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"I'm calling for hope, comfort and maybe some advice...": Interaction and caller satisfaction in telenursing
Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten.
2023 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Background: The provision of nursing over the telephone is an appreciated asset in many parts of the world. Interaction between telenurse and caller is important for caller satisfaction, and satisfaction in turn is positively related to outcomes such as adherence, engagement in self-care and well-being. Despite the long history of telehealth services, research about interaction in telenursing is still in a developmental stage.

Aim: The overall aim of the thesis was to develop a questionnaire that enables valid and reliable exploration of telenurse–caller interaction, and caller satisfaction with calls, and to explore interaction and its importance for caller satisfaction.

Methods: The thesis applied a deductive approach based on a theoretical nursing model; the Interaction Model of Client Health Behavior (IMCHB). Interaction in the IMCHB, is divided into four components: health information, affective support, decisional control, and professional-technical competencies. In the first study (I), the Telenursing Interaction and Satisfaction Questionnaire (TISQ) was developed. Variables were identified through a literature review, structured according to the IMCHB, and worded as questionnaire items. Content validity was evaluated with input from cognitive interviews with callers, and professionals using the Content Validity Index (CVI). A consecutive sample of 1,400 callers received the TISQ by post, and test-retest reliability of single items was evaluated. In Study two (II), 25 items from the TISQ focusing on interaction between callers and telenurses were selected to form the Telenursing Interaction and Satisfaction Scale (TISS), a scale for the measurement of caller satisfaction with interaction in four subscales according to the IMCHB. Psychometric properties of the TISS were evaluated with a focus on data quality, factor structure, convergent validity, and reliability. In Study three (III), caller satisfaction with interaction (i.e., TISS scores) and their associations to overall satisfaction with calls were explored using descriptive statistics, repeated measures ANOVA and ordinal logistic regression models. In Study four (IV), 30 transcripts of authentic calls were analysed using content analysis with directed approach. A coding scheme based on the four components of interaction in the IMCHB was developed and applied for deductive categorisation of data. Manifest content of conversations (n = 37,447 words) was presented quantitatively and qualitatively. In addition, data was coded and analysed in relation to phases in the conversation process for telenursing: opening, listening, analysing, motivating, and ending.

Results: The 60 item TISQ showed good content validity in the telenursing setting (I), with a Scale-CVI of 0.91. Test–retest reliability of single items was moderate to good (I). TISS-data deviated significantly from a normal distribution, but all response options were endorsed (II). The confirmatory factor analysis confirmed the four-factor structure of the TISS, and factor correlations were high (rs = 0.88 to 0.96) (II). A higher order model showed marginally deteriorated model fit values (II). Ordinal alpha, scale reliability, and test–retest reliability were satisfactory for all scales, and convergent validity was satisfactory (II). Callers expressed the highest level of satisfaction with affective support, while their satisfaction with decisional control was comparatively lower (III). Callers’ satisfaction with interaction was positively associated with overall satisfaction with calls, even when considering experienced waiting time, main result of the call, fulfilment of expectations, age, gender, self-rated health status and time of call (III). A total of 97% of manifest words in conversations were identified as nursing interaction based on the IMCHB (IV). Health information was the primary focus, particularly during the listening and analysing phases (IV). Affective support was the least prominent component, and callers’ reactions to advice were seldom discussed (IV). The opening phase was the shortest, and analysing phase the most word consuming (IV).

Conclusions: The TISQ, including the TISS, provide a valid and reliable questionnaire for the study of telenurse-caller interaction, and caller satisfaction. Caller satisfaction with the interaction can be measured using the four subscales in the TISS. In cases where there is a problem with multicollinearity, a total scale score from the TISS can be utilized. All four components of interaction in the IMCHB play a crucial role in determining overall caller satisfaction with calls. Therefore, the development of interaction in telenursing need to consider all four components. The exchange of health information presents challenges for both telenurses and callers, and affective support can be provided to callers without verbalizing emotions. Among the four components, decisional control may have the largest potential for improvement in the studied setting. This can be achieved by acknowledging callers’ reactions to advice.

Abstract [sv]

Bakgrund: Omvårdnad via telefon är en värdefull och uppskattad resurs i många delar av världen. Interaktionen mellan telefonsjuksköterska och uppringare har stor betydelse för uppringares nöjdhet med samtalen. Ökad nöjdhet leder i sin tur till högre grad av följsamhet till råd, ökat engagemang i egenvård och förbättrat välbefinnande. Trots att vård via telefon har funnits länge, befinner sig forskningen om interaktion via telefon fortfarande i ett utvecklingsskede.

