Mutual Shaping of Telehealthcare in Northern Saskatchewan Community Experiences of the Socio-Technical and Spatial Dimensions of Care

Social Sciences & Humanities Research Council (SSHRC), CGS Doctoral ScholarshipPeer Reviewed: Telehealth is offered as a technological solution for challenges with accessing care across Canada’s more remote communities. Telehealth technologies can bridge healthcare access gaps by connecting patients and providers; however, there are notable utilization and structural constraints that potentially challenge long-term sustainability. This article contributes a snapshot of community perspectives and experiences from Northern Saskatchewan on the use of telehealth technologies. Specifically, this article locates the strengths and barriers for telehealth use within northern and remote Indigenous community contexts and draws attention to the importance of community collaborations and place-based considerations. Drawing on theoretical insights from science and technology studies (STS), it is argued that understanding the social and spatial contexts in which telehealth is experienced is critical, especially as technologies continue to play an important role in delivering healthcare. The analysis reveals how users and technologies, along with their mediated environments and situated contexts, mutually shape telehealthcare practice and experiences. In the context of this study, a mutual shaping approach provides insight into the factors shaping technology use—it uncovers how socio-spatial and human factors (users) shape technology design, implementation, and utilization, and simultaneously, how technologies shape healthcare practices and experiences associated with telehealth and the socio-technical space of the clinic

Mutual Shaping of Tele-Healthcare Practice: Exploring Community Perspectives on Telehealth Technologies in Northern and Indigenous Contexts

In Canada, northern and Indigenous communities face well documented challenges to accessing healthcare services prompting the urgent need to adopt alternative and innovative solutions to overcome barriers of limited access due to geographic distance, physician shortages, limited resources, and high cost of service delivery. Telehealth – the means of delivering health care services and information across distance – promises to augment services to address some of these barriers and has been increasingly relied upon to bridge healthcare service gaps. Despite the promise of telehealth, notable utilization barriers and structural constraints remain that challenge long-term sustainability. Little is known about how well these technologies work from community telehealth users’ perspectives. Current work in the area has tended to focus on the increased efficiency and cost effectiveness of telehealth in facilitating healthcare services, with less focus on users’ perspectives obscuring the important roles played by users and technologies. In sum, more work needs to be done to present a complete picture of users’ experiences and community needs – a gap this dissertation aims to tackle. In doing so, this research captures a snapshot of community perspectives from four Northern Saskatchewan communities, drawing attention to users’ experiences in relation to the social and technical factors shaping telehealth use. Working in partnership with the communities of Hatchet Lake Denesuline First Nation, the Northern Villages of Île-à-la-Crosse and Pinehouse Lake, and the Town of La Ronge, and external stakeholders/knowledge users working directly with these communities, this work resulted in valuable insights into the user-technology interface. Emerging from community concerns with accessing healthcare services and education/training, the goal of this project was to better understand strengths and barriers for telehealth use. Methodologically, the personal accounts and lived experiences of telehealth users were explored using qualitative methods grounded in Community-Based Participatory Research (CBPR) and decolonizing methodologies utilizing Constructivist Grounded Theory (CGT) that is drawn from interpretive-constructivist epistemological frameworks. In-depth, semi-structured qualitative interviews/focus groups with 24 telehealth users, field notes and general observations provided the basis for data collection, and NVivo 12 was used to organize, iteratively code and analyze community insights. Thematic analysis and socio-technical mapping explored themes across community contexts and provided understanding of the interrelationship of shared and unique insights whereby community telehealth users’ voices guided interpretations. This dissertation highlights the importance of community collaborations and identifies the strengths and barriers for utilizing telehealth within northern and Indigenous contexts. Using theoretical frameworks drawn from Science and Technology Studies (STS), this dissertation makes the argument that users and technologies play significant roles in shaping tele-healthcare practice – a mutually co-constitutive relationship embedded within larger socio-structural systems that pose varying constraints. Analysis revealed that users and technologies mutually shape tele-healthcare practices and care experiences – i.e. technologies shape patients’ and local/remote providers’ use of the system in enabling/constraining ways and users shape technologies through reconfiguration or “tinkering”. A mutual shaping approach following the relational/performative view of socio-technical agency serves as a pathway for examining socio-cultural factors shaping how technologies are designed, implemented, and used, and alternatively how technologies shape practice and meanings of socio-technical spaces. Further, it is argued that understanding the context in which telehealth technologies are situated and experienced will be increasingly critical as technological systems play greater roles in service delivery

