Investigating Clinician Experiences of Teleneuropsychology Service Implementation within Rural Inpatient Rehabilitation Settings: A Mixed Method Approach

Abstract

Objective: The aim of this study was to understand clinicians' experiences of teleneuropsychology service implementation within rural inpatient rehabilitation settings and the variability of those experiences across rural settings and clinical disciplines.

Method: Clinicians (n = 56 from four rehabilitation settings) who were involved in a hub-and-spoke teleneuropsychology service completed surveys throughout service implementation. A purposive sample of 16 clinicians then completed semi-structured interviews at the conclusion of the service implementation period. Quantitative data were analyzed descriptively and qualitative data were analyzed using thematic analysis, prior to the results being converged.

Results: Four themes characterizing clinicians' experiences were identified. Pre- and early-implementation considerations included factors such as early collaboration and consultation, which were identified as important for service integration into rural settings. Facilitators/barriers included factors such as technology usability, which positively or negatively influenced service implementation. Benefits and outcomes included perceptions on the impact of the service, such as improved equity and quality of care in rural settings. Finally, future applications encapsulated what the clinicians envisaged for the future of teleneuropsychology services, such as hybrid teleneuropsychology/in-person services. Some differences were identified in clinicians' experiences across rural settings and disciplines, including preferences for technology infrastructure and satisfaction with teleneuropsychology sessions.

Conclusions: Most clinicians reported positive experiences and acceptability of the teleneuropsychology service. Facilitators and barriers, which can guide the successful establishment of future teleneuropsychology services, were identified. These findings may be used to contribute to improving equity and quality of care for people living with neuropsychological impairments, especially those living in rural areas.

Keywords: Implementation; Mixed method design; Neuropsychology; Rural health; Telehealth; Teleneuropsychology.