Syfte: Det övergripande syftet med avhandlingen var att utveckla en enkät som möjliggör utforskandet av interaktion mellan uppringare och telefonsjuksköterskor, samt att utforska interaktionens betydelse för uppringares nöjdhet med samtal.

Metod: Avhandlingsarbetet har genomförts med en deduktiv ansats baserad på en teoretisk modell för omvårdnad, the Interaction Model of Client Health Behavior (IMCHB). I modellen består interaktion av fyra komponenter; hälsoinformation, affektiv support, inflytande över beslut och professionell-teknisk kompetens. I den första delstudien (I) utvecklades en enkät, the Telenursing Interaction and Satisfaction Questionnaire (TISQ). Relevanta variabler identifierades i litteratur, sorterades utifrån strukturen i IMCHB, och formulerades därefter till frågor i en enkät. Enkätens innehållsvaliditet utvärderades med hjälp av kognitiva intervjuer med uppringare, och med professionella personers bedömning av frågornas relevans med hjälp av Content Validity Index (CVI). Ett konsekutivt urval av 1 400 uppringare till 1177 direkt fick TISQ via postutskick, och enskilda frågors test-retest reliabilitet utvärderades (I). I delstudie två (II) valdes 25 frågor i TISQ ut, för att bilda en mätskala, the Telenursing Interaction and Satisfaction Scale (TISS). TISS består av fyra delskalor baserat på de fyra interaktionskomponenterna i IMCHB, och syftar till att mäta uppringares nöjdhet med interaktion. TISS utvärderades psykometriskt med fokus på datakvalitet, faktorstruktur, kriterievaliditet och reliabilitet. I Studie tre (III) utforskades uppringares nöjdhet med interaktion, samt dess betydelse för övergripande nöjdhet med hela samtalet, med hjälp av deskriptiv statistik, rANOVA och ordinal logistisk regression. I den fjärde delstudien (IV) analyserades 30 telefonsamtal (n = 37 447 ord) med hjälp av innehållsanalys med deduktiv ansats. Data kategoriserades med hjälp av ett kodningsschema baserat på de fyra interaktionskomponenterna i IMCHB. Det manifesta innehållet i samtalen beskrevs kvantitativt och kvalitativt. I tillägg analyserades innehållet i relation till Samtalsprocessen, ett arbetssätt som används vid 1177 direkt, och som består av följande faser; öppna, lyssna, analysera, motivera, och avsluta.

Resultat: TISQ, bestående av 60 frågor, uppvisade god innehållsvaliditet i den studerade kontexten (Scale-CVI/Ave = 0.91). Test-retest reliabilitet för enskilda frågor var medelgod till god för alla frågor utom en (I). Data som genererats med hjälp av TISS avvek signifikant från normalfördelningen, men alla svarsalternativ användes (II). De fyra delskalorna i TISS bekräftades i en konfirmatorisk faktoranalys, och korrelationer mellan de fyra faktorerna var höga (rs = 0.88 to 0.96) (II). En higher-ordermodell visade marginellt försämrad modellanpassning (II). Reliabilitet för samtliga delskalor var tillfredsställande, liksom kriterievaliditet (II). Uppringare var mest nöjda med affektiv support, medan nöjdheten med inflytande över beslut var jämförelsevis lägre (III). Uppringares nöjdhet med samtliga fyra interaktionskomponenter uppvisade ett positivt och signifikant samband med övergripande nöjdhet med samtal, även efter korrigering för upplevd väntetid, huvudresultat av samtalet, grad av uppfyllda förväntningar, ålder, kön, självskattat hälsotillstånd och tidpunkt för samtal (III). Totalt 97% av manifest innehåll i de transkriberade samtalen kodades som omvårdnadsinteraktion i enlighet med IMCHB (IV). Hälsoinformation dominerade samtalsinnehållet, speciellt i lyssna och analysfas. Affektiv support var minst förekommande, och uppringares reaktioner på råd diskuterades sällan (IV). Öppnafasen var kortast, och analysfasen var längst (IV).

Konklusion: TISQ, vilken inkluderar TISS, uppvisar god validitet och reliabilitet i den studerade kontexten, och kan användas för att studera interaktion mellan uppringare och telefonsjuksköterska, och uppringares nöjdhet. Uppringares nöjdhet med interaktion kan mätas med hjälp av de fyra delskalorna i TISS. I de fall multikollinearitet är ett problem kan en total-score användas. Nöjdhet med samtliga fyra interaktionskomponenter är viktigt för uppringares övergripande nöjdhet med samtal. Därför bör alla fyra beaktas vid utveckling av omvårdnadsinteraktion på telefon. Interaktion som berör hälsoinformation kan vara utmanande för både telefonsjuksköterska och uppringare, och affektiv support kan förmedlas utan att verbalisera känslor. Bland de fyra interaktionskomponenterna uppvisade inflytande över beslut störst potential till utveckling. Detta kan uppnås genom att telefonsjuksköterskor i större utsträckning uppmärksammar uppringares reaktioner på givet råd.

