Emma E. Thomas

Aims: Programme accreditation and certification are key mechanisms for standardising, assuring, and continuously improving the quality of cardiac rehabilitation. Comparative evidence on existing accreditation and certification schemes remains limited. This review compared these schemes to identify key characteristics, standards, convergences, divergences, implementation, and gaps to inform future quality improvement directions. Methods: A scoping review following PRISMA-ScR guidelines was conducted searching four databases, grey literature and accreditation bodies’ websites (August–September 2025). Cardiac rehabilitation certification schemes with publicly accessible descriptive or evaluative documentation were included. Extracted data were analysed narratively. Results: Eleven peer-reviewed studies and 38 organisational documents met the inclusion criteria. Four schemes from USA, United Kingdom, Europe, and the International Council of Cardiovascular Prevention and Rehabilitation were included in the comparative analysis because sufficient public documentation was available. Certification standards were mapped across schemes, consolidated into 18 and classified according to Donabedian domains. Thirteen standards were universal (endorsed by all four schemes) or near-universal (endorsed by three) including multidisciplinary care, assessments, exercise, education, and counselling; however, their operationalisation varies. Certification uptake was concentrated in high-income settings. Reported barriers were related to resources, cost, and infrastructure. Evidence of certification impact was limited. Conclusion: Shared standards suggest broad consensus on the core components of high-quality cardiac rehabilitation. Resource, cost, and infrastructure barriers may influence certification accessibility and adoption. Leveraging shared standards while allowing flexible implementation pathways may support broader uptake of quality-assured cardiac rehabilitation. Further rigorous evaluation is needed to determine whether certification translates into sustained improvements in service quality and meaningful health gains.

Objectives: We assessed the test–retest reliability, criterion validity, and agreement of the Global Physical Activity Questionnaire (GPAQ) against accelerometry for estimating physical activity (PA) and sedentary behaviour (SB) among Indian adults at high risk of type 2 diabetes. Methods: We validated the original GPAQ in a subsample of 196 participants from the Kerala Diabetes Prevention Program. Participants were identified as being at high risk based on an Indian Diabetes Risk Score (IDRS) ≥ 60 and the absence of diabetes on an oral glucose tolerance test. To assess test–retest reliability, participants completed the GPAQ on two occasions, one week apart. Criterion validity and agreement were evaluated by comparing GPAQ responses with seven days of concurrent ActiGraph GT3X accelerometer data. Statistical analyses included intraclass correlation coefficients (ICCs) for reliability, Spearman’s correlation coefficients (ρ) for criterion validity, and Bland–Altman plots for agreement. Results: The mean (SD) age of participants was 47.0 (7.4) years, and 51% were female. ICCs for test–retest reliability ranged from 0.37 for moderate-intensity PA to 0.61 for vigorous-intensity PA. Spearman’s ρ for criterion validity ranged from 0.14 for SB to 0.38 for overall moderate-to-vigorous PA. Bland–Altman plots showed that the GPAQ consistently overestimated PA across all intensity levels while underestimating SB. Conclusions: The GPAQ demonstrated poor-to-moderate test–retest reliability, low criterion validity, and poor agreement with accelerometry for assessing PA and SB among Indian adults at high risk of type 2 diabetes.

Introduction: Telehealth in Residential Aged Care Homes (RACHs) is recommended to improve access to specialist health services. Successful telehealth adoption depends on reliable technical infrastructure, a skilled workforce, and revised models of care. This study aimed to evaluate the impact of a telehealth training program on RACH staff's knowledge and skills, telehealth uptake, related challenges and how to sustain its use. Method: A quasi-experimental design study. After delivering an onsite training program, we conducted t-tests with pre- and post-surveys, analysed feedback from training consultants, and performed follow-up interviews with RACH's senior managers. Results: From August 2023 to October 2024, 41 RACHs received onsite telehealth training, primarily attended by nurses (88%). Survey results showed significant improvements in perceived telehealth knowledge, skills and confidence. A key motivator for implementing telehealth was enabling family members to attend consultations, while the major barrier was transitioning external health providers from phone to video consultations. In followup data, senior staff reported increases in telehealth activity and staff's confidence in using it, but potential for more activity. They wanted ongoing support, particularly to improve external providers' capability and willingness to use telehealth, indicating sustained telehealth adoption requires more than just access to equipment and training in RACHs. Discussion: Telehealth training can be effective in increasing knowledge, skills and confidence to use telehealth in RACHs. However, RACHs need ongoing training and support, especially given workforce challenges and staff retention issues. Engaging all stakeholders, particularly external service providers is crucial to ensure that telehealth-supported models of care are well integrated within the broader health system.

