Understanding Variation in Adoption of Video Telehealth and Implications for Health Care Systems

Main Article Content

Megan E Gately, PhD, OTD, OTR/L Emma D. Quach, PhD Steven D. Shirk, PhD Scott A. Trudeau, PhD, OTR/L



Telehealth has rapidly expanded since COVID-19. Veterans Health Administration (VHA), the largest integrated health care system in the United States, was well-positioned to incorporate telehealth across specialties due to existing policies and infrastructure.


The objective of this study is to investigate predictors of occupational therapy (OT) practitioners’ adoption of video telehealth.


This study presents data from a convenience sample of VHA occupational therapy (OT) practitioners administered pre-pandemic, in fall 2019. Survey development was guided by the Promoting Action on Research Implementation in Health Services framework, and gathered clinician attitudes, experiences, and perspectives about video telehealth to deliver OT services. Items included telehealth usage, perceived effectiveness of specific OT interventions, and perceptions about evidence. Our outcome variable denoted practitioners’ level of adoption of video telehealth: telehealth users (adopters), non-users who want to use telehealth (potential adopters and reference group), and non-users who do not want to use telehealth (non-adopters). In multiple multinomial logistic regressions, we tested whether level of adoption was associated with years of VHA work experience and perceived strength of evidence.


Of approximately 1455 eligible practitioners, 305 VHA occupational therapy practitioners participated in the survey (21% response rate). One hundred and twenty-five (41%) reported using video telehealth, whereas 180 (59%) reported not using video telehealth. Among non-users, 107 (59%) indicated willingness to adopt telehealth whereas 73 (41%) were not willing. More VHA work experience predicted higher odds of being an adopter than a potential adopter; perceptions of stronger evidence regarding video telehealth predicted higher odds of being a potential adopter than a non-adopter.


Clinician beliefs and years of experience exerted an influence on clinicians’ use or willingness to use video telehealth. Efforts to enhance adoption of video telehealth should address clinicians’ beliefs regarding the innovative nature of and organizational resources necessary to foster utilization.

Article Details

How to Cite
GATELY, Megan E et al. Understanding Variation in Adoption of Video Telehealth and Implications for Health Care Systems. Medical Research Archives, [S.l.], v. 10, n. 5, june 2022. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/2751>. Date accessed: 30 june 2022. doi: https://doi.org/10.18103/mra.v10i5.2751.
Research Articles


