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Behavioural interventions delivered to people in rural areas via telehealth: A narrative systematic review of studies from the last 12 years

Abstract
People who live in rural areas have historically experienced a disparity when receiving behavioural health services. Specialty treatment providers are often located in cities and require people who need help to travel great distances. The recent advent of COVID 19 has highlighted this issue but has also pushed forward the necessity of developing alternative means of service delivery which can be beneficial for people in rural areas. One such alternative is telehealth, which utilises telecommunications technologies in place of traditional media. Clients could receive much needed treatment via synchronous telehealth using videoconferencing technology, asynchronous telehealth, which could be an effective consultation tool, patient monitoring with the help of fitness trackers or diaries and mobile health which makes use of applications on mobile devices. This review seeks to answer the following questions: A.) What behavioural interventions are currently being adapted to be delivered via telehealth to people in rural areas? B.) What types and methods of telehealth delivery is most used? C.) How effectively are these interventions being applied? D.) What elements make them effective? E.) What are the challenges of delivering ABA interventions via telehealth technologies to rural areas? F.) What solutions have the studies presented to overcome these challenges? Methodology Five databases were searched using multiple keywords optimised to find studies that are most relevant to the research questions. The studies needed to have been conducted in rural areas, implemented behavioural interventions, delivered via telehealth and should have been conducted in the last ten years. Results The behavioural interventions that the researchers trialled in the qualifying studies were Cognitive Behavioural Therapy and Behavioural strategies such as contingency management, shaping, prompting, and fading. The most common type of telehealth used was hybrid telehealth which is a combination of two or more types, followed by asynchronous telehealth and synchronous telehealth. An element that may have contributed to success was the level of therapist involvement in the treatment and the immediacy of feedback. The interventions were also found to be cost effective and highly acceptable by the participants. The researchers reported having encountered technical difficulties, limited availability and knowledge on equipment, internet inconsistencies, constant distractions due to uncontrolled settings and reduced participant adherence in the absence of therapist involvement. Some of the solutions suggested included providing a nearby centralised venue with good internet and equipment access, utilising more easily accessible technologies such as mobile phones, setting up a specific area in the home for treatment, and increasing therapist involvement in care. Conclusion Although only few studies met the inclusion criteria, this review was able to determine that behavioural interventions can be delivered effectively to people in rural areas and be highly acceptable by the target population despite existing limitations.
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Thesis
Type of thesis
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Citation
Date
2023
Publisher
The University of Waikato
Rights
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