skip to main content

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.


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.


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.


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

more » « less
Author(s) / Creator(s):
; ; ; ; ; ;
Publisher / Repository:
Oxford University Press
Date Published:
Journal Name:
Journal of the American Medical Informatics Association
Medium: X Size: p. 832-845
p. 832-845
Sponsoring Org:
National Science Foundation
More Like this
  1. Abstract Purpose

    To explore system/staff‐ and patient‐level opportunities to improve colorectal cancer (CRC) screening within an 11‐clinic Federally Qualified Health Center (FQHC) in rural Appalachia with CRC screening rates around 22%‐30%.


    Using a convergent parallel mixed‐methods design, staff (n = 26) and patients (n = 60, age 50‐75, 67% female, 83% Results

    Among staff, inner setting factors that could promote CRC screening included high workplace satisfaction, experiences tracking other cancer screenings, and a highly active Performance Improvement Committee. Inner setting hindering factors included electronic medical record inefficiencies and requiring patients to physically return fecal tests to the clinic. Outer setting CRC screening promoting factors included increased Medicaid access, support from outside organizations, and reporting requirements to external regulators, while hindering factors included poor social determinants of health, inadequate colonoscopy access, and lack of patient compliance. Among patients, perceived screening benefits were rated relatively higher than barriers. Top barriers included cost, no symptoms, fear, and transportation. Patients reported high likelihood of getting a stool‐based test and colonoscopy if recommended, yet self‐efficacy to prevent CRC was considerably lower.


    Contextualized perceptions of barriers and practical opportunities to improve CRC screening rates were identified among staff and patients. To optimize multilevel CRC screening interventions in rural Appalachia clinics, future quality improvement, research, and policy efforts are needed to address identified challenges.

    more » « less
  2. Background

    Rural and remote communities were especially vulnerable to the COVID-19 pandemic due to the availability and capacity of rural health services. Research has found that key issues surrounded (1) the lack of staff, (2) the need for coordinated health services, and (3) operational and facility issues. Similarly, research also confirms that irrespective of hospital capacity issues existing during crisis, compared to urban communities, rural communities typically face poorer access to health services. Telehealth programs have long held promise for addressing health disparities perpetuated by inadequate health care access. In response to the current COVID-19 pandemic, Adventist Health Saint Helena Hospital, a rural hospital in northern California, urgently worked to expand telehealth services. However, as Adventist Health Saint Helena Hospital is the longest-serving rural hospital in the state of California, administrators were also able to draw on experiences from the pandemic of 1918/1919. Understanding their historically rural and heavily Latino populations, their telehealth approach was coupled with cultural approaches for prioritizing socially responsive and equitable access to health services.


    This study aimed to present one rural community’s holistic sociotechnical response to COVID-19 in redesigning their health care delivery approach. Redesign efforts included the expansion of digital health services coupled with county-wide collaborations for nondigital mobile health centers, testing, and vaccination clinics to meet the needs of those with limited digital access and language barriers.


    We present data on telehealth services for maintaining critical care services and a framework on the feasibility of private-public partnerships to address COVID-19 challenges.


    In this paper, we provide a critical review of how a rural hospital adapted its health care approach to incorporate telehealth services and distance services to meet the needs of a diverse population.


    This paper contributes empirical data on how rural communities can use telehealth technologies and community partnerships for a holistic community approach to meet health needs during a natural disaster.

    Conflicts of Interest

    None declared.

    more » « less
  3. Abstract Purpose/Objectives

    We aim to explore Current Procedural Terminology (CPT) codes for caregiving training services and their potential impacts on caregivers of people living with dementia.

    Description of the Project/Program

    In response to the growing need for support for caregivers of people living with physical and mental health issues, CPT codes for caregiving training services will be activated for the calendar year 2024. These codes cover (1) family group behavior management and modification training services and (2) caregiver training for techniques to help patients maintain their quality of life. Caregivers will access such training support through the CPT codes provided by treating practitioners. The duration of training will vary by code.


    Implementing CPT codes for caregiver training services highlights the vital role of caregivers in patient care. This support may improve their skills and communication with healthcare providers. However, timing and accessibility in care delivery need clarification, especially for caregivers of people living with dementia. Regular skill assessment and culturally competent care are essential. Before providing the service, provider training may also promote person-centered care, benefiting patients and their caregivers.


