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HEAL6031 Health Science – Dissertation Research Project Proposal (Country Western Australia)
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Background: Telehealth is a digital health modality that was developed to enable health professionals to deliver clinical and non-clinical services in regional WA. With the rapid pace of global digitization, the emergence of the National E-Health Strategy in 2008, provided a pathway to promote the delivery of e-Health solutions and foster the adoption of digital health by consumers of health care. The WA Health Digital Strategy and the WA Country Health Service (WACHS) Digital Innovation Strategy were developed to promote digitalized models of health care delivery and support a technically sound workforce. Research demonstrated the importance of e-health inclusion in university curricula to prepare future allied health graduates to deliver digital health services successfully. This need accelerated by the COVID-19 pandemic illustrated the lack of reference to digital health competencies within the competency framework for allied health graduates.
Objectives: The first objective is to conduct a scoping review to examine the digital health readiness of the allied health staff. The second objective is to determine their acceptability and confidence level in using telehealth and digital health modalities in country WA. Objective three is to identify the training needs of allied health staff in country WA in the delivery of health services digitally.
Methods: This research will conduct an initial scoping review and adopt a cross-sectional study design to assess the digital health readiness of allied health graduates. The quantitative data collected from the survey will be analysed using the Statistical Package for the Social Sciences (SPSS) software. In addition, training needs for graduate allied health staff will be drawn from semi-structured interviews of key representatives from each allied health discipline at Curtin University.
Results: Expected results are an examination of the capabilities to use digital health technology to deliver health care among graduate allied health staff in country WA. It will also identify opportunities for training graduate allied health students to deliver more effective and equitable care as a practicing professional.
Conclusion: The findings of this study are intended to benefit WA Country Health Service (WACHS) to assess the digital capabilities of its graduate allied health staff and equip them with skills to successfully practice in this digitized era.
2. Aim and objectives
The aim of this study is to evaluate the current level of digital health readiness among graduate allied health staff in country Western Australia (WA).
Specific objectives are to:
- Conduct a scoping review to examine the digital health readiness of allied health staff.
- Determine the acceptability and confidence level of using telehealth and digital health modalities among graduate allied health staff in country WA.
- Identify the training needs of graduate allied health staff in country WA in the delivery of services via telehealth and digital health modalities.
Telehealth refers to the electronic and telecommunication-based expansion of clinical and non-clinical health care services, including telemedicine (telehealth clinical services) and electronic health record (EHR) systems(Bursell, Jenkins, Brazionis, Rowley, & Brown, 2013).
Telehealth activity was first initiated in Western Australia through telepsychiatry in 1996 (Dillon & Loermans, 2003). In 1999, the Commonwealth, State and Territory Governments jointly signed the $16 million AUD telehealth project to improve accessibility to healthcare and health education, as well as health administration in regional and remote areas of WA (Dillon & Loermans, 2003). Between 1999 and 2001, the emphasis was on selecting appropriate locations and establishing infrastructure for telehealth (Dillon & Loermans, 2003). Thereafter the emphasis shifted to service delivery, with telehealth services starting to be provided in the form of real-time videoconferencing, store-and-forward techniques (for radiology or transmission of other patient images), access to information databases, and patient support via call centre services such as Health Direct (Dillon & Loermans, 2003).
Further collaboration between the Commonwealth, State and Territory Governments to coordinate the development of digital health modalities in Australia was evident with the release of the National E-Health Strategy in 2008(Australian Health Minister’s Advisory Council, 2008), which provided a pathway to promote the delivery of eHealth solutions to key users of health information and to foster adoption of eHealth by consumers, care providers and health care managers(Australian Health Minister’s Advisory Council, 2008).E-Health covers a wider spectrum of services than telehealth, including any use of electronic systems to support health delivery. At this time, seven hospitals in WA (Royal Perth, King Edward Memorial, Sir Charles Gairdner,Princess Margaret, Fremantle, Graylands and Swan District Hospitals) were administeringan array of telehealth services to other hospitals in metropolitan and rural areas as well as nursing stations, with the most common purpose being for education, wound care, psychiatry, tele-ECG, image transfer for dermatology and paediatric burn care (Gray et al., 2011).
