1 Introduction

Interviews are a viable and highly utilized data collection tool in qualitative research [1, 2] as well as in clinical practice [3]. In healthcare, patient interviews are used to obtain the relevant medical history information which assists in developing an appropriate clinical diagnosis and decision making [4]. Traditionally, these interviews have been conducted in-person in accordance with the consensus among scholars that this format is the ‘gold-standard’ for conducting interviews [1, 5, 6]. However, alternatives to in-person interviews became imperative when the Corona Virus Disease 2019 (COVID-19) was declared a pandemic by the World Health Organization (WHO) on 11 March 2020 [7,8,9]. In response to this declaration; nationwide lockdowns, as well as regulations around strict controls on movement and physical contact between people were implemented worldwide, with the aim of reducing transmission of the virus [3, 10, 11]; which rendered practices such as in-person interviews unfeasible and unsafe in some cases for either research purposes or for healthcare service provision [3, 10]. COVID-19 created a crisis in health, economy, education, sports, and global mobility, in ways that our human civilization has never seen before [11, 12]. Over and above the crisis it caused, the pandemic also created opportunities for re-imagining data collection for research, as well as healthcare provision remotely through information and communication technologies (ICT) where safety, access and distance are a barrier [3, 11].

Conducting videoconferencing interviews on ICT platforms such as Skype, Zoom Meetings and Google Meet are comparable to in-person interviews as communication is done in real-time and follows the same protocols as traditional in-person interviews [10, 13]; thus, providing a strong foundation for building rapport which is critical in family-centered early hearing detection and intervention (FC-EHDI). Consequently, videoconferencing interviews, which are the focus of the current paper, are one of the fastest and reliable means of collecting qualitative data [10]. These interviews are attractive to qualitative researchers due to their convenience, cost-effectiveness and ability to reach participants over a large geographical spread when compared to in-person interviews. Furthermore, unlike teleconferencing interviews, videoconferencing interviews also afford the researcher the opportunity to transmit and respond to non-verbal cues [14], which are important in FC-EHDI, especially when a communication challenge in the form of a hearing impairment is a factor to consider.

Amidst the COVID-19 pandemic, transitioning from in-person to videoconferencing healthcare delivery through telehealth bridged the gap between service provision, community need and community safety [3, 15, 16]; and increased utilization and integration of telehealth into the health environment [17]. The COVID-19 pandemic also forced researchers, current researchers included, to transition from in-person interviews to videoconferencing interviews for data collection. It was during this process that the researchers realized that, like many other healthcare professionals (HCPs), audiologists do not have advanced preparation or training in this regard [13, 18, 19]. Lack of preparation for transitioning to telehealth as an alternative model for service delivery has resulted in limited use of telehealth, especially within the South African context, where it would be most beneficial due to limited HCPs compared to the population size requiring services [3, 20]. Thus, Khoza-Shangase [21] argues for careful deliberation around the use of alternative healthcare delivery models to increase access to early intervention.

South Africa has a high prevalence of congenital hearing impairment, with estimates indicating a prevalence of four to six in every 1000 live births in the public sector [22, 23]. Furthermore, the South African context is characterized by a quadruple burden of disease where the HIV/AIDS epidemic coexists with a burden of tuberculosis, high maternal and child mortality, high levels of violence and injuries, as well as a growing burden of non-communicable diseases, which all contribute towards speech and language pathology prevalence [24]. Moreover, the South African context continues to experience resource-constraints which perpetuate the view that infant and childhood hearing impairment is less urgent when compared to other healthcare priorities and has consequently received lesser financial attention and minimal political will from the National Department of Health [9, 17, 25].

Consequently, implementation of EHDI services which encompass the earliest possible identification, diagnosis and provision of intervention for newborns and infants with hearing impairment in order to curb the communication disability associated with a late-identified hearing impairment through FC-EHDI, continues to be a challenge [24, 26, 27]. The original concept of telehealth was providing healthcare to underserved populations [18], such as infants and children with hearing impairment within the South African context. However, more studies are necessary to ensure that telehealth services are comparable to in-person service provision before these services can be implemented as a valid means of service delivery, as proposed by professional bodies in audiology [28]. Thus, the aim of this scoping review was to explore use of videoconferencing as a service delivery method in FC-EHDI programs in South Africa. Review of practices of videoconferencing consultations has implications for FC-EHDI service delivery, policy-making, and supports evidence-based decision making within the South African context.

