Discussion Forum 1

[kbalsara]

1. Using Telerehabilitation as a case study, put yourself in the shoes of an implementation facilitator, and reflect upon the fit of Telerehabilitation using the following discussion prompts:

• How does the proposed intervention fit with the priorities of your organizations?
• How does it fit with community values, including the values of diverse cultural groups?

2. Using the Telerehabilitation as a case study, put yourself in the shoes of an implementation facilitator, and reflect upon how to facilitate the Telerehabilitation using the following discussion prompts:

• What strategies could you use to target key stakeholders’ awareness, knowledge, attitudes, and intention to integrate the new intervention?
• What strategies could you use to target the motivation and capability of individuals and organizations to engage in implementation process strategies to integrate the new intervention?

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basically the telerebilitation fit my community in tanzania,as many people needs it due to, higher rate injury trafiic accident ,higher rate of chronic diseases,of higher rate women being faced by violance and marginalized
values are diverse but through advocacy ,training ,political will, policy in place and governance

strategies to be used is through
1..needs to asses how much they know knowledge ,attitude
2..involve the community leader,church leader,policy maker
3..community awareness..in radio ,TV,gatherings,in sports etc

training and advocacy to politician, leaders, traditional leader, the community in school, church ,bus stands, in ward meetings
intrgrate awarenes in policy, and in schools..involving stake holders and other implementing partners

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1.
Telerehabilitation allows patients to interact with providers remotely and can be used both to assess patients and clients

b.
Multicultural considerations in therapy can help a therapist avoid any offensive or inappropriate suggestions, behaviors, or reactions, enabling the client to feel safe opening up to their therapist. Using a person’s correct pronouns is an effective way for a culturally sensitive therapist to show the client respect.

2.

I recommend the integration of telerehabilitation into clinical training. However, experts’ opinions on key core knowledge and skills needed and the local contextual factors that might influence its adoption and implementation should be considered during the training. Approaching telerehabilitation training and integration in this way would provide guidelines for contextually relevant and sustainable telerehabilitation services across all clinical platforms.
b.
Share evidence-based information with your patient through diverse media, in an understandable language;. • Encourage active participation in thorough out the process.
for a safe and assertive telerehabilitation practice
Using simple words, simple commands for exercises, and avoiding technical language are also key valuable strategies to use during telerehabilitation.

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1. Using Telerehabilitation as a case study, put yourself in the shoes of an implementation facilitator, and reflect upon the fit of Telerehabilitation using the following discussion prompts:

• How does the proposed intervention fit with the priorities of your organizations?

Given that my organization is health research related;
=>Increased Access to Care: Telerehabilitation expands access to care for individuals who may face barriers to traditional in-person services, such as distance, transportation issues, or physical limitations.
=>Improved Efficiency: Telerehabilitation can reduce the time and resources required for delivering rehabilitation services, allowing therapists to see more patients and decrease wait times.
=>Cost-Effectiveness: Telerehabilitation can be more cost-effective than traditional in-person services, as it eliminates the need for travel and reduces the use of physical space and equipment.
=>Enhanced Patient Outcomes: Studies have shown that Telerehabilitation can produce similar or better outcomes than in-person services, particularly for conditions such as stroke

• How does it fit with community values, including the values of diverse cultural groups?

=>Accessibility: Telerehabilitation can be particularly valuable for communities with limited access to rehabilitation services. This includes rural areas, underserved populations, and individuals with mobility impairments or chronic conditions.
=>Cultural Sensitivity: Telerehabilitation providers must be culturally sensitive and understand the beliefs, values, and practices of diverse populations. This may involve providing language interpretation, accommodating religious preferences, and respecting cultural norms regarding physical contact and privacy.
=>Community Engagement: It is important to engage with the community early on in the implementation process to gather input and build support for Telerehabilitation. This can help ensure the intervention is tailored to the community’s needs and values.

2. Using the Telerehabilitation as a case study, put yourself in the shoes of an implementation facilitator, and reflect upon how to facilitate the Telerehabilitation using the following discussion prompts:

• What strategies could you use to target key stakeholders’ awareness, knowledge, attitudes, and intention to integrate the new intervention?
My focus would be on integration strategies such as;
=> Raising Awareness through involvement of stakeholders in public awareness events, webinars, social media campaigns, and targeted media outreach, highlighting the benefits of Telerehabilitation and addressing common misconceptions.
=>Building Knowledge: Conduct educational workshops and training programs specifically designed for each stakeholder group. This ensures tailored content addressing their specific concerns and needs. For instance, training healthcare providers on Telerehabilitation protocols, patient safety, and ethical considerations is essential for building their confidence and competence.
=>A change in mindset through Engaging stakeholders in pilot programs, showcasing success stories, and promoting peer-to-peer learning can help shift negative perceptions and foster a more positive attitude towards Telerehabilitation.
=>Fostering Intention: Addressing concerns, outlining clear benefits, and demonstrating feasibility can help solidify stakeholder intention to integrate Telerehabilitation. This could involve providing financial incentives, streamlining reimbursement processes, and offering practical support during the initial implementation phase.

