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Table 3 Summary of views on telehealth by participant group and NPT generative mechanisms

From: ‘Massive potential’ or ‘safety risk’? Health worker views on telehealth in the care of older people and implications for successful normalization

Clinician group Coherence Cognitive participation Collective action
Urban clinicians Low. Perception of telehealth did not cohere with that of other groups of clinicians. Perceived the service differently for rural than for urban patients. Low. Do not see telehealth as a legitimate model of service for ‘real’ rehab patients (particularly urban patients). Interactional workability – low. Only suitable for high-functioning or remote patients (who have no option for face-to-face consults). Patient-therapist interactions would suffer due to narrowing of the scope of what can be seen and done via videoconference.
Relational integration – low. Focussed on current patients rather than wider service delivery limitations
Rural allied health clinicians High. Clearly defined, differentiated and understood telehealth and its potential High. Willingness to engage with telehealth as a model of service; viewed telehealth as a legitimate way to expand their services; looking at ways to create a community of practice utilising local health professionals. Interactional Workability – High. Promising way to provide access to services for rural patients who lack local services.
Relational integration – High. Clear understanding of the wider health network and could see opportunities for using telehealth to link urban and rural services
Contextual integration: Low Considerable organization, systemic and technological infrastructure barriers
Novice telehealth urban clinicians Developing. Telehealth still conceptualised as an adjunct to traditional model of service. Developing. Burgeoning acceptance of telehealth but retained concerns about the efficacy of telehealth for more severely impaired patients. Interactional workability – low to moderate. Agreed that a significant proportion of work could be done via telehealth but still felt that it was not suitable for significantly impaired patients.
Relational integration – low. Conventional model of service seen as ‘core business’, with telehealth incorporated at their discretion, rather than embracing novel ways of working using telehealth.
Telehealth clinicians High. Clearly differentiated telehealth as a distinct model of service that required new ways of working. High. Engaged with the service and were thinking about ways to expand its scope and make it work Interactional workability – moderate. Careful planning and improvements in technology required to maximise what can be done via telehealth
Skill-set workability – questionable. Concerned that on the ground supporters of videoconferences adequately trained.
Relational integration – moderate to high Concerns about keeping up with rapidly changing technology to maintain working knowledge; forged supportive networks with residential aged care facilities
Contextual integration – Moderate Technological infrastructure and tech support required
Reflexive monitoring – High.
Re-conceptualised telehealth as a distinct model, rather than an adjunct to traditional models. Thinking about ways in which they could improve, expand and respond to challenges in providing their services via telehealth
Residential aged care staff High. Positive about the impacts of telehealth as a new service not previously available to their residents High. Embraced the service and collectively enrolled. Interactional workability – High. Positive outcomes for residents. Teleconference as good as face-to-face.
Relational integration – High. Established links with urban rehabilitation and geriatric services.
Skill-set workability – High. Displayed the skills to support interventions; increased their skill-set through doing so.