This paper is part of a larger research project titled “Family-Centered EHDI: Caregivers' experiences and evaluation of the process and practices in the South African context”, forming part of the first steps in formulating a framework for Family-Centered Early Intervention (FCEI) for children with hearing impairment in South Africa. This paper was prompted by the researchers’ transitioning from in-person interviews to videoconferencing interviews for data collection of the study at the height of the COVID-19 pandemic.

2 Methodology

This scoping review adopted Moher et al.’s [29] methodological framework, which comprised of the following stages: (1) identifying the research question; (2) searching for relevant studies; (3) selecting studies; (3) charting the data; and (4) collating, summarizing and reporting the results. Both researchers agreed on the research question; search terms, keywords and phrases; as well as on the relevant databases.

The aim of this scoping review was to explore the review question: “Can videoconferencing be used by audiologists as a service delivery method in FC-EHDI programs in South Africa?”.

2.1 Data sources and search strategy

A computer-aided search of four online journal databases, chosen on the basis of their content and accessibility to the researchers, was conducted. Electronic bibliographic databases including Sage, Science Direct, PubMed and Google Scholar were searched to identify peer-reviewed publications, published in English between April 2017 and April 2021, focusing on patients and HCPs' perceptions, attitudes, and experience of videoconferencing use in healthcare (Table 1). The following keywords were used: remote, videoconferencing, telehealth, telepractice, telemedicine, healthcare, service delivery. Boolean operators “AND” and “OR” were used between the phrases. The Boolean operator “NOT” was not used.

Table 1 Inclusion/Exclusion criteria for study inclusion
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A manual search of the reference lists of the articles included in the review was also conducted to identify additional articles. The researchers chose the period April 2017-April 2021 to ensure that current evidence was included when the review was conducted. This period was selected on the basis of evidence that demonstrated a growth in telehealth outpaced that of all other avenues of accessing healthcare from 2016 to 2017; thus, highlighting the need for increased efforts in exploring telehealth technology application in healthcare at this time [30,31,32]. Furthermore, a plethora of research on the use of ICT in healthcare was available at the height of the COVID-19 pandemic [33, 34], for inclusion in the scoping review. The time frame may have limited inclusion of seminal work in this field, which may have influenced current findings. Thus, this is acknowledged as a limitation in the interpretation of the findings in the current review. Another limitation of this review is that since the completion of this scoping review, additional studies have since been published; however, a sample of these newly published studies has also been reviewed and the findings highlighted in this review.

2.2 Citation management

All citations were imported into the web-based bibliographic manager Mendeley.

2.3 Eligibility criteria

Eligibility of published studies was identified using a two-stage screening process; whereby, all the studies that contained the keywords and phrases were initially considered for the review, then studies that did not focus on the use of ICT in healthcare were excluded from the study.

2.4 Title and abstract relevance screening

Title and abstract screening were conducted in accordance with Arksey and O’Malley’s [35] recommendations to eliminate studies that did not meet the current review’s inclusion criteria. The titles of the publications were examined as part of the first level review; then the abstracts were examined during the second level review; and lastly, during the third level review, the entire article was examined.

The first author identified all the articles for review. Both authors reviewed all articles that were included or excluded from the review to ensure the reliability and validity of the process of identifying the relevant articles. A high level of agreement was found on the kappa analysis (> 0.8). Following the data analysis, two independent reviewers (i.e., another PhD fellow and an academic member of staff in the department), reviewed the manuscript and the data to validate the researchers’ conclusions.

2.5 Data characterization

All relevant publications were recorded on a Microsoft Excel 2016 document [36], according to the following categories: author(s), publication year, title, context, study design, participants, and outcomes. Both researchers recorded the characteristics of each study.