Further initiatives to support the transition to digital health, an umbrella term for areas including eHealth, telehealth and other digital health modalities (Australian Digital Health Agency 2020), included the release of the National Digital Health Strategy (2018-2022) (National Digital Health Strategy and Framework for Action, 2018), the WA Health Digital Strategy (2020-2030)(Government of Western Australia, 2020b)and the WA Country Health Service (WACHS) Digital Innovation Strategy (2019-2022)(WA Country Health Service, 2019). Each of the national, WA and WACHS digital health strategies includes strategies to promote digital-enabled models of care and support a technology-enabled workforce.Central also to each of these strategies was the ability of digital health services to reduce barriers to equity of access to health care and allow the community to have greater access to services closer to home.
Allied health is a comprehensive term that encompasses a wide range of health disciplines excluding nursing and medicine (McAllister & Nagarajan, 2015). Technical skills, discipline experience, and professional practises vary widely among allied health professionals (McAllister & Nagarajan, 2015). Each allied health discipline has its own skill framework set by their respective professional associations, which specifies the competencies and practise threshold standards that are needed for specific work functions, procedures, tasks, and professional outcomes (McAllister & Nagarajan, 2015).
In 2011, the Australian Government Department of Health commissioned a study to identify the eHealth readiness of Australia’s allied health practitioners for digital health practice(Australian Government, 2011). Readiness for eHealth use was analysed along three dimensions: infrastructural readiness (operating environment); aptitudinal readiness (depth of skills and capability to use eHealth); and attitudinal readiness (willingness to use eHealth). The findings suggested that while allied health practitioners typically had the necessary aptitudinal readiness for eHealth, few mainstream infrastructure applications were designed specifically for the allied health sector and attitudinal readiness ranged from “strongly convinced” to “expressively negative”(Australian Government, 2011).
The necessity of educating future health practitioners for practice in an eHealth-enabled healthcare setting has been outlined both nationally in Australia’s National eHealth Strategy and internationally in the European Commission’s (2001) eHealth Action Plan (Lam et al., 2016). Studies of the knowledge and willingness of allied health students to use telehealth have shown the importance of tertiary institutions providing eHealth training to students at university to improve their preparedness for using telehealth as a health professional (Lam et al., 2016). While students are confident in engaging with online activities in their personal lives, they are unable to comprehensively apply these skills to professional health contexts (Lam et al., 2016). With the exception of references to digital health competencies in the new Australian Registered Nurse practise standards(Nursing And Midwifery Board of Australia, 2016), competency frameworks for medical and allied health practitioners lack reference to relevant digital health competencies for new graduates(Butler-Henderson, Dalton, Probst, Maunder, & Merolli, 2020).
The rapid adoption of telehealth as a result of global digitalisation, as well as the emphasis on innovative data and digital health systems for directing and enforcing the health system and service improvement, illustrate the need to address factors related to organizational and provider readiness for eHealth(Calder, Dunkin, Rochford, & Nichols, 2019). This need has been accelerated by the COVID-19 pandemic that has seen the rapid adoption of telehealth as a means for people to access health services in their homes without having to visit health facilities thus reducing the likelihood of transmission from person-to-person contact (Calder et al., 2019).
As part of its response to COVID-19, the Australian government has introduced measures for telehealth expansion under the Medicare Benefits Scheme (MBS), including the introduction of MBS items for services provided by allied health practitioners(Calder et al., 2019). In further recognition of the impact of digital health technologies on the health workforce and their education needs, a National Digital Health Workforce and Education Roadmap was released in late 2020 to provide a framework for understanding the digital capability requirements of the health workforce and ensure the benefits created by digital health technologies can be realised(Australian Digital Health Agency, 2020).
4. Significance of this study
The WA Country Health Service (WACHS) is committed to adopting digital health as a way of promoting a more sustainable health service and to achieve greater equity of access to services for country residents. Strategic directions outlined in its Digital Innovation Strategy 2019-2022 are consistent with strategies developed by WA Health and the Australian Government for realising the benefits of digital health strategies. However, for these benefits to be realised, the health workforce must be able to confidently use digital health technologies. This study will examine the capabilities of graduate allied health staff in country WA to use telehealth and digital health modalities to deliver health services.
It will also identify the extent to which digital health skills are included in the competencies outlined for allied health graduates. Its findings will provide WACHS with useful information to assess the digital capabilities of its graduate allied health staff and to develop appropriate training to equip them with the skills to successfully use digital technologies to deliver health services. This outcome supports strategic directions outlined in the Digital Innovation Strategy 2019-2022, particularly to “support a technology-enabled workforce equipped with the right information to deliver high-quality services” (WACHS 2018, p3).
