Author ORCID Identifier
Doctor of Philosophy
Health Related Sciences
Tony Gentry, Ph.D., OTR/L, FAOTA
BACKGROUND: Approximately 8.1 million people in the United States 18 and older have difficulty performing one or more daily activities because of vision impairment or blindness (Erickson, Lee, & von Schrader, 2020; Taylor, 2018). If the impairments caused by vision loss are not addressed, they can result in financial difficulties, suffering, disability, loss of productivity, and decreased quality of life (National Center for Chronic Disease Prevention and Health Promotion, 2011). Currently, in-person low vision rehabilitation services are the gold standard for teaching people how to adapt to and compensate for these deficits, however, the access and utilization of these services by people with vision impairments is poor. Telerehabilitation is one service delivery option that has been used in other settings to increase access and utilization of low vision services. This study investigated the underlying factors that are related to three stakeholder groups’ behavioral intention to use telerehabilitation as a low vision rehabilitation service delivery option.
METHODS: This pilot study utilized an anonymous pre-validated online survey to collect data from people with vision impairments, eye care professionals, and vision rehabilitation professionals. Participants were recruited by email or through social media.
RESULTS: Fifty-two people participated in the survey – 12 males (23%) and 40 females (77%). Participants’ ages ranged from 21 to 79 years of age (M = 45.2, SD = 12.6). Twenty-two people with vision impairments (42%) participated in the survey, followed by 21 (40%) vision rehabilitation professionals, and nine (17%) eye care professionals. Most of the participants reported feeling very comfortable with using computers (85%), mobile devices (85%), and videoconferencing software (64%). More than half of the sample reported being very skilled using computers (70%), mobile devices (76%), and videoconferencing programs (59%). All participants, except for one, reported using a computer for at least 1 year. Twenty-one participants – 3 people with vision impairments, 3 eye care professionals, and 15 vision rehabilitation professionals - reported having used telerehabilitation. Twenty participants (43%) reported having the behavioral intention to use telerehabilitation in the future while 17 participants (36%) stated that they planned on using telerehabilitation in their daily lives. For this study’s adapted and extended UTAUT model, small effect size relationships were noted between behavioral intention and performance expectancy (r = .295), and behavioral intention and resistance to change (r = .254). Age, gender, and experience were not found to be confounding variables between the predictor variables and behavioral intention. The people with vision impairment group was noted to have small effect sizes for the relationships between behavioral intention and performance expectancy (r = .218), and effort expectancy (r = .271), and technology anxiety (r = -.321). Age, gender, or experience were not found to act as confounding variables in these relationships. Eye care professionals had a moderate effect size for the relationship between behavioral intention and performance expectancy (r = .414) which appeared to be confounded by gender (r = .830) and experience (r = .671). They also had a small effect size relationship between behavioral intention and technology anxiety (r = .213) which appeared to be confounded by experience (r = .515). Gender and experience were also noted to be confounding variables for the relationship between behavioral intention and resistance to change. Age, gender, or experience were not found to act as confounding variables in these relationships. For the vision rehabilitation group, there was only one small effect size found for the relationship between behavioral intention and resistance to change (r = .243) which was noted to be confounded by experience (r = .463).
CONCLUSIONS: The use of telerehabilitation as a low vision service delivery option is still a new area of inquiry. This study was the first to explore the underlying factors of three stakeholder groups’ behavioral intention to use telerehabilitation as a service delivery option. Most of the participants with vision impairments reported not having difficulty accessing traditional in-person low vision rehabilitation services, or not planning on using telerehabilitation services in the future. These findings were contrary to assertions made by previous literature (Lam and Leat, 2013; Hoque and Sorwar, 2017). Eye care professionals also reported being very comfortable and skilled with various technologies, but were more open to change and accepting of new technologies, like telerehabilitation. Therefore, eye care professionals’ behavioral intention to use telerehabilitation in the future was higher than the other two groups. The vision rehabilitation group was similar to the eye care professional group in the behavioral intention to use telerehabilitation, and similar to the people with vision impairments group in their high level of resistance to change. Like the people with vision impairments group, the vision rehabilitation professional group appeared to be satisfied with the in-person low vision rehabilitation services that are already being delivered, and may not recognize the need for another service delivery option at this time. This study provides preliminary information that can be used in future studies that seek to understand why different stakeholder groups choose to accept and plan to use telerehabilitation. Once this information is better understood, researchers can build upon this information to increase the actual use of telerehabilitation among all three stakeholder groups. Limitations of this study that impact the interpretation of this study’s results and generalizability to a broader population are poor response rates, single survey response method, stringent inclusion criteria, and accessibility issues. Recommendations for future studies consist of addressing the study’s limitations as well as the intrinsic and extrinsic factors of each stakeholder group’s behavioral intention to use telerehabilitation. Overall, this study adds to the body of knowledge in the areas of telerehabilitation and low vision rehabilitation.
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