Implementation and Institutionalization of a Telebehavioral Health Hub-and-Spoke Model in Rural Texas Counties
Main Article Content
Abstract
Objective: This study assessed implementation and institutionalization of hub-and-spoke telehealth services in five rural and underserved communities. Results provide insights into the unique considerations for telebehavioral care in rural locations.
Methods: Telephone interviews were conducted with a purposive sample of rural spoke site coordinators (n=5) across 5 counties. Interviews were transcribed, then thematically analyzed using an open coding scheme.
Results: Five primary themes emerged regarding implementation, including (a) initial planning and implementation; (b) community factors; (c) internal process perceptions; (d) community perceptions of services; and (e) lessons learned. Historical changes in telehealth delivery and the likelihood of sustainability emerged as themes related to institutionalization. When comparing findings to domains in the Consolidated Framework for Implementation Research, key aspects of community buy-in, flexibility and tailoring of services, and collaboration between network partners were identified. Weaknesses in the production and support subsystems were identified using the Levels of Institutionalization Framework.
Conclusions: Key considerations for others looking to implement and institutionalize telebehavioral health interventions include a focus on relationship building, considering community context to ensure relevant setup of services, consistent communication and outreach with multiple levels of stakeholders, and adapting to changing technology and infrastructure.
Article Details
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