Introduction: As telehealth services are increasingly utilised and mature, it is important to continue to assess the preferences of both consumers and providers to ensure that these services are being used in the most acceptable and effective manner. This review aims to analyse both consumer and provider preferences for telephone and video consultations. Methods: A systematic search of MEDLINE, CINAHL and Embase databases was conducted in April 2023 to identify studies that investigated consumer or provider preferences for either telephone or video consultations. Data were extracted and synthesised narratively with the main reported findings from each article categorised in regard to modality preference (i.e. preference for either telephone or video; no preference between modality, equivalency, or mixed preference statements). Results: A total of 78 articles were included in the analysis. Studies were published between 2003 and 2023, with the majority (86%) published after 2020. While most studies used quantitative survey methods (69.2%), five used qualitative (6.4%) and 19 used a mixed methods approach (24.4%). The majority of included studies (54% of consumer studies and 76% of provider studies) reported video as the preferred telehealth modality over telephone. Discussion: Although video is mostly preferred over telephone, a number of consumer studies reported equivalent preference for telephone and video consultations and highlighted the benefits of each modality for different purposes.

Aims: CaLD populations face considerable digital health inequities; strategies are needed to ensure telehealth models of care are available to all. We aimed to identify and describe interventions that enhance telehealth access for CaLD communities. Methods: We systematically searched four databases (PubMed, Scopus, Embase, and CINAHL). Included studies were published between 2011 and 2024 and reported on at least one of the outcomes described in the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework. Two authors independently screened articles, solutions were synthesized qualitatively. Results: Twenty-seven articles were included in the review and primarily used videoconferencing as the predominant telehealth modality (n = 14, 52%). Five strategies were identified to promote telehealth use across CaLD communities including: (i) Provide bilingual options; (ii) Enhance staff cultural competence; (iii) Provide flexible adaptions to align with consumer needs; (iv) Supply technology and technological support; and (v) Involve digital health navigators and/or health educators. Conclusions: Culturally competent professionals supported by language services and technological support are strategies which can help improve equity of access to telehealth services for people from CaLD communities. Such strategies can support the implementation of practical solutions to overcome health inequities and prevent access gaps.

Objective: We aimed to understand gaps in telehealth use across culturally and linguistically diverse (CALD) populations in a metropolitan Australian setting and elicit solutions to support inclusive telehealth‐delivered care.Methods: Three workshops (one in‐person, two online) were conducted with purposefully recruited consumers (N = 6, including 2 who were also interpreters; representing six different language and cultural backgrounds) and clinical and nonclinical staff (N = 14) between July and October 2022. Audio‐recordings and notes were analysed using inductive thematic analysis to identify barriers and potential solutions for including CALD consumers in telehealth appointments.Results: A central identified theme was “Don't assume, ask”. CALD consumers felt they were not offered the choice for telehealth due to staff assumptions about their insufficient digital literacy, technological capability, and English proficiency. CALD consumers communicated willingness to experience telehealth benefits such as avoiding travel, and a desire to have the choice with care modality. Staff required increased training around booking a video interpreter and emphasised the role of the health service in supporting telehealth and upskilling consumers and staff. Interpreters self‐identified as “communication specialists” but felt their skills were undervalued and underutilised by clinicians. A key sentiment from CALD consumers was that they did not have equal opportunities to access healthcare overall – encompassing all aspects of care regardless of modality. Key messages for consumers, clinicians, interpreters, and executives were compiled into recommendations.Conclusion: Our collaboration highlighted the need for more education and reinforcement to promote equitable and efficient processes for accessing telehealth appointments for CALD consumers requiring an interpreter.Patient or Public Contribution: Patients, caregivers, and interpreters from culturally and linguistic diverse backgrounds were workshop participants and co‐developers of solutions to address telehealth access gaps. Final research outputs were also circulated to participants for feedback before being disseminated.

Telehealth-facilitated models of palliative care are a patient-focused way to deliver specialist care in or closer to home for people with a life-limiting illness. Telehealth can increase access to palliative care and support people experiencing symptoms of advanced disease in their own home, reducing the discomfort of travel. This retrospective cohort study examines the activity and outcomes of a regional telehealth-facilitated palliative care service to (i) describe which patients are most likely to use telehealth; and (ii) explore possible impacts of telehealth on patient outcomes including place of death, timely access to care, responsiveness to urgent needs and pain management. Analysis of service activity data (patient demographics, care modality, consultation frequency) and Palliative Care Outcomes Collaborative data registry (place of death, timely access to palliative care, responsiveness to urgent needs as measured by time in unstable phase, pain management) were undertaken. Outcomes were compared between patients who had no videoconsultations (n = 683) and those who had one or more videoconsultations (n = 524). Compared to people who had no videoconsultations, those who had at least one appointment via video were: more than twice as likely to die at home and spent a shorter amount of time in the unstable phase of palliation. Mixed results were found regarding timely access to palliative care. There was no significant difference in pain management between consultation modes. Telehealth-facilitated palliative care has multiple benefits, including the increased likelihood of fulfilling someone’s wish to die at home, often their preferred place of death.