2.6 Ethical considerations

This scoping review adhered to the ethical standards for studies which do not include direct contact with human or animal subjects, including informed subjectivity and reflexivity, purposefully informed selective inclusivity, and audience transparency [37].

3 Results and discussion

In total, 1095 articles that contained the search words were screened (Fig. 1). Fifty-two of these were based on videoconferencing; whereas 1043 investigated systematic, scoping, narrative, and literature reviews; reviews and/or opinion pieces; history of telehealth and progress made; videoconferencing interviews for university and job interviews; knowledge management in telehealth; distance education support; and future directions of telehealth. Thirty-four of the 52 articles were excluded because they focused on telephone and or text-based communication during healthcare access and were comparing outcomes of in-person versus telehealth service delivery.

Fig. 1
figure 1

The PRISMA flow diagram describing the process of study selection. Source [29]

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Eighteen peer-reviewed studies were included in this review (Supplementary Table ). These included 11 surveys, three ethnographic studies, three exploratory qualitative, and one cross-sectional study. All the articles were published in English. Gray literature was not included in this review. The synthesis included the research focus, context, participants, and outcomes. The studies included in this review were heterogeneous as they included quantitative, qualitative, and mixed-methods studies.

Findings of the current review revealed that although the concept of telehealth has existed since the early twentieth century and its benefits are widely reported, the overall uptake of telehealth outside emergency situations such as the COVID-19 pandemic was slow and fragmented [38,39,40]. This finding is not surprising as telehealth is viewed as a complex enterprise that raises multiple questions and challenges of multilevel sociopolitical, economical, organizational, professional, legal, technological and strategic factors [12, 41], with limited inclusion of this service delivery modality in curricula [3]. These elements are underscored in the five key themes that emerged from the current data synthesis namely; videoconferencing use, need for videoconferencing training, videoconferencing benefits, videoconferencing challenges, and recommendations for successful videoconferencing. Although conducted mostly in high-income countries (HICs) that vary from the South African context with regards to populations, resources, and health priorities, the studies included in the current review provide much needed direction for implementing videoconferencing FC-EHDI services within the South African context where there is limited research focus in this area. The articles will be reported and discussed under each of these identified themes.

3.1 Videoconferencing use

Considering the COVID-19 pandemic, the landscape of telehealth markedly evolved, resulting in telehealth services being widely implemented within healthcare services to bridge the barriers that prevented people from accessing healthcare services in person [11, 16, 38]. This mode of service delivery has several key strengths that can enhance remote emergency response, assist with disease diagnosis, and provide ongoing healthcare delivery [38, 39].

In the current study, publications that focused on the use of videoconferencing in healthcare aimed to investigate attitudes, perceptions, experiences, and application of telehealth, in various contexts. McClellan [42] examined rural clinical mental health staff members’ attitudes towards telehealth in Kentucky, United States. Results of the study revealed that 56% of mental health staff members were providing services through videoconferencing. In Kraljevic et al.’s [43] study, which examined Speech-Language Pathologists’ (SLP) perceptions and their application of telehealth in Croatia during the COVID-19 pandemic, 71% of the participants reported that they offered videoconferencing consultations to all their clients. Of these participants, 79% reported that they were satisfied, while 17% reported that they were completely satisfied with the services.

However, in Cole et al.’s [44] study, which aimed to understand perceptions of, and actual experiences with telehealth among caregivers and early intervention HCPs in Colorado, United States; participants reported that only 25% of the children on their caseload were receiving services via telehealth. Furthermore, in Powel et al.’s [45] study which described patient experiences with videoconferencing visits with their primary care physicians; 74% of the participants reported that they had used video calls on their smartphones for personal use, but not for accessing healthcare services.

Similarly, Dean et al.’s [46] study evaluated the pediatric surgical telehealth pilot program implemented in Canada from the family and HCPs’ perspective. Eighty-four percent of the participants revealed that they were experiencing telehealth for the first time, and 99% of these participants further reported that they would use telehealth again. Furthermore, in Zalewski et al.’s [47] study, where they describe the challenges and lessons learned while applying dialectical behavior therapy via telehealth across eight countries; results revealed that 88% of the participants had switched from in-person to telehealth using videoconferencing due to COVID-19; despite 74% of the participants never having used this platform prior to the pandemic.

