ACOS/Research & Development Service, VA Caribbean Health Care System, San Juan, PR 00921, United States.
School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, PR 00925, United States.
Mil Med. 2024 Aug 19;189(Suppl 3):211-220. doi: 10.1093/milmed/usae077.
Traumatic brain injury (TBI) can impact language processing, necessitating language-tailored approaches. Telehealth may expand rural Veterans' access but has unknown feasibility for language preferences. This study explored telehealth/Veterans Video Connect satisfaction for Spanish/English TBI screening.
The study was approved by the VA Caribbean Healthcare System Institutional Review Board and the Research and Development Committee. Mixed methods evaluated telehealth satisfaction in Veterans receiving TBI assessments from October 2021 to October 2023. Surveys included the 16-item Clinical Video Telehealth (CVT) questionnaire on communication, technical factors, coordination, and overall satisfaction, and the 21-item Telemedicine Satisfaction and Usefulness Questionnaire (TSUQ) examining usefulness, ease of use, manners, quality, and satisfaction. Mean domain/item scores were calculated among 57 Veterans, 12 English, and 45 Spanish-speaking. Semi-structured interviews also elicited user experiences from 4 providers and 5 Veterans. Transcripts underwent qualitative coding for themes using Atlas.ti.8.
On CVT (0-5 scale), overall satisfaction averaged 4.50 (English) and 4.69 (Spanish). Lowest scoring item for English users was easy video connection (4.25), while unclear expectations had the lowest Spanish score (3.60). For TSUQ, overall mean scores were 4.50 (English) and 4.67 (Spanish), with improved health post-telehealth having the lowest average (English 3.33, Spanish 3.67). Qualitatively, Veterans and providers noted strengths like access and communication but weaknesses around connectivity, care delays, and privacy. Differences emerged regarding convenience (Veterans) versus operational barriers (providers). There was a strong positive correlation for Spanish surveys and a moderate correlation for English surveys (r = 0.71 Spanish surveys, r = 0.69 English surveys) between TSUQ and CVT for individual respondents.
Patients conveyed positive experiences, but qualitative data revealed actionable targets for optimization like infrastructure and coordination improvements. Key limitations include small samples and lack of comparison to in-person care. Still, high satisfaction coupled with specific user feedback highlights telehealth's potential while directing enhancements. The results found high Veteran satisfaction with Spanish/English TBI telehealth, but mixed methods illuminated salient domains for better accommodating user needs, particularly regarding logistics and technology. Rigorously integrating experiences with metrics over expanded diverse samples and modalities can further guide refinements to enhance telehealth with a language-tailored approach.
创伤性脑损伤 (TBI) 会影响语言处理，因此需要采用针对语言的方法。远程医疗可以扩大农村退伍军人的获得途径，但对于语言偏好尚不清楚是否可行。本研究探讨了远程医疗/退伍军人视频连接对西班牙语/英语 TBI 筛查的满意度。
该研究得到了退伍军人事务部加勒比海医疗系统机构审查委员会和研究与发展委员会的批准。混合方法评估了 2021 年 10 月至 2023 年 10 月期间接受 TBI 评估的退伍军人对远程医疗的满意度。调查包括 16 项临床视频远程医疗 (CVT) 问卷，用于评估沟通、技术因素、协调和整体满意度，以及 21 项远程医疗满意度和有用性问卷 (TSUQ)，用于评估有用性、易用性、礼貌、质量和满意度。在 57 名退伍军人、12 名英语使用者和 45 名西班牙语使用者中计算了 5 个领域/项目的平均得分。还对 4 名提供者和 5 名退伍军人进行了半结构化访谈，以了解用户体验。使用 Atlas.ti.8 对转录本进行主题的定性编码。
在 CVT（0-5 分制）中，整体满意度平均为 4.50（英语）和 4.69（西班牙语）。英语使用者得分最低的项目是视频连接容易（4.25），而西班牙语得分最低的项目是期望不明确（3.60）。在 TSUQ 中，整体平均得分为 4.50（英语）和 4.67（西班牙语），远程医疗后健康状况改善的平均得分最低（英语 3.33，西班牙语 3.67）。定性分析表明，退伍军人和提供者注意到了访问和沟通等优势，但也存在连接性、护理延迟和隐私等方面的劣势。便利性（退伍军人）与运营障碍（提供者）方面存在差异。西班牙语调查的相关性很强（r=0.71），英语调查的相关性也很强（r=0.69），个体受访者的 TSUQ 和 CVT 之间存在很强的正相关。
患者传达了积极的体验，但定性数据揭示了可操作的目标，以改善基础设施和协调等方面。主要限制包括样本量小和缺乏与面对面护理的比较。尽管如此，高满意度加上具体的用户反馈突出了远程医疗的潜力，同时也指导了改进。结果发现，退伍军人对西班牙语/英语 TBI 远程医疗非常满意，但混合方法凸显了一些重要领域，以更好地满足用户需求，特别是在物流和技术方面。在扩展的不同样本和模式中，通过经验与指标的严格结合，可以进一步指导改进，以通过语言定制的方法来增强远程医疗。
