Development of a conceptual framework to understand the stakeholder's perspectives on needs and readiness of rural tele-practice for childhood communication disorders.

Background: Tele-practice promotes universal and equitable access to quality health services and emerged as an alternative to overcome physical barriers to intervention access in the 90s. There has been a steady increase in adoption since then, and during the COVID-19 pandemic, there was a surge in online modes of healthcare service delivery. Yet, tele-practice adoption and utilization in rural and remote areas are not spontaneous. Therefore, as a first step, prior to the implementation of a comprehensive tele-practice model, a baseline situational analysis was undertaken to assess the needs and readiness of parents of children with disabilities and different cadres of health care providers towards accepting tele-practice services in their settings. This paper describes the process of development of the conceptual framework that guided the baseline needs and readiness assessment (situational analysis). Methods: The Bowen's feasibility framework served as the primary framework to evaluate the feasibility outcomes of the implementation. Therefore, this framework also guided the baseline situational analysis. For specificity of the framework to tele-practice, several telemedicine planning frameworks relevant for low- and middle-income countries were reviewed to identify and map suitable constructs and attributes to the Bowen's constructs. A description of the framework selection process and a review of each of the selected telemedicine frameworks are provided. Results: The constructs and attributes from this conceptual framework were used to develop the guides for focus group discussions (FGDs) and semi-structured interviews (SSIs). The guides were prepared separately for each stakeholder group. Conclusions: The developed framework facilitated the assessment of needs and readiness suited to the context and among various stakeholders involved in the proposed implementation of the comprehensive model of tele-practice for childhood communication disorders in rural communities.