• What strategies could you use to target the motivation and capability of individuals and organizations to engage in implementation process strategies to integrate the new intervention?
My focus would be on capacity building strategies such as;
=> Building Ownership: Involving stakeholders in the planning and decision-making process promotes a sense of ownership, leading to greater investment and commitment.
=>Highlighting the Value Proposition: Clearly outlining the benefits of Telerehabilitation – improved patient outcomes, increased efficiency, cost savings – can be instrumental in motivating stakeholders to invest their time and resources.
=>Facilitating Collaboration: Encouraging collaboration between healthcare providers, patients, researchers, and technology developers can foster innovation and drive continuous improvement in Telerehabilitation delivery.
=>Providing Training and Resources: Accessible and tailored training programs, technical support, and ongoing educational resources are essential for equipping individuals and organizations with the necessary skills and knowledge to effectively utilize Telerehabilitation.

• This reply was modified 3 weeks, 4 days ago by [email protected].

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1. Using Telerehabilitation as a case study, put yourself in the shoes of an implementation facilitator, and reflect upon the fit of Telerehabilitation using the following discussion prompts:

• How does the proposed intervention fit with the priorities of your organizations?
=>Increased Access to Care: telerehabilitation on improving physical activity, physical function, and quality of life in patients. Telerehabilitation is effective, safe, and feasible in patients with chronic obstructive pulmonary disease,[15] patients with coronavirus disease 2019 (COVID-19) and patients undergoing chemotherapy.
=>Improved Efficiency: telerehabilitation services are more cost-effective and, at the same time, have the same treatment results compared to traditional (face-to-face) rehabilitation.
=>Cost-Effectiveness:Due to the moment-to-moment access to treatment, telerehabilitation improves treatment compliance, reduces trips to the doctor’s office, and ultimately improves patient satisfaction.
=>Enhanced Patient Outcomes: telerehabilitation for patients after knee arthroplasty, in contrast to traditional rehabilitation, had a better effect on functional improvement and subsequently the quality of life of patients.
• How does it fit with community values, including the values of diverse cultural groups?

2. Using the Telerehabilitation as a case study, put yourself in the shoes of an implementation facilitator, and reflect upon how to facilitate the Telerehabilitation using the following discussion prompts:

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1. The use of Telerehabilitation as an intervention to reduce the number of people with unmeant rehabilitation need in Uganda by the Uganda ministry of health fits directly with the priorities of the ministry since this reduces on the expenses required to have a rehabilitation specialist travel to different parts of the country to attend to the different clients.
The is improved mobile network coverage and many Ugandan are now using smart phones this is evident that use of telerehabilitation will easy be adopted by different cultures since the shared information can easily be translated into different languages.
Currently there are no cultural limitations to use of phones and the issues of privacy can be address through software encryption.
The people in remote communities will easily appreciate telerehabilitation since they will not have to incur an extra transportation cost to have checkups and reviews during the rehabilitation process.

2. To the different stakeholder on board I will employ the five engagement levels of the international association for public participation and this will include;- sharing information across all national media channels to alert them of the new proposed intervention and later I will have to call for a physical stakeholders meeting to consult them of what they think of the Telerehabilitation innervation since their feedback is very important and a good number of the stakeholders will be identified and involved in developing the materials to be incorporated in the telerehabilitation intervention. These stakeholders will include both the inner context like the rehabilitation professionals who will be providing the service and the managers of the facilities where they work for proper implementation of the intervention.

To increase motivation and capacity of the individuals and organisations involved in the implementation of the telerehabilitation strategy, I will use the capacity building strategy which will include training all rehabilitation staff and facility managers involved in the implementation of the use of the telerehabilitaion software and also allocation of allowance for providing this service.

CPDs programs will be implemented in all health facilities educate all health workers on how to advice patients on how to use this service.
Training and advocacy to political leaders, traditional leader, the community meetings, school, churches on the use and benefits of the new proposed telerehabilitation intervention.

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Today, rehabilitation is considered an integral part of Universal Health Coverage services. Rehabilitative services are essential to ensuring the population improves their quality of life. Increasing access to rehabilitation through telerehabilitation services fits well with the Kenyan rehabilitation and assistive technology strategy of 2022-26. There a huge unmet need for rehabilitation for especially people who reside in the hard -to -reach areas and the Kenyan government has a shortage of rehabilitation personnel to serve this need. The rehabilitation personnel have limited skills and knowledge on telerehabilitation and this can be explored and addressed. Although most Kenyan use a mobile phone, quite a number do not have smart phones and some areas have poor connectivity of electricity. However, the intervention of telerehabilitation is a grant idea.
Culturally, there are no limitations in use of mobile phones, though as mentioned, most populace do not have a smart phone and use of such devices may be limiting due to low literacy levels. Capacity building needs to be conducted if the community welcome the idea of the telerehabilitation intervention.
To enhance the acceptability of the telerehabilitation intervention, I will engage policy makers, stakeholders and right holders in sensitization meetings, so as that an informed decision is made and way forward arrived at. I will consult several data sources to identify the need for tele rehabilitation, consult the rehabilitation teams about their expertise in this field and where necessary plan for training of staff. AS a team, we shall come up with a detailed telerehabilitation program with a monitoring and evaluation plan.

