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UBC Theses and Dissertations

Advancing telehealth physiotherapy for Indigenous people : navigating virtual therapeutic relationships Petry Moecke, Débora Melissa

Abstract

Telehealth, a rapidly evolving area of healthcare delivery, holds promise for enhancing access to physiotherapy services, particularly for Indigenous populations in remote and underserved areas. However, establishing strong therapeutic relationships through virtual platforms remains a critical challenge. This dissertation aims to advance telehealth physiotherapy for Indigenous communities, focusing on navigating virtual therapeutic relationships. Study 1: A scoping review synthesizing international literature on telehealth for Indigenous populations was conducted, highlighting critical factors to guide the development of culturally informed telehealth services (Chapter 2). Study 2: A local analysis of telehealth usage and physiotherapy needs in First Nations communities was undertaken, which underscored the potential benefits of telehealth in increasing access to physiotherapy and addressing prevalent health issues but emphasized the need for improved infrastructure, professional capacity and awareness. (Chapter 3) Studies 3 and 4: Physiotherapists' and First Nations peoples’ perspectives (respectively) on telehealth as a medium for physiotherapy delivery were explored through qualitative interviews, with a focal point on patient-provider relationships within the virtual context. Both studies showed an overall optimism toward telehealth but identified several challenges and potential strategies to mitigate them. Training gaps, limited awareness about physiotherapy, trauma, confidentiality concerns, limited health digital literacy, and communication issues were some of the barriers identified. This research advocates for telehealth and cultural safety training, a focus on physiotherapists’ roles as allies and educators, hybrid models of physiotherapy care, knowledge of community context and cultural norms, integration of traditional and land-based activities, and collaboration with local support staff (Chapters 4 and 5). Study 5: Based on these insights, a panel of experts engaged in a modified Delphi process and reached a consensus on culturally sensitive best practice recommendations intended to guide physiotherapists delivering and policymakers supporting effective telehealth services to Indigenous populations (Chapter 6). Together these studies highlight the critical role of therapeutic relationships, particularly in Indigenous contexts shaped by colonial histories. Establishing trust and rapport is paramount for the success of telehealth programs. The developed best practices serve as a tangible resource for healthcare providers and organizations, aligning with efforts to improve Indigenous health and promote equitable access to healthcare services.

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Attribution-NonCommercial-NoDerivatives 4.0 International