Developing of Home Based Virtual Care Program for Patients with Chronic Wounds: An Action Research Study

Abstract

Abstract Introduction: Patients with chronic wounds face various challenges in in-person visits to wound healing centers. Virtual care technology as a new approach can be effective in solving these challenges, but it has a limited place in the management of chronic wounds. This study aimed to design and implement a virtual care program at home for patients with chronic wounds. Method: The present study was conducted using the practical/participatory action research approach based on Bowman's cycle model. To develop the virtual care program, qualitative data collection was performed in the planning stage in two consecutive phases of literature review and descriptive-qualitative study. The data extracted from the literature review were analyzed using textual content analysis and conventional content analysis was used for qualitative section. The integration of both phases was done in the data analysis stage. The action stage was implemented in two parts: designing a virtual care system for patients with chronic wounds and implementing the program through the system. In the observation stage, the effectiveness of the program was measured quantitatively (Wound-QoL, TUQ and TeSS questionnaires) and qualitatively (individual interviews). Findings: Based on the analysis of the data from the planning stage, the barriers in providing virtual care were identified into six categories including lack of policymaking in virtual care, ethical challenges in virtual information and communication technology, social, economic and cultural issues, information technology users' insufficient knowledge and limitation of virtual care scope of practice and incomplete two-way interaction. Facilitators of providing virtual care included the development of information and communication technology infrastructure, support of health policymakers and decision-makers, and providing comprehensive care with family participation. Care needs of patients with chronic wounds for virtual care were identified in three categories as the need for informing, needs related to health dimensions and need for specialized financial support. In related to the characteristics and structure of the virtual care program, two themes were extracted: the requirements of the change towards the provision of virtual care and the characteristics of the scope of practice of virtual care. The quantitative findings of the evaluation stage showed that from the patients' point of view, the usability of the virtual care program was favorable and the satisfaction with the received program was high. The implementation of the designed program had a favorable effect on the quality of life. The quantitative findings of the observation stage showed that from the patients' point of view, the usability of the virtual care program was favorable and the satisfaction with the received program was high. The implementation of the designed program had a favorable effect on the quality of life. In the action stage, experiences of the users of the program were identified in seven categories: the experience of receiving a creative and new method of wound care, improving knowledge and practice in the field of wound management, creating a constructive interaction between the patient and the wound therapist, improving the health status and quality of life, effectiveness of virtual care in better wound management, easy and affordable access to health care services, and the challenges of receiving virtual care. Conclusion: The findings of the current research identified several barriers and facilitators for the implementation of the virtual care program. For the successful development and implementation of this program, various aspects of the care needs of patients with chronic wounds were identified and the characteristics and structure of the program were determined. Based on the experiences of patients using the program and the opinion of the expert panel, virtual care can be used as an applicable model for managing health problems and wound management in patients with chronic wounds at home.