1. Cooley S. Dementia Care for Veterans: Enhancing Comprehensive, Coordinated Services. Generations. 2010;34(2):57-63.
2. Heyworth L, Kirsh, S., Zulman, D., Ferguson, J.M., Kizer, K.W. Expanding Access through Virtual Care: The VA’s Early Experience with Covid-19. New England Journal of Medicine. 2020;doi:10.1056/CAT.20.0327
3. VHA Notice 2018-25. Expansion of Telehealth Services Into The Home and Other Non-VA Settings. 2018.
4. Halle AD, Mroz TM, Fogelberg DJ, Leland NE. Occupational Therapy and Primary Care: Updates and Trends. Am J Occup Ther. May/Jun 2018;72(3):7203090010p1-7203090010p6. doi:10.5014/ajot.2018.723001
5. Lum HD, Nearing K, Pimentel CB, Levy CR, Hung WW, Kaskie B. Anywhere to Anywhere: Use of Telehealth to Increase Health Care Access for Older, Rural Veterans. Public Policy & Aging Report. 2020;30(1):12-18. doi:10.1093/ppar/prz030
6. Slightam C, Gregory AJ, Hu J, et al. Patient Perceptions of Video Visits Using Veterans Affairs Telehealth Tablets: Survey Study. J Med Internet Res. Apr 15 2020;22(4):e15682. doi:10.2196/15682
7. Mehrotra A, Huskamp HA, Souza J, et al. Rapid Growth In Mental Health Telemedicine Use Among Rural Medicare Beneficiaries, Wide Variation Across States. Health Aff (Millwood). May 1 2017;36(5):909-917. doi:10.1377/hlthaff.2016.1461
8. Sharma U, Clarke M. Nurses’ and community support workers’ experience of telehealth: a longitudinal case study. BMC Health Services Research. 2014/04/10 2014;14(1):164. doi:10.1186/1472-6963-14-164
9. Serwe KM, Nissen R. Survey of Occupational Therapy Education in Telehealth. Journal of Occupational Therapy Education. 2021;5(2)doi:10.26681/jote.2021.050206
10. Chike-Harris KE, Garber K, Derouin A. Telehealth Educational Resources for Graduate Nurse Faculty. Nurse Educator. 2021;doi:10.1097/nne.0000000000001055
11. DelliFraine JL, Dansky KH, Rumberger JS. Can organizational support for technology influence job satisfaction? Health care management review. Oct-Dec 2006;31(4):300-7. doi:10.1097/00004010-200610000-00005
12. Mikhailova O. Adoption and implementation of new technologies in hospitals: a network perspective. IMP Journal. 2018;12(2):368-391. doi:10.1108/IMP-05-2017-0027
13. Bauer MS, Damschroder L, Hagedorn H, Smith J, Kilbourne AM. An introduction to implementation science for the non-specialist. BMC Psychology. 2015;3(32)
14. Kitson A, Harvey G, McCormack B. Enabling the implementation of evidence based practice: a conceptual framework. Quality in Health Care. 1998;7:149-58.
15. Stetler CB, Damschroder LJ, Helfrich CD, Hagedorn HJ. A Guide for applying a revised version of the PARIHS framework for implementation. Implementation Science. 2011;6(99)
16. Rycroft-Malone J, Seers K, Chandler J, et al. The role of evidence, context, and facilitation in an implementation trial: implications for the development of the PARIHS framework. Implementation Science. 2013;8(28)
17. Helfrich CD, Damschroder LJ, Hagedorn HJ, et al. A critical synthesis of literature on the promoting action on research implementation in health services (PARIHS) framework. Implementation Science. 2010;5(82)
18. Helfrich CD, Li Y, Sharp ND, Sales AE. Organizational readiness to change assessment (ORCA): Development of an instrument based on the Promoting Action on Research in Health Services (PARIHS) framework. Implementation Science. 2009;4(38)
19. Harris PAT, R.; Thielke, R.; Payne, J.; Gonzalez, N.; Conde, J.G. Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-381.
20. Gately ME, Tickle-Degnen L, Voydetich DJ, Ward N, Ladin K, Moo LR. Video Telehealth Occupational Therapy Services for Older Veterans: National Survey Study. JMIR Rehabil Assist Technol. Apr 27 2021;8(2):e24299. doi:10.2196/24299
21. Emani S, Peters E, Desai S, et al. Who adopts a patient portal?: An application of the diffusion of innovation model. J Innov Health Inform. Oct 25 2018;25(3):149-157. doi:10.14236/jhi.v25i3.991