    Activating CPT codes for caregiving training services may enhance caregivers' support and skills, including dementia care.

    more » « less
  4. Telehealth technologies play a vital role in delivering quality healthcare to patients regardless of geographic location and health status. Use of telehealth peripherals allow providers a more accurate method of collecting health assessment data from the patient and delivering a more confident and accurate diagnosis, saving not only time and money but creating positive patient outcomes. Advanced Practice Nursing (APN) students should be confident in their ability to diagnose and treat patients through a virtual environment. This pilot simulation was completed to help examine how APN students interacted in a simulation-based education (SBE) experience with and without peripherals, funded by the National Science Foundation’s Future of Work at the Human-Technology Frontier (FW-HTF) program. The SBE experience was created and deployed using the INACSL Healthcare Simulation Standards of Best PracticesTM and vetted by a simulation expert. APN students (N = 24), in their first assessment course, were randomly selected to be either a patient (n = 12) or provider (n = 12) in a telehealth simulation. Student dyads (patient/provider) were randomly placed to complete a scenario with (n = 6 dyads) or without (n = 6 dyads) the use of a peripheral. Students (providers and patients) who completed the SBE experience had an increased confidence level both with and without the use of peripherals. Students evaluated the simulation via the Simulation Effectiveness Tool-Modified (SET-M), and scored their perception of the simulation on a 1 to 5 point Likert Scale. The highest scoring areas were perceived support of learning by the faculty (M=4.6), feeling challenged in decision-making skills (M=4.4), and a better understanding of didactic material (M=4.3). The lowest scoring area was feeling more confident in decision making (M=3.9). We also recorded students’ facial expressions during the task to determine a probability score (0- 100) for expressed basic emotions, and results revealed that students had the highest scores for joy (M = 8.47) and surprise (M = 4.34), followed by disgust (M = 1.43), fear (M = .76), and contempt (M = .64); and had the lowest scores of anger (M = .44) and sadness (M = .36). Students were also asked to complete a reflection assignment as part of the SBE experience. Students reported feeling nervous at the beginning of the SBE experience, but acknowledged feeling better as the SBE experience unfolded. Based on findings from this pilot study, implications point towards the effectiveness of including simulations for nurse practitioner students to increase their confidence in performing telehealth visits and engaging in decision making. For the students, understanding that patients may be just as nervous during telehealth visits was one of the main takeaways from the experience, as well as remembering to reassure the patient and how to ask the patient to work the telehealth equipment. Therefore, providing students opportunities to practice these skills will help increase their confidence, boost their self- and emotion regulation, and improve their decision-making skills in telehealth scenarios. 
    more » « less
  5. Background

    COVID-19 has severely impacted health in vulnerable demographics. As communities transition back to in-person work, learning, and social activities, pediatric patients who are restricted to their homes due to medical conditions face unprecedented isolation. Prior to the pandemic, it was estimated that each year, over 2.5 million US children remained at home due to medical conditions. Confronting gaps in health and technical resources is central to addressing the challenges faced by children who remain at home. Having children use mobile telemedicine units (telerobots) to interact with their outside environment (eg, school and play, etc) is increasingly recognized for its potential to support children’s development. Additionally, social telerobots are emerging as a novel form of telehealth. A social telerobot is a tele-operated unit with a mobile base, 2-way audio/video capabilities, and some semiautonomous features.


    In this paper, we aimed to provide a critical review of studies focused on the use of social telerobots for pediatric populations.


    To examine the evidence on telerobots as a telehealth intervention, we conducted electronic and full-text searches of private and public databases in June 2010. We included studies with the pediatric personal use of interactive telehealth technologies and telerobot studies that explored effects on child development. We excluded telehealth and telerobot studies with adult (aged >18 years) participants.


    In addition to telehealth and telerobot advantages, evidence from the literature suggests 3 promising robot-mediated supports that contribute to optimal child development—belonging, competence, and autonomy. These robot-mediated supports may be leveraged for improved pediatric patient socioemotional development, well-being, and quality-of-life activities that transfer traditional developmental and behavioral experiences from organic local environments to the remote child.


    This review contributes to the creation of the first pediatric telehealth taxonomy of care that includes the personal use of telehealth technologies as a compelling form of telehealth care.

    more » « less