Howland Kim, Edvardsson Kristina, Lees Helen, Hooker Leesa
Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia.
Department of Rural Health Sciences, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia.
Int J Nurs Stud Adv. 2024 Dec 3;8:100277. doi: 10.1016/j.ijnsa.2024.100277. eCollection 2025 Jun.
Universal well-child health nursing services in high-resource countries promote the health and well-being of children and families while preventing health inequities. The COVID-19 pandemic and technological advancements have led to the increased use of telehealth in this field. To enhance policies and practices, it's important to understand the acceptability and effectiveness of telehealth, as well as the barriers and enablers to its implementation, and to determine when its use is appropriate and safe.
To explore the global evidence on the use of telehealth in well-child health settings within high-income countries. Focussing on the effectiveness and acceptability of telehealth, along with the factors affecting its implementation and the considerations for safety from the perspectives of both providers and families.
A mixed methods systematic review.
A systematic review was conducted following PRISMA guidelines. The inclusion criteria for the review included: primary research papers written in English, conducted in high-income countries, focused on telehealth in the well-child health setting, and involving children under six years of age. The search, which was completed in July 2023, systematically explored the CINAHL, ProQuest Central, PubMed, and Web of Science bibliographic databases. Studies were critically appraised for quality, and relevant data extracted. A convergent segregated approach was employed to synthesise both quantitative and qualitative data, which is presented in a narrative format.
A total of 4,354 records were identified and screened, and 169 full-text papers were assessed for eligibility, resulting in 20 papers for inclusion. Telehealth acceptability among families was reported in 13 of the 20 studies reviewed, with participants expressing high satisfaction regarding its use as a complement to standard care. Only three studies examined practitioners' acceptance, revealing mixed responses. Effectiveness was observed in 15 studies, with no significant differences found between the control and telehealth groups, suggesting that telehealth may achieve outcomes like those of standard care. Four studies identified both enablers and barriers to the implementation of telehealth, though none addressed concerns regarding safety and appropriateness.
Telehealth shows promise for well-child health services, but there is limited evidence of its effectiveness and safety. The COVID-19 pandemic increased its use, yet risks need further exploration. To validate telehealth in this field, we must identify effective applications, tackle implementation barriers, and ensure client safety. Additional research is essential for developing evidence-based policies for future practices.
资源丰富国家的普遍儿童健康护理服务在促进儿童及其家庭的健康和福祉的同时，还能预防健康不平等现象。新冠疫情和技术进步导致该领域远程医疗的使用增加。为了完善政策和实践，了解远程医疗的可接受性和有效性，以及其实施的障碍和推动因素，并确定其使用何时恰当且安全非常重要。
探索高收入国家儿童健康环境中使用远程医疗的全球证据。重点关注远程医疗的有效性和可接受性，以及从提供者和家庭角度影响其实施的因素和安全考量。
混合方法系统评价。
按照PRISMA指南进行系统评价。该评价的纳入标准包括：用英文撰写的、在高收入国家开展的、聚焦于儿童健康环境中远程医疗的、涉及六岁以下儿童的原创研究论文。于2023年7月完成的检索系统地探索了CINAHL、ProQuest Central、PubMed和Web of Science书目数据库。对研究的质量进行严格评估，并提取相关数据。采用收敛性分离方法综合定量和定性数据，并以叙述形式呈现。
共识别并筛选了4354条记录，评估了169篇全文论文的 eligibility，最终纳入20篇论文。在纳入综述的20项研究中，有13项报告了家庭对远程医疗的可接受性，参与者对其作为标准护理补充的使用表示高度满意。只有三项研究考察了从业者的接受情况，结果不一。15项研究观察到了有效性，对照组和远程医疗组之间未发现显著差异，这表明远程医疗可能取得与标准护理类似的结果。四项研究确定了远程医疗实施的推动因素和障碍，但均未涉及安全和适当性方面的问题。
远程医疗在儿童健康服务方面显示出前景，但其有效性和安全性的证据有限。新冠疫情增加了其使用，但风险仍需进一步探索。为了在该领域验证远程医疗，我们必须确定有效的应用，克服实施障碍，并确保客户安全。更多研究对于制定未来实践的循证政策至关重要。
