Despite decades of low utilization, telemedicine adoption expanded at an unprecedented rate during the COVID-19 pandemic. This study examined quantitative and qualitative data provided by a national online sample of 228 practicing physicians (64% were women, and 75% were White) to identify facilitators and barriers to the adoption of telemedicine in the United States (U.S.) at the beginning of the COVID-19 pandemic. Logistic regressions were used to predict the most frequently endorsed (20% or more) barriers and facilitators based on participant demographics and practice characteristics. The top five reported barriers were: lack of patient access to technology (77.6%), insufficient insurance reimbursement (53.5%), diminished doctor-patient relationship (46.9%), inadequate video/audio technology (46.1%), and diminished quality of delivered care (42.1%). The top five reported facilitators were: better access to care (75.4%), increased safety (70.6%), efficient use of time (60.5%), lower cost for patients (43%), and effectiveness (28.9%). Physicians’ demographic and practice setting characteristics significantly predicted their endorsement of telemedicine barriers and facilitators. Older physicians were less likely to endorse inefficient use of time (p < 0.001) and potential for medical errors (p = 0.034) as barriers to telemedicine use compared to younger physicians. Physicians working in a medical center were more likely to endorse inadequate video/audio technology (p = 0.037) and lack of patient access to technology (p = 0.035) as a barrier and more likely to endorse lower cost for patients as a facilitator (p = 0.041) than providers working in other settings. Male physicians were more likely to endorse inefficient use of time as a barrier (p = 0.007) than female physicians, and White physicians were less likely to endorse lower costs for patients as a facilitator (p = 0.012) than physicians of color. These findings provide important context for future implementation strategies for healthcare systems attempting to increase telemedicine utilization.

Purpose Working with patients and families with different cultural backgrounds is now commonplace in all areas of speech-language pathology. This includes supporting those with eating, drinking, and swallowing problems. Becoming more culturally sensitive as clinicians requires us to think less of them versus us, and instead what matters to them, and how best for us to provide expert care. Our starting point for this important topic is not how we tweak our clinical recommendations to fit someone's “culture.” Rather, let us examine what is culture and how should it factor into our professional work? We need to understand how our patients and families view health and well-being, or lack thereof, in general. This will enable us to frame our support and offer optimal care to all stakeholders. This leads naturally to a consideration of the concepts of autonomy, informed consent, and how these factor into person-centered care, and shared decision making. Conclusions As well as gaining an understanding of the frameworks of health and illness, we consider how food and drink are much more than mere nutrition and hydration. Foods signal our individual and collective identities. Thus, to be a respectful and professional clinician, we need to appreciate our role as a cultural guest with all whom we serve. We propose that there is no such thing as being “culturally competent.” Expert clinicians possess a respect for the patient and their expertise-by-experience of health and illness. Such respect is founded in the position of cultural humility, to be a guest of someone's world view, in the same way that we respect being a guest in a patient's physical home.

Background: The responsibility of care for Veterans and Service Members (V/SMs) with traumatic brain injury (TBI) often defaults to informal family caregivers. Caregiving demands considerable knowledge, skill, and support to facilitate the health and well-being of V/SMs and themselves. Persistent and common TBI caregiver issues include strain, depression, and anxiety. While evidence-based, brief interventions have been developed and implemented for family caregivers in Veteran neurodegenerative populations, few interventions have been developed, adapted, or tested to support the unique needs of caregivers of V/SMs with TBI. Objective: This study will adapt and test an evidence-based, personalized, 6-session telehealth caregiver intervention, “Resources for Enhancing All Caregivers’ Health” (REACH), to meet the unique needs of caregivers of V/SMs with TBI. If successful, a community-based participatory research team will develop an implementation plan to roll out REACH TBI across the national Veterans Affairs Polytrauma System of Care. Methods: This mixed methods, crossover waitlist control clinical trial will use a Type 1 Hybrid Effectiveness-Implementation approach to adapt and then test the effects of REACH TBI on key TBI caregiver outcomes. Results: This study was funded by the Department of Defense in September 2023. Participant enrollment and data collection will begin in 2024. Conclusions: If effective, REACH TBI will be the first evidence-based intervention for caregivers of V/SMs with TBI that can be scaled to implement across the Veterans Affairs Polytrauma System of Care and fill a notable gap in clinical services. International Registered Report Identifier (IRRID): PRR1-10.2196/57692

