Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Sep 12, 2022
Date Accepted: Dec 1, 2022
Date Submitted to PubMed: Dec 16, 2022
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Reducing patients’ cognitive load for telehealth video visits through student-delivered helping sessions at a United States Federally Qualified Health Center: A pilot intervention study
ABSTRACT
Background:
The task complexity involved in connecting to telehealth video visits may disproportionately impact healthcare access for populations already experiencing inequities. Human intermediaries who act as “technology helpers” may aid in addressing such healthcare access disparities by reducing cognitive load demands required to learn and use patient-facing telehealth technologies.
Objective:
We conducted a pilot study of an equity-focused intervention in which patients at a Federally Qualified Health Center (FQHC) were offered a student-led “helping session” for conducting a telehealth video test-run or logging into the patient portal. For process evaluation, we evaluated recruitment methods, reach, delivery process, and preliminary impact of a novel, “warm accompaniment” intermediary intervention focused on cognitive load reduction.
Methods:
Over a 2-week period during the COVID-19 pandemic, English- or Spanish-speaking adult patients scheduled for a telehealth visit were offered a cognitive load theory-informed telehealth “helping session” via phone. The “technology helpers” systematically recorded recruitment efforts, observations and daily reflection notes. Following the intervention, all patients who had telehealth visits 4 weeks before, during, and 4 weeks after the intervention period were asked to complete a survey, and intervention participants were also asked to participate in an interview. Electronic health records (EHR) were reviewed to assess patients’ visit format before and after the intervention. Descriptive and inferential statistical analyses of recruitment records, EHR data and surveys were performed. Interviews, observations, and reflection notes were qualitatively analyzed to develop delivery process-related themes.
Results:
Of the 239 patients eligible to participate, 34/239 (14.2%) completed the intervention, and 3 completed subsequent interviews. No one participated who was left a voicemail (77/239; 0%). Intervention survey participants (n=15) had lower education and less technological experience than non-intervention survey participants (n=113). Through our process evaluation, we identified three emergent helping strategies for cognitive load reduction: providing step-by-step guidance for configuring and learning, building rapport to create confidence while problem solving, and being on the same page to counter external distractions. For intervention impact, participants reported increased understanding, but that learning the video visit software was more difficult than non-intervention participants. Regarding visit experience, we did not find differences with cognitive load when using telehealth-related technologies, impacts on visit modality or technical problems during the visit. However, intervention participants were significantly less satisfied with video visits.
Conclusions:
The intervention reached individuals who were more likely to need technology assistance. However, results did not show significant differences between intervention and non-intervention participants that could not potentially be explained by baseline differences between groups—but small sample sizes limit conclusions. FQHC patients may require both improved access to online technologies and human intermediary support to make telehealth video visits feasible. Future large, randomized studies should investigate blended strategies for facilitating video visit access.
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