Table 1 The NASSS framework assessment of the diabetes in pregnancy telehealth service
1 | Condition: | |
1A | Diabetes in pregnancy | simple |
1B | Co-morbidities: age, multiple co-morbidities; Sociocultural: English proficiency, health literacy, | complicated |
2 | Technology: | |
2A | Material properties: Telehealth or phone. Variable issues with audio/video | simple/complicated |
2B | Knowledge generated by it: health information and BSL provided | simple |
2C | Knowledge to use it: telephone use viewed as simple but technology issues reported for video conferencing | complicated for video conferencing |
2D | Supply model: Health service provided or personal mobile phone | simple |
3 | Value proposition | |
3A | Supply side: Decreased COVID exposure/efficiency/ maintenance of service | simple |
3B | Demand side value: Decreased COVID exposure, convenience, access to care in setting of pandemic, reduced cost | simple |
4 | Adopters | |
4A | Staff: Clerical and medical staff need to learn new skills. Increased paperwork during consultations | complicated- |
4B | Patient: variable-dependent on care need, health and technology literacy. Less satisfied for maternity care to be received via telehealth | complicated for maternity video/ simple for telephone use |
4C | Carers: assumes a caregiver will be available when needed | complicated |
5 | Organisations | |
5A | Capacity to innovate in general: accelerated by COVID | simple |
5B | Readiness for this technology: enhanced readiness in the setting of COVID directed need | simple |
5C | Nature of adoption and/or funding: health service directive to transition to telehealth in response to COVID. Change to government funding regulations to enable reimbursement | complicated |
5D | Extent of change needed to organisational routines: Change from in person consultations to mostly telehealth. Development and dissemination of telehealth guidelines for staff | complicated |
5E | Work needed to plan, implement and monitor change: Clerical and medical staff worked to triage appointments types and communicate with patients. | complicated |
6 | Wider system | |
6A | Political/ policy context: Government directives regarding change to funding of telehealth, provision of PPE as required | simple |
| Â | Professional bodies: Guidelines developed regarding management. Professional bodies supportive | complicated |
| Â | Sociocultural context: issues regarding equity of access for non-English speaking women/ use of telehealth | complicated |
7 | Embedding and adaption over time | |
7A | Scope for adaption over time: proposed hybrid model of in-person and on-going telehealth consultations. Need for ongoing funding model of telehealth. | complicated |
7B | Organisational resilience: Organisation continues to adapt to uncertainties related to COVID | complicated |