In Imlach et al.’s [48] study, 5% of the participants reported that they had used videoconferencing to access general practices in New Zealand during the COVID-19 lockdown, while only 17% had experienced this modality prior the lockdown. Furthermore, in Wu et al.’s [49] study that established a smartphone-enabled telehealth model for palliative care family conferences; 90% of the families reported that they were using videoconferencing for the first time; and 71% of those families were willing to use videoconferencing again. Moreover, in Dahl-Popolizio et al.’s [50] study which explored how Occupational Therapists used telehealth during the COVID-19 pandemic; 77% of the participants supported telehealth as a substitute for in-person services, while 78% supported telehealth as a permanent option for service delivery. Encouragingly, in Taylor et al.’s [51] study which identified changes in telehealth use and the mechanisms that contributed to the changes, participants reported a 60% increase in video consultation use during the COVID-19 pandemic.

Similarly, in Saunders et al.’s [52] study which assessed Audiologists’ opinions about teleaudiology, only 32.5% of the participants had used videoconferencing prior to COVID-19, nevertheless they reported that they would use it after the pandemic. However, in Yang et al.’s [53] study, which explored perspectives of families of children with disabilities, receiving occupational therapy services, regarding the use of telehealth in early intervention; participants reported that they preferred in-person visits, with the use of telehealth as a supplement to in-person consultations. Participants indicated a preference for use of telehealth as part of follow-up or to facilitate communication between caregivers and HCPs. Nevertheless, participants reported that they preferred telehealth over ‘nothing’ or ‘no early intervention’ services.

Similar findings of videoconferencing use from studies published since the completion of this review are reported; including limited use of videoconferencing prior to the COVID-19 pandemic, increased use of this service delivery mode during the pandemic [54, 55], telehealth being viewed as an effective service delivery mode [56, 57], and participants’ satisfaction with using videoconferencing during consultations [56].

With the advent of enhanced ICT and the COVID-19 pandemic, many services evolved to virtual service delivery, including in healthcare where adoption of technology-infused service delivery is increasingly prevalent [58, 59]. Telehealth has expanded to include all aspects of healthcare such as primary care, specialty medical care, and mental/behavioral health [58, 60], as evidenced by current findings. Thus, enabling patients living in remote areas to receive the same services as those who live in metropolitan centres with easy access to high quality healthcare [61]. These findings offer significant insights for videoconferencing FC-EHDI within the South African context. Through the inclusion of remote service delivery, audiologists can increase access to healthcare and support services for the child with hearing impairment and their families; for effective management of the child’s daily hearing needs, ultimately increasing the family’s engagement and overall satisfaction with EHDI services [60].

Videoconferencing would enable the audiologist to provide intervention to families in the comfort of their homes [62]; which has been shown to improve child development and is argued to be the best contextually-responsive approach for the African context [27, 62, 63]. Furthermore, these videoconferencing home visits may increase the family’s sense of control and comfort; thus, allowing them to get the most benefit from the service. Furthermore, these home visits would allow HCPs to tailor their approach to service delivery, and increase caregiver participation [63, 64]. Without telehealth, home visits have been deemed to not be feasible within the South African context due a low per capita health budget and a shortage of professionals [65,66,67]. However, South Africa’s contextual realities including a lack of resources, finances, poor infrastructure and technology necessitate careful consideration of parents, families and HCPs’ attitudes and perceptions of telehealth and its application.

3.2 Need for videoconferencing training

In addition to being beneficial, telehealth is also viewed as disruptive, complex and requiring HCPs to learn new methods of consulting [38]. HCPs may not be knowledgeable and aware of telehealth, given the limited telehealth training that is offered in the curricula for medical and allied health professionals [3, 38]. Thus, it is imperative that educational programs for HCPs also focus on the understanding of telehealth and its applications to ensure that the healthcare workforce is telehealth-ready [3, 39, 68].

