The Diffusion of Telehealth in Rural American Indian Communities: A Retrospective Survey of Key Stakeholders
Open accessAbstract
Objective: Mental health issues are a serious concern for many American Indian Veterans, especially for post-traumatic stress disorder and related psychiatric conditions. Yet, acquiring mental health treatment can be a challenge in Native communities where specialized services are largely unavailable. Consequently, telehealth is increasingly being suggested as a way to expand healthcare access on or near reservation lands. In this study, we wanted to understand the factors affecting the diffusion of telehealth clinics that provided mental health care to rural, American Indian Veterans. Materials and Methods: We surveyed 39 key personnel and stakeholders who were involved in the decision-making process, technological infrastructure, and implementation of three clinics. Using Roger Everett's Diffusion Theory as a framework, we gathered information about specific tasks, factors hindering progress, and personal reactions to telehealth both before and after implementation. Results: Many participants expressed initial concerns about using telehealth; however, most became positive over time. Factors that influenced participants' viewpoint largely included patient and staff feedback and witnessing the fulfillment of a community health need. The use of outside information to support the implementation of the clinics and personal champions also showed considerable influence in the clinics' success. Conclusion: The findings presented here address critical gaps in our understanding of telehealth diffusion and inform research strategies regarding the cultural issues and outcomes related to telemental health services. Information contained in this report serves as a long overdue guide for developing telemental health programs and policies among American Indians, specifically, and rural populations in general.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Brooks et al reported challenges setting up infrastructure to accommodate video consulting, including setting up the telehealth backbone.
“Brooks et al [33] also reported on challenges setting up the infrastructure to be able to accommodate video consulting: “respondents noted many challenges in the clinic implementation process. Among these were … setting up the telehealth backbone.””
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [33]
Authors reported that support and high-quality training were necessary to achieve widespread growth.
“Authors reported that support and high-quality training were necessary to achieve widespread growth [2,32-43].”
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [33]
Challenges to and opportunities for widespread implementation for patients and caregivers were reported in 6 articles.
“Challenges to and opportunities for widespread implementation for patients and caregivers were reported in 6 articles [2,32-34,38,42].”
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [33]
Of the reviewed articles that reported patient or caregiver challenges, these were primarily clinician perceptions rather than direct reports from patients or caregivers.
“Of the articles that did report patient or caregiver challenges [2,32-34,38,42], these were primarily clinician perceptions, rather than direct reports from patients or caregivers.”
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [33]
At least one challenge or opportunity related to political, regulatory, cultural, contextual, or financial factors was reported in all 13 reviewed studies.
“At least one challenge or opportunity related to political, regulatory, cultural, contextual, or financial factors was reported in all studies (n=13) [2,32-43].”
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [33]
Other telehealth champion roles included health care coordinators or IT staff.
“Other roles included health care coordinators or IT staff [33,35,40,43].”
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [33]
Information from other organizations using telehealth, such as background information about services and clinical protocols, promotes take-up and spread of video consulting.
“Brooks et al [33] highlighted the importance of information (eg, background information about services, clinical protocols) from other organizations using telehealth in promoting take-up and spread.”
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [33]
Complexity in the organizational domain was managed more effectively when telehealth champions were available, as reported in 11 reviewed articles.
“Complexity in the organizational domain was managed more effectively when telehealth champions were available, as reported in 11 of the reviewed articles [2,33-37,39-43].”
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [33]
Cites
Rogers, E. M., Singhal, A., & Quinlan, M. M. (2019) · Routledge eBooks · doi:10.4324/9780203710753-35 · Cited by 37,557 · see citing works
Stanton, B. F., & Rogers, E. M. (1963) · Journal of Farm Economics · doi:10.2307/1235767 · Cited by 6,725 · see citing works
Problems in families of male Vietnam veterans with posttraumatic stress disorder.
Jordan, B. K., Marmar, C. R., Fairbank, J. A., Schlenger, W. E., Kulka, R. A., Hough, R. L., & Weiss, D. (1992) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.60.6.916 · Cited by 710 · see citing works
Problems in families of male Vietnam veterans with posttraumatic stress disorder.