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1. Using Telerehabilitation as a case study, put yourself in the shoes of an implementation facilitator, and reflect upon the fit of Telerehabilitation using the following discussion prompts:

• How does the proposed intervention fit with the priorities of your organizations?
1. Increase accessibility improve access to rehabilitation services, especially for patients in remote or underserved areas
2. Technology and innovation: using digital tools for rehab services is important
3. Cost effective
4. Improve patient outcome especially continuing of care which is key priority of our organization. But we need to integrate current rehab program, train our staff and prepare infrastructure etc.
• How does it fit with community values, including the values of diverse cultural groups?
1. Community values: accessibility and equity. It will help decreasing healthcare gap. Patient centered outcome and family or carers’ involvement.
2. Cultural values: multilanguage is important, respect tradition, involve community leaders.

2. Using the Telerehabilitation as a case study, put yourself in the shoes of an implementation facilitator, and reflect upon how to facilitate the Telerehabilitation using the following discussion prompts:

• What strategies could you use to target key stakeholders’ awareness, knowledge, attitudes, and intention to integrate the new intervention?
We will organize webinars, workshops, use champion history or cases, distribute information through multi channels, encourage pilot studies, hand on demonstration etc.
• What strategies could you use to target the motivation and capability of individuals and organizations to engage in implementation process strategies to integrate the new intervention?
Leadership top-down support which align strategic goals, partnership cooperation, capacity building (training), evaluation and use feedback mechanisms.

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2a) What strategies could you use to target key stakeholders’ awareness, knowledge, attitudes, and intention to integrate the new intervention?
My focus would be on integration strategies such as;
– Conduct a stakeholders’ meetings and get to assess what their thoughts, knowledge, attitude towards the new initiative, introduce the intervention to them and let them brainstorm about what to adapt and what not. Address the pros and cons of the intervention, cost, and intended outcome among others. Share knowledge on policies that support the intervention.
2b) What strategies could you use to target the motivation and capability of individuals and organizations to engage in implementation process strategies to integrate the new intervention?
My focus would be on capacity building strategies such as;
Involving then, capacity building their knowledge gap on matters of the new intervention, collaborate with them, inform, consult and empower them. Its important for them to accept and own the new intervention.

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Community engagement and educational initiatives must be part of implementation strategy to ensure that everyone can effectively utilize telerehabilitation services

Building trust with diverse cultural group is essential

Telerehabilitation can significantly improve access to care for underserved populations, align with community values around equity and inclusion /

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1. Telerehabilitation is defined by ReLAB-HS as, “the delivery of rehabilitation services using information and communication technologies and is proposed as an alternative to in person consultation to provide rehabilitation.” Furthermore, it “encompasses a range of rehabilitation services that include assessment, monitoring, therapy, prevention, supervision, education, consultation, and counseling.”
This proposed intervention supports the priorities to increase access to rehabilitation services for those with unmet needs in an equitable and resource-efficient way. It recognizes that in LMICs rehabilitation services are limited in scale and scope of practice leaving many without access to rehabilitation care. Additionally, as an evidenced-based practice driven organization, telerehab is promising because promising evidence is emerging to support it’s impact and cost-effectiveness. Importantly, telerehab can also be used for professional development of local staff to increase the strength of the local health system, and perhaps ultimately decrease the initial significant need for remote services.
Regarding it’s fit with community values, I would need to study the intended group as there is no “one-size fits all” approach to rehabilitation in general, but in particular regard to community values. For example, some communities may have gender preferences for clinicians. Other communities may have community concerns over the use of technology, particularly on religious holy days. Engaging all stakeholders can help develop a telerehab program that is suitable to the intended community, and ultimately avoid culturally insensitive words or actions.

2. For a stakeholder analysis I would use the pre-implementation strategies of qualitative, in-depth research, including key informant interviews and surveys to assess true stakeholder engagement and staff/organizational readiness, needs and capacity. I would use information from other implementation efforts to contextualize the current situation and help inform changes at this pre-implementation stage. I could use dissemination strategies such as developing intervention advertising to targeted participants. Project Last Mile, supported by the CocaCola Foundation, Gates Foundation, USAID and PEPFAR has had tremendous success in this area. They’ve been able to leverage Coca-Cola’s distribution expertise to help navigate supply chain management issues in African LMICs while also using their branding expertise. (www.projectlastmile.com) In this way, they support both the supply and the demand for healthcare services. I would closely examine the guideposts they have used, and shared, to help promote uptake of services – and to ensure that those services are unique and intentional to the community at hand.

Integration strategies which optimize intervention accessibility and success include reminder systems, staff coaching, regular review of staff roles, process and procedures. I have worked at NYP-Cornell Weill Medical Center in NYC and over the years I have seen meetings such as these transform from a top-down to a blend of bottom-up feedback. Now, they are referred to as “Town Hall Meetings” giving staff a chance to voice what is working and what isn’t. This allows training sessions to be more informative as they can be tailored to areas of need, rather than rudimentary review of areas already successfully adopted.
Capacity building strategies aim to improve the motivation and capability of organizations, offering technical assistance and opportunities for peer working and developing. Leadership offers individuals the opportunity to grow their professional and leadership skills. By fostering a a learning and networking environment, the organization, and our intervention of telerehab, has the best chance of success. Again, I refer to Project Last Mile – an organization I studied in a supply chain management class. Specifically, I am thinking of the “Girl Champ” brand that was developed in eSwatini to support adolescent girls and young women decrease their risk of HIV infection. (1). Networking allows transfer and development of thought and experience leading to broader and more encompassing outcomes for the organization than a linear, top down approach.