Cwikel and Friedmann [69] explored Social Workers’ perceptions of the integration of e-therapy in social work practice in Israel. Results of their study revealed that 96% of the participants had never used e-therapy and had not been trained to use it as a mode of service delivery. In Kraljevic et al.’s [43] study, only 4.2% of the SLPs reported receiving education in telepractice via webinars or in-person training before the COVID-19 pandemic. Sixty-nine percent of these participants further reported that telehealth education was “absolutely necessary” for HCPs. Similarly, in Kandola et al. [70] and Imlach et al. [48] studies, participants reported a need for a computer education component to be provided for telehealth participants, in addition to some level of support and assistance in preparing for video consultations.

Embracing telehealth technology into all aspects of healthcare has created a growing role for HCPs to integrate and use telehealth technologies in practice. However, current findings reveal that there is a gap in the knowledge and training of HCPs for telehealth practice [68, 71]. According to Smith et al. [39], regular telehealth practice leads to more sustainable models of care and a telehealth-ready workforce. Thus, to ensure a telehealth-ready healthcare workforce, telehealth training and education should be included in the curriculum and post-graduate telehealth accreditation should be mandated [39, 71]. This would send a clear message to current and future HCPs that telehealth is a legitimate part of usual and standard care. As well as increase telehealth use in everyday practice [3, 39].

Various suggestions exist regarding the knowledge and skills required to provide telehealth; however, a clear approach to educate HCPs is not yet mandated [3, 68, 71]. A multimodal telehealth education program is recommended in order to ensure didactic education and simulation experiences [71]. Khoza-Shangase et al. [3] argue for training programs to adopt a hybrid training model that includes telehealth as part of training and clinical service provision. This hybrid training model will provide a well-rounded educational experience that aligns with professional competencies for telehealth practice [68, 71]. Furthermore, ethical principles of patient care in telehealth must also be included as part of telehealth education [71]. For FC-EHDI videoconferencing services to be implemented in South Africa, due consideration of the content, format and timing of HCPs telehealth education is required; while being cognizant of the potential uses of videoconferencing in FC-EHDI, including screening, diagnostic testing, and FCEI [72].

3.3 Videoconferencing benefits

The benefits of telehealth are widely recognized [16, 58]. Telehealth has been heralded for its potential to increase healthcare access and improve the efficiency of healthcare delivery [3, 12, 73]. Perceived benefits that were reported by HCPs and patients in the current review include telehealth experiences being “just as good as” or “better than” traditional in-person medical visit experiences [74]; having access to expertise saves lives, money and time [48, 50, 75]; reducing stress, travel time, employment and school disruptions [46, 48, 52, 76]; ease of having consultations fitted around their day without the hassle of waiting time [48, 52]; telehealth consultations were less rushed, more focused and personal, and provided space to talk more freely than usual [48]; increased consultation volumes [51]; flexibility with scheduling appointments and conducting visits during a family’s typical routines, such as dinnertime [44, 52]; access to families living in rural areas [44, 50, 53]; heightening family engagement and use of coaching practices [44, 47, 76]; facilitate parent training [53]; as well as compatibility with daily life and family structure [76].

Current findings are consistent with available literature on telehealth [60, 68, 77]; as well as studies published after the current review [56, 57, 78, 79]. There have been dramatic changes in healthcare in recent years, as evidenced by shortages of HCPs, mandates to decrease costs, and advances in technology, which necessitate adoption of telehealth as a mode of service delivery. Telehealth technologies present new and unique opportunities to increase patient access to healthcare, decreasing costs, and improve desired healthcare outcomes [68]. In audiology, especially within the South African context, telehealth seeks to provide an array of hearing care services to those who need them due to having to travel long distances to access services, and limited access to or lack of resources [3, 28, 72, 73]; thus, allowing remote and rural populations the same access to resources as is available to the patient in urban areas without the need to travel [80]. However, given South Africa’s contextual challenges, the need for financial and resource allocation for telehealth within existing healthcare infrastructures and models; and due consideration of how best to implement effective FC-EHDI services through telehealth technology is warranted [3, 73]. Lack of such consideration will restrain South Africa from gaining benefits of telehealth including increased accessibility; cost-effective service delivery; enhanced family engagement; multidisciplinary collaboration; cultural and linguistic considerations; as well as opportunities to use this mode of service delivery for training and professional development.

