Formative Evaluation of a School-Based Telehealth Program Using Interactive Technology to Connect RNs to APRNs

Abstract

Problem Statement: School nurses are often the only healthcare provider on a school campus and may also be the only healthcare provider that a student comes in contact with. School health rooms staffed with RNs have a more limited scope of care than those staffed with APRNs. Telehealth provides a way to increase student access to primary care services which may reduce absenteeism and support families while at the same time increasing support for school RNs and enhancing inter-professional collaboration. Purpose: The purpose of this formative evaluation is to determine if the Virtual Keiki Care program was successfully implemented in a feasible, realistic, and reliable way such that RNs were able to comfortably and confidently utilize the new technology efficiently and correctly in order to produce a perceived benefit to their students and themselves. Methods: A formative evaluation guided by the CDC’s framework for program evaluation in public health along with Kellogg’s Logic Model was designed using surveys and interviews incorporating the verified Technology Acceptance Model (TAM) tool to collect data on RNs’ perceived barriers, facilitators, benefits, ease of use and usability. Results: The Virtual Keiki Care program was successfully implemented with strong positive perception of benefit to self and student as well as high ease of use and usability; however, rates of utilization were low attributed to barriers including time, technological difficulties, training needs, lack of eligible patients, and other contextual factors. Discussion: Utilization rates were highest on Neighbor Islands and amongst participants that were part of the original pilot of the Virtual Keiki Care program. Perceived benefits to students and staff as well as barriers and facilitators are consistent with literature findings. Perceived ease of use appeared to increase with more time as a school nurse and more time trained in the program. Perceived usability appeared to decrease with more time as a school nurse and more time trained in the program. Barriers may be mitigated through optimizing training, increasing stakeholder support and incorporating support staff. Contextual factors may pose challenges but do not preclude successful implementation of school-based telehealth. Future uses for the Virtual Keiki Care program include expansion to different end users, more locations, increased collaboration and different types of visits including chronic care. Keywords: Telehealth, school-based, facilitators, barriers, ease of use, usability