Final Assignment

MAMMOGRAPHY DETECTION AND PREVENTION OF BREAST CANCER 1

Mammography Detection and Prevention of Breast Cancer

Nikita Chapman

Liberty University

Author Note

Nikita Chapman

I have no known conflict of interest to disclose.

Correspondence concerning this article should be addressed to

Nikita Chapman. Email: [email protected]

MAMMOGRAPHY DETECTION AND PREVENTION OF BREAST CANCER 2

Mammography Detection and Prevention of Breast Cancer

Several recommendations have been proposed for breast cancer screening and

intervention, including breast awareness, self-breast examination, clinical breast examinations,

and mammography, to mention a few. These techniques are meant to offer early detection of

breast cancer, especially in its early forms in women before cancer spreads (Black et al., 2019).

Early detection of breast cancer has been praised for reducing breast cancer mortalities in

women. According to experts, mammography remains the most effective screening tool for

breast cancer in women.

Mammography has led to a reduction of breast cancer mortalities by approximately

40%. However, 30% of women are still considered to fail in undertaking recommendations for

timely mammography screening (Alizada et al., 2021). Mammography screening has increased

from approximately 29% to 70% among women, which is remarkable. However, the rate has

remained unchanged for several years due to challenges, such as barriers and disparities in

mammogram adherence.

Mammography as a screening too; for breast cancer among women is complex and

multifactorial. Several factors are associated with mammography screening adherence among

women, including socioeconomic disparities such as income level, education, insurance,

geographical settings and location, health beliefs in communities, and health literacy (Black et

al., 2019). Women with higher levels of education are associated with higher incomes and better

insurance plans. They are also linked with increased health literacy and thus are likely to have

better adherence to mammography breast cancer screening; this leads to subsequent early

detection and less likelihood of breast cancer mortalities. High-income levels and insurance have

MAMMOGRAPHY DETECTION AND PREVENTION OF BREAST CANCER 3

been attached to improved adherence in mammography screening among white women, but

these factors are not positively reflected in black women's adherence to mammography breast

screening (Alizada et al., 2021). However, several other factors, such as perceived discrimination

and distrust in the health sectors, are associated with the negative adherence patterns in black

women.

Purpose of the Study and Research Question

Adherence to mammography breast screening among women has indicated fluctuations.

Mammography has remained at the same rate for several decades; it is alarming. More breast

awareness programs are conducted to educate women on the importance of screening and early

detection of breast cancer. The study will identify women among the communities who are not

receiving timely mammography breast screening. It will explore past and current efforts to

improve breast screening among women. Its results will be used in developing a better plan to

improve adherence to mammography breast screening among women; it is an essential and

crucial health measure. Therefore, the research question for this study is;

Q1. Do counseling and addressing personal barriers improve mammography adherence among

women above 40 years?

The critical variables in the research question and population are;

1. Counseling and addressing personal barriers is the independent variable.

2. Mammography adherence is the dependent variable.

3. The population of interest in the study is women above 40 years

MAMMOGRAPHY DETECTION AND PREVENTION OF BREAST CANCER 4

Significance and Contribution to Nursing Research

Most estimates reveal that breast cancer treatment is reducing among women globally,

with averages indicating approximately 72.8% globally. Most regions in the United States have

recorded rates below the global goal of approximately 81.1% (Jiwa et al., 2021). The stats place

most of the regions in the United States in a higher need for initiatives to improve early detection

and prevention methods. Therefore, this research is significant for nursing research because it

will provide insights and understanding for better methods in improving adherence levels in

mammography in breast cancer screening, which will provide a benchmark in healthcare for

improving high-quality care.

Research Methodology and Design

The study shall utilize a qualitative non-experimental methodology and incorporate

several research designs, such as quality improvement, healthcare delivery innovations, and

policy evaluations. The qualitative methodology will effectively describe and answer a broad

range of questions illustrated in this research proposal, and it is also considered adequate for

studies involving several concepts and frameworks (Kang, 2018, p. 661). This study will be

focused on improving adherence to mammography breast screening for women in the United

States. Outcome measurement is an essential aspect of the quality improvement process. For this

project, the outcome measurement shall include determining the number of women undertaking

non-adherence who are scheduled for a mammogram after counseling and addressing personal

barriers. Specific data shall be collected regarding the quality of elements responsible for driving

improvements, especially with selected primary healthcare sites (Klarenbach et al., 2018). An

analysis shall be conducted for post and pre-intervention mammography rates to indicate the

MAMMOGRAPHY DETECTION AND PREVENTION OF BREAST CANCER 5

effectiveness of interventions, such as counseling and addressing personal barriers, in the

changes for improved adherence in mammography breast cancer screening.

Conceptual Framework; Model for Improvement

A conceptual framework is essential in plotting a map connecting all the essential

aspects of the study. The conceptual framework shall use the model for improvement because it

is the most appropriate for quality improvement, especially in the healthcare realm (O'Donovan

et al., 2020). This improvement model shall be based on three essential questions for healthcare

organizations because it will help the organizations set aims, establish measures, and select

appropriate changes. Once the changes are approved, the following step shall involve testing,

following the PDSA criteria. This illustrates planning for the changes, doing what is represented

by the implementing plan, studying and evaluating the represented results, and acting upon the

results.