3.4 Videoconferencing challenges

The COVID-19 pandemic amplified the need for contact-free encounters, becoming a catalyst for the growth of these services [81, 82], that ensure patient and clinician health and safety, as well as uninterrupted service delivery [3]. Consequently, this mode of healthcare service delivery is receiving extensive research focus, including the challenges associated with its application [83]. Articles in this review, also investigated the challenges of videoconferencing use. The following challenges were identified: limited access to internet connection [44, 45, 48, 53, 70, 74, 84]; patient and HCPs’ lack of familiarity with online tools [48, 70]; videoconferencing is detrimental to establishing rapport [52]; equipment-related or technical challenges [42, 44, 48, 50, 70, 84]; limited visual and auditory cues [42, 47]; lack of physical examinations [43, 48, 53]; privacy and security concerns [45, 48]; lack of confidence in telehealth meeting family’s needs [52]; and increased administration time for arranging appointments while ensuring that billing is compliant [51]. Similar challenges are reported in studies conducted by Cangi et al. [54], Wittmar et al. [55], Cottrell et al. [56], Elbeltagy et al. [57], Campbell et al. [78], and Almog and Gilboa [79], which did not form part of this review as they were published outside of the review’s stipulated period. Additional challenges reported in these studies include lack of an appropriate home environment for telehealth [55, 78, 79]; videoconferencing is an unsuitable substitution for in-person care for some populations and/or health conditions (including hearing impairment) [54,55,56, 78, 79]; dependence on the primary caregiver [79]; high preparation time [55]; and inability to provide the full range of services [55, 57].

In many countries, South Africa included, the quality of healthcare that is available to populations in rural contexts is lower than the quality of healthcare that is available in urban contexts [85]. The difference in the quality of healthcare between these two contexts is due to factors such as a lack of public transport to some healthcare facilities, and a lack of services in rural contexts. Although this problem is a worldwide phenomenon, it is particularly acute in low-and-middle income countries such as South Africa [85]. South Africa has a poorly functioning health system, where systemic failures in the public sector persist. The public sector provides healthcare to 85% of the population,while the private sector only provides healthcare to 15% of the population [83];consequently, the country is characterized by poor health outcomes [83]. Telehealth is recognized as the most cost-effective solution to South Africa’s poor health outcomes and the difference in the quality of healthcare between rural and urban contexts [3, 80].

However, findings of the current review reveal that the notion that telehealth will allow the rural population the same healthcare access as the urban population is an exception rather than the norm [58, 80]. Thirty-three percent of the population in rural contexts in America reportedly lack the broadband internet access required for videoconferencing [38]. Furthermore, a report by the World Bank has shown that household internet access disaggregated by rural/urban location, with internet access rates being low for rural and poorer households in sub-Saharan Africa [85]. Thus, to implement FC-EHDI, issues of internet use as well as access require due consideration, especially within the rural context which is supposed to gain the most benefit from such remotely provided services.

Furthermore, patients’ lack of digital health literacy, or the ability to access and evaluate health information using digital tools needs to be addressed, especially within the South African context. South Africa has low literacy levels with only 28% of a group of 20- to 24 year-olds having a grade 12 qualification [86]. In addition to low literacy levels, digital health literacy has been shown to be non-existent or rudimentary for patients, thus reducing attendance of telehealth visits; despite 50% of these patients owning a phone that can connect to the internet [87, 88]. Constantino et al. [88], maintains that the additive impact of health and digital health literacy barriers creates a seemingly insurmountable roadblock for already vulnerable populations. Furthermore, the lack of information in the patient’s language, and HCPs’ lack of expertise in ICT have made it difficult to adopt telehealth [38, 80]. Although, English is the prominent language in South Africa, only 10% of the South African population uses English as their home language [89]. This has resulted in 11 million South Africans not receiving healthcare services in their home language, which results in poorer health outcomes [90]. Thus, these aspects require due consideration within the linguistically, culturally, and socioeconomically diverse South African context.