Jordan, B. K., Marmar, C. R., Fairbank, J. A., et al. (1992) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.60.6.916 · Cited by 482 · see citing works
Determinants of successful telemedicine implementations: a literature study
Broens, T. H. F., Huis in't Veld, R. M. H. A., Vollenbroek-Hutten, M. M. R., Hermens, H. J., van Halteren, A. T., & Nieuwenhuis, L. J. M. (2007) · Journal of Telemedicine and Telecare · doi:10.1258/135763307781644951 · Cited by 466 · see citing works
Systematic review of evidence for the benefits of telemedicine
Hailey, D., Roine, R., & Ohinmaa, A. (2002) · Journal of Telemedicine and Telecare · doi:10.1258/1357633021937604 · Cited by 400 · see citing works
Clinical and Educational Telepsychiatry Applications: A Review
Hilty, D. M., Marks, S. L., Urness, D., Yellowlees, P., & Nesbitt, T. S. (2004) · The Canadian Journal of Psychiatry · doi:10.1177/070674370404900103 · Cited by 224 · see citing works
Mental Illness and Family Burden: A Public Health Perspective
Goldman, H. H. (1982) · Psychiatric Services · doi:10.1176/ps.33.7.557 · Cited by 167 · see citing works
Beals, J., Manson, S. M., Shore, J. H., Friedman, M. J., Ashcraft, M., Fairbank, J. A., & Schlenger, W. E. (2002) · Journal of Traumatic Stress · doi:10.1023/a:1014894506325 · Cited by 147 · see citing works
Self-citationFactors Affecting the Adoption of Telemedicine—A Multiple Adopter Perspective
Menachemi, N., Burke, D. E., & Ayers, D. J. (2004) · Journal of Medical Systems · doi:10.1023/b:joms.0000044964.49821.df · Cited by 141 · see citing works
Procedural and Methodological Issues in Telepsychiatry Research and Program Development
Frueh, B. C., Deitsch, S. E., Santos, A. B., Gold, P. B., Johnson, M., Meisler, N., Magruder, K. M., & Ballenger, J. C. (2000) · Psychiatric Services · doi:10.1176/appi.ps.51.12.1522 · Cited by 135 · see citing works
Barriers to Providing Effective Mental Health Services to American Indians
Johnson, J. L., & Cameron, M. (2001) · Mental Health Services Research · doi:10.1023/a:1013129131627 · Cited by 127 · see citing works
Cultural aspects of telepsychiatry
Shore, J. H., Savin, D. M., Novins, D. K., & Manson, S. M. (2006) · Journal of Telemedicine and Telecare · doi:10.1258/135763306776738602 · Cited by 107 · see citing works
Self-citationTelepsychiatry at Forty: What Have We Learned?
Baer, L., Elford, R. D., & Cukor, P. (1997) · Harvard Review of Psychiatry · doi:10.3109/10673229709034720 · Cited by 96 · see citing works
Helitzer, D., Heath, D., Maltrud, K., Sullivan, E., & Alverson, D. C. (2003) · Telemedicine Journal and e-Health · doi:10.1089/153056203766437516 · Cited by 93 · see citing works
A Developmental Model for Rural Telepsychiatry
Shore, J. H., & Manson, S. M. (2005) · Psychiatric Services · doi:10.1176/appi.ps.56.8.976 · Cited by 85 · see citing works
Self-citationObstacles for rural American Indians seeking alcohol, drug, or mental health treatment.