(1) Brault, M. A., Christie, S., Aquino, S., Rendin, A., Manchia, A., Curry, L. A., & Linnander, E. L. (2021). Project Last Mile and the development of the Girl Champ brand in eSwatini: engaging the private sector to promote uptake of health services among adolescent girls and young women. SAHARA-J: Journal of Social Aspects of HIV/AIDS, 18(1), 52–63. https://doi.org/10.1080/17290376.2021.1894224

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-How does the proposed intervention fit with the priorities of your organization?
This intervention aligns with our organization’s values ​​of making healthcare services accessible to all. Our country is spread over a vast area, so many places are far away from healthcare. Therefore, the introduction of telerehabilitation will not only increase the availability of care services but also reduce the number of people with disabilities.
-How does it fit with community values, including the values of diverse cultural groups?
This intervention will be cost-effective and time-saving, making it accessible to the public. We will make a list of the limitations of implementing such intervention in culturally different areas. In my opinion, there will be no restrictions on telerehabilitation.
-What strategies could you use to target key stakeholders’ awareness, knowledge, attitudes, and intention to integrate the new intervention?
We need to emphasize the importance and efficiency of attracting and engaging stakeholders. Schedule regular meetings and training sessions to ensure that stakeholders are fully informed.
-What strategies could you use to target the motivation and capability of individuals and organizations to engage in implementation process strategies to integrate the new intervention?
We will make profitable offers to organizations and individuals. We will provide methodical advice, consulting services, long-term cooperation agreements, etc to cooperating organizations. However, participation and leadership will be increased by providing non-financial support to individuals such as improving their knowledge, supporting them to learn new things, attending training, etc.

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• How does the proposed intervention fit with the priorities of your organizations?
Looking at the inner context, telerehabilitation fits within the organization priorities as there is a priority/mission to ensure healthy populations, and telerehabilitation enables greater access and availability of rehab services for all. It also fits within the larger national rehab strategy and goals of ensuring greater and equitable access to rehab services, particularly for those within remote/rural areas. It also enables economies of scale as you are able to use less resources but reach more people, and this helps address some of the challenges related to shortage or rehab/AT professionals. The only challenge is the lack of ICT infrastructure in the country. While there is a strategy to strengthen ICT across the country, how and where telerehabilitation will be delivered will have to be closely aligned with ICT priorities.

• How does it fit with community values, including the values of diverse cultural groups?
Now looking at the outer context, telerehabilitation fits in terms of values related to affordability and access. However, Tanzania is a very person-centered culture where relationships are very important and in-person care and service is needed to build relationships. For this reason, there may be some populations that may be hesitant to use telerehabilitation but I believe that the values of affordability (i.e. reducing transport costs/opportunity costs associated with travelling to get rehab services, particularly for those in remote areas) and accessibility (being able to access care closer to home) will outweigh some of the importance placed on in-person care.

• What strategies could you use to target key stakeholders’ awareness, knowledge, attitudes, and intention to integrate the new intervention?
Engagement of key stakeholders at the design of the implementation and in the implementation process itself will be very important. Engaging with clinical staff, management, key policy makers/decision makers, and clients/users in various capacities will be important to raise awareness, knowledge, attitudes and intention of the intervention.

• What strategies could you use to target the motivation and capability of individuals and organizations to engage in implementation process strategies to integrate the new intervention?
Anchoring messages on what telerehabilitation can do for rehab services in the country and targeting these messages to each different stakeholder group will be important. In addition, providing individuals and staff within an organization with the right training and tools to effectively deliver the intervention is one way to motivate and engage them. Staff can be involved in the design of the intervention (i.e. how to roll it out, where to roll it out, where to pilot, etc.) and this will make them have more ownership towards the intervention.

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>How does the proposed intervention fit with the priorities of your organizations?>Increased Access to Care: Tele rehabilitation expands access to care for individuals who may face barriers to traditional in-person services, such as distance, transportation issues, or physical limitations.
Cost-Effectiveness: tele rehabilitation improves treatment compliance, adherence reduces stress of covering long distance to meet the health worker or follow up appointment hence enhancing patients recovery process
>How does it fit with community values, including the values of diverse cultural groups?
community engagement is essential, the engagement starts early during implementation process to collect facts and generate support for Tele rehabilitation. This can help ensure the intervention is focus to community’s needs and values with respect to preferred language, cultural norms and religious background or beliefs and taboos
>What strategies could you use to target key stakeholders’ awareness, knowledge, attitudes, and intention to integrate the new intervention?
Evaluation and use of feedback mechanisms and training programs, possible support, and continuous educational resources are beneficial for equipping individuals and organizations with the necessary skills and knowledge to effectively deliver evidence Tele rehabilitation .