The cyclical nature of the PSDA is essential for the development of the model of

improvement, and this is because the repeated cycles will be refined for optimum results. The

process can be initiated on a small scale and implemented on a large scale after realizing

effective results (O'Donovan et al., 2020). The model will be effective in answering three

questions for the study.

1. What shall the study accomplish? This question shall effectively answer the purpose and

aim of the study, which involves improving mammography adherence among women

with non-adherence practices in communities.

MAMMOGRAPHY DETECTION AND PREVENTION OF BREAST CANCER 6

2. How will the improvements be measured? It will effectively refer to outcome

measurements; this shall be guided by the model for improvement that illustrates that all

improvements require changes.

3. What changes shall be made for improvement? This question shall be essential in

focusing on changes that will be effective for improvements. It explains the changes that

will lead to improved adherence to mammography breast screening among women.

Conclusion

Several recommendations have been proposed for breast cancer screening and

intervention, including breast awareness, self-breast examination, clinical breast examinations,

and mammography, to mention a few. These techniques are meant to offer early detection of

breast cancer, especially in its early forms in women before cancer spreads. The study will

identify women among the communities who are not receiving timely mammography breast

screening. It will explore past and current efforts to improve breast screening among women. Its

results will be used in developing a better plan to improve adherence to mammography breast

screening among women. The study shall utilize a qualitative non-experimental methodology

and incorporate several research designs, such as quality improvement, healthcare delivery

innovations, and policy evaluations. The qualitative methodology will effectively describe and

answer a broad range of questions illustrated in this research proposal.

MAMMOGRAPHY DETECTION AND PREVENTION OF BREAST CANCER 7

References

Alizada, F., Lachyan, A. S., & Simon, N. H. (2021). A literature review assessing knowledge,

attitude, and preventive practices towards breast cancer among Indian women.

http://dx.doi.org/10.24327/ijrsr.2021.1204.5901

Black, E., & Richmond, R. (2019). Improving early detection of breast cancer in sub-Saharan

Africa: why mammography may not be the way forward. Globalization and Health,

15(1), 3-3. https://doi.org/10.1186/s12992-018-0446-6

Jiwa, N., Takats, Z., Leff, D. R., & Sutton, C. (2021). Breast health screening: a UK-wide

questionnaire. BMJ Nutrition, Prevention & Health, bmjnph-2021.

https://doi.org/10.1136/bmjnph-2021-000266

Kang. (2018). Use of Breast Cancer Screening and Its Association with Later Use of Preventive

Services among Medicare Beneficiaries. Radiology., 288(3), 660–668.

https://doi.org/10.1148/radiol.2018172326

Klarenbach, S., Sims-Jones, N., Lewin, G., Singh, H., Thériault, G., Tonelli, M., Doull, M.,

Courage, S., Garcia, A. J., Thombs, B. D., & Canadian Task Force on Preventive Health

Care (2018). Recommendations on screening for breast cancer in women aged 40-74

years who are not at increased risk for breast cancer. CMAJ : Canadian Medical

Association journal = journal de l'Association medicale canadienne, 190(49), E1441–

E1451. https://doi.org/10.1503/cmaj.180463

O'Donovan, J., Newcomb, A., MacRae, M. C., Vieira, D., Onyilofor, C., & Ginsburg, O. (2020).

Community health workers and early detection of breast cancer in low-income and

MAMMOGRAPHY DETECTION AND PREVENTION OF BREAST CANCER 8

middle-income countries: a systematic scoping review of the literature. BMJ global

health, 5(5), e002466.

LITERATURE REVIEW MATRIX NURS500

Name: Nikita Chapman Date: 23 Jan 22 Course: NURS500

Complete Citation in APA format

Level of Evidence

Theoretical/ Conceptual Framework if present

Research Question(s)/ Hypotheses

Research Design Methodology

Statistical Analysis & Results

Conclusions Implications for Future research and Practice

Alizada, F., Lachyan, A. S., & Simon, N. H. (2021). A literature review assessing knowledge, attitude, and preventive practices towards breast cancer among Indian women. http://dx.doi .org/10.2432 7/ijrsr.2021. 1204.5901

Peer- reviewed journal

Assessing the attitude and knowledge on preventive practices towards breast cancer.

Do women know about breast cancer and breast self- examination? What is the attitude of women towards breast cancer?

The study used a review approach. The articles reviewed were identified and analyzed through an electronic data search through inclusion criteria of 2010 and afterward Malaysia (Alizada et. 2021).