5.1 Objective 1 – Scoping review
A scoping review is a tool devised to optimally determine the depth of literature available and provide an overview of the volume of literature, and material available on a specific topic(Munn et al., 2018). In this study, the scoping review will examine the digital health readiness of allied health staff. It will follow the guidelines for conducting a scoping review as described in the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis and its reporting will be consistent with the PRISMA Extension for Scoping Reviews Checklist. Studies will be included in the review based on the following criteria: (i) relevant to the digital literacy of allied health staff; and (ii) published in the peer-reviewed literature from 2010 onwards in the English language. Search for articles will be conducted in PubMed, Scopus and theCumulative Index to Nursing and Allied Health Literature (CINAHL) electronic databases.
5.2 Objective 2 – Survey to assess digital health readiness of allied health graduates
The study will adopt a prospective cross-sectional design in which a survey will be administered to all graduate allied health staff in WACHS to collect data about their acceptance of, and confidence levels in, using telehealth and digital health modalities to deliver health services. Inclusion criteria will consist of the following relevant allied health disciplines employed within the WACHS network: physiotherapists, occupational therapists, speech pathologists, dietitians andsocial workers.Graduate allied health staff will include those graduating within the past two years.
A survey instrument will be developed following discussions with senior WACHS allied health staff to identify key issues and from relevant information identified in the scoping review or drawn from the wider literature. The survey will primarily consist of closed-ended questions with a few open-ended questions to elicit information that may have been missed in the closed-ended questions. The survey will be administered using REDCap, a web application for building and managing online surveys and databases(Government of Western Australia, 2020a). All graduate allied health staff will receive an email requesting their participation and providing a link to the survey.
Quantitative data will be analysed using descriptive statistical methods including frequency distributions for categorical data and means and standard deviations or medians, interquartile ranges and ranges, according to normality, for continuous data. Comparisons between allied health groups will include χ2 or Fisher exact tests, as appropriate. Data from the open-ended questions will be reviewed to identify any common themes raised by participants. The quantitative data analysis will be conducted using the Statistical Package for the Social Sciences (SPSS) software.
5.3 Objective 3 – Training needs of graduate allied health staff to enhance digital health readiness
In addition to findings from the survey assessing digital health readiness of graduate allied health staff in country WA, evidence to guide the identification of the training needs of graduate allied staff will be drawn from semi-structured interviews conducted with key representatives from each of the allied health disciplines at Curtin University. The purpose of these interviews will be to determine the extent to which digital health competenciesare included in discipline curricula. Interviewees will also be asked to provide any information, if known, relating to curricula in allied health schools at other universities.
The questionnaire for the semi-structured interviews will be developed with input from senior WACHS allied health staff and following a review of all allied health professional standards in Australia. Interviews will be limited to one university for practical reasons of feasibility, given the time frame and resources available to complete the study. Findings from the survey of graduate allied health staff together with information obtained from the interviews with allied health representatives at Curtin University will be used as the basis to develop recommendations as to the training needs of graduate allied health staff to develop their digital readiness to deliver effective and equitable healthcare to country residents.
6. Data storage
Data from the surveys and interviews will be de-identified and stored on the R-drive at Curtin University, which is a secure research environment only accessible to the approved research team. The data will be kept for a minimum of seven years after submission of the dissertation and/or publication, following Curtin University’s Records and Data Management policy. Ownership of the data will belong to WACHS.
7. Ethical Issues
Ethics approval will be sought from the WA Country Health Service Ethics Review Committee, and an application for reciprocal ethics approval will be made to Curtin University’s Human Research Ethics Committee. All study participants will be required to sign a participant consent form prior to participation within the proposed study. All requirements to protect the privacy and confidentiality of participants and their data will be met as stipulated in the National Statement on Ethical Conduct in Human Research 2007 (updated 2018) (National Health and Medical Research Council, 2007).
8. Project Time Schedule
|Prepare and submit research proposal|
|Prepare and submit ethics application|
|Conduct scoping review of literature|
|Submit literature review|
|Pilot test questionnaire|
|Preparation of extended journal article|
|Prepare summary report for WACHS and presentation|
9. Facilities and Resources
WACHS will facilitate access to RedCap to prepare the survey instrument and will organise the distribution of the survey to its graduate allied health staff.
Curtin University will provide access to its online library databases to SPSS software and printing services.
