First name
Pegah
Last name
Maleki

Title

Acceptability, Feasibility, and Quality of Telehealth for Adolescent Health Care Delivery During the COVID-19 Pandemic: Cross-sectional Study of Patient and Family Experiences.

Year of Publication

2021

Number of Pages

e32708

Date Published

2021 Nov 15

ISSN Number

2561-6722

Abstract

<p><strong>BACKGROUND: </strong>Data regarding the acceptability, feasibility, and quality of telehealth among adolescents and young adults (AYA) and their parents and caregivers (caregivers) are lacking.</p>

<p><strong>OBJECTIVE: </strong>The aim of this study was to assess the noninferiority of telehealth versus in-person visits by comparing acceptability with respect to efficiency, effectiveness, equity, patient-centeredness, and confidentiality.</p>

<p><strong>METHODS: </strong>Cross-sectional web-based surveys were sent to caregivers and AYA following video visits within an Adolescent Medicine subspecialty clinic in May-July 2020. Proportions of AYA and caregivers who rated telehealth as noninferior were compared using chi-squared tests. Feasibility was assessed via items measuring technical difficulties. Deductive thematic analysis using the Institute of Medicine dimensions of health care quality was used to code open-ended question responses.</p>

<p><strong>RESULTS: </strong>Survey response rates were 20.5% (55/268) for AYA and 21.8% (123/563) for caregivers. The majority of the respondents were White cisgender females. Most AYA and caregivers rated telehealth as noninferior to in-person visits with respect to confidentiality, communication, medication management, and mental health care. A higher proportion of AYA compared to caregivers found telehealth inferior with respect to confidentiality (11/51, 22% vs 3/118, 2.5%, P&lt;.001). One-quarter (14/55) of the AYA patients and 31.7% (39/123) of the caregivers reported technical difficulties. The dominant themes in the qualitative data included advantages of telehealth for efficiency and equity of health care delivery. However, respondents' concerns included reduced safety and effectiveness of care, particularly for patients with eating disorders, owing to lack of hands-on examinations, collection of vital signs, and laboratory testing.</p>

<p><strong>CONCLUSIONS: </strong>Telehealth was highly acceptable among AYA and caregivers. Future optimization should include improving privacy, ameliorating technical difficulties, and standardizing at-home methods of obtaining patient data to assure patient safety.</p>

DOI

10.2196/32708

Alternate Title

JMIR Pediatr Parent

PMID

34779782

Title

Facilitators and Barriers to Implementation of Long-Acting Reversible Contraceptive Services for Adolescent Girls and Young Women in Gaborone, Botswana.

Year of Publication

2021

Date Published

2021 Mar 22

ISSN Number

1873-4332

Abstract

<p><strong>STUDY OBJECTIVE: </strong>Botswana has a high pregnancy rate among adolescent girls and young women (AGYW). Long-acting reversible contraceptive (LARC) use among AGYW in Botswana is low, despite its high effectiveness for preventing pregnancy. Using an implementation science framework, we assessed barriers and facilitators to LARC implementation among AGYW in Botswana.</p>

<p><strong>DESIGN: </strong>Cross-sectional mixed methods.</p>

<p><strong>SETTING: </strong>Gaborone, Botswana.</p>

<p><strong>PARTICIPANTS: </strong>20 sexually active AGYW ages 18-24; 20 health system stakeholders.</p>

<p><strong>INTERVENTIONS: </strong>Surveys and semi-structured interviews grounded in the Consolidated Framework for Implementation Research (CFIR).</p>

<p><strong>MAIN OUTCOME MEASURES: </strong>Themes reflecting barriers and facilitators of LARC implementation.</p>

<p><strong>RESULTS: </strong>The median age for AGYW was 22 (IQR 21-23). Twenty percent were using an implant and none had ever used an intrauterine device. Barriers and facilitators to LARC implementation spanned factors at each CFIR domain: 1) LARC characteristics like side effects; 2) the clinics' inner settings, including availability of youth-friendly services; 3) characteristics of health system stakeholders, such as LARC skills, and AGYW experiences, attitudes and beliefs about LARCs; 4) the outer setting external to clinics and Botswana's health system including reproductive health law and policy for minor adolescents; and 5) the implementation process level such as the availability of free or low-cost LARCs.</p>

<p><strong>CONCLUSIONS: </strong>We identified multi-level, context-specific factors that affect LARC implementation. Our findings can inform the development of interventions to increase LARC implementation in Botswana by addressing intersecting factors across patient, clinic, health system, and sociopolitical levels, such as providing confidential services to minors and improving LARC training and supply chain pipelines.</p>

DOI

10.1016/j.jpag.2021.03.005

Alternate Title

J Pediatr Adolesc Gynecol

PMID

33766793

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