschme (Eds.), The impact of telemedicine on health cae management (241-244). Amstedam, Nethelands: los Pess. Scott, R., Coates, K. & McCathy, G. (1999). The value of an evaluation famewok fo telehealth initiatives. In M. Nelich & R. Ketschme (Eds.), The impact of telemedicine on health cae management (39-45). Amstedam, Nethelands: los Pess. The Telehealth Industy in Canada: Industy pofile and capability analysis. Retieved Novembe 25,2000, fom Wold Wide Web: http://stategis.ic.gc.ca/ssg/it05495e.htm. Wachte, G. (2001). 2001 State telemedicine legislative summay. Retieved Apil 28, 2001, fom Wold Wide Web: http://tie.telemed.og/legal/state/summay200 I.asp.

21 Appendix I MIRA COST OUTCOMES SURVEY Subject Name Subject ill Date Inteviewe _ 1. Because ofthe way this couse uses video confeencing, I was able to take this couse. Stonj?;ly Awee Agee Disagee Stonj?;ly Disagee N.A. 2. Indicate how stongly you agee o disagee with the following statement. Because of ~he way this couse uses video confeencing, I am moe confident that I can each my academic j?;oals. Stonj?;ly Awee Agee Disagee Stongly Disagee NA 3. Appoximate costs offood pe week while at class o due to taveling to class site? wm!a,-.'c~'f. '~i ~ ". --'~~~: d}~~: 4. Appoximate costs ofchild cae while at school?!i~:. il -'0:"'" i'. ~ \1. ~ ~~;.~ 5.!Any othe costs incued due to attending school (excluding tuition).

22

23 IP~I~s~~~:~j~~_~-;~~_~--~~~--~-~~~-~~~_-~~~:~] II IO.! ow m";y hoos pe week do you wok fo pay? (wite you esponse in the spaj il i p-yi~~~ h h h hh J i[=j[: h :h ~~_~_~~_~~~! h.. h h h h.h _hh h hu-._~~j 11. Do you live: (select all that apply) with you paents as a dependent? with you spouse o patne? in off-campus housing alone? in off-campus housing with unelated oommates? in a domitoy (single o with oommates)? in a sooity o fatenity? othe (please specify) I...----? 12. Numbe ofdependent, school-age childen living with you? (wite you esponse in the space povided) I numbe 13. Do you take this couse pimaily: (select only one) at home? at you place of employment? at the main campus? at a community distance leaning site (such as, a libay, a high school)? at a emote campus? othe (please specify) I? 14. How fa do you live fom this couse delivey site? (select only one) 0-5 miles 6-10 miles 11-20 miles 21-50 miles moe than 50 miles not applicable 15. How fa do you live fom ou institution o campus? (select only one esponse) 0-5 miles 6-10 miles 11-20 miles 21-50 miles 51-100 miles moe than 100 miles

24 17. Please ente you age in the space povided Age: I. 18. RacelEthnicity: (select all that apply) Ameican Indian/Alaskan Native Afican-AmeicanIBlack AsianlPacific Islande White Hispanic/Latino Othe (please specify) I 19. Sex: (select only one) Male Female 20. Oveall, I have been vey dissatisfied C satisfied with this couse dissatisfied satisfied vey ===-------.'..-.-.-.-'~-..-...-..--~-'---...-.--.-..-.--.----.-.-,;,;:;,. ~-.--_w----.. ~---~----:---.-.- - "-.------. -_ _ --:- _-_ -...--'-11 I a typical week duing this semeste, appoximately how much time did you spend in!....... -...... I select only one esponse pe question) IIFo this couse (Inclu~e all the time you spent I i/o you couse(s) dunng class, laboatoy! \Isess~ons, unj?aid intenships" and study time" Do I i~ot mclude time spent fo a Job you wee paid to!!jpefom o fo pesonal easons)!i ~ Ii : _~!l-.ei!q~j~ij.q~i!k~<?!a~!!ies:...._... _ ~ ]1

....;:;;-~,~,.;;.;;;~ 25 =~:1=.-~:1II::~. 1 \ Ten! to :to i o II n! None/ 1 Il Five I.. Two \~one\ N~t \ : \1 s o: ou: ou!lbou: ou \lapphcab i lin.ou! Nine\.., ',, II I' I t JlM~!.~ ~j ~ il~.--~=j--e- ~ - te._ --~ 12iT~te-;;,;~g~ih-,;;;;-;;;;;cto;:;; oihe! nn l in!! ; \students at you institution by way of.e- : il \1 _: 1\, \1 : \ i ail o o~he~ Ittime-dela edit el,ectomc j :1 :1 \1 ;\ I ~\! :l 1- ommumcatlon (such as bulletin boads o: :l,i il'! I I [;. '1' 'I? I I,, l ' ii22f~~:::::~:~~e~et!w;id Wid~ w;t; t~~'~'"-:~-~ --~-i \L l~ccess efeence mateials andlo conduct II it I it :L'![I~'! I! I I I. " L.J I e.~~_~~h1,_.- c...._-..=-==...=~----; =-,,----.J."-.' _i -- - L.==) : --- --- i 23. Think about a simila couse you have taken that [ 1) elied pimaily on face-to-face discussions][ 2) wee offeed via coespondence o distance leaning without Video confeencing]. Compaed to that couse, because of the way this couse uses Video Confeencing: how likely [ ae][ wee] you to: (select only one esponse pe question) Much Moe Likely Somewhat Moe Likely About the Same Somewhat Less Likely Much Less Likely No basis fo Judgement! Not Applicable 0397S467 0,..to be able to take this couse. Much Moe Likely Somewhat Moe Likely About the Same Somewhat Less Likely Much Less Likely No Basis fo jugementin.a., _~u o. inion,!o what extent we.~ e~~h ofthe followj~i~e~!~ityi~t~s couse: 'Ii! lease ate each of the following fom 1 to 5 whee: JI~sele~t only one esponse pe I ;I'S the 10 t. 'ty d 5' it we~ pioi, an IS t h e h g -h' est pioity i[- i!9.uestlon'\ i -f~l_--!. i! I, - - - -.---- -;;-- -.--.'---'-- -- -- ---'...1 JDC JD 24.\ ~tuc~un. ng the couse.s~ ~hat students don't waste!.n.l:i.i -1' --.l. --!'.! I.! ~me m non-c?use activities (such as standing in 11 1 i! 2 II 31 I 41: I 51! J l~ne, c~!jl_i.!!u!t1!g, etc,) \L ii' :1 i, i ICC. -.-------------------- - -- -------.--1 -----~ - t - --!- -=4;-- ~ p5.1~~abling stud~nts-t~ ~~~=~~k; ;tti~~; th~--~~i[l~=~.,[;:-~itcf 1:- ~ I! ' l' 2' 3 i \ 4 'L' \ 5" _...~.;.;:,;;;;;..~;;;;:;;ot'~-.,-~~,"-' -.-------...~. ~;.:;::o~w.~. --,.-.. ----_:.-. -_.'. -1.'".-...;;:-~..._...~;;;;J._-_;;:;.;.;;;.e-.. ).._-,-_.--1 ;,;;;.;;;;j

26 26. Please elaboate ifthee is anything else you would like us to know about you ex eience takin this couse?.ia/ 27.Estimated Net (afte taxes and expenses) Annual Household income... $10-14,999 $15-30,000 $31-50,000 $51 000 and above