Duran, B., American Indian Service Utilization and Psychiatric Epidemiology Risk and Protective Factors Project Team, OETZEL, J. G., Lucero, J. E., Jiang, Y., Novins, D. K., Manson, S. M., & Beals, J. (2005) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.73.5.819 · Cited by 71 · see citing works
Self-citationVeld, R. M. H. A. H. I. ’., Huijgen, B. C. H., Schaake, L., Hermens, H. J., & Vollenbroek-Hutten, M. M. R. (2007) · Telemedicine Journal and e-Health · doi:10.1089/tmj.2007.0090 · Cited by 63 · see citing works
Chapter 7: The Diffusion of Telemedicine
Grigsby, J., Rigby, M., Hiemstra, A., House, M., Olsson, S., & Whitten, P. S. (2002) · Telemedicine Journal and e-Health · doi:10.1089/15305620252933428 · Cited by 57 · see citing works
Barton, P. L., Brega, A. G., Devore, P. A., Mueller, K. J., Paulich, M. J., Floersch, N., Goodrich, G. K., Talkington, S., Bontrager, J., Grigsby, B., et al. (2007) · Telemedicine Journal and e-Health · doi:10.1089/tmj.2006.0091 · Cited by 55 · see citing works
The diffusion of innovation: Factors influencing the uptake of telehealth
Walker, J., & Whetton, S. (2002) · Journal of Telemedicine and Telecare · doi:10.1258/13576330260440934 · Cited by 45 · see citing works
Spaulding, R. J., Russo, T. C., Cook, D. J., & Doolittle, G. C. (2005) · Journal of Telemedicine and Telecare · doi:10.1258/1357633054461903 · Cited by 35 · see citing works
Recruitment of Physicians To Rural America: A View Through the Lens of Transaction Cost Theory
Fannin, J. M., & Barnes, J. N. (2007) · The Journal of Rural Health · doi:10.1111/j.1748-0361.2007.00081.x · Cited by 9 · see citing works
Recruitment and retention of federal physicians on the Navajo Reservation.
Rl, B., May, P. A., & Tj, S. (1982) · PubMed · Cited by 8 · see citing works
Cl, H., & Felsen, J. D. (1975) · PubMed · Cited by 6 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Barriers to Use of Telepsychiatry: Clinicians as Gatekeepers
Cowan, K. E., McKean, A. J., Gentry, M. T., & Hilty, D. M. (2019) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2019.04.018 · Cited by 380 · see citing works
A systematic review of providers’ attitudes toward telemental health via videoconferencing.
Connolly, S. L., Miller, C. J., Lindsay, J. A., & Bauer, M. S. (2020) · Clinical Psychology: Science and Practice · doi:10.1111/cpsp.12311 · Cited by 389 · see citing works
James, H. M., Papoutsi, C., Wherton, J., Greenhalgh, T., & Shaw, S. E. (2021) · Journal of Medical Internet Research · doi:10.2196/23775 · Cited by 164 · see citing works
Benavides-Vaello, S., Strode, A., & Sheeran, B. C. (2013) · The Journal of Behavioral Health Services & Research · doi:10.1007/s11414-012-9299-6 · Cited by 165 · see citing works
McFarland, L. V., Raugi, G. J., & Reiber, G. E. (2013) · Telemedicine and e-Health · doi:10.1089/tmj.2012.0327 · Cited by 48 · see citing works
- Authors
- Brooks, E., Manson, S. M., Bair, B., Dailey, N., & Shore, J. H.
- Affiliations
- United States Department of Veterans Affairs (US)
- University of Colorado Anschutz (US)
- Corresponding author
- Brooks, Elizabeth
- Venue
- Telemedicine and e-Health
- Publisher
- SAGE Publications
- Published
- 2012-01
- Volume
- 18
- Issue
- 1
- Pages
- 60-66
- ISSN
- 1530-5627 (ISSN-L)
- 1556-3669
- PMC
- PMC3306586
- OpenAlex
- W2048316957
- Cited by
- 58
- References
- 25
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 4 · 2023: 3 · 2022: 5 · 2021: 13 · 2020: 10 · 2019: 1 · 2018: 2 · 2017: 5 · 2016: 3 · 2015: 3 · 2014: 1 · 2013: 3 · 2012: 2
- FWCI
- 1.88
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Telemedicine Journal and e-Health (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Office of Rural Health
- National Center on Minority Health and Health Disparities
- National Institute on Minority Health and Health Disparities (P60MD000507, 1 P60 MD00507-01)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Social Sciences › Health › Indigenous Health, Education, and Rights
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- telemedicine, telemental health, rural health, mental health services, diffusion of innovations, post-traumatic stress disorder, reservation lands, stakeholder perspectives, implementation barriers, health care access
- MeSH terms
- Mental Disorders, Decision Making, Diffusion of Innovation, Female, Health Services Accessibility, Health Services Needs and Demand, Humans, Indians, North American, Male, Mental Health Services, Middle Aged, Military Medicine, Psychiatry, Psychological Theory, Retrospective Studies, Rural Population, United States, Veterans, Telemedicine, Health Care Surveys
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