The study utilized 12 articles, 7 of them conducted in India, and the rest from other parts of the world, including Pakistan, Nigeria, Bangladesh, Iran, and Malaysia (Alizada et. 2021). 16% of the women revealed knowledge of breast cancer in India, 50% in Pakistan, and a 2% self-examination practice among Indian women. The study illustrated poor knowledge of breast cancer and the self- examination among women. Most women were unaware of the mammogram or other screening methods.

Women with little knowledge of breast cancer and self-examination cause an increased incidence rate because they inhibit the early detection of breast cancer. Awareness and education are necessary to mitigate the challenges of inadequate knowledge about breast cancer and self-examination.

The study provides information illustrating gaps in breast cancer detection and prevention. More research is required to provide substantive information about the importance of early detection and prevention of breast cancer. The use of mammograms in screening and detecting breast cancer should also be emphasized.

Black, E., & Richmond, R. (2019). Improving early detection of

Peer- reviewed journal

Early detection practices and the effectiveness of

Mammography and other screening methods may not be the most

The study reviewed breast cancer literature, screening methods, and their

Results illustrate that women with breast cancer in SSA are younger than in high-income nations. Treatment options are limited, leading to poor

According to the study, early detection of breast cancer should be context-specific in SSA. Early

Further research is required in evaluating the feasibility and acceptability of clinical downstaging

LITERATURE REVIEW MATRIX NURS500 breast cancer in sub-Saharan Africa: why mammograp hy may not be the way forward. Gl obalization and Health, 15(1 ), 3- 3. https://doi .org/10.1186 /s12992- 018-0446-6

mammograph y in breast cancer detection and prevention in SSA.

effective in SSA.

effectiveness in SSA.

prognoses. Engagement with early detection and screening practices, such as the mammogram, is low, contributing to late- stage diagnosis.

detection strategies, such as mammography, need complementary methods to reduce mortalities from breast cancer in low-income nations, such as SSA (Black & Richmond, 2019).

as a tool for controlling breast cancer in SSA.

Jiwa, N., Takats, Z., Leff, D. R., & Sutton, C. (2021). Breast health screening: a UK-wide questionnair e. BMJ Nutrition, Prevention & Health, bmjnph- 2021. https://doi.or g/10.1136/b mjnph- 2021- 000266

Peer- reviewed journal

The study emphasized on the concept of self-testing based on the nipple fluid.

NAF is an acceptable tool in screening breast cancer.

The study was conducted through an online survey. The survey consisted of four parts, including an overview of breast health, essential demographic data, questions on the acceptability of NAF as a screening tool, and opinions regarding NAF collection for cancer screening

A total of 3178 respondents completed questionnaires, all having consent to participate in the study. This gave a 74.0% response rate out of the 4305 respondents who interacted with the questionnaires (Jiwa et al., 2021). The larger population of women (89.8%) were keen to understand the risks involved with breast cancer, 8.5% were not decided, and 1.6% did not want to know the risk involved with breast cancer. 29.2% of women needed to know the risk of breast cancer due to

The study illustrated that the concept of NAF as a screening tool was highly acceptable. The study also illustrated that public awareness of breast cancer screening protocols and mammograms needed improvements.

Evaluating improvements needed on mammograms as a tool for breast cancer screening. Increased public awareness is required to enhance the knowledge of breast cancer to more women.

LITERATURE REVIEW MATRIX NURS500 (Jiwa et al., 2021).

family history and 11.5% due to personal history. 83.4% of respondents were unaware of NAF, with 92.0% indicating acceptability for home screening.

Kang. (2018). Use of Breast Cancer Screening and Its Association with Later Use of Preventive Services among Medicare Beneficiarie s. Radiology ., 288(3), 660–668. https://doi.or g/10.1148/ra diol.201817 2326

Peer- reviewed journal

Retrospective assessing the association between mammograph y screening with preventive services for women enrolled in Medicare.

There is an association between screening mammography and the use of a variety of preventive services in women who are enrolled in Medicare.

The study collected data for the research through retrospective Medicare claims from 2010 to 2014 identifiable research files (Kang, 2018, p. 666). Qualitative analysis was conducted by applying a multivariate logistic regression model.

The study recorded 555705 patients as cohorts. 185625 of them underwent mammography, reflecting 33.4% of the total cohorts (Kang, 2018, p. 667). The results did not indicate significant differences in screened and unscreened women in preventive services.

The use of mammography for screening breast cancer was associated with increased adherence to other preventive methods.

The association between mammography and cervical cancer screening should be emphasized through further research.

Klarenbach, S., Sims- Jones, N., Lewin, G., Singh, H., Thériault, G., Tonelli, M., Doull, M.,

Peer- reviewed journal

Screening through mammographs may identify breast cancer earlier, leading to more effective and less

Recommendati ons for screening women for breast cancer should remain similar to those of the previous task force.

The study relied on two evidence reviews. Review protocols for the study were entered in PROSPERO. The Grading of Recommendatio

Mammography screening for breast cancer causes modestly reduced breast cancer mortalities for women between 40 and 70 years. Mammography was recommended for such women, with more specific descriptions

From the study, mammography is considered more effective for screening breast cancer in women between 40 and 70 years.