22. American Occupational Therapy Association. 2015 AOTA Salary and Workforce Survey. 2015. www.aota.org
23. Association AOT. Occupational therapy practice framework: Domain and process. American Journal of Occupational Therapy. 2014;68(S1):S1-S48.
24. Bolt M, Ikking T, Baaijen R, Saenger S. Occupational therapy and primary care. Primary Health Care Research & Development. 2019;20doi:10.1017/s1463423618000452
25. Leland NE, Fogelberg DJ, Halle AD, Mroz TM. Occupational Therapy and Management of Multiple Chronic Conditions in the Context of Health Care Reform. American Journal of Occupational Therapy. 2016;71(1):7101090010p1-7101090010p6. doi:10.5014/ajot.2017.711001
26. Darkins A. The growth of telehealth services in the Veterans Health Administration between 1994 and 2014: a study in the diffusion of innovation. Telemed J E Health. Sep 2014;20(9):761-8. doi:10.1089/tmj.2014.0143
27. Gagnon M-P, Lamothe L, Fortin J-P, et al. Telehealth adoption in hospitals:an organisational perspective. Journal of health organization and management. 2005;19(1):32-56. doi:10.1108/14777260510592121
28. Ross J, Stevenson F, Lau R, Murray E. Factors that influence the implementation of e-health: a systematic review of systematic reviews (an update). Implementation Science. 2016/10/26 2016;11(1):146. doi:10.1186/s13012-016-0510-7
29. Nobakht Z, Rassafiani M, Hosseini SA, Ahmadi M. Telehealth in occupational therapy: A scoping review. International Journal of Therapy and Rehabilitation. 2017;24(12):534-538. doi:10.12968/ijtr.2017.24.12.534
30. Önal G, Güney G, Gün F, Huri M. Telehealth in paediatric occupational therapy: a scoping review. International Journal of Therapy and Rehabilitation. 2021;28(7):1-16. doi:10.12968/ijtr.2020.0070
31. Terry DL, Buntoro SP. Perceived Usefulness of Telehealth Among Rural Medical Providers: Barriers to Use and Associations with Provider Confidence. Journal of technology in behavioral science. Jun 5 2021:1-5. doi:10.1007/s41347-021-00215-5
32. Zahoransky MA, Lape JE. Telehealth and Home Health Occupational Therapy: Clients’ Perceived Satisfaction With and Perception of Occupational Performance. International Journal of Telerehabilitation. 2020;12(2)
33. Szekeres M, Valdes K. Virtual health care & telehealth: Current therapy practice patterns. J Hand Ther. Jan-Mar 2022;35(1):124-130. doi:10.1016/j.jht.2020.11.004
34. Hoel V, von Zweck C, Ledgerd R, World Federation of Occupational T. Was a global pandemic needed to adopt the use of telehealth in occupational therapy? Work. 2021;68(1):13-20. doi:10.3233/WOR-205268
35. Sturesson L, Groth K. Effects of the Digital Transformation: Qualitative Study on the Disturbances and Limitations of Using Video Visits in Outpatient Care. J Med Internet Res. Jun 27 2018;20(6):e221. doi:10.2196/jmir.9866
36. Khoshrounejad F, Hamednia M, Mehrjerd A, et al. Telehealth-Based Services During the COVID-19 Pandemic: A Systematic Review of Features and Challenges. Front Public Health. 2021;9:711762. doi:10.3389/fpubh.2021.711762
37. Alipour J, Hayavi-Haghighi MH. Opportunities and Challenges of Telehealth in Disease Management during COVID-19 Pandemic: A Scoping Review. Applied clinical informatics. Aug 2021;12(4):864-876. doi:10.1055/s-0041-1735181
38. Lopez AM, Lam K, Thota R. Barriers and Facilitators to Telemedicine: Can You Hear Me Now? Am Soc Clin Oncol Educ Book. Mar 2021;41:25-36. doi:10.1200/EDBK_320827
39. O'Connell ME, Haase KR, Grewal KS, et al. Overcoming Barriers for Older Adults to Maintain Virtual Community and Social Connections during the COVID-19 Pandemic. Clin Gerontol. Jan-Feb 2022;45(1):159-171. doi:10.1080/07317115.2021.1943589
40. Moo LR. Home Video Visits: 2-D View of the Geriatric 5-Ms. Journal of the American Geriatrics Society. 2020;
