Low-Bandwidth Telephony for Urban and Rural Access to Nursing Services for Survivors of Stroke and Their Caregivers

Trends related to rapidly aging populations nationally and internationally, combined with shortages in skilled health professionals and rising health care costs have necessitated efficient and cost-effective technologies for improved access to health care services. This paper discusses the use of low-bandwidth telephonic technology for providing nursing and counseling services to stroke caregivers in urban and rural areas and addresses factors that affect adoption and utilization of technologies for their intended use. Twenty-one subjects with recent stroke and their caregivers and five nurses were enrolled in the study. Seventy-two telehealth visits (i.e. tele-visits) were made to urban and rural locations using standard plain-old-telephone-service (POTS). Eighty-three percent of televists experienced first-time completion success at a bandwidth of 27.6+3 kbps. Over one-third (36%) of visits were unsolicited and initiated by caregivers using the protocol. Each tele-visit lasted approximately 20 minutes. Televisit sessions ranged from providing health care instruction for caregivers to stroke-related education to caregiver counseling. Televists were widely accepted by stroke subjects and caregivers. Acceptance and utilization of telehealth services correlated with rapport between at-home users and nurses.