Mutual Shaping of Tele-Healthcare Practice: Exploring Community Perspectives on Telehealth Technologies in Northern and Indigenous Contexts

Abstract

In Canada, northern and Indigenous communities face well documented challenges to accessing healthcare services prompting the urgent need to adopt alternative and innovative solutions to overcome barriers of limited access due to geographic distance, physician shortages, limited resources, and high cost of service delivery. Telehealth – the means of delivering health care services and information across distance – promises to augment services to address some of these barriers and has been increasingly relied upon to bridge healthcare service gaps. Despite the promise of telehealth, notable utilization barriers and structural constraints remain that challenge long-term sustainability. Little is known about how well these technologies work from community telehealth users’ perspectives. Current work in the area has tended to focus on the increased efficiency and cost effectiveness of telehealth in facilitating healthcare services, with less focus on users’ perspectives obscuring the important roles played by users and technologies. In sum, more work needs to be done to present a complete picture of users’ experiences and community needs – a gap this dissertation aims to tackle. In doing so, this research captures a snapshot of community perspectives from four Northern Saskatchewan communities, drawing attention to users’ experiences in relation to the social and technical factors shaping telehealth use. Working in partnership with the communities of Hatchet Lake Denesuline First Nation, the Northern Villages of Île-à-la-Crosse and Pinehouse Lake, and the Town of La Ronge, and external stakeholders/knowledge users working directly with these communities, this work resulted in valuable insights into the user-technology interface. Emerging from community concerns with accessing healthcare services and education/training, the goal of this project was to better understand strengths and barriers for telehealth use. Methodologically, the personal accounts and lived experiences of telehealth users were explored using qualitative methods grounded in Community-Based Participatory Research (CBPR) and decolonizing methodologies utilizing Constructivist Grounded Theory (CGT) that is drawn from interpretive-constructivist epistemological frameworks. In-depth, semi-structured qualitative interviews/focus groups with 24 telehealth users, field notes and general observations provided the basis for data collection, and NVivo 12 was used to organize, iteratively code and analyze community insights. Thematic analysis and socio-technical mapping explored themes across community contexts and provided understanding of the interrelationship of shared and unique insights whereby community telehealth users’ voices guided interpretations. This dissertation highlights the importance of community collaborations and identifies the strengths and barriers for utilizing telehealth within northern and Indigenous contexts. Using theoretical frameworks drawn from Science and Technology Studies (STS), this dissertation makes the argument that users and technologies play significant roles in shaping tele-healthcare practice – a mutually co-constitutive relationship embedded within larger socio-structural systems that pose varying constraints. Analysis revealed that users and technologies mutually shape tele-healthcare practices and care experiences – i.e. technologies shape patients’ and local/remote providers’ use of the system in enabling/constraining ways and users shape technologies through reconfiguration or “tinkering”. A mutual shaping approach following the relational/performative view of socio-technical agency serves as a pathway for examining socio-cultural factors shaping how technologies are designed, implemented, and used, and alternatively how technologies shape practice and meanings of socio-technical spaces. Further, it is argued that understanding the context in which telehealth technologies are situated and experienced will be increasingly critical as technological systems play greater roles in service delivery.