>What strategies could you use to target the motivation and capability of individuals and organizations to engage in implementation process strategies to integrate the new intervention?
Capacity building strategies focus at improving the and capability of organizations and motivation of its staff, giving opportunities for individual development and career to grow their professional and leadership skills.

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>How does the proposed intervention fit with the priorities of your organizations?>Increased Access to Care: Tele rehabilitation expands access to care for individuals who may face barriers to traditional in-person services, such as distance, transportation issues, or physical limitations.
Cost-Effectiveness: tele rehabilitation improves treatment compliance, adherence reduces stress of covering long distance to meet the health worker or follow up appointment hence enhancing patients recovery process
>How does it fit with community values, including the values of diverse cultural groups?
community engagement is essential, the engagement starts early during implementation process to collect facts and generate support for Tele rehabilitation. This can help ensure the intervention is focus to community’s needs and values with respect to preferred language, cultural norms and religious background or beliefs and taboos
>What strategies could you use to target key stakeholders’ awareness, knowledge, attitudes, and intention to integrate the new intervention?
Evaluation and use of feedback mechanisms and training programs, possible support, and continuous educational resources are beneficial for equipping individuals and organizations with the necessary skills and knowledge to effectively deliver evidence Tele rehabilitation .

>What strategies could you use to target the motivation and capability of individuals and organizations to engage in implementation process strategies to integrate the new intervention?
Capacity building strategies focus at improving the and capability of organizations and motivation of its staff, giving opportunities for individual development and career to grow their professional and leadership skills.

[[email protected]]

1. Using Tele rehabilitation as a case study, put yourself in the shoes of an implementation facilitator, and reflect upon the fit of Tele rehabilitation using the following discussion prompts:
• How does the proposed intervention fit with the priorities of your organizations?
Tele rehabilitation increase access to patients care especially those who may not have chance to travel due to bad weather ,long distance or financial constrain
• How does it fit with community values, including the values of diverse cultural groups?
Engagement of community is essential as it starts early right from implementation process to collect data and fact to generate possible solution to the needs that require Tele rehabilitation which the intervention is focus on community needs with respect to preferred language, taboos and religious beliefs

2. Using the Tele rehabilitation as a case study, put yourself in the shoes of an implementation facilitator, and reflect upon how to facilitate the Tele rehabilitation using the following discussion prompts:

• What strategies could you use to target key stakeholders’ awareness, knowledge, attitudes, and intention to integrate the new intervention?
use of feedback and evaluation strategies and enhancing capacity building training of individual and organization while embracing motivation as key factor.
• What strategies could you use to target the motivation and capability of individuals and organizations to engage in implementation process strategies to integrate the new intervention?
Capacity building strategies that focuses on improving the organization and giving opportunity to individual development ,career support to exercise their leadership talents.

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-How does the proposed intervention fit with the priorities of your organization?
The intervention aligns with our organizational mission, which is to provide the highest possible level of health services to all people in Uganda through delivery of promotive, preventive, curative, palliative and rehabilitative health services at all levels”. My Country Uganda has a big population with diverse cultural heritage. Therefore the introduction of Tele rehabilitation will increase the availability and provision of health services , and above all inclusion for all.

-How does it fit with community values, including the values of diverse cultural groups?
Tele rehabilitation will make health services accessible to all, since the medium is cost effective and not time consuming in reach. Different cultural groups will embrace the intervention positively without limitations’, However, In Uganda the Rural setting that comprises of low income earners ,highly peasants may face the challenge of poccessing the gadgets to use, the resources to keep updated always like having sustainable data plus reliable network.

-what strategies could you use to target key stakeholders’ awareness, knowledge, attitudes and intention to integrate the new intervention?
Through thorough involvements, making the stake holders part ad partial of the company, organizing regular meetings, capacity building, and as well encouraging feed back sessions for evaluation.

-what strategies could you use to target the motivation and capabilities of individuals and organizations to engage in implementation process strategies to integrate the new intervention?
capacity building through trainings and workshops emphasizing the organizational goal and vision, appreciation and recognition to good performers inorder to motive other employees, bottom-top face to face interactions for clarity and comfort to create a sense of belonging in the organization, the giving opportunities for career growth would boast the productivity of the organization.

[Oda Msuha]

1. -Telerehabilitation could fit within our organization/country particularly in a way of expanding health care accessibility as a single staff can reach out many client including those who come from remote areas and those with difficult transport requirement example those who are using wheelchair which is too costful to higher a private means of transport with the barrier of infrastructures. Thus through Telerehabilitation it will help to promote health care outcome but challenges is lack of awareness of the technology, training for provider and limited internet network in some areas.
-Telerehabilitation will fit with most of community values as it promotes family and community support as the patient does not need to travel far away from home in order to access service is it will be within their reach and this can help to speed recovery as the patient will be happy to see his/her family member with her or him.
also in terms of cost, its cost effective because no need for transport cost. also the patient will be comfortable has she/he wont need to travel far to acquire service.
again it can promote equity as both urban and rural individuals will be able o access the same quality of care this also enhance population from primary care hospital to get similar service
Also it saves time.
2.Dissemination strategies which will involve developing evidence informed interventions thorough employing cost effective data and promoting it to targeted specific group and tell out how it has been beneficial or has help in the community by holding meetings with them to strengthen the evidence to whom and what conditions the intervention has been effective and/or not helpful
– capacity building strategies which will involve providing training , technical assistance, tools and facilitation to support implementation process by knowing how costful and what the resources are needed. also it will help to establishing opportunity to peer networking together with experties so has to promote or improve services to the organization

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1. Using Telerehabilitation as a case study, put yourself in the shoes of an implementation facilitator, and reflect upon the fit of Telerehabilitation using the following discussion prompts:

• How does the proposed intervention fit with the priorities of your organizations?