Further research is required to evaluate the effectiveness of mammography in other age brackets and the effectiveness of combining mammography with

LITERATURE REVIEW MATRIX NURS500 Courage, S., Garcia, A. J., Thombs, B. D., & Canadian Task Force on Preventive Health Care (2018). Recommend ations on screening for breast cancer in women aged 40-74 years who are not at increased risk for breast cancer. CM AJ : Canadian Medical Association journal = journal de l'Associatio n medicale canadienne, 190(49), E1441– E1451. https://doi.or g/10.1503/c maj.180463

invasive cancer treatment.

ns, Assessment, Development and Evaluation (GRADE) approach was utilized in determining the quality of evidence provided and the strength of the recommendation (Klarenbach et al., 2018).

recommended for other screening methods.

other screening methods.

LITERATURE REVIEW MATRIX NURS500 O'Donovan, J., Newcomb, A., MacRae, M. C., Vieira, D., Onyilofor, C., & Ginsburg, O. (2020). Community health workers and early detection of breast cancer in low-income and middle- income countries: a systematic scoping review of the literature. B MJ global health, 5(5), e002466.

Peer- reviewed journal

The study examined the role of community health workers in the early detection and prevention of breast cancer.

The research questions included; Where and how community health workers are deployed in the role of detection and prevention of breast cancer. How the community health workers are trained on breast cancer detection. The cost associated with the deployment of community health workers in breast cancer detection programs.

The study was conducted through a review approach. The review process effectively followed the preferred reporting items for systematic reviews and meta-analyses. Eight databases were utilized to identify peer- reviewed publications from 1998 to 2019 (O’Donovan et al., 2020). Data were systematically extracted from the resources into data charting forms a shared spreadsheet in Microsoft Excel.

The initial search provided 2938. A total of 2574 studies were provided after deduplicating the initial resources. A screening of the 2574 studies yielded 47 studies subjected to full-text review (O’Donovan et al., 2020). Following the exclusion and inclusion criteria, 31 more studies were excluded, and only 16 were left. The roles of community health workers were identified, including awareness and community education, performing community- based breast screening, and making referrals for further examination or critical considerations.

Community health workers can play a vital role in the early detection and prevention of breast cancer. Therefore, they need to be supported in a wider health system.

Early detection is essential in the prevention of breast cancer. A study can examine how community health workers can promote detection and prevention of breast cancer and the connection they may have in mammogram utilization (O’Donovan et al., 2020).

Pashayan, Antoniou, A., Ivanuš, U., & Esserman, L. (2020). Publisher

Peer- reviewed journal

Risk-stratified prevention and early detection strategies for breast cancer.

Not Applicable A descriptive qualitative approach is used in the study.

The study illustrates risk assessment for breast cancer, risk-stratified prevention, risk-stratified detection, and the implementation of these strategies.

The study shows substantial progress in estimating risks of developing breast cancer, applying risk stratification,

Further research is required to evaluate the acceptability and the feasibility of implementing risk- stratified detection

LITERATURE REVIEW MATRIX NURS500 Correction: Personalized early detection and prevention of breast cancer: ENVISION consensus statement (Nature Reviews Clinical Oncology, (2020), 10.1038/s41 571-020- 0388- 9). Nature Reviews.

and modeling the benefit-harm balance in early detection and prevention of breast cancer.

and prevention of breast cancer.

White, M. C., Kavanaugh- Lynch, M., Davis- Patterson, S., & Buermeyer, N. (2020). An Expanded Agenda for the Primary Prevention of Breast Cancer: Charting a Course for

Peer- reviewed journal

A structured, innovative approach to integrating scientific evidence with community perspectives in developing a plan to reduce breast cancer incidences (White et al., 2020, p. 714).

Not Applicable The study used a descriptive approach to reduce breast cancer incidences.

The results indicate that the new approaches by BCPP embrace expansive mind frames, which are essential in mapping prevention measures for the future. (White et al., 2020, p. 714).

The prevention methods identified in the primary prevention plan can reduce breast cancer incidences.

Extending research to ascertain the effectiveness of implementing dialogues and awareness to advocate reduced breast cancer incidences is an opportunity provided by the gaps in this study (White et al., 2020, p. 714).

LITERATURE REVIEW MATRIX NURS500 the Future. Inter national journal of environment al research and public health, 17(3 ), 714. https://doi.or g/10.3390/ij erph170307 14

ETHICAL PRINCIPLES 1

Ethical Principles

Nikita Chapman

Liberty University

Author Note

Nikita Chapman

I have no known conflict of interest to disclose.

Correspondence concerning this article should be addressed to

Nikita Chapman. Email: [email protected]

ETHICAL PRINCIPLES 2

Ethical Principles

Organization worldwide has made rapid progress in the field of research to

determine and evaluate different studies for future evaluations, standard formations, protecting

the individual's health and activities such as clinical surveillance, disease prevention, or control.

