Telepractice implementation readiness and planning assessment in public-sector using mixed methods.

Need: A systematic needs and planning assessment is considered critical prior to large scale program implementation of new interventions (Ekeland et al, 2010; Kidholm et al, 2012) to avoid costly implementation errors (AlDossary et al, 2017) A comprehensive tele-practice model of screening, identification and rehabilitation of children below 6 years with hearing and speech-language disorders is proposed in Tamil Nadu Towards this, a situational analysis was undertaken to understand the perceived needs and readiness for telepractice integration. Aim: To understand the existing needs and assess telepractice readiness among various public-sector stakeholders involved in identification and rehabilitation of children with disability using mixed methods approach Method: Cross-sectional design using mixed methods including Focus Group Discussion (FGD) and Semi-structured interviews (SSI) of various stakeholders and geospatial mapping. Study site: Two representative rural districts in South India, Tamil Nadu, having nearly equal population, area and socio-economic conditions were selected to conduct the study. Material: Purposive homogeneous sampling was used for FGDs and Maximum variation sampling was used for SSIs Fathers and mothers of children with disability under 6 years of age, and various service providers working in public-sector services participated in the study. Procedure: Guide development -- The Bowen's feasibility framework was used as the primary framework (Bowen D.J., et al., 2010) and relevant attributes from various telemedicine frameworks (Addotey- Delove M.N., et al., 2020; Kiberu, et al., 2019; AlDossary et al., 2017; Mauco, et al., 2018) were mapped to these constructs. The interview guides were developed based on this framework. Data collection: The FGDs were conducted inperson in the rural community, and the SSI was conducted in-person or through a secure video-conferencing platform depending on the participant's convenience The FGD and SSI were audio recorded with prior written consent of all participants. For the geospatial analysis, the address of all enumerated children with disability below 6 years of age and service providers (centre and staffing) were obtained for the study sites All public-sector service centres and providers were included Analysis: All recordings were verbatim transcribed and uploaded in NVIVO software v. 12. Each transcript was coded and themes were identified using a deductive approach. For geo-spatial analysis, the geo-locations of providers and patients were obtained using Google Maps platform with latitude and longitude information. Data was imported to a web-based GIS analysis software -- TNG is to obtain buffer maps, distances and spread maps. Results: FGDs were conducted on four groups of mothers, two groups of fathers, two groups of anganwadi teachers and two groups of primary and secondary government teachers SSIs were conducted with 3 ASLPs, 2 welfare officers and 5 special educators. Parental perceptions on availability and accessibility of diagnostic and rehabilitation facilities, barriers and challenges faced in seeking care, as well as satisfaction with quality of care were obtained Caregiver's comfort and agreeability for telepractice, their intention to try and perceived fit of telepractice was identified. The service providers perceived the currently available services for hearing and speech-language disorders to be inadequate and were ready to explore telepractice Yet, they perceived a need for training, capacity building and more community engagement before implementing such services. The visual map of geographic distribution of persons with disability and all service centres in the selected districts revealed regional disparities in availability of services, non-availability of ASLP staffing and the average distance travelled by patient to avail diagnostic and rehabilitation services in these districts. Conclusions: The situational analysis informed us about the key grass root level personnel who can be engaged for telepractice, parental and service provider apprehensions towards telepratice and suitable locations for integrating telepractice in the community. [ABSTRACT FROM AUTHOR]