In Uganda, Ministry of Health is mandated to handle all related health issues and within the Ministry, there is a division of Disability and Rehabilitation that handles any rehabilitation and AT issues within the country and the mission is to provide the highest possible level of health services to all people in Uganda through delivery of rehabilitative health and AT services at all levels. The division is also aligning the rehabilitation and AT strategic plan to the other health policies. Since the ministry is trying to achieve the Universal health coverage by taking rehabilitation and AT services to the last mile, embracing telerehabilitation to help in the assessment, referral and management of patients who need rehabilitation and AT services from the community or primary health care workers to rehabilitation professionals. The division is also prioritizing data capturing for rehabilitation and AT services to help in advocacy and policy for rehabilitation and AT.

• How does it fit with community values, including the values of diverse cultural groups?

The telerehabilitation Apps used by ReLAB-HS in Uganda and by the primary health care workers was designed in consultation with other stakeholders in which the community values and the diversity of the culture was taken in to consideration. It capture the vital information required by the ministry of health policy. It capture the data which was already being captured within the health facilities in addition to the rehabilitation need information.

2. Using the Telerehabilitation as a case study, put yourself in the shoes of an implementation facilitator, and reflect upon how to facilitate the Telerehabilitation using the following discussion prompts:

• What strategies could you use to target key stakeholders’ awareness, knowledge, attitudes, and intention to integrate the new intervention?

Engagement with key stakeholders at the policy level pointing out the need to shift to technology to ease service delivery in rehabilitation field. Highlighting the benefit the intervention will bring in the service delivery of rehabilitation. Enhances their knowledge on the telerehabilitation apps, how it will work and data capturing of the rehabilitation services, how the technology will help save money on human resource since the already available primary health care worker cand be trained to use the app and no need to higher rehabilitation professionals up to community level.

• What strategies could you use to target the motivation and capability of individuals and organizations to engage in implementation process strategies to integrate the new intervention?

Designing an awareness raising strategy which spells out clearly what telerehabilitation is and why telerehabilitation mode of service delivery. Pointing out the benefit of embracing telerehabilitation, the shortcoming and how it will take rehabilitation services to the last mile, the ability of data capturing and achieving more.

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1. The proposed intervention fit with the priority of my organization in the following points
a) My organisation is forcusing improving accessibility of rehabilitation services in our region through involving tele-rehabilitation. We have done the preliminary studies to feasibility of tele rehab in Tanzania (Shayo, M.J., Shayo, P., Haukila, K.F., Norman, K., Burke, C., Ngowi, K., Goode, A.P., Allen, K.D., Wonanji, V.T., Mmbaga, B.T. and Bettger, J.P., 2023. Expanding access to rehabilitation using mobile health to address musculoskeletal pain and disability. Frontiers in Rehabilitation Sciences, 3, p.982175.). In short it is our priority.
2. There is an on going study where we have reached a stage of developing physiotherapy prescription bank, and in this study we have preliminarly identified that about 98% of 300(n)adults with MSK attending our clinic use mobile phone, of them 64.7% use smart phone and 94% of them use it personally while 6% share the phone with another person.
Ninety four percent charge their phones with electricity at home, those who use text messages 100% (300N) can read them without help, 96% can write them without help. Through this preliminary results we have seen indicators that if tele-rehabilitation starts at our organisation; the community has phone, and by using text message many will be able to get the information, although majority use smart phone we may miss others if we start using videos in such group, however level of literacy is sufficient for basic communication and provision of printed exercise program for home use with text or call reminder

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1. Using Telerehabilitation as a case study, put yourself in the shoes of an implementation facilitator, and reflect upon the fit of Telerehabilitation using the following discussion prompts:
• How does the proposed intervention fit with the priorities of your organizations?
• How does it fit with community values, including the values of diverse cultural groups?

Response : The proposed intervention fit with the priorities of our organization which intends to improve access of the population to rehab services. Telerehab seems to be an innovative way to ease the offer of rehab services at the lowest cost and with the potential to reach the most remote located clients… Actually, the use of technologies to improve communication and the spread of information and knowledge is gaining place inside diverse cultural groups. Community values may not hinder the fitness of telerehab as an intervention, but some factors like low maintenance, misuse and damage, language barriers, mindset…may negatively affect the implementation outcomes and sustainment.

[Yasmin Garcia Mendez]

Using Tele-rehabilitation as a case study, put yourself in the shoes of an implementation facilitator, and reflect upon the fit of Tele-rehabilitation using the following discussion prompts:

How does the proposed intervention fit with the priorities of your organizations?
The priority of PAHO regarding rehab and AT is to increase access and strengthen them within health system. So far, systematic assessments of the rehab situation and AT capacity have shown a lack of trained professionals to delver rehab and AT interventions. Tele-rehabilitation would fit with the priorities as it will help to reduce the gaps in access due to lack of rehab workforce.