Ort, förlag, år, upplaga, sidor
Linköping: Linköping University Electronic Press, 2023. , s. 80
Serie
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1856
Nyckelord [en]
Telenursing, Telephone nursing, Social interaction, Nurse-patient relations, Patient satisfaction, Nursing models, Surveys and questionnaires
Nationell ämneskategori
Omvårdnad
Identifikatorer
URN: urn:nbn:se:liu:diva-194314DOI: 10.3384/9789180752022ISBN: 9789180752015 (tryckt)ISBN: 9789180752022 (digital)OAI: oai:DiVA.org:liu-194314DiVA, id: diva2:1761992
Disputation
2023-09-01, Önnesjösalen (K3), Kåkenhus, Campus Norrköping, Norrköping, 13:00 (Svenska)
Opponent
Handledare
Anmärkning

Funding agencies: Region Östergötland (RÖ), the Research Council of Southeast Sweden (FORSS), and Linköping University (LiU)

2023-06-02 The thesis was first published online. The online published version reflects the printed version. 

2024-06-12 The thesis was updated with an errata list which is also downloadable from the DOI landing page. Before this date the PDF has been downloaded 327 times.

Tillgänglig från: 2023-06-02 Skapad: 2023-06-02 Senast uppdaterad: 2024-06-12Bibliografiskt granskad
Delarbeten
1. Development and content validation of the Telenursing Interaction and Satisfaction Questionnaire (TISQ)
Öppna denna publikation i ny flik eller fönster >>Development and content validation of the Telenursing Interaction and Satisfaction Questionnaire (TISQ)
Visa övriga...
2019 (Engelska)Ingår i: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625, Vol. 22, nr 6, s. 1213-1222Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background Caller satisfaction with telephone advice nursing (TAN) is generally high, and the interaction is essential. However, a valid questionnaire exploring caller satisfaction in TAN with focus on perceived interaction is lacking. Objective To develop and assess content validity and test-retest reliability of a theoretically anchored questionnaire, the Telenursing Interaction and Satisfaction Questionnaire (TISQ), that explores caller satisfaction in TAN by focusing on perceived interaction between the caller and the telenurse. Methods The study was performed in three stages. First, variables relevant for patient satisfaction in health care were identified through a literature search. Variables were then structured according to the Interaction Model of Client Health Behavior (IMCHB), which provided theoretical guidance. Items relevant for a TAN context were developed through consensus discussions. Then, evaluation and refinement were performed through cognitive interviews with callers and expert ratings of the Content Validity Index (CVI). Finally, test-retest reliability of items was evaluated in a sample of 109 individuals using intraclass correlation coefficients (ICC). Results The TISQ consists of 60 items. Twenty items cover perceived interaction in terms of health information, affective support, decisional control and professional/technical competence. Five items cover satisfaction with interaction and five items overall satisfaction. Remaining items reflect singularity of the caller and descriptive items of the call. The TISQ was found to exhibit good content validity, and test-retest reliability was moderate to good (ICC = 0.39-0.84). Conclusions The items in the TISQ form a comprehensive and theoretically anchored questionnaire with satisfactory content validity and test-retest reliability.

Ort, förlag, år, upplaga, sidor
WILEY, 2019
Nyckelord
communication; content validity; nurse-patient relations; patient experiences; patient satisfaction; surveys and questionnaires; telenursing
Nationell ämneskategori
Omvårdnad
Identifikatorer
urn:nbn:se:liu:diva-161153 (URN)10.1111/hex.12945 (DOI)000486250400001 ()31513328 (PubMedID)
Anmärkning

Funding Agencies|Ostergotland County Council; Medical Research Council of Southeast Sweden

