A mixed methods realist analysis of telehealth delivery of complex wheelchair assessment in Aotearoa New Zealand: contexts, mechanisms, and outcomes

Purpose: 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. Materials and Methods: 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). Results: 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 (N=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. Conclusions: 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.