Elsevier

Child Abuse & Neglect

Volume 85, November 2018, Pages 47-57
Child Abuse & Neglect

Research article
Perceptions of caregivers and adolescents of the use of telemedicine for the child sexual abuse examination

https://doi.org/10.1016/j.chiabu.2018.08.009Get rights and content

Abstract

Background

Childhood sexual abuse is a common cause of morbidity and mortality. All victims should receive a timely comprehensive medical exam. Currently there is a critical shortage of child abuse pediatricians who can complete the comprehensive child sexual abuse examination. Telemedicine has emerged as an innovative way to provide subspecialty care to this population. Despite the growing popularity of telemedicine, no literature exists describing patient and caregiver perceptions of telemedicine for this sensitive exam.

Objective

To explore caregiver and adolescent perspectives of the use of telemedicine for the child sexual abuse examination and discover factors that drive satisfaction with the technology.

Participants and Setting

Caregivers and adolescents who presented for a child sexual abuse medical evaluation at our county’s child advocacy center.

Methods

We completed semi structured interviews of 17 caregivers and 10 adolescents. Guided by the Technology Acceptance Model interviews assessed perceptions about: general feelings with the exam, prior use of technology, feelings about telemedicine, and role of the medical team. Interviews were audio-recorded, transcribed, coded and analyzed using content analysis with constant comparative coding. Recruitment ended when thematic saturation was reached.

Results

There was an overwhelming positive response to telemedicine. Participants reported having a good experience with telemedicine regardless of severity of sexual abuse or prior experience with technology. Behaviors that helped patients and caregivers feel comfortable included a clear explanation from the medical team and professionalism demonstrated by those using the telemedicine system.

Conclusion

Telemedicine was widely accepted by adolescents and caregivers when used for the child sexual abuse examination.

Section snippets

What is known

Telemedicine is emerging as an innovative solution to the shortage of child abuse pediatricians who perform the child sexual abuse evaluation. There is currently no research that explores caregiver’s and patient’s perceptions of this technology for the sexual abuse exam.

What this study adds

We demonstrated that telemedicine was widely accepted by adolescents and caregivers when used for the child sexual abuse examination. Drivers of satisfaction included good virtual communication and professionalism by the telemedicine provider.

Interview guide development

Constructs from the Technology Acceptance Model (TAM) were used to guide the conceptual framework and aid in understanding factors that may shape acceptance of technology in this population (Davis, Bagozzi, & Warshaw, 1989) (Fig. 1). The developers of TAM adapted the model from the Theory of Reasoned Actions (Fishbein & Ajzen, 1975). The model suggests that one’s attitude towards technology is related to behavioral beliefs, normative beliefs, perceived usefulness, and perceived ease of use. In

Results

From January to July 2017 40 caregivers and adolescents were recruited to participate in the study based on eligibility and purposive sampling. Those that were recruited, but did not respond after two follow up phone calls were withdrawn from the study. Thematic saturation was considered reached when no new themes emerged that would be consistent with the research question. (Saunders et al., 2017) After study team members agreed it was reached, two additional TM interviews were completed to

Discussion

We set out to understand the perspectives of both adolescents and caregivers of the use of TM for the CSA exam. We felt this was an important area to explore, as there is no prior literature directly addressing patient and caregiver views of this technology, specifically for the child sexual abuse examination.

In 2015 JAMA published a Viewpoint article warning of potential consequences of the rapid expansion of new digital health technologies. It encouraged physicians to ensure new products

Conclusions

TM was widely accepted by adolescents and caregivers when used for the child sexual abuse examination. Participants had an overwhelming positive response regardless of severity of sexual abuse or prior experience with technology. Behaviors that helped patients and caregivers feel comfortable included a clear explanation from the medical team, evidence of professionalism, and virtual communication competency.

Conflicts of interest

None

Acknowledgements

This study was funded by the Ray E. Helfer Society Education Grant

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