title: Spanning boundaries into remote communities: an exploration of experiences with telehealth chronic disease self-management programs in rural northern ontario, Canada.
abstract: BACKGROUND
  In rural and remote settings, providing education programs for chronic conditions can be challenging because of the limited access and availability of healthcare services. The purpose of this study was to explore the experiences of participants in a chronic disease self-management program via telehealth (tele-CDSMP) and to identify facilitators and barriers to inform future tele-CDSMP delivery models.
  
  
  METHODS
  Nineteen tele-CDSMP courses were delivered to 13 Northern Ontario (Canada) communities. Two types of group were delivered: (1) single telehealth site (one community formed a self-management group linked to program leaders via telehealth) and (2) multiple telehealth sites (several remote communities were linked to each other and program leaders via telehealth). Following the completion of the courses, participants were invited to partake in a focus group.
  
  
  RESULTS
  Overall, 44 people participated in the focus groups. Four main themes were identified by tele-CDSMP participants related to the overall experience of the program: (1) bridging the access gap, (2) importance of group dynamics, (3) importance of strong leaders, and (4) preference for extended session time. Key barriers were related to transportation, lack of session time, and access to Internet-based resources. The main facilitators were having strong program leaders, encouraging the development of group identity, and providing enough time to be comfortable with technology.
  
  
  CONCLUSIONS
  Our findings suggest overall the tele-CDSMP was a positive experience for participants and that tele-CDSMPs are an effective option to increasing access to more geographically isolated communities.
authors.affiliation: 1 Women's College Research Institute , Toronto, Ontario, Canada .
authors.forename: Sara J T
authors.initials: SJ
authors.lastname: Guilcher
authors.forename: Tarik
authors.initials: T
authors.lastname: Bereket
authors.forename: Jennifer
authors.initials: J
authors.lastname: Voth
authors.forename: Vinita A
authors.initials: VA
authors.lastname: Haroun
authors.forename: Susan B
authors.initials: SB
authors.lastname: Jaglal
mesh_terms: D000328:Adult; D002908:Chronic Disease / Q000628:therapy*; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010353:Patient Education as Topic; D019035:Rural Health Services / Q000706:statistics & numerical data; D012648:Self Care; D017216:Telemedicine