Humans rely on numerous social cues during their interactions with others [91]. These social cues include body language; facial expression; slight shifts in posture; variations of vocal pace, tone and loudness; use of gestures; modifying the physical distance; and initiating or withdrawing from conversations [83, 91]. However, with traditional videoconferencing approaches, there are substantial limits that affect the fluidity of these social experiences [91]. Thus, these social cues must be modified accordingly through making eye contact, i.e., the HCP looks at the camera and not the client’s face on the screen; limiting facing down when taking notes, as this may appear as disinterest or distraction; conveying empathy through careful selection of the words used; leaning into the camera; and head nodding to encourage the client [68].

Another significant limitation of telehealth is the lack of a comprehensive physical examination [12]. According to Chowdhury et al. [92], some aspects of a physical examination are simply not feasible via telehealth. Thus, the true effectiveness of a telehealth physical examination, its impact on diagnosis, and healthcare outcomes is yet to be determined across various settings [12], health conditions, client populations, and across disciplines including audiology. Furthermore, clinician training must highlight the limitations associated with telehealth and inform on alternative methods that can be used in these situations [39].

In addition to the above-mentioned challenges associated with videoconferencing, patients’ privacy and security concerns are not surprising due to frequent health data breaches and cyber-attacks [93]. Watzlaf et al. [94] reported that laptops, network servers, desktop computers, and other portable electronic devices constituted 51% of all healthcare data breaches between 2010 and 2015. As telehealth utilization increases in healthcare, it is imperative that HCPs and policy makers ensure that privacy policies are in place and easy-to-understand [38]. Furthermore, HCPs need to be familiar with the security features of their telehealth systems so that they can be able to mitigate security risks and protect their patient base [38, 93], while maintaining their confidentiality [72].

Both HCPs and patients should trust that the transmission of information during telehealth encounters remains private and secure [58]. Findings from the current review have significant implications for FC-EHDI videoconferencing consultations within the South African context, given the low digital literacy levels. Audiologists have an ethical and legal duty to protect their client’s privacy and increasing data security while receiving, storing, and transferring data. If clients do not trust the telehealth platform, they will be reluctant to provide audiologists with the necessary information for efficient assessment, differential diagnosis and effective management [86]; and this will in turn negatively impact program outcomes and efficacy of telehealth services.

Lastly, administrative and clinical complexities are inherent with such an ambitious initiative as telehealth [95]. Hence, these authors recommended establishing an easy scheduling procedure to deliver more streamlined workflow. Thus, appropriate scheduling and administration aspects should be considered prior to implementation of videoconferencing consultations in any context. Furthermore, appropriate renumeration is needed for all telehealth services [39]. Payment rates should reflect the cost of the service without incentivizing the use of one service delivery mode over another. Thus, there is a significant need of regulatory visibility governing payment parity across in-person and videoconferencing consultations [96]. It is essential that HCPs are educated about how the cost of telehealth is regulated, with clear regulations around billing for such services [68].

Prior to the COVID-19 pandemic, professional bodies had recommended the use of telehealth in various contexts; however, payment parity was not stipulated [96]. This all changed within the last year of the COVID-19 pandemic, when newer legislation supporting seamless integration of overcoming barriers surrounding the compensation structure were implemented across the US [38]. However, there is currently a lack of a position statement which offers a directive for audiologist in navigating through telehealth – including billing, within the South African context. The Health Professions Council of South Africa (HPCSA), which is the statutory body for HCPs, including audiologists, endorses advances in tele-audiology; however, there is a lack of practical support for post-COVID-19 use of telehealth and the conditions that are required to be met in order for appropriate reimbursement to be implemented [14]; hence the importance of the current findings on implementing effective FC-EHDI within this context.

3.5 Recommendations for successful videoconferencing

Telehealth offers a unique alternative to improve access, quality, continuity, and integration of health services for the benefit of the population [12, 41]. Thus, there is a need for HCPs to champion the use of telehealth in healthcare service delivery [20, 68]. For HCPs to address future healthcare needs, it is imperative that HCPs are knowledgeable about telehealth technologies and their application [3, 68].