Tillgänglig från: 2019-10-25 Skapad: 2019-10-25 Senast uppdaterad: 2023-06-02
2. Psychometric evaluation of the Telenursing Interaction and Satisfaction Scale
Öppna denna publikation i ny flik eller fönster >>Psychometric evaluation of the Telenursing Interaction and Satisfaction Scale
2023 (Engelska)Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 37, nr 3, s. 687-697Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Aims and Objectives Interaction between caller and telenurse in telenursing is important for caller satisfaction and subsequent compliance. Despite this, satisfaction measures with focus on interaction in telenursing are scarce and rarely anchored in nursing theory. The aim was to evaluate the psychometric properties of the Telenursing Interaction and Satisfaction Scale (TISS) with focus on data quality, factor structure, convergent validity, and reliability.Methodological Design and Justification This psychometric study was based on cross-sectional data.Research Methods, Instruments, and/or Interventions Callers to the National Medical Advisory Service in Sweden (n = 616) completed the 60-item Telenursing Interaction and Satisfaction Questionnaire based on Coxs Interaction Model of Client Health Behavior. Twenty-five of these items were selected to form the TISS in four subscales according to the model. Data quality was evaluated in terms of missing data patterns and score distributions. The factor structure was evaluated with confirmatory factor analysis for ordinal data, convergent validity with Spearman correlations, internal consistency with ordinal alpha, scale reliability with composite reliability coefficients, and test-retest reliability with intraclass correlations.Results The amount of missing data was acceptable and equally distributed. Data deviated significantly from a normal distribution. All response options were endorsed. The factor analysis confirmed the hypothesised four-factor structure; factor loadings ranged from 0.56 to 0.97 and factor correlations were high (0.88-0.96). Internal consistency (ordinal alpha = 0.82-0.97), scale reliability (0.88-0.99), and test-retest reliability (ICC = 0.77-0.86) were satisfactory for all scales.Study Limitations The study design did not allow drop-out analysis.Conclusions The TISS showed satisfactory psychometric properties in the study sample. It provides a measure that enables quantitative measurement of caller satisfaction with interaction in telenursing.

Ort, förlag, år, upplaga, sidor
WILEY, 2023
Nyckelord
interaction; nurse-patient relations; patient satisfaction; psychometrics; surveys and questionnaires; telenursing; telephone nursing
Nationell ämneskategori
Övrig annan medicin och hälsovetenskap
Identifikatorer
urn:nbn:se:liu:diva-192343 (URN)10.1111/scs.13149 (DOI)000923595200001 ()36718016 (PubMedID)
Anmärkning

Funding Agencies|Forskningsradet i Sydostra Sverige [FORSS-847311, FORSS-930659]; Region Ostergotland [RO LiO-925191, RO LiO-938203]

Tillgänglig från: 2023-03-15 Skapad: 2023-03-15 Senast uppdaterad: 2024-05-02Bibliografiskt granskad
3. Role of interaction for caller satisfaction in telenursing - A cross-sectional survey study
Öppna denna publikation i ny flik eller fönster >>Role of interaction for caller satisfaction in telenursing - A cross-sectional survey study
2023 (Engelska)Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 32, nr 15-16, s. 4752-4761Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Aims and objectives The aim of this study was to explore caller satisfaction with interaction, and the association to overall satisfaction with calls. Background In the era of expanding healthcare at distance, the telephone remains a common tool for the provision of nursing care. Interaction between telenurse and caller in telenursing is vital for safety, satisfaction and adherence reasons. Few studies have quantitatively explored interaction in calls and how it relates to overall satisfaction with calls. Design Cross-sectional survey study with a deductive approach. Methods A total of 466 callers to the Swedish Medical Advisory Service completed the Telenursing Interaction and Satisfaction Questionnaire. Satisfaction with four theoretically defined components of interaction were compared using repeated measures ANOVA. Associations between satisfaction with interaction and overall satisfaction with calls were evaluated with ordinal logistic regression models with and without adjustment for age, sex, health status, waiting time, time for call, main result of the call and expectations. The study followed the STROBE checklist. Results Callers were most satisfied with affective support, followed by professional-technical competence, health information and decisional control-in that order. A summated score of satisfaction with interaction was positively and significantly associated with overall satisfaction with calls before and after adjustment for waiting time, main result of call and variables related to the individual caller. Conclusions Caller satisfaction with interaction is generally high but can be improved, especially regarding decisional control. Satisfaction with interaction is important for overall satisfaction with calls. Relevance to clinical practice This study provides support for professionals at all levels in telenursing organisations to pay attention to interactional matters. The development of best practice for telenurses needs to consider all four components of interaction to enhance satisfaction with calls.

Ort, förlag, år, upplaga, sidor
Wiley, 2023
Nyckelord
communication; e-health; interaction; nurse-patient relation; nursing care; patient satisfaction; telenursing; telephone nursing
Nationell ämneskategori
Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi
Identifikatorer
urn:nbn:se:liu:diva-188595 (URN)10.1111/jocn.16524 (DOI)000851437600001 ()36081322 (PubMedID)
Anmärkning

Funding Agencies|Forskningsradet i Sydostra Sverige [FORSS-847311, FORSS-930659]; Region Ostergotland [LIO-925191, LIO-938203]

Tillgänglig från: 2022-09-19 Skapad: 2022-09-19 Senast uppdaterad: 2024-05-02Bibliografiskt granskad

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