To explore care providers’ level of familiarity with telehealth technology, APRN students in a Graduate Nursing Program at a Southeastern US university were recruited as a study sample. All students in this study are registered nurses pursuing advanced degrees in Nursing Practice, who were recruited because they deliver health care throughout the community currently in various practice settings and using various technological modalities. Specifically, these APRN students have been exposed to telehealth technology in their current education setting. After a Nursing Program leader agreed to participate in the study, a preliminary interview was conducted to contextualize the survey. We interviewed three nursing faculty members and refined the survey questions about technology use in three major domains—daily life, work, and the education program. Final consensus was reached on the number of open-ended questions and refinement of survey instruments. In the process, internal review board approval was obtained to contact and survey the graduate nursing students. As one of the coauthors had a conflict of interests due to her position as a nursing faculty member, the nonnursing author alone was involved in data collection and analyses. Two cohorts of APRN students were then invited to participate in a voluntary online survey during the Spring and Summer semesters in 2018. One cohort started the program in the Spring (primarily in the family program), while the summer cohort was in their final semester of the program across disciplines such as Family Medicine, Psychiatric/Mental Health, Pediatric Medicine, and Adult Geriatric Medicine.

To assess the survey instruments’ face validity, researchers, nurse practitioners, and technologists evaluated and refined our items before pretesting. During the pretest, we collected 20 responses and revised our items for the final survey accordingly. Table 1 presents the questions that the participants responded to using a 7-point Likert scale (1: strongly disagree to 7: strongly agree).

The survey also included open-ended questions that explored individual APRN students’ use of health and nonhealth information technology at work, in their education programs, and for personal use. Participants were asked to name the types of health information technologies that they have used frequently in the three different settings (eg, “Which health information technology do you use in your work setting?”).

The study generated both quantitative and qualitative results. We sent an online, cross-sectional survey to the two cohorts enrolled in the Graduate Nursing program (a total of 155 students) during the Spring and Summer semesters and had been exposed to telehealth technology in a simulation laboratory. A total of 109 responses were collected from the Spring cohort (n=71) and Summer cohort (n=38), with a 70.32% response rate. All the data were self-reported, so the researchers carefully evaluated nonresponse bias [14,15] and the common method bias [16]. Nonresponse bias occurs when there is a systematic difference between respondents and nonrespondents. We checked nonresponse bias by comparing the difference between early and late responses for each cohort in the Spring and Summer semesters and confirmed that there was no mean difference between them. Second, as we collected independent variable and dependent variable data in the same survey, we further performed the Harman single-factor analysis to assess common method bias. The results showed that one factor explained 35.24% of the variance, confirming no threat of the common method bias. However, not all students answered the demographic or key research questions, resulting in smaller sample sizes.

A total of 86 students responded to the demographic questions. As shown in Table 2, 70.9% of these students were female and most (67.4%) were between the ages of 26 and 40 years. Approximately half of the students (49%) were working full-time at a health care organization at the time of the survey, and 32.6% had obtained a master’s degree already.

As the first step in designing a technology education curriculum, this research explored care providers’ familiarity with telehealth technology by considering their level of exposure to using various features of both health- and nonhealth-related technologies in different settings. Acknowledging the scarcity of research in this domain, our study focused particularly on the characteristics of telehealth technology, which combines various technological features such as electronic health data management, real-time communication using multimedia, and chatting without hybrid formats, and further traced the system types that care providers have used across different settings. The results from both the quantitative and qualitative analyses showed that care providers have positive attitudes about telehealth technology’s ability to enhance their care performance with respect to overall task performance, effectiveness of care, quality of care tasks, and sharing information. Further, technologies for personal use shared similarities with the focal telehealth technology, nurturing their abilities to communicate virtually and manage multimedia images, as well as highlighted the benefits of using nonhealth technology in life when using telehealth technology at work.

