DOI: 10.6084/m9.figshare.28927915.v1
title: A mixed methods realist analysis of telehealth delivery of complex wheelchair assessment in Aotearoa New Zealand: contexts, mechanisms, and outcomes

description: This study examined telehealth delivery of complex wheelchair assessment in Aotearoa New Zealand, specifically: what works, for whom, and in which contexts, with exploration of culturally specific factors for indigenous Māori. A mixed methods realist evaluation was conducted with remote specialist assessors (physiotherapists and occupational therapists), on-site assistants, and wheelchair users. Interviews/focus groups, mobility goal achievement, satisfaction, and fidelity of tele-delivered assessment of wheelchair and seating (tAWS) contributed to Context-Mechanism-Outcome configurations (CMOc). Four remote specialist assessors delivered tAWS, but it was declined by on-site assistants in 78% of cases in which specialist assessors perceived it could work. When tAWS was delivered to wheelchair users (<i>N</i> = 5), the majority of goals were achieved, with high service satisfaction. CMOc’s highlight the influence of system design in the uptake of telehealth by health professionals. While therapists can navigate complexity for successful tAWS, therapist and system barriers limit its uptake, particularly confidence in conducting assessment and use of technology among the non-adopters. Telehealth specific training in culturally-responsive rehabilitation is recommended. This evaluation contributes to telehealth program theory and the mechanisms to be addressed for telehealth to meet its potential to enhance equity in health outcomes. Appropriately fitted wheelchairs are an essential tool for participation in society for those who need them.Access to specialist assessors to undertake complex wheelchair and seating assessments is extremely limited in many health systems, particularly for indigenous people, such as Māori.Tele-delivered wheelchair assessments by trained and experienced assessors can improve access and equity in receiving services for wheelchair users.Barriers to uptake of tele-delivered wheelchair assessment related to system design disincentivising use of telehealth, and low confidence of on-site (allied health) assistants. Facilitators included high trust between specialist and onsite assessors and their orientation to learning and meeting wheelchair users’ needs.Tele-delivered wheelchair assessment warrants further research to determine its effectiveness when implementation barriers are addressed. Appropriately fitted wheelchairs are an essential tool for participation in society for those who need them. Access to specialist assessors to undertake complex wheelchair and seating assessments is extremely limited in many health systems, particularly for indigenous people, such as Māori. Tele-delivered wheelchair assessments by trained and experienced assessors can improve access and equity in receiving services for wheelchair users. Barriers to uptake of tele-delivered wheelchair assessment related to system design disincentivising use of telehealth, and low confidence of on-site (allied health) assistants. Facilitators included high trust between specialist and onsite assessors and their orientation to learning and meeting wheelchair users’ needs. Tele-delivered wheelchair assessment warrants further research to determine its effectiveness when implementation barriers are addressed.