A Case Study of Telehealth Usage in Three First Nation Communities: Understanding the Role of Technology Users in Health Care Practice

In Canada, decision makers and First Nation communities often relied on telehealth to address the need for health care services. However, telehealth implementation has been marked by a series of structural constraints such as health care policies, resources, and technology. In the literature, researchers have focused on the efficiency and effectiveness of telehealth in facilitating health care services in rural and remote First Nation communities without addressing user needs. This thesis research is a case study using mix methods to understand telehealth in three northern Alberta First Nation communities. Using a theoretical framework based on the social construction of technology (SCOT) and Giddens' structuration theory, the objective of the thesis is to understand the role that telehealth plays in First Nation communities' health care services -- if any. As well, the thesis seeks to understand who or what shapes telehealth usage and its implication on health care practice.;Methods. The data in this study was collected using observations and interviews with 63 health care providers, administrators, staff, and patients over a period of approximately 1.5 years in the Athabasca Tribal Council Region. There are several key findings: first, telehealth does play a role in First Nation communities. However, this role is structured by institutional actors whose rules and resources constrain how telehealth is enacted in each First Nation communities. Second, while some users had positive perspectives of telehealth, their overall experience of telehealth revealed that negative human factors, space, and technology disrupted the development of relationships and negatively impacted users' desire to utilize telehealth. Despite these constraints, some users innovatively circumvented these challenges, managed their telehealth relationships, enhanced health care services, and changed how knowledge was shared in their communities.;Conclusions. The analysis confirms some of the findings on the structural constraints of telehealth use in First Nation communities. It also reveals that First Nation communities and individuals actively use telehealth when it enabled them to address specific health needs rather than general health needs. First Nation communities must be consulted to develop telehealth programs and technology designs that reflect their specific needs.