Aim of the study
We hypothesize that profession (i.e., OT or midwife), age in years, and area of work have significant and meaningful influence on the provision of HCD.
Furthermore, we hypothesize that profession, age in years, area of work, possibility of reimbursement by health insurance, and application used (i.e., phone, email, chat, SMS, video-telephony apps and services) have a significant and meaningful influence on experience of a given HCD service by health care providers.
Design of the study
In our reporting of the survey we follow the CHERRIES guidelines that were mainly designed for web-based surveys (1, 22).
Setting of the study
The cross-sectional survey was accessible from May 11, 2020 to May 26, 2020. The population of interest encompasses OTs (registered members of the Swiss Professional Association of Occupational Therapists (“ErgotherapeutInnen-Verband Schweiz”, EVS, N = 2454 members) and midwifes (registered members of the Swiss Federation of Midwives “Schweizerischer Hebammenverband”, SHV, N = 3301 members) professionally registered in Switzerland. We collected data by means of an online survey. Representatives of the respective professional associations contacted OTs and midwives directly by email and provided information about the survey as well as a link to the online questionnaire. Participants received no financial incentives.
We used the survey creation platform www.unipark.com to compile an online questionnaire (23).The platform allows for the creation and testing of surveys and provides an online link where it can be accessed. A data center situated in Germany hosts the platform which is certified by the German Federal Cyber Security Authority BSI and compliant with the ISO 27001 data safety and protection regulations (24). Multiple participants were able to fill out the survey using the same IP-address. This was deemed necessary as the survey targeted health professionals who might share an IP-address or even an office computer in their places of work. To fill out the survey multiple times in the same browser, cookies had to be erased first. After the running time of the online survey had ended, we exported e data and imported into SPSS.
Before filling in the questionnaire, we informed potential participants about the purpose of the study, which stated: “With the COVID-19 pandemic, the digital future has become the present. In the short term examinations, treatments, and therapy with physical presence have been replaced by treatments at a distance. In doing so, health care professionals (i.e., OTs midwives) must not only treat clients effectively, but must also observe the legal requirements. We would like to ask you a few questions about your experiences during the COVID-19 pandemic. Based on your answers, we would like to develop recommendations for you in cooperation with the professional associations.” Potential participants were provided with information about the approximate length of time to fill in the survey (i.e., ten minutes). The function and contact information of the two main investigators were provided.
The questionnaire consisted of 13 questions. The demographic section asked for information about the following: age in years, work experience in years, profession (i.e., OT or midwife), the field of activity of the institution/organization of employment, specific outpatient area (e.g., practice) inpatient sector (e.g., hospital, birth center, retirement home), the home environment, or school setting. Multiple answers were possible here.
If a participant confirmed that during the COVID-19 pandemic, he/she performed HCD (i.e., necessary urgent examinations, treatments, and therapies at a distance) rather than in his/her office or the client’s home, the following questions concerning which media were used (phone, e-mail, chat, SMS, videotelephony apps and services) as well as their respective suitability for examinations, treatments and therapies at a distance (rated on a Likert scale from 1 = negative, 2 = rather negative, 3 = rather positive, 4 positive, 5 = I do not know). If he/she did not confirm this, the questionnaire skipped ahead to a question about perceived advantages and disadvantages of HCD. If participants confirmed that they had used videotelephony, they were then asked about which specific videotelephony apps and services they used when providing HCD. Possible answers were Doxy.me, Skype, Viber, WhatsApp, MS Teams, FaceTime, Messenger, Zoom or others. Doxy.me is a US-based video-telephony and instant messaging service geared especially towards telemedicine. Skype is a videotelephony service that also allows audio calls and instant messaging. MS Teams is a workplace-focused collaboration platform that includes instant messaging, video- and audio telephony and file sharing services. Both Skype and MS Teams are owned and operated by Microsoft Inc. FaceTime is a VoIP (voice over internet protocol) and video-telephony service operated by Apple Inc. that exclusively runs on macOS and iOS devices. Whats-App and Viber are VoIP and instant-messaging software applications that allow for video calls. WhatsApp is owned by Facebook Inc., while Viber is operated by the Japan-based multinational company Rakuten Inc. Messenger is a feature of Facebook’s main platform and offers instant messaging as well as audio and video calls between the platform’s users. Zoom is another US-based videotelephony service.
Participants were asked how 1. they and 2. their “clients experienced necessary urgent examinations, treatments, and therapies at a distance” (rated on a Likert scale 1 = negative, 2 = rather negative, 3 = rather positive, 4 positive, 5 = I do not know).
Participants were asked about the possibility of reimbursement of the HCD services they provided by health insurance (yes, no, I do not know).
Regarding desired training opportunities when carrying out HCD, participants could choose among multiple answers regarding knowledge about 1. infrastructure, 2. applications (apps), 3. law and data protection, 4. reimbursement by health insurance, 5. federal and cantonal ordinances, 6. client needs, 7. client requirements, 8. effectiveness, 9. communication methods, 10. the examination and treatment process, 11. suitable methods. Similarly, participants could choose multiple answers regarding need for training opportunities in these twelve topics. Moreover, OTs and midwives reported in comments to open-ended questions what they perceived as advantages and disadvantages of HCD. Answers to questions that allowed for commentary on further desired support are not reported here.
The questionnaire was available in German, French and Italian (the three languages spoken as a first national language by 63.5%, 22.5% and 8.1% of inhabitants in Switzerland, respectively) (25). All three language versions were translated and checked by a native speaker. The full questionnaires are available in the annex. Skipping questions was not possible except for the last four questions concerning advantages and disadvantages of therapy at a distance and desired support/need for training opportunities.
The questionnaire was driven by the immediate need for survey data during the COVID-19-induced lockdown. As it is a new tool, psychometric properties regarding the construction, validity, and reliability of measurement could not be collected (26). One OT and one midwife not involved in the study filled out a test version and had only some minor suggestions for changes (e.g., regarding response options for area of work).
Institutional Review Board approval was not required.
We used descriptive statistics including frequency distributions and means and standard deviations to analyze sociodemographic data. We calculated frequency distributions to describe the respondents’ use of media, their opinions of the media’s applicability, their experience of HCD, reimbursement of services and desired training opportunities. We performed chi-square tests of independence to examine differences in media use patterns between OTs and midwives.
We tested data for Gauss-Markov theorems 1 to 6. To test for the first hypothesis (“profession, age in years, and area of work have an influence whether HCD was provided”) we performed a binary logistic regression analysis. To test for the second hypothesis (“profession, age in years, area of work, reimbursement, and application used have an influence on experience of this HCD service”) we performed an ordinal logistic regression. We calculated response and cooperation rates according to Smith (27). Missing data were deleted listwise. We performed statistical analysis with IBM SPSS Statistics 26®.
Analysis of qualitative data:
The analysis of the answers to the open questions was based on the principles of the Quantitative Content Analysis according to Früh (34). The category scheme was derived from the data itself. Based on the repeated review of all answers to the question about the advantages and chances of HCD (n = 1052), six clearly distinguishable categories were formed, each containing different topics/motives. The assessment of all answers to the question about the disadvantages and limitations of HCD (n = 1129) resulted in five categories, one of which comprised three sub-categories. We concentrated the analysis on the first points mentioned in the answers, since this is the most spontaneous reaction to the question and probably most likely reflects what is most important to the respondents.