title: Reaching rural communities with culturally appropriate care: a model for adapting remote monitoring to American Indian veterans with posttraumatic stress disorder.
abstract: OBJECTIVE
  Providing specialized healthcare to rural communities can be extremely difficult, and consequently many health organizations are turning to the use of telehealth technologies for care delivery. One such technology, remote monitoring, has been successfully implemented with patients suffering from chronic and other medical conditions. A drawback, however, is that remote monitoring devices are programmed to reach a broad audience, and consequently the content may not be suitable for all patients-especially those who are not a part of the dominant culture.
  
  
  METHODS
  This report provides a model for adapting remote monitoring to specific populations who are undergoing care for posttraumatic stress disorder. Adaptation changes focus on (1) information gathering, (2) process and dialogue changes, (3) testing, and (4) patient and administrative feedback. Data for such modifications were gathered through a series of community meetings, patient interviews, and provider feedback. A case example highlights the successful implementation of the adaptation model for a rural American Indian Veteran population.
  
  
  RESULTS
  Patients showed high acceptability of both the programmatic and cultural adaptations. Feasibility of the program also appeared positive, with most patients reporting that the readability of the program was appropriate, the dialogue duration was not burdensome, and technical problems were rare.
  
  
  CONCLUSIONS
  Remote monitoring provides the ability to be modified for use with certain subpopulations. Procedural recommendations in this report highlight special considerations for working with American Indians living on or near reservation areas, although the model can be broadly adapted to several groups.
authors: Centers for American Indian and Alaska Native Health, University of Colorado-Denver, Aurora, CO 80045, USA. elizabeth.brooks@ucdenver.edu
authors: Elizabeth
authors: E
authors: Brooks
authors: Douglas K
authors: DK
authors: Novins
authors: Tim
authors: T
authors: Noe
authors: Byron
authors: B
authors: Bair
authors: Nancy
authors: N
authors: Dailey
authors: Jeff
authors: J
authors: Lowe
authors: W J Buck
authors: WJ
authors: Richardson
authors: Kara
authors: K
authors: Hawthorne
authors: Jay H
authors: JH
authors: Shore
mesh_terms: D054521:Cultural Competency; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D007198:Indians, North American; D018670:Monitoring, Ambulatory; D011570:Psychiatry / Q000458:organization & administration; D019035:Rural Health Services / Q000458:organization & administration; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology / Q000628:therapy*; D017216:Telemedicine / Q000295:instrumentation / Q000458:organization & administration*; D014481:United States; D014728:Veterans