How does it fit with community values, including the values of diverse cultural groups?
We will need to explore this more in depth as we work with different countries, different communities within countries. This will need to be explored in a case by case scenario. For example, there are some indigenous communities who cannot be photographed or video recorded due to religious and culturural beliefs. But, some larger cities welcome technology innovations.
In some countries of the Americas Region, we have observed that people change phone numbers very often and this hinder the possibility to follow up. We learned about this with a wheelchair study we implemented in El Salvador, we lost to follow up several users due to this factor.

Post your thoughts on the Discussion Board. Look at the posts of your peers. Are there similar thoughts? How do they differ?
They differ in that most of my peers have already experience implementing Tele-rehabilitation whereas we don’t have yet. And other difference is that they mostly come from implementing organizations whereas we, as PAHO do not implement but provide technical support to Ministries of Health in the assessment, planning, and monitoring and evaluating their strategic plans, and so far not in implementing.

What strategies could you use to target key stakeholders’ awareness, knowledge, attitudes, and intention to integrate the new intervention?
Dissemination strategies such as social media campaigns for clients, advertising and educational sessions in professional associations meetings, high-level forums for policy/decision makers and org managers/administrators.

What strategies could you use to target the motivation and capability of individuals and organizations to engage in implementation process strategies to integrate the new intervention?
Capacity building strategies such as providing training and technical assistance, workshops and round tables, peer networking opportunities such as professional conferences, etc.

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1. Using Telerehabilitation as a case study, put yourself in the shoes of an implementation facilitator, and reflect upon the fit of Telerehabilitation using the following discussion prompts:

• How does the proposed intervention fit with the priorities of your organizations?
Telerehabilitation aligns well with my organization’s priorities and includes increased accessibility: Telerehabilitation can extend rehabilitation services to patients in remote or underserved areas who may have difficulty accessing in-person services, as well as cost efficiency: By reducing the need for physical infrastructure and travel, telerehabilitation can lower the costs of delivering rehabilitation services.

• How does it fit with community values, including the values of diverse cultural groups?
Telerehabilitation has the potential to fit well with community values as it addresses several key areas:
Equity and Inclusion: Telerehabilitation bridges the gap for communities that face barriers to accessing traditional rehabilitation services, promoting health equity.
Respect for Cultural Practices: With cautious implementation, telerehabilitation can be adapted to respect and integrate cultural practices and preferences, ensuring culturally competent care.

2. Using the Telerehabilitation as a case study, put yourself in the shoes of an implementation facilitator, and reflect upon how to facilitate the Telerehabilitation using the following discussion prompts:

• What strategies could you use to target key stakeholders’ awareness, knowledge, attitudes, and intention to integrate the new intervention? Stakeholder identification, analysis, and engagement. Workshops, webinars, and training sessions for stakeholders.

• What strategies could you use to target the motivation and capability of individuals and organizations to engage in implementation process strategies to integrate the new intervention? Incentives, Support Systems, Resource Allocation, Change Champions, Clear Guidelines and Protocols, and Monitoring and Feedback mechanisms.

[Zaynab Khalfan]

As an implementation facilitator for Telerehabilitation, it is crucial to first assess how this proposed intervention aligns with the priorities of the organizations involved. In this case, Telerehabilitation offers the potential to improve access to rehabilitation services, increase efficiency, and reduce costs, which are likely priorities for healthcare organizations aiming to provide high-quality care while managing resources effectively.

Next, considering how Telerehabilitation fits with community values, including those of diverse cultural groups, is essential. It is important to ensure that the implementation of Telerehabilitation respects and aligns with cultural values and preferences. This may involve adapting the intervention to be culturally sensitive, providing language support, and involving community members in the planning and delivery of services.

As for facilitating the implementation of Telerehabilitation, targeting key stakeholders’ awareness, knowledge, attitudes, and intention to integrate the new intervention is critical. Strategies could include conducting educational sessions, providing evidence-based information on the benefits of Telerehabilitation, and addressing any concerns or misconceptions that stakeholders may have.

To target the motivation and capability of individuals and organizations to engage in the implementation process, strategies such as providing training and support, establishing clear communication channels, and involving stakeholders in decision-making can be effective. It is also important to monitor progress, gather feedback, and make adjustments as needed to ensure successful integration of Telerehabilitation into existing healthcare systems.

[Yasmin Garcia Mendez]

To what extent have local organizational structures, networks, and culture supported the implementation of the new intervention?
This can be measured from the planning to the implementation processess.
The inner context can prevent or hinder the successful implementation of an EIRI. The organizational structure outlines how rules, roles and responsibilities are directed to achieve the goals for the organization and thereby the rehabilitation interventions provided. The organizational structure, can thereby, facilitate or place barriers to the implementation of an EIRI. Same as the culture of the organization.

To what extent has the implementation of the new intervention been responsive to clients’ group demographics, knowledge, beliefs, and self-efficacy?
This will only be responded after evaluating the outcomes of the intervention implementation.