Dean et al. [46], Zalewski et al. [47], Imlach et al. [48], Taylor et al. [51], Cwikel and Friedmann [69], and Chrapah et al. [75] provided the following recommendations for successful telehealth services: conduct telehealth services in the office where there is better access to materials and privacy; discuss limitations with clients that they must express their emotions through words; HCPs must sit back so that the client can see gestures; technological support must be provided in real time; implement systems that are easy-to-use, private and secure; administrative and technical support; use of ‘workarounds’ such as patients can send photos or emailing blood pressure readings as an adaptation to the telehealth environment; use of a digital whiteboard to enhance patient education; need for effective scheduling and excellent communication between all parties; and basic connectivity should be more robust with steady bandwidth.

Similar recommendations for successful videoconferencing are reported by Smith et al. [39] and Constantino et al. [88]; including the establishment of telehealth policies; education and training for HCPs; and introduction of telehealth accreditation for HCPs. Furthermore, Smith et al. [39], Constantino et al. [88] and Reeves et al. [12] provided the following additional recommendations: supporting all stakeholders with an effective communication and change management strategy; establishing systems to manage telehealth services on a routine basis; provision of different modalities of telehealth (i.e. intermittent audio-only, video-enabled or in-person visits); provision of easily accessible, understandable educational materials in multiple languages on the use of videoconferencing; and provision of the services of a dedicated healthcare navigator to further assist with onboarding and boost digital health literacy where telehealth services are implemented. Moreover, Wittmar et al. [55], Cottrell et al. [56], and Almog and Gilboa [79] recommend a blended model of telehealth and in-person consultations as a mode of service delivery in order for patients to get optimal healthcare outcomes.

The recommendations provided in this review offer significant insight for successful videoconferencing, thus contribute towards increasing telehealth acceptance and use amongst HCP and families. According to Gajawarala et al. [58] and Khoza-Shangase et al. [97], telehealth acceptance will likely increase as patients and HCPs become more adept at and comfortable with using telehealth instead of in-person interactions. However, a hybrid approach to service delivery in FC-EHDI within the South African context may be ideal when this telehealth is initially implemented in order to facilitate acceptance and uptake of telehealth as an independent, alternative service delivery mode. Given the limited telehealth training that HCPs have received, and use of telehealth within the South African context, the recommendations from the current review provide valuable insights. Thus, the findings in this review are significant for the implementation of effective FC-EHDI programs within the South African context; which will enable FC-EHDI professionals to improve healthcare access and outcomes to a heterogeneous population across diverse settings within the South African context.

4 Conclusion

In-person interviews are the gold standard for collecting rich data in qualitative research and relevant case history information in healthcare. However, the COVID-19 pandemic provided an incentive for a viable alternative to in-person interviews to curb the spread of the virus and subsequently highlighted the telehealth’s immense capabilities to respond to global emergencies and increase access to healthcare services during the COVID-19 pandemic and beyond, especially within resource-constrained contexts such as South African.

Videoconferencing is crucial in providing telehealth services to vulnerable and underserved populations who stand to benefit the most. The flexibility and convenience; access to global talent pool; efficient screening process; enhanced collaboration; reduced environmental impact; cost savings; accessibility and inclusivity; as well as better work-life balance that videoconferencing provides needs embracing. However, telehealth is a complex enterprise that raises multiple questions and challenges. Despite these challenges, evidence in support of the positive effects of telehealth through innovative use of ICT is mounting. Thus, to improve access to EHDI services and effective FC-EHDI programs to be implemented within the South African context, the necessary technological infrastructure, knowledge of digital technology applications, as well as a national policy and legal framework for telehealth are required with due cognizance of the socio-economic and political realities within the South African context. However, while telehealth in the form of videoconferencing can enhance accessibility and efficiency in FC-EHDI services, it should be considered as a complement to traditional in-person services rather than a complete replacement. A hybrid model that combines both approaches can provide the best of both worlds, ensuring that families receive comprehensive and person-centered care while taking advantage of the benefits offered by videoconferencing technologies.