A Participatory Action Research approach to telemedicine supported health care delivery in rural Nepal

Rural and geographically isolated, the majority of Nepalese communities have very low incomes, poor transportation, and scarce health care resources; these people provide the context for this study. The consequences of these deprivations include high maternal and infant mortality rates, high prevalence of infectious disease and poverty. There are therefore exceptional challenges and disparities in meeting health care needs. However the recent advent of modern information communication technology (ICT) or Telemedicine has unleashed a new wave of opportunities for supporting the delivery of health care services. Despite suggestions that telemedicine will offer hope in developing countries there is only limited published evidence to support this claim. Telemedicine is and must remain a process of the delivery of care rather than a technology. The system must connect patients and healthcare professionals in a chain of care, rather than follow the wide array of existing or new and advanced technology. The successful introduction of telemedicine with tangible outputs requires an in-depth understanding of the existing health care system of the country and its challenges; strongly expressed ‘genuine need’ for the service by all the stakeholders as interested partners (patients, practitioners, health care service providers and the public); the actual status of ICT infrastructure in the country and costs. This study used a Participatory Action Research (PAR) approach to explore the feasibility, acceptability and impact of a telemedicine system in partnership with Dhulikhel Hospital: Kathmandu University Hospital and with three of its 12 rural, remote outreach centres, and the populations they serve. Participatory, repeated data collection methods included surveys, interviewing, listening and being with staff and communities over a two year period. The researcher and researched engaged in a complex inter-locking journey from which the Unlocking, Unblocking and Validation concepts emerged. The findings of this study emphasise the pivotal role that the rural health care workers play. Telemedicine not only has a place in improving access to healthcare through enhanced communication but it also empowers health care workers. These people need continued support to develop their competencies and boost their confidence within the changing health care environment. In conclusion telemedicine is primarily about people rather than technology. Effective and holistic telemedicine development is built upon a combined, interactive model involving access, communication and empowerment

Youtube, Dr, Pimple Popper, and the Human Body

Pimple poppers around the world rejoice at the Youtube series, Dr. Pimple Popper, where they can experience a range of different ways to pop something out of the skin. A highly popular series that features videos of Dr. Sandra Lee, a certified medical dermatologist, who squeezes and cuts open cysts, lipomas, and any other forms of degenerative skin conditions. These videos are taken by her medical assistants, while she performs surgeries on her patients. Dr. Lee has gained a mass following as her views and subscriptions surpass a million. The popularity of her channel demonstrates validity of a research topic, as many speculations can be made about this channel’s popular appeal. This channel is a media and communications topic, while integrating other academic fields, as it transcends into symbolic constructions and perceptions of what is a clean human body. The perception of the human body has historically been abstractified and critiqued as a medium of interpretation or as a tool to execute systemic power. Now, we must ponder the current interpretation of the human body, as it becomes the focus of a popular Youtube series. This postulation can be explored through Michel Foucault’s medical gaze theory and Mary Douglas’s cultural theory on dirt. The utilization of anthropological and philosophical theories, applied to Dr. Pimple Popper, can give us answers about how Dr. Lee’s patients are affecting the way viewers make sense of their own bodies through visually graphic material

A Virtual University Infrastructure For Orthopaedic Surgical Training With Integrated Simulation

This thesis pivots around the fulcrum of surgical, educational and technological factors. Whilst there is no single conclusion drawn, it is a multidisciplinary thesis exploring the juxtaposition of different academic domains that have a significant influence upon each other. The relationship centres on the engineering and computer science factors in learning technologies for surgery. Following a brief introduction to previous efforts developing surgical simulation, this thesis considers education and learning in orthopaedics, the design and building of a simulator for shoulder surgery. The thesis considers the assessment of such tools and embedding into a virtual learning environment. It explains how the performed experiments clarified issues and their actual significance. This leads to discussion of the work and conclusions are drawn regarding the progress of integration of distributed simulation within the healthcare environment, suggesting how future work can proceed

The Business of Health in Africa: Partnering With the Private Sector to Improve People's Lives

Examines the investments needed to meet the healthcare demands of sub-Saharan Africa and the policy changes needed to leverage the private sector, such as enforcing quality standards, fostering risk-pooling programs, and mobilizing public and donor funds