Although the study was exploratory, our explicit focus on care providers’ use of technology in the three domains suggests that a telehealth education curriculum can be complemented by the use of other similar technology. In summary, our findings showed that (Figure 1): (1) there is strong overlap in technology familiarity between workplace and education programs and (2) daily experience of using nonhealth technology does not mesh with the existing nursing education, although care providers use mobile technology features daily that share commonalities with telehealth technology features. Thus, we propose that a telehealth curriculum needs to incorporate the existing experience of using technology, promoting similarity between telehealth technology and daily technology use. More specifically, adding components of social media and virtual communication to the existing nursing education may enhance the familiarity with a telehealth technology. For example, including social media channels to promote communication among students and between faculty members and students may promote their positive experiences with the similar features of telehealth technology [17]. As another example, to alleviate any negative perceptions such as frustration with technology about using technology overall, adding YouTube-based instructions on trouble shooting for telehealth can help enhance care providers’ autonomy in processing necessary information about a new technology [18].

From a practical standpoint, it is timely to assess care providers’ technology experience about their increasing role at the forefront of using virtual patient care modalities, particularly with rural or underserved populations [12]. It is important to understand APRN students’ use of technology in the workplace, daily life, and educational programs to gain an understanding of their ability to adapt to the health care arena, as this arena will require them to use and be increasingly adaptable to technology in order to facilitate patient communication and improve patient safety and practice outcomes. Many health technologies have transformed professional health care practices, which alters the educational requirements for future practitioners. A flexible education program employing new technologies in the market in a timely manner has helped care providers familiarize themselves with various features from such health technologies and increase their comfort level [19-21]. For example, many educators use personal digital assistants in clinical education to take advantage of the current technology to enhance care providers’ learning outcomes [22-24]. More recently, a video-based education program was shown to increase nursing students’ satisfaction and learning experiences [25]. Furthermore, the telehealth curriculum has suggested the inclusion of problem-based solving and telehealth site visits in the curriculum [26].

However, development of a new technology program is not an easy task. Considering the fast-moving technology advances in the health care arena [27], a technology curriculum for health profession students may not keep up with the speed and variety of the prevalent health technologies. Moreover, care providers’ technological ability to combine technology use and health care services is still neither defined well nor instructed frequently. An alternative educational focus on “related” technology experience in daily life may allow health care educators to take a proactive approach to incorporating newly developed health technology into education settings. In particular, health care educators can identify similar, widely available technologies that provide similar technology experience in the education setting and encourage providers to use them in training, all of which can help care providers enter the workforce with positive attitudes about new workplace technology.

Health care information technology vendors should also consider care providers’ familiarity and experience with health as well as nonhealth information technologies for the design of a new health technology in the market. This is closely related to system usability, and a well-designed telehealth technology providing additional care monitoring and decision support capabilities can reduce care providers’ frustration toward the technology [28]. Addition of familiar features may encourage care providers to reduce the level of frustration about health technology and adopt a new health technology at work.

This research was an initial pilot study for a grant proposal. First, given the time and resources available when the study was conducted, only APRN students (n=109) in limited specialties such as Family Medicine participated. Future researchers should consider recruiting more APRN students with diverse specialties. Second, to capture care providers’ continuous use of various domain technologies, their technology use behaviors should be tracked over time and analyzed using a cross-sectional time-series analysis. Third, a more in-depth survey is necessary to capture providers’ daily use of nonhealth technology to compare technology use in both work and nonwork contexts. As participants self-tracked their use of various technologies across three different settings based purely on their memory and willingness, more robust data collection will enhance this study’s qualitative analysis findings. Finally, in this paper, we identified the importance of considering care providers’ technology experience across contexts and their care performance using telehealth technology. Future research may examine whether and how experience can influence attitudes and behaviors related to using telehealth technology through robust statistical analysis.

This study provided insights to inform a new telehealth nursing education program by exploring nursing students’ technology use characteristics at work, in daily life, and in an educational setting. These findings contribute to the health education literature and to health policy initiatives by demonstrating a new approach to incorporate care providers’ existing experience of using cross-domain technologies to design a tailored telehealth technology curriculum.