Objective: The purpose of this research study was to determine the factors that influence the willingness of caregivers, who are caring for a family member who has had a stroke, to use telehealth technologies in the home.
Design, Population, Sample, Setting, Years: This preliminary study employed a descriptive design with a sample of 20 caregivers (over 40 years of age) caring for a family member who had had a stroke within the previous year. Subjects were recruited through the MedStar Visiting Nurse's Association homehealth agency in the Washington, DC metropolitan over a 12-month period (2000-2001).
Intervention and Outcome Variables: Telehealth videophones were installed in the home of caregivers of stroke patients to assess their acceptance and utilization of the technology to communicate with home health nurses.
Methods: The study was conducted over a 6-week period for each subject. Upon receiving a verbal agreement by telephone from the caregiver to participate in the study, a home visit was scheduled by a nurse and bioengineer. During the initial visit the bioengineer installed the telehealth equipment (a videophone), and the nurse assessed the caregivers' mental status and readiness to use the technology. A week later, the nurse completed a second home visit to assess the emotional and physical caregiving abilities of the caregiver. For the next two weeks, the nurse contacted the caregiver via videophone once a week. The caregiver was encouraged to initiate calls to the nurse, as needed. For the final two weeks of the intervention, the nurse and caregiver had telehealth visits only at the caregiver's initiation of a call. Detailed notes regarding the technical aspects and content of the calls and the caregiver-telehealth interactions were kept by the nurse. Following completion of telehealth visits, the equipment was removed from the home, and the caregivers were interviewed over the phone regarding factors influencing their use of the telehealth technology.
Findings: Content of the conversations between the caregiver and nurse ranged from discussions related to physical needs and care of the patient to a need for emotional support by the caregiver in dealing with the isolation and stress imposed by caregiving. The development of rapport between the telehealth nurse and caregiver was found to be a major factor affecting the frequency and content of interactions. Potential blocks to the use of telehealth were identified. They included length of time from acute diagnosis, concerns by the caregiver in maintaining home security, and acceptance of technology.
Conclusions: Identification of potential blocks to the use of telehealth is vital prior to developing and evaluating programs using telehealth as a method of rehabilitative technology.
Implications: There is a need to future research on the use of telehealth technology by caregivers of clients with other diagnoses and at different times over the stage of an illness.
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