41. Wallack EM, Harris C, Ploughman M, Butler R. Telegerontology as a Novel Approach to Address Health and Safety by Supporting Community-Based Rural Dementia Care Triads: Randomized Controlled Trial Protocol. JMIR Res Protoc. Feb 22 2018;7(2):e56. doi:10.2196/resprot.8744
42. Tso JV, Farinpour R, Chui HC, Liu CY. A Multidisciplinary Model of Dementia Care in an Underserved Retirement Community, Made Possible by Telemedicine. Front Neurol. 2016;7:225. doi:10.3389/fneur.2016.00225
43. Hale-Gallardo JL, Kreider CM, Jia H, et al. Telerehabilitation for Rural Veterans: A Qualitative Assessment of Barriers and Facilitators to Implementation. J Multidiscip Healthc. 2020;13:559-570. doi:10.2147/JMDH.S247267
44. Werneke MW, Deutscher D, Grigsby D, Tucker CA, Mioduski JE, Hayes D. Telerehabilitation During the COVID-19 Pandemic in Outpatient Rehabilitation Settings: A Descriptive Study. Phys Ther. Jul 1 2021;101(7)doi:10.1093/ptj/pzab110
45. Yi JS, Pittman CA, Price CL, Nieman CL, Oh ES. Telemedicine and Dementia Care: A Systematic Review of Barriers and Facilitators. J Am Med Dir Assoc. Jul 2021;22(7):1396-1402.e18. doi:10.1016/j.jamda.2021.03.015
46. Alexander NB, Phillips K, Wagner-Felkey J, et al. Team VA Video Connect (VVC) to optimize mobility and physical activity in post-hospital discharge older veterans: baseline assessment. BMC Geriatr. Sep 22 2021;21(1):502. doi:10.1186/s12877-021-02454-w
47. Di Lorito C, Duff C, Rogers C, et al. Tele-Rehabilitation for People with Dementia during the COVID-19 Pandemic: A Case-Study from England. Int J Environ Res Public Health. Feb 10 2021;18(4)doi:10.3390/ijerph18041717
48. Bertoncello C, Colucci M, Baldovin T, Buja A, Baldo V. How does it work? Factors involved in telemedicine home-interventions effectiveness: A review of reviews. PLoS One. 2018;13(11):e0207332. doi:10.1371/journal.pone.0207332
49. Arbesman M, Mosley, L.J. Systematic Review of Occupation- and Activity-Based Health Management and Maintenance Interventions for Community-Dwelling Older Adults. American Journal of Occupational Therapy. 2012;66:277-283.
50. Kaldenberg J, Smallfield S. Occupational Therapy Practice Guidelines for Older Adults With Low Vision. Am J Occup Ther. Mar/Apr 2020;74(2):7402397010p1-7402397010p23. doi:10.5014/ajot.2020.742003
51. Smallfield S, Elliott SJ. Occupational Therapy Interventions for Productive Aging Among Community-Dwelling Older Adults. Am J Occup Ther. Jan/Feb 2020;74(1):7401390010p1-7401390010p5. doi:10.5014/ajot.2020.741003
52. Bennett S, Laver K, Voigt-Radloff S, et al. Occupational therapy for people with dementia and their family carers provided at home: a systematic review and meta-analysis. BMJ Open. Nov 11 2019;9(11):e026308. doi:10.1136/bmjopen-2018-026308
53. Smallfield S, Molitor, W.L. Occupational Therapy Interventions Supporting Social Participation and Leisure Engagement for Community-Dwelling Older Adults: A Systematic Review. American Journal of Occupational Therapy. 2018;72(7204190020)
54. Hunter E, & Kearney, P. Occupational Therapy Interventions to Improve Performance of Instrumental Activities of Daily Living for Community-Dwelling Older Adults: A Systematic Review American Journal of Occupational Therapy. 2018;72:7204190050.
55. Liu C, Chang, W., Chang, M.C. Occupational Therapy Interventions to Improve Activities of Daily Living for Community-Dwelling Older Adults: A Systematic Review. American Journal of Occupational Therapy. 2018;72:7204190060.
56. Abbott-Gaffney CR, Gafni-Lachter L, Cason J, et al. Toward successful future use of telehealth in occupational therapy practice: What the COVID-19 rapid shift revealed. Work. 2022;71(2):385-394. doi:10.3233/WOR-210789
57. Hung Kn G, Fong KN. Effects of telerehabilitation in occupational therapy practice: A systematic review. Hong Kong J Occup Ther. Jun 2019;32(1):3-21. doi:10.1177/1569186119849119