ICCH 2011: Videoconferencing kari_hagen
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Videoconferencing vs face-to-face meeting in counseling for rare disorders
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ICCH 2011: Videoconferencing kari_hagen
- 1. Videoconferencing vs. face-to-face meetings in counseling for rare disorders Kari Hagen a,b, Rolf Wynn a,c , Oddgeir Friborg d,e a Telemedicine Research Group, Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Norway b Frambu Centre for Rare Disorders, Oslo, Norway c Division of Addiction and Specialized Psychiatry, University Hospital of North Norway, Tromsø, Norway d Department of Psychology, Faculty of Health Sciences, University of Tromsø, Norway e Psychiatric Research Centre of North Norway, University Hospital of North Norway, Tromsø, Norway
- 4. Two types of clinical conferences at Frambu
- 6. Aim of the study To compare the two types of clinical conferences, videoconferencing vs. face-to-face meetings, in the ambulatory consulting service regarding the participants’ satisfaction
- 9. Who participated in the clinical consultations and answered the questionnaire? 1 VC = Videoconference 2 FtF = Face-to-face meeting 3 Clients ( N = 122) were mainly parents (72 mothers, 41 fathers, 2 clients, 7 other relatives). Informants VC 1 FtF 2 Σ Clients 3 27 95 122 Local professionals 79 151 230 Professionals from Frambu 16 7 23 Sum 122 253 375
- 13. Main results: Same degree of satisfaction in VC and FtF # No significant difference between videoconference and face to face conference User satisfaction VC FtF Number of participants (N) 94 224 Mean score 4.4 4.3 # SD 0.5 0.6
- 14. Main result: Significant higher degree of user activity in FtF than VC *** p< 0.001compared to the VC User activity VC FtF Number of participants (N) 103 249 Mean score 3.7 4.2*** SD 1.3 1.0
- 18. [email_address]
Notes de l'éditeur
- Videoconferencing vs. face-to-face meetings in counseling for rare disorders Kari Hagen a,b, Rolf Wynn a,c , Oddgeir Friborg d,e Mr Chairman, dear colleagues Thank you for giving med the opportunity to present this study from Norway – which was done in cooperation with professor Rolf Wynn and assistant professor Oddgeir Friborg at University of Tromsø I am Kari Hagen and work as an communication advisor at Frambu in Oslo. a Telemedicine Research Group, Department of Clinical Medicine, Faculty of Health Sciences, University of Troms ø , Norway. b Frambu Centre for Rare Disorders, Oslo, Norway. c Division of Addiction and Specialized Psychiatry, University Hospital of North Norway, Troms ø , Norway. d Department of Psychology, Faculty of Health Sciences, University of Troms ø , Norway. e Psychiatric Research Centre of North Norway, University Hospital of North Norway, Troms ø , Norway. Key words: Videoconferencing, rare disorders, questionnaire, exploratory factor analysis, user satisfaction, user participation
- Around the world, there are several thousand different rare disorders, and the number is increasing due to better diagnostics The definition of the prevalence of rare disorders varies between countries. In Europe a disorder is concidered to be rare when the prevalence is less than 1 in 2000 people. In Norway the prevalence is defined as less than 1 in 10.000. The country has 5 million inhabitants which gives a number of less than 500 patients per disorder The rare diagnosis are quite different, but have in common a complexity which makes that the patients have special needs from different services.
- Frambu is one of 16 resource centers for rare disorders in Norway - and is situated close to Oslo. The centre is working with more than100 different rare disorders. Frambu is not a hospital providing treatment and diagnostics - - The main tasks are information and counseling given by a multidisciplinary staff for example medical doctors, psychologists, nurses, physiotherapists or special eduaction teachers Information is provided in courses, on web, by publications and videos One of the cornerstones of Frambu are ambulatory clinical conferences. Frambu provides free consulations to individuals suffering from rare disorders, their families and local professionals. This service is tailored to each person, organized as a meeting in the person’s municipality. One or two professionals from Frambu travel to meet the person with a rare disorder and his or her relatives, together with several local professionals and often professionals from the specialized health care service. Such meetings often gather 10-20 participants and most often the topics to be discussed are an actual problem in the kondergarten, school or related to adolescence or moving to own home, related to the specific disorder.
- Face to face conferences are a traditional method in the counseling service from the centre. We have more than fifteen years experiences with this method, and both the clients and the professionals are satisfied with the service. I will use the term client further on in my presentation for the group of patients with rare disorders , their parents and other family members. A typical clinical conference is a co-located conference organised as a meeting with one or two professionals from Frambu, (the red one), the clients (the two green), and between five and fifteen local professionals from the municipality and the spesialist health care services (and they are blue). The challenge with this high appreciated service is that Norway is a long-distance country, that travelling is expensive and too much time is spent on travelling for the professionals . Therefore we started to offer videoconferences in the counselling i 2007 In the sketch you can see that the professionals from Frambu – who are red colored are moved out of the room and attend the meeting by videoconference. What you also can see, is that the number of professionals from Frambu has increased. .
- This is a typical videoconferenceroom which is found all over Norway. There is free access to studios in all the municipalities in Norway. They are placed in hospitals, schools, libraries and social security offices. So far so good… But these representants for the competent professionals at Frambu and the other resource centres, were needed to be convinced that videoconferencing was acceptable from the clients’ and local professionals’ point of view.
- We were in need of documentation, but forund only little scientific research is done on evaluation of these services. Therefore we wanted to compare the two methods with regard to the participants’ satisfaction
- We hypothesized that Professionals and clients participating in videoconferences show the same degree of satisfaction with the meeting as those participating in face to face clinical conferences
- In the period from January 2008 until March 2010 724 participants in clinical conferences were asked to participate in the study 375 of them were included in the study as informants. We used a self developed questionnaire to evaluate the users’ experiences with the clinical conferences An exploratory factor analysis was performed on the test scores from the questionnaire to examine whether the items should be summed in one or several subscale scores .