However, due to scientific invention, the primary research portion of maintaining the record is on

electronic gadgets, which have created the considerable threat of disclosure, misuse, and leakage

of research information about an individual (Tsan, 2019, p. 188) In medicine, various researches

have been carried out based on qualitative and quantitative methods to fulfill diagnostic and

clinical information. Countries have organized data of individuals through public health

information systems.

One of the basic principles in medical research is protecting information and

research work as a private matter. Hence, the world's health sectors have designed certain ethical

principles, rules, and regulations to meet the requirement of research records privacy. The need

of the principles is to protect medical records communicate the responsibility to the

researcher/investigator to maintain confidentiality. Ethical principles strengthen patients' health

records, ensure security, and limit the use or disclosure of health information dignified,

respectable way. These ethical principles, carrying out research, enable the organization, health

sector services, and critical public authorities to understand the consequences, responsibilities,

and obligations during performing duties. Ethical principles provide a mechanism, directions,

and systematic guidance for research and investigations and enable entities for sustainable health

information protection.

Informed Consent

ETHICAL PRINCIPLES 3

Informed consent is one of the essential parts of any research work. Informed consent

will be helpful for the participant to understand well what the basics of research being done are

and what would be the possible outcomes. Through the consent form, every detail regarding the

research will be provided to the participant, and he will be allowed to take his time and

understand it well. The process and privacy of the research will be explained to the participant,

and it will be ensured that this research will remain highly confidential with his information and

no information regarding the research and participants will be leaked.

The consent form will be written in easy language so that it would be easy for the

participant to understand, and he will be allowed freely to ask if there are any queries regarding

the research. This informed consent will let the participant decide voluntarily whether either he

would like to become a part of it or not. The participant needs to think about the research and

understand its aim and purpose for the conduction (Tsan, 2019, p. 188). They will also be able to

understand their role in the research study. It will also help the participant understand their

medical condition, rates of success, and the information about treatment he would like to get to

cure himself. Time is given to the participant to consider, and then the consent is taken.

Protection of Privacy

Protection of the privacy of the data is very crucial for the study. The participant tries

to give the best possible honest response (Xiang & Cai, 2021). They tend to volunteer in a study

so that they will not be explicitly exposed for any reason and will not become a test subject for

other scientific studies. Privacy protects the participants from various sources of potential harm.

Furthermore, it also protects them from distress and social embracement of any kind. I will

protect the privacy of my study by collecting the data and analyzing it on my own. No one will

be part of it, and it will not be handed over to anyone for analysis.

ETHICAL PRINCIPLES 4

Furthermore, only two copies of the research data will be created that will remain

between the researcher and the supervisor only. The data used for the process could be saved in

specific coding languages that would only be understandable to the researcher. Another major

step that can be taken to protect the privacy of the participant's data is that the whole collected

data will be destroyed after the six months of publishing the article and completion of the

research. All the confidential files will be maintained and saved so that participants can go

through research in a relaxing manner.

IRB Review:

IRB consists of a group of specialists who go through the research, and they are

formally designated to observe each part of the research. This specialist asks about each subject

whenever biomedical research is conducted (Tsan, 2019, p. 187). Once they approve the

research, it can move in a further direction. IRB is allowed to make changes in research or even

cancel it if it is not worthy of being conducted or contains any part that can be harmful to people.

They review the research project thoroughly and then allow it to be carried on. For my research

proposal, the IRB analyst will undoubtedly allow it as my research will be confidential and will

not be harmful to humanity in any possible way. As IRB has the authority to approve, a research

proposal with properly informed consent, confidential data, and harmless for humanity will be

accepted.

Risk-Benefit Ratio

A risk-benefit ratio for my study, based on human psychology, will be favorable. This ratio

defines the ratio of risk occurrence or potential of gaining a benefit from a research study. If the

number of risks is less than the benefits obtained from the study, then the study is likely to be

ETHICAL PRINCIPLES 5

successful. My study participants will observe more benefits and understand their medical

conditions at the end, and they will fully understand their profits at the end of the study.

References

Tsan, M.-F. (2019). Measuring the Quality and Performance of Institutional Review

Boards. Journal of Empirical Research on Human Research Ethics, 14(3), 187–189.

https://doi.org/10.1177/1556264618804686

Xiang, D., & Cai, W. (2021). Privacy Protection and Secondary Use of Health Data: Strategies

and Methods. BioMed Research International,

2021 http://dx.doi.org/10.1155/2021/6967166

DATA COLLECTION: TELEHEALTH 1

Data Collection: Telehealth

Nikita Chapman

Liberty University

Author Note

Nikita Chapman

I have no known conflict of interest to disclose.

Correspondence concerning this article should be addressed to

Nikita Chapman. Email: [email protected]

DATA COLLECTION: TELEHEALTH 2

Data Collection: Telehealth

Every day people need to travel to access health care. With the help of telehealth, instead of

accessing health care, health care can access them in their homes. Telehealth is the delivery of a

health service across a distance. An example of telehealth maybe if a patient has a video

conference appointment from their home or a regional hospital directly to a specialist at the main

city hospital. Telehealth can also be delivered using the simple telephone by sharing information.

