title: Remote participants' experiences with a group-based stroke self-management program using videoconference technology.
abstract: BACKGROUND
  Telehealth is an all-inclusive term for the provision of health services using information and communication technology. Videoconference delivery is one form of telehealth whereby a synchronous, two-way audio and visual connection is made between two or more sites. Videoconference is used in remote areas to improve access to healthcare, perform individual clinical assessments and deliver group education. Moving On after Stroke (MOST®) is a group-based, self-management program for stroke survivors and their caregivers, which consists of information sharing, facilitated discussion, goal-setting, and exercise. This program was delivered simultaneously to local participants onsite in Thunder Bay, Canada, and distant participants in smaller, remote communities in Northwestern Ontario using videoconferencing (MOST-Telehealth Remote). The objective of this study was to explore the experiences of remote participants, their perceptions regarding factors that enable or limit videoconference participation, and to obtain suggestions for enhanced delivery of videoconferenced group programs.
  
  
  METHODS
  This qualitative study used an interpretive methodology. Semi-structured interviews were conducted in person with remote MOST-Telehealth Remote (MOST-TR) participants within one year post-program. Participants were recruited using purposive sampling and included both male and female stroke survivors and caregivers, those who participated alone and those who participated with others at the remote site. Twenty-seven people were approached, eight declined, and 19 agreed to participate. The average age of participants was 66.2 years (range 48-84). The interviews were transcribed and coded using NVivo v2.0 (www.gsrinternational.com). Data were analyzed for common categories using qualitative descriptive methods.
  
  
  RESULTS
  All participants valued access to the program without having to travel long distances. They felt safe in discussions and when exercising with the group across videoconference. Many reported 'feeling as if they were in the same room' but also acknowledged that there were limitations to participating via videoconference. Participants recognized a loss of subtleties in communication and the group facilitators found it difficult to discern whether participants were finding the exercises too difficult or too easy. The videoconference medium also limited participants' ability to privately or informally address concerns. Factors facilitating engagement and participation were similar to factors in face-to-face groups. Additionally, the importance of collaboration with onsite coordinators, volunteers, and other local participants was highlighted. Facilitators have the added responsibility of including all participants more explicitly, especially those offsite. Suggestions to improve group cohesion and participation included a preliminary face-to-face meeting with all participants, implementing technical strategies, and ongoing onsite support.
  
  
  CONCLUSIONS
  For MOST-TR participants, videoconference participation was valuable. Addressing the limitations of videoconference connection and enhanced local support may improve the experience for remote participants in small-group, videoconferenced, self-management programs. Using videoconference technology to participate in existing programs greatly increases accessibility for people living in remote areas.
authors.affiliation: St. Joseph's Care Group, Thunder Bay, Ontario, Canada. taylord@tbh.net
authors.forename: Denise M
authors.initials: DM
authors.lastname: Taylor
authors.forename: Sharon Dale
authors.initials: SD
authors.lastname: Stone
authors.forename: Maria P
authors.initials: MP
authors.lastname: Huijbregts
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D012424:Rural Population; D012648:Self Care / Q000523:psychology*; D012657:Self-Help Groups; D012944:Social Support; D000071939:Stroke Rehabilitation; D017216:Telemedicine; D049269:Videoconferencing