The Mamma Mia program is an internet-based intervention designed to prevent and/or intervene with perinatal mental health symptoms, such as depression symptoms. The purpose of this mixed-methods study, which occurred in a virtual setting, was to evaluate the perceived acceptability, obtrusiveness, and preliminary perceived usefulness of the Mamma Mia program by postpartum mothers who had access to the program through a larger parent study. Quantitative data on perceived obtrusiveness of the program (Unobtrusiveness Scale) were collected from 1772 pregnant women participating in a larger, three-arm randomized controlled parent study (clinicaltrials.gov: NCT04300894); qualitative data were obtained through semi-structured one-on-one interviews with a subset of these postpartum mothers (n = 55). Participants reported they found the program to be beneficial, emphasizing its guided content, focus on self-care, integration of mindfulness and educational components, and trustworthiness. Participants appreciated the structured nature of the program and expressed a high level of trust in the program, which was crucial for its perceived value and effectiveness. However, reported obtrusiveness of the intervention increased as participants progressed through the postpartum period, suggesting an evolving user experience with the program. Participants offered suggestions for improvement to the program, such as that the program should be app-based, the program should be available for partners to use, and that the program requires some updates to images and postpartum content. Overall, the study findings highlight the participants’ perceptions that the program is acceptable and useful. Future work is warranted to explore the enhancements proposed by participants to further optimize the program’s impact.

Background: Traumatic brain injury (TBI) is a serious public health problem and is associated with an increased number of health comorbidities. Objective: This study examined: (a) longitudinal trajectories of participation over the 10 years after TBI in a group of Black individuals, and (b) demographic and injury-related predictors of those trajectories. Method: This study included 1,989 Black individuals in the national TBI Model Systems (TBIMS) Database, who had at least one of each Participation Assessment with Recombined Tools-Objective (PART-O) subscale scores at one or more follow-up time points (1, 2, 5, and 10 years after TBI). Results: Lower PART-O Productivity trajectories were observed among participants who were male (b = −.26, p  = .001), were older at the time of injury (b = −.02, p  < .001), had a lower education level (b = .06, p  < .001), had public insurance coverage (b = .17, p  = .009), and had longer posttraumatic amnesia (PTA) duration (b = −.28, p  < .001). Lower PART-O Social trajectories emerged among participants who were older at the time of injury (b = −.02, p  < .001), did not have a partner at the time of injury (b = .66, p  < .001), had public insurance coverage (b = .19, p  = .009), and had longer PTA duration (b = −.19, p  = .001). Lower PART-O Out and About trajectories emerged among participants who were older at the time of injury (b = −.01, p  = .018) and had a lower education level (b = .05, p  < .001). Conclusion: The findings highlight the importance of understanding the strengths, risk factors, and unmet needs of this group, many of whom experience decreased community and social engagement after TBI.

The purpose of this study is to apply the theory of reasoned action (TRA) and technology acceptance model (TAM) to U.S. physicians’ adoption of telemedicine during the COVID-19 pandemic. A total of 230 physicians licensed in the U.S. completed a cross-sectional survey during the COVID-19 pandemic assessing telemedicine use and components of the TRA and TAM. Path models representing the TRA, TAM, and a trimmed version of the TAM were tested. The TRA was an adequate to poor fit for modeling physicians’ decisions concerning telemedicine use. The TAM demonstrated better fit, although a trimmed TAM was ultimately retained for parsimony with mostly good or adequate fit indices. Subjective norms, perceived usefulness, and attitude toward telemedicine may be important targets for trainings and advocacy efforts to facilitate and sustain telemedicine use in a post-pandemic context.