An example of this can be sending a digital image by email or through cellphones is an

excellent example of telehealth. It is a method of supporting people in remote rural, or remote

areas that cannot have access to specialists or experienced doctors for complex or higher degree

diseases (Jennett & Andruchuk, 2001). Telehealth can be beneficial for a range of appointments,

such as follow-up appointments.

Many of these conventional hurdles to telemedicine adoption have been broken down by the

quick popularity of telehealth in reaction to the severe social distancing regulations related to

COVID-19 (Hirko, 2020, p. 1817). For many health care organizations or clinics, a quick change

to this alternative is seen as the only way to earn revenue and provide assistance to patients. For

several healthcare organizations or clinics, a quick change to this alternative is seen as the only

way to earn revenue and provide assistance to patients (Hakim et al., 2020, p. 48). While many

of these organizations took a cautious and deliberate response, others have not.

Many have adapted to this strategy without considering its impact and whether this approach

is capable in the long run and is productive for both parties (Hilty, 2018, p. 819). It is undeniable

that doctors' and patients' direct experiences with telehealth will change their minds, either

constructively or destructively, regarding this model of care provision. In order to check the

effectiveness of the approach, a study needs to be conducted, and a methodology needs to be

DATA COLLECTION: TELEHEALTH 3

outlined. This methodology importantly includes the main three steps that are: study setting,

sampling process, and the procedure, and finally, the data collection.

Research Design

A research design needs to be outlined and constructed to determine the possible impact and

implications of the approach. The need for this approach is already identified because the rise

and new pandemic waves of Covid-19 variants highlight the importance (Hirko, 2020, p. 1818).

Due to lockdowns and social distancing restrictions, it is hard for people to attend medical

appointments or consultations and difficult for doctors to manage the patients for face-to-face

consultations or appointments. Therefore, present-day it is the need of time. The competency of

this approach needs to be evaluated, for which further study needs to be conducted.

Study Setting

The study needs to be conducted essentially at hospitals. For using this strategy, clinical

variables may need to be considered. These characteristics are to be taken into account on a

service-by-service basis, with clear documentation to assist physicians in selecting people who

could benefit from a telehealth session.

Patient information: The variable that should be considered are age, any comorbidities,

communication barriers, the urgency to provide medical care because of the disease, possible

sensory impairment, and whether they are qualified for the use of telehealth.

Accessing type of delivery: It can be provided in a "hybrid" approach, with some

consultations taking place in person and others taking place over the phone. Patients with

complex or advanced-stage diseases will need in-person consultations or appointments to access

their condition by the doctors, and then their subsequent consultations or follow-up appointments

can be conducted with the help of telehealth service.

DATA COLLECTION: TELEHEALTH 4

All these points need to be consulted with the doctors first, and it is vital to take their point of

view. Similarly, patients and people also need to be consulted to take their point of view

regarding this approach. Furthermore, the patients who have already used this approach can

provide more insight into the effectiveness as this approach is more importantly about patients. It

is essential to understand the effectiveness of this approach and whether it aided in tackling the

problems patients were facing.

Sampling Processes and Procedure

Many people belonging to a different line of fields, for example, a specialist in bioinformatics,

medical health assistance, policymaking, and public policy, need to be interviewed to understand

this approach and tackle it effectively from every aspect. The representatives or experts are

brought in to contribute information and comments but are not considered the study's writers,

neither are responsible for its accuracy, and the study may not necessarily represent their

perspectives. Representatives are given chances to respond to the preliminary study "as part of

the peer-review process," in addition to the previous discussion. Conducting interviews and

discussion with them is to understand any loophole or the issues with the policies based on the

use of telehealth.

The representatives will highlight the scope of this approach and provide their view on

tackling the issues with the stakeholders. They will also be given a questionnaire covering

questions regarding communication, doctors' consultation, and disease management on their

behalf. Moreover, whether they would be more comfortable directly using a telephone as a

means of communication or software that would help them connect with their choice of expert or

specialist to help them with their medical conditions. Accessing their answers will help identify

the mode of delivery people will be more comfortable using the approach.

DATA COLLECTION: TELEHEALTH 5

People who have used this strategy during or before the pandemic will be provided with

different questionnaires; they will cover their experience and effectiveness. The changes they

would want to see in the strategy and the problems they came across.

Data Collection

The survey of people and patients and the interviews of representatives will be collected and

analyzed. The questionnaires will be evaluated, and their contents will be analyzed. The results'

significance can be calculated using various software, and this software will aid in representing a

small set of possibilities and estimations that are not very accurate. Similarly, the interviews of

representatives will also be evaluated, and combining the suggestions and requirements or

problems that patients faced will be put together to make telehealth effective, efficient, and cost-

effective. Lastly, chi-square will be performed to look for links between systematic review

findings and possible outcomes, whether the reviews utilized statistical analysis, and if the

reviews included quality of data evaluation in their results (Totten et al., 1995).