[Yasmin Garcia Mendez]

To what extent is there leadership, an evidence-informed practice culture, and a support network that is supporting the sustainment of the intervention?
There is a significant lack of leadership in many countries where we work.

To what extent are there external policy drivers, incentives, or regulatory frameworks that are supporting the sustainment of the intervention?
These are inexistent in most of the countries.

[Yasmin Garcia Mendez]

Using Telerehabilitation as a case study, refer to one of the three key determinants of capacity building and reflect on what factors may influence the use of implementation science in Telerehabilitation.
Referring to the workforce capacity, the lack of knowledge, skills and abilities, as well as the involvement in design, conduct and evaluate implementation effors are factors that will influence implementation science in tele-rehabilitation.

Reflect on how the factors that may influence your own organization’s use of implementation science.
The motivations, leadership, trust and culture might not be aligned with implementation science in my unit yet.

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2. Using the Telerehabilitation as a case study, put yourself in the shoes of an implementation facilitator, and reflect upon how to facilitate the Telerehabilitation using the following discussion prompts:

• What strategies could you use to target key stakeholders’ awareness, knowledge, attitudes, and intention to integrate the new intervention?

Response: communication strategies like messages on the benefits of telerehab through medias, one to one communication with sensitization flyers or other mass communication tools, organizing training sessions to targeted groups, …

• What strategies could you use to target the motivation and capability of individuals and organizations to engage in implementation process strategies to integrate the new intervention?

To target the motivation and capability of insividuals and organizations, i can distribute prototype of the telerehab and encourage periodic reporting on the use and regular follow up, i would also put in place networks to encourage experience exchange among users, organize continuous training sessions, put in place reward and accountability systems for organizations which integrated the new strategies, …

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Facilitating Telerehabilitation Implementation
1. Targeting Key Stakeholders’ Awareness, Knowledge, Attitudes, and Intention

Awareness Campaigns:
– Presentations and workshops
– Educational materials
– Online presence

Knowledge Enhancement:
-Training programs
-Webinars and e-learning
-Resource portals

Attitude Adjustment:
-Role models and champions
-Patient testimonials
-Addressing concerns

Intention to Integrate:
-Pilot programs
-Incentives
-Policy and procedure alignment

Targeting Motivation and Capability for Implementation

Motivation:
-Clear value proposition
-Goal setting
-Feedback mechanisms

Capability:
-Skill development
-Technical support
-Resource allocation

Organizational Engagement:
-Leadership buy-in
-Implementation teams
-Interdepartmental collaboration

Continuous Improvement:
-Monitoring and evaluation
-Iterative feedback
-Success celebrations

[[email protected]]

As an implementation facilitator for Telerehabilitation, I would use a multi-faceted approach to target key stakeholders’ awareness, knowledge, attitudes, and intentions to integrate the new intervention. First, I would organize informational sessions and workshops to educate stakeholders about Telerehabilitation’s benefits, evidence, and practical aspects. Creating tailored communication materials, such as brochures and videos, highlighting success stories and case studies would reinforce positive attitudes. Engaging stakeholders through interactive Q&A sessions and involving them in pilot projects could foster a sense of ownership and commitment.

To target the motivation and capability of individuals and organizations, I would implement capacity-building strategies such as training programs and continuous professional development opportunities focused on Telerehabilitation. Providing technical support and resources, including user-friendly guides and troubleshooting assistance, would enhance capability. Additionally, establishing a support network or community of practice among practitioners can facilitate knowledge exchange and peer support, maintaining motivation. Regular feedback and recognition of early adopters’ successes can further incentivize engagement.

Reflecting on peers’ posts, I notice similar strategies emphasizing education, stakeholder engagement, and capacity-building, though some may differ in specific tactics based on their organizational contexts and resources. Comparing these approaches can provide valuable insights for refining our implementation strategies.

[Samuel Lagu]

1. Awareness creation strategies like webinars, conferences, seminars, workshops, publications, and briefing Communication strategies. Regular communication to provide updates to stakeholders, reinforce the benefits, and remind stakeholders of their commitment to integrating the intervention.
Sharing of success stories through scripts and documentaries.

2. Provide training to all the health workers and stakeholders involved in the intervention,
Providing real-time feedback through agreed channels
Encouraging cross-learnings
Provision of the necessary support, mentorship, and supervision.
Availability of data and gadgets to be used.

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Qn 1
How does the proposed intervention fit with the priorities of your organizations?
Increased patient consultations(hence lesser queues), improved quality of services, increased geographical coverage especially in rural areas
• How does it fit with community values, including the values of diverse cultural groups?
Given the wide use of phones and smart phones, this intervention will be widely acceptable. Education and awareness generation activities will be needed to remove some scepticism/lack of trust which might be available in the beginning

Qn 2
What strategies could you use to target key stakeholders’ awareness, knowledge, attitudes, and intention to integrate the new intervention?
Stakeholder engagement from the beginning, including engagement during the design of the intervention and regular touchpoints during implementation to update or modify the intervention based on feedback

• What strategies could you use to target the motivation and capability of individuals and organizations to engage in implementation process strategies to integrate the new intervention?
Getting buy in from the beginning, understanding the needs of the organisations to implement the intervention, creating the intervention to be usable and fit for the context

[Author]

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