Australian Digital Health Agency. (2020). National Digital Health Workforce and Education Roadmap. Retrieved from https://www.digitalhealth.gov.au/sites/default/files/2020-11/Workforce_and_Education-Roadmap.pdf
Australian Government. (2011). The eHealth Readiness of Australia’s Allied Health Sector. Retrieved from https://www1.health.gov.au/internet/publications/publishing.nsf/Content/CA2578620005D57ACA2579090014230A/$File/Allied%20Health%20ehealth%20readiness%20survey%20report.pdf
Australian Health Minister’s Advisory Council. (2008). National E-Health Strategy. Retrieved from https://www1.health.gov.au/internet/main/publishing.nsf/Content/69B9E01747B836DCCA257BF0001DC5CC/$File/Summary%20National%20E-Health%20Strategy%20final.pdf
Bursell, S.-E., Jenkins, A. J., Brazionis, L., Rowley, K. G., & Brown, A. D. (2013). Telehealth in Australia: an evolution in health care services. Medical Journal of Australia, 199(1), 23-24. doi:https://doi.org/10.5694/mja12.11324
Butler-Henderson, K., Dalton, L., Probst, Y., Maunder, K., & Merolli, M. (2020). A meta-synthesis of competency standards suggest allied health are not preparing for a digital health future. International Journal of Medical Informatics, 144, 104296. doi:https://doi.org/10.1016/j.ijmedinf.2020.104296
Calder, R., Dunkin, R., Rochford, C., & Nichols, T. (2019). Australian health services: too complex to navigate: a review of the national reviews of Australia’s health service arrangements.
Dillon, E., & Loermans, J. (2003). Telehealth in Western Australia: The challenge of evaluation. Journal of Telemedicine and Telecare, 9(2_suppl), 15-19. doi:10.1258/135763303322596147
Government of Western Australia. (2020a). REDCap. Retrieved from https://fsh.health.wa.gov.au/-/media/HSPs/CAHS/Documents/Research/ResearchEducationProgram/WAHealth_REDCapFAQs.pdf
Government of Western Australia. (2020b). WA Health Digital Strategy. Retrieved from https://ww2.health.wa.gov.au/-/media/Files/Corporate/Reports-and-publications/Digital-strategy/Digital-Strategy-2020-2030.pdf
Lam, M., Hines, M., Lowe, R., Vilapakkam Nagarajan, S., Keep, M., Penman, M., & Power, E. (2016). Preparedness for eHealth: Health Sciences Students’ Knowledge, Skills, and Confidence. Journal of Information Technology Education: Research, 15, 305-334. doi:10.28945/3523
McAllister, L., & Nagarajan, S. V. (2015). Accreditation requirements in allied health education: strengths, weaknesses and missed opportunities. Journal of teaching and learning for graduate employability, 6(1), 2-24.
Munn, Z., Peters, M. D. J., Stern, C., Tufanaru, C., McArthur, A., & Aromataris, E. (2018). Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Medical Research Methodology, 18(1), 143. doi:10.1186/s12874-018-0611-x
National Health and Medical Research Council. (2007). National Statement on Ethical Conduct in Human Research Retrieved from https://www.nhmrc.gov.au/about-us/publications/national-statement-ethical-conduct-human-research-2007-updated-2018
Nursing And Midwifery Board of Australia. (2016). Registered nurse standards for practice. Retrieved from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx
WA Country Health Service. (2019). WA Country Health Service Digital Innovation Strategy. Retrieved from http://www.wacountry.health.wa.gov.au/fileadmin/sections/publications/Publications_by_topic_type/Service_Strategies/ED-CO-18-84303__eDoc_-_CO_-_2019-05-13_Digital_Innovation_Strategy_Final_Version_13_May_2019.pdf
Other potentially useful sources of industry info –
Australasian Telehealth Society – www.aths.org.au – ‘resources’ tab
Center of Research Excellence in Telehealth (university of QLD) – http:s://cretelehealth.uq.edu.au – concluded in Sept 2019 but some good Australian publications under the ‘our work’ tab
WACHS strategic plan 2019-24 – access via www.wacountry.health.wa.gov.au – a number of strategic priorities directly and indirectly link to use of digital health (p. 7 – leading innovation and technology, addressing disadvantage and inequity, delivering value and sustainability). WACHS Value of ‘Curiosity’ (p.9). Page 11 & 17 – measures of success reference service delivery via telehealth.
www. wacountry.health.wa.gov.au – follow links in left hand menu to telehealth (right hand short cuts aren’t working) for background on current use of telehealth in WACHS services
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