Exploring the Transtheoretical Model of Change, Barriers, and Motives to Telemedicine Adoption in Athletic Training

Purpose: The delivery of healthcare services by athletic trainers (ATs) has evolved over the past two years as a result of the COVID-19 pandemic. Previous research has identified an integration of telemedicine as a necessary, urgent replacement for face-to-face patient encounters in athletic training; however, there is a lack of data to support the habitual and intentional change to one's clinical practice that includes telemedicine. Therefore, the purpose of this study was to identify and analyze ATs respective stages of change related to telemedicine adoption, as well as explore motivating factors and barriers related to the adoption of telemedicine. Methods: We performed a cross-sectional study of 883 credentialed ATs. The survey contained a modified TTM stages of change assessment and 51-item telemedicine barriers and motives tool adapted from previous literature. A logistic regression was performed to assess highest level of education with telemedicine adoption status. Results: Overall, most ATs were categorized in the action, maintenance, and termination stage (n=551/882, 62.4%) for telemedicine adoption. Other participants were categorized in the stages as unaware (n=8, 0.9%), precontemplation (n=82, 9.3%), contemplation (n=78, 8.8%), and preparation (n=164, 18.6%). The logistic regression model was statistically significant (p<0.001). The model was highly sensitive (86.3%; specificity=23.3%). Throughout the seven barrier subscales, most participants expressed concerns with at least one 'hamper to success' (790/883) or technological barrier (711/883); however, they did not commonly identify barriers with administration (226/883). ATs strongly disagreed/disagreed that telemedicine was seen as a local threat (637, 93.5%) and disagreed that their collaborating physician would not like telemedicine (454, 86.6%). Conclusions: The results of the study suggest that most ATs have recently changed their delivery of healthcare in the last 6+ months and intend to maintain telemedicine use as part of their clinical practice. Additionally, telemedicine success was hampered by a lack of exposure but did feel that telemedicine fills gaps in patient care and addresses improved patient satisfaction. Additionally, increasing an ATs highest level of degree earned was associated with an increased likelihood of being in stage five on the modified-TTM assessment suggesting focused, professional development could sustain telemedicine use in athletic training.