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JCPSLP
Volume 16, Number 3 2014
Journal of Clinical Practice in Speech-Language Pathology
participants indicated that these barriers could be
overcome with the provision of appropriate equipment and
ongoing ICT support.
I know we have them [video-teleconferencing facilities]
here, I wouldn’t know where they are though and I
wouldn’t know whether we could use them.
(Trudy)
Three participants highlighted environmental workplace
barriers, such as a lack of confidentiality in open-plan
offices and shared work stations. Allocation of telehealth-
specific therapy rooms was identified as a facilitator to
overcome this. Participants from the private sector felt
that SPA must lobby Medicare and private health insurers
to promote the need to fund SLP services via telehealth.
There was also confusion about whether new initiatives
such as the National Disability Insurance Scheme would
fund telehealth services. Participants also indicated that
workplace policy documents to support the implementation
of telehealth are needed.
Discussion
This study was designed to explore the existing barriers
and potential facilitators to telehealth use identified by SLPs
not using this service delivery method. Coding of data
generated the following themes: information, training,
clinician attitudes and perceptions, and organisational and
policy barriers. Given the paucity of research investigating
this population, it is important to compare and contrast
these findings with what is known about SLPs who use
telehealth. Identification of common barriers and facilitators
may lead to an important increase in the uptake of
telehealth. Many participants recognised the broad appeal
of telehealth including five participants who indicated a
desire to utilise it in the future.
Two significant factors differentiate telehealth users (Hill &
Miller, 2012) from non-users: attitudes and perceptions, and
organisational and policy barriers. The participants in this study
hold some perceptions that contradict recent research
including that clients have limited capacity for telehealth
(Dunkley et al., 2010; Sharma, Ward, Burns, Theodoros &
Russell, 2013) and that telehealth is limited to research
settings and rural and remote areas (Mashima & Doarn,
2008). Clearly there is a need for further dissemination and
promotion of evidence that has highlighted the use of
telehealth across diverse settings and locations (i.e.,
Mashima & Doarn, 2008; Reynolds et al., 2009).
Access to appropriate technology is problematic.
Organisational policy preventing the use of Skype appears
common despite its recent use in SLP literature (e.g.
Boisvert, Hall, Andrianopolous & Chaclas 2012; Erickson,
2012). However, the DoHA Telehealth Technical Standards
Position Paper (2012) supports such policy by highlighting
that “consumer-centric” options like Skype have lower
security and poorer quality compared to business grade
options (e.g. Polycom, Redback). Despite the accessibility
of the telephone, its potential use to deliver clinical services
is not being realised, even with supporting evidence (e.g.,
Carey, O’Brian, Onslow, Block, Jones, & Packman, 2010)
and reduced confidentiality concerns. Overall, the SLPs
without access to appropriate technology viewed telehealth
more negatively which highlights the importance of funding
appropriate infrastructure and recognising potential use of
existing resources.
As in previous studies (Hill & Miller, 2012; Mashima
& Doarn, 2008), the need for cost-benefit analyses
was emphasised in this research. Many participants
were not convinced that telehealth would improve cost
telehealth would require a partnership between all SLPs.
Most participants believed that telehealth was limited to
specialised research and university settings. Several
questioned the relevance of the current evidence given that
highly controlled research conditions do not reflect their
clinical settings.
The majority of participants thought telehealth intervention
would be more time consuming than the equivalent
intervention delivered FTF due to the required preparation
and technical problem-solving. Participants also reported
that a fear of technology posed a significant barrier.
People are a bit reluctant to take things on, you know
… “I don’t know how to make this work” so it’s kind of
a technological fear.
(Rhonda)
A number of participants questioned the appropriateness
of telehealth for clients from culturally and linguistically
diverse backgrounds and those with complex
communication needs. In addition, most participants said
that they would not assess dysphagic clients via telehealth
due to safety concerns.
The participants largely reported that clients have little or
no access to the required technology and limited capacity
and willingness to accept telehealth. Most also reported
that clients prefer FTF services. Conversely, two remote
SLPs felt their clients would welcome telehealth because of
improved access and reduced travel time.
Several participants were unwavering in believing that their
service must be delivered FTF to be effective. They were
concerned that telehealth could negatively affect rapport
building and client relationships. Additionally, they feared
missing crucial incidental information only available when in
the same room as the client. Paediatric SLPs thought
therapeutic processes such as modelling, behaviour
management and managing sensory needs could be
difficult via telehealth. They were also concerned that parents
would not be engaged as they would need to manage the
session and their child independently without a SLP in the
room. Conversely, one paediatric clinician thought telehealth
could provide a useful insight into a child’s home
environment and an opportunity for better treatment
generalisation. Overall the majority of paediatric SLPs felt
strongly that the relationship-based approach frequently
used with parents would not be compatible with telehealth.
The five SLPs who intended to use telehealth in the
future recognised the need to allow sufficient time to
develop and trial methods and resources. In addition, one
SLP emphasised the need to gain their client’s perspective
before commencing. Participants broadly believed that
telehealth should not replace FTF delivery but many
recognised that telehealth could be an appropriate adjunct
delivery option.
Theme 4: Organisational and policy
barriers
Limited or no access to telehealth technology in the
workplace is a significant barrier, particularly within the
government sector. Three participants indicated that they
had no access to necessary equipment while 13 indicated
that although the equipment was available, medical and
mental health staff had priority access. Conversely, SLPs in
the private sector did not report access to equipment as
being a significant barrier. Eight participants identified that
using Skype to deliver services was problematic, primarily
because it was against organisational policy (in a range of
settings). This policy was reported to be in place because
of concerns about reliability, security and confidentiality. The