- A closer look at the informants 122 clients – who were mainly parents Of the 230 local professionals, nearly 40 % were professionals from schools and kirndergarten, 15% health professionals, 15 % working as milieu terapists or assistants, Additionally 23 professionals from Frambu completed the questionnaire
- We developed the questionnaire selecting items from previous used questionnaires on user satisfaction in videoconferences. The questionnaire was developed in two different versions, one for clients who got it on paper, distributed by mail. The professionals got an electronic questionnaire, sent by e-mail. The questionnaires consisted in total of 35 items, and could be completed in about 5-7 minutes. For the purpose of user satisfaction and user activity 12 items were selected, and measured on a five point Likert scale -------- Dette er referansene (som jeg har med dersom det kommer spørsmål) Spaulding RJ, Davis K, Patterson J. A comparison of telehealth and face-to-face presentation for school professionals supporting students with chronic illness. J Telemed Telecare 2008;14:211-4. Weatherburn G, Dowie R, Mistry H, Young T. An assessment of parental satisfaction with mode of delivery of specialist advice for paediatric cardiology: face-to-face versus conference. J Telemed Telecare 2006;12 (Suppl 1):57-9. Liu X, Sawada Y, Takizawa T, Sato H, Sato M, Sakamoto H, et al. Doctor-patient communication: A Comparison between telemedicine consultation and face-to-face consultation. Intern Med 2007;46:227-32. Demiris G, Speedie SM, Hicks LL. Assessment of Patients' Acceptance of and Satisfaction with Teledermatology. J Med Syst 2004;28:575-9. Bakken S, Grullon-Figueroa L, Izquierdo R, Lee N-J, Morin P, Palmas W, et al. Development, validation, and use of English and Spanish versions of the Telemedicine Satisfaction and Usefulness Questionnaire. J Am Med Inform Assoc 2006;13:660-7.
- The 12 items which you can see on this slide, contained topics such as feelings during the meeting, expectations to the meeting, dialogue and cooperation, active involvement during the meeting, such as questions, responses, comments, and problem solving and outcomes of the meeting.
- An exploratory factor analysis was performed on the scores from these items. This procedure resulted in two components as vi named “user satisfaction” and “user activity” The largest component, user satisfaction, constituted a linear combination of ten variables The sum score reliability of these ten items was high, with a Cronbach’s alpha of .85. The smallest component, comprising of only two items, we called user activity – i ndicate to which extent the participants used the opportunity to make comments and to ask questions during the conference. The two components explained 51.8 percent of the total variance, which indicated a good factor model
- And here come the main result of the study. We found the same degree of satisfaction in VC and FTF For the sumscore of satisfaction the mean score, in a scale from 1 to 5, was 4.4 for VC and 4.3 FTF, thus indicating a high degree of satisfaction in both groups. There was no statistically significant difference between the two groups. (95 % of the sample had a score higher than 3.0, which represented the middle score.)
- Further, we found a statistically significant higher degree of user activity in FTF than in VC Regarding the sumscore user activity the mean score was 3.7 for VC and 4.2 for FTF. The difference between these two scores was statistically high significant. On this variable, 78.5 % percent of the sample scored higher than the middle score > 3.0. In the regression analyses we entered 4 predictors: meeting modality (i.e. face-to-face vs. videoconferencing), role (client, professional), age, previous experience (with videoconferencing). diagnoses Only modality resulted in significant difference
- The main finding in the study was that all the participants scored high on user satisfaction , regardless of modality and role (4.3 on a scale from 1 to 5). The high and consistent level (of user satisfaction) may be taken to reflect that this was a wanted service and that it was generally well conducted, also through the videoconferencing service - And our hypothesis was supported. With respect to user activity, the study found a high mean score (4.0 on a scale from 1 to 5) . But a significant difference between VC and FtF The participants were more active in posing questions, responding and commenting in face-to-face meetings than in videoconferences. No differences was explained by the other predictors : Clients vs. Professionals, Age, Previous experience, Diagnoses
- - One reason that the participants in videoconferences were less active, might be due to the fact they were unfamiliar with this way of communication. They did perhaps not feel confident about the manner in which videoconferences are conducted - Another possible reason might be that due to the constraints of the technology, it is necessary to have a clearer structure in the turn-taking procedures, and it is necessary to clearly signal and wait for turn to talk. Some might experience this as more demanding than face-to-face interactions, where body language and small non-verbal signals are easier to interpret. -Training may improve equipment-handling skills as well as skills in handling the particularities of communication by this kind of technology, There were more professionals from Frambu present at the videoconferences than in the face-to-face meetings, which was a desired outcome of using videoconferencing instead of face-to-face meetings. The increased number of professionals from the Centre present could imply that a broader range of expertise was available at the meetings.
- We conclude that Videoconferencing is a good method for clinical conferences from a resource centre. Participants in videoconferences are satisfied, and VC may be used instead of Ftf conferences and ought to be implemented as equal modalities. ( - More videoconferences might increase the total number of clinical conferences possible within the available resources - And might lead to a broader multidisciplinary scope from the centre in the meetings.) A remaining challenge is to more actively involve the local professionals, This will probably follow by support and training Support and training It is necessary for organisations going for counseling using means like VC to organize proper technical support and training of the professionals. The professionals need to acquire communication skills for this technology, To be able to make a good dialogue and a relaxing atmosphere in the conference. They also need skills in equipment-handling Organisations going for increased use of videoconference should offer an education program for the employees It is not more complicated than to consider that videoconferencing has to be learnt to be conducted well.
- Thank you for your attention