FACTORS ASSOCIATED WITH THE SUCCESSFUL IMPLEMENTATION OF TELEHEALTH

The purpose of this Doctor of Nursing Practice project was to identify factors that support adoption of telehealth in a for-profit retail health clinic. A cross-sectional design was employed to address project aims. Nurse practitioners and licensed vocational nurses from four southern California counties completed an online survey in fall 2014, which included demographic items as well as a telehealth adoption tool adapted from the Instrument to Measure Perceptions of Adopting an Information Technology Innovation. This instrument measures five diffusion of innovations theory (DIT) constructs (relative advantage, compatibility, trialability, observability, complexity) as well as result demonstrability, voluntariness, and image. Three open-ended questions were also included. The DIT and Promoting Action on Research Implementation in Health Services model (PARiSH) provided theoretical and conceptual foundations for this project. Sixtythree nurses from this retail health clinic completed the survey (response rate 68%). Of these, 43% worked in high-adoption counties (regions achieving 77% of all telehealth visits). High adopters and low adopters (those underutilizing the innovation of telehealth) did not differ in terms of years of experience, levels of education, and months on telehealth at baseline. Significantly different were nurse responses to the voluntariness construct: “My boss requires me to use telehealth” and “Although it might be helpful, using telehealth is compulsory in my job” with high adopters perceiving these more positively. Two items measuring compatibility were significantly associated with telehealth adoption: “I think that using telehealth fits well with the way I like to work” iv and “Using telehealth fits into my work style” with low adopters perceiving both items more negatively. To improve adoption of telehealth, organizational leadership may want to consider strategies to improve perceived voluntariness and compatibility. For example, champions could be assigned to oversee the low-adopter clinics to offer expert support and provide encouragement to reduce the challenges associated with the stress of a new innovation.