Combining these steps and following this research model will aid significantly in

understanding the scope and effectiveness of telehealth for the patients and the doctors. The

ethical consideration should also be evaluated. Patient consent is vital because their information

will be taken for this approach, and there is a difference between in-person and Telehealth

appointments or consultations. Furthermore, during a telemedicine consultation, the same level

of privacy and confidentiality must be maintained during an in-person session (Cottrell &

Russell, 2020).

This approach can be helpful not only in a pandemic but also in accessing medical care for the

people living in the country or remote areas. As a result, it should not be taken as a temporary

Band-Aid but a long-term solution for people to securely receive health services.

DATA COLLECTION: TELEHEALTH 6

References

Cottrell, M. A., & Russell, T. G. (2020). Telehealth for musculoskeletal

physiotherapy. Musculoskeletal Science and Practice, 48, 102193. https://doi-

org.ezproxy.liberty.edu/10.1016/j.msksp.2020.102193

Hakim, A. A., Kellish, A. S., Atabek, U., Spitz, F. R., & Hong, Y. K. (2020). Implications for the

use of telehealth in surgical patients during the COVID-19 pandemic. The American

Journal of Surgery, 220(1), 48-49. https://doi.org/10.1016/j.amjsurg.2020.04.026

Hilty. (2018). The Need to Implement and Evaluate Telehealth Competency Frameworks to

Ensure Quality Care across Behavioral Health Professions. Academic Psychiatry Official

Journal of the American Association of Directors of Psychiatric Residency Training and

the Association for Academic Psychiatry., 42(6), 818–824.

https://doi.org/10.1007/s40596-018-0992-5

Hirko. (2020). Telehealth in response to the COVID-19 pandemic: Implications for rural health

disparities. Journal of the American Medical Informatics Association : JAMIA., 27(11),

1816–1818. https://doi.org/10.1093/jamia/ocaa156

Jennett PA, Andruchuk K. Telehealth: 'real life' implementation issues. Comput Methods

Programs Biomed. 2001 Mar;64(3):169-74. doi: 10.1016/s0169-2607(00)00136-x.

PMID: 11226614

Totten, P. L., King, B. J., & Chatterji, J. (1995). U.S. Patent No. 5,458,195. Washington, DC:

U.S. Patent and Trademark Office. https://doi.org/10.1016/1352-0237(94)00035-N

RESEARCH PROPOSAL: TELEHEALTH 1

Research Proposal: Telehealth

Nikita Chapman

Liberty University

Author Note

Nikita Chapman

I have no known conflict of interest to disclose.

Correspondence concerning this article should be addressed to

Nikita Chapman. Email: [email protected]

RESEARCH PROPOSAL: TELEHEALTH 2

Data Analysis

The data collection will be based on the survey involving patients who will be interviewed.

The questions related to the interview and the questionnaire will be developed to understand the

comfort and satisfaction level of the patients who are using the telehealth system to seek help

from their physicians. With the interviewer, the questionnaire will distribute relevant information

and data regarding the benefits of the telehealth system. Considering the conditions due to the

pandemic, these tools will be facilitated by video calls and emails to avoid physical contact.

After collecting the data in the form of an interview and questionnaire, the synthesized

data will then be subjected to SPSS, which is a statistical tool to analyze the collected data and

its significance (Gamble, 2017, p. 2338). For this purpose, a quantitative approach will be

utilized to involve the patients' responses regarding their experience with the telehealth system

(Gamble, 2017, p. 2339). These responses need to be statistically explained to better understand

the success rate of telehealth systems in familiar people, especially in remote areas.

The questionnaire and interviews will also involve the demographic information of the

patients and their background to understand better the facilitation of the telehealth system in

different areas and people. The demographic information will include age, gender, ethnicity, and

race to determine which group benefited the most from the telehealth system. For this purpose,

the descriptive analysis will also be done, which will represent the background of the participants

in the form of percentages and frequencies (Hancock et al., 2019, p. 114).

An inferential statistical test will analyze the determination of other factors included in the

questionnaire and interview questions. Inferential statistical tests allowed the researchers to

explain the possible findings from which a conclusion can be drawn representing that particular

population. For this purpose, a Chi-square test will be performed to determine significant

RESEARCH PROPOSAL: TELEHEALTH 3

findings that can help explain the proposed telehealth system, i.e., whether it fulfilled its purpose

and facilitated people of remote areas.

Rationale

The use of quantitative analysis helps provide synthesized data that explains the figures, which

can help us determine the benefits of the telehealth (tele-wound) system for the people of distant

and remote areas.

Level of Significance

The significant value in this test will be p < 0.05. The p-value, p=0.01, is considered

highly significant (Gamble, 2017).

Anticipated Results

It is estimated that the proposed telehealth system will be beneficial for remote areas as it is

based on the provision of medical help to inaccessible areas. Sometimes the people of remote

areas have to cover long distances to reach the hospitals; however, with the help of telehealth

systems, they can access their physicians without the physical journey. Regular checkups can be

efficiently conducted through this system to avoid long distances and receive medical help

without waiting for their turn.

