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Title: Human technology intermediation to reduce cognitive load: understanding healthcare staff members’ practices to facilitate telehealth access in a Federally Qualified Health Center patient population
Abstract Objectives

The aim of this study was to investigate how healthcare staff intermediaries support Federally Qualified Health Center (FQHC) patients’ access to telehealth, how their approaches reflect cognitive load theory (CLT) and determine which approaches FQHC patients find helpful and whether their perceptions suggest cognitive load (CL) reduction.

Materials and Methods

Semistructured interviews with staff (n = 9) and patients (n = 22) at an FQHC in a Midwestern state. First-cycle coding of interview transcripts was performed inductively to identify helping processes and participants’ evaluations of them. Next, these inductive codes were mapped onto deductive codes from CLT.

Results

Staff intermediaries used 4 approaches to support access to, and usage of, video visits and patient portals for FQHC patients: (1) shielding patients from cognitive overload; (2) drawing from long-term memory; (3) supporting the development of schemas; and (4) reducing the extraneous load of negative emotions. These approaches could contribute to CL reduction and each was viewed as helpful to at least some patients. For patients, there were beneficial impacts on learning, emotions, and perceptions about the self and technology. Intermediation also resulted in successful visits despite challenges.

Discussion

Staff intermediaries made telehealth work for FQHC patients, and emotional support was crucial. Without prior training, staff discovered approaches that aligned with CLT and helped patients access technologies. Future healthcare intermediary interventions may benefit from the application of CLT in their design. Staff providing brief explanations about technical problems and solutions might help patients learn about technologies informally over time.

Conclusion

CLT can help with developing intermediary approaches for facilitating telehealth access.

 
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NSF-PAR ID:
10489042
Author(s) / Creator(s):
; ; ; ; ; ;
Publisher / Repository:
Oxford University Press
Date Published:
Journal Name:
Journal of the American Medical Informatics Association
Volume:
31
Issue:
4
ISSN:
1067-5027
Format(s):
Medium: X Size: p. 832-845
Size(s):
p. 832-845
Sponsoring Org:
National Science Foundation
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