Mataxen & Webb (2019), explained that implementing a telehealth system to provide tele-

wound facilities to remote areas has proved to be beneficial in wound care of the patients.

According to this study, the individuals who were treated with the help of telehealth systems are

considered to have improved patient outcomes, which also resulted in cost savings leading to

speedy healing. Mataxen & Webb (2019), also suggested that the implementation of telehealth

systems is directly related to the improvement of the patients as it benefits the patient's clinical

RESEARCH PROPOSAL: TELEHEALTH 4

signs and healthcare systems in general. However, more research is still required to make the

systems more efficient in different locations where the patients can be treated.

In another study conducted by Hancock et al. (2019), the efficiency of the telehealth system

was assessed, which resulted in positive outcomes in the clinical trials. In this, the patients in the

remote areas were included and assessed by implementing the telehealth strategies. Clinical trials

detect the results brought a positive response from the patient, and this system was efficient in

providing clinical wound care treatment leading to cost-efficiency. From the findings of these

studies, it can be estimated that the current proposal will bring positive outcomes in terms of

increased patient satisfaction and improved healthcare leading to cost-efficiency.

Strengths and Weaknesses of Proposed Study

The telephone system utilizes modern means of communication while taking the patients to

avoid the rush in the hospitals or healthcare facilities. This system is targeted at the people of

remote areas where it is difficult for the patients to find different ways to cover these distances to

reach their nearest healthcare center. The proposed study will help them save their effort of

coming to the nearest healthcare facility for regular checkups. It is even more beneficial for older

people because of their health status. The tele-wound system under the category of telehealth

system will also provide the patients with necessary checkups without coming to the healthcare

facility (Hancock et al., 2019, p. 114)

However, it will be difficult for the elderly population to understand and utilize this system

because of technical knowledge. They may find it challenging to operate a digital system even

though it is easier to understand, but it may become more challenging for older adults. There is

also a chance of network unavailability, which can be due to natural disasters.

RESEARCH PROPOSAL: TELEHEALTH 5

The involvement of both interviews and questionnaires will help cover more patients who

have been using the telehealth system. The questionnaires may be complicated for some

participants to fulfill due to a deficiency of technical knowledge. Therefore, the conduction of

interviews will suffice and allow the continuation of the data collection. The use of

telecommunication systems, including video calls and emails, will help avoid physical contact.

The implementation of statistical analysis will increase the validation of the research as it can

provide the statistically analyzed data representing whether the implementation of telehealth

systems will be beneficial for remote areas.

Suggestions for Future Research

Currently, the studies are restricted to limited remote areas with a small population based on

the older people, especially when it comes to the tale wound healthcare system. Therefore, there

is a need to expand the area of research, which can include people from different areas and acne

cities with an increased variety (Rutledge et al., 2021). It is necessary to understand how people

from different ethnicities consider implementing telehealth systems and what benefits will be

provided to the patients regarding the improvement in the provision of quality healthcare.

This study is limited to a smaller area. However, it can be expanded to larger areas. The study

can be expanded nationwide to understand the benefits of the telehealth system in different areas.

However, it can also be expanded to intercontinental interaction and implementation of

telehealth systems so that people from different countries can interact with physicians (Rutledge

et al., 2021). Moreover, there is also a necessity to make the general public aware of telehealth

systems through their mobile phone applications, which can bring various benefits, including

cost-efficiency of both the patients and the organizations. The adoption of telehealth systems and

the provision of digital care solutions is beneficial and, therefore, should be researched at a larger

RESEARCH PROPOSAL: TELEHEALTH 6

scale to identify limiting factors and possible solutions for the continuation of telehealth systems

(Gamble, 2017, p. 2340).

RESEARCH PROPOSAL: TELEHEALTH 7

References

Gamble. (2017). Guidelines for the Content of Statistical Analysis Plans in Clinical

Trials. JAMA : the Journal of the American Medical Association. 318(23), 2337–2343.

https://doi.org/10.1001/jama.2017.18556

Hancock, S., Preston, N., Jones, H., & Gadoud, A. (2019). Telehealth in palliative care is being

described but not evaluated: A systematic review. BMC Palliative Care, 18(1), 114-

114. https://doi.org/10.1186/s12904-019-0495-5

Mataxen, P. A., & Webb, L. D. (2019). Telehealth nursing: More than just a phone call. Nursing

(Jenkintown, Pa.), 49(4), 11-

13. https://doi.org/10.1097/01.NURSE.0000553272.16933.4b

Rutledge, C. M., O'Rourke, J., Mason, A. M., Chike-Harris, K., Behnke, L., Melhado, L.,

Downes, L., & Gustin, T. (2021). Telehealth competencies for nursing education and

practice: The four P's of telehealth. Nurse Educator, 46(5), 300-

305. https://doi.org/10.1097/NNE.0000000000000988