{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T14:45:33Z","timestamp":1780929933173,"version":"3.54.1"},"reference-count":79,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2024,2,1]],"date-time":"2024-02-01T00:00:00Z","timestamp":1706745600000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000001","name":"National Science Foundation","doi-asserted-by":"publisher","award":["RAPID-COVID-19-#2031662"],"award-info":[{"award-number":["RAPID-COVID-19-#2031662"]}],"id":[{"id":"10.13039\/100000001","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,4,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>The aim of this study was to investigate how healthcare staff intermediaries support Federally Qualified Health Center (FQHC) patients\u2019 access to telehealth, how their approaches reflect cognitive load theory (CLT) and determine which approaches FQHC patients find helpful and whether their perceptions suggest cognitive load (CL) reduction.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>Semistructured interviews with staff (n\u2009=\u20099) and patients (n\u2009=\u200922) at an FQHC in a Midwestern state. First-cycle coding of interview transcripts was performed inductively to identify helping processes and participants\u2019 evaluations of them. Next, these inductive codes were mapped onto deductive codes from CLT.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Staff intermediaries used 4 approaches to support access to, and usage of, video visits and patient portals for FQHC patients: (1) shielding patients from cognitive overload; (2) drawing from long-term memory; (3) supporting the development of schemas; and (4) reducing the extraneous load of negative emotions. These approaches could contribute to CL reduction and each was viewed as helpful to at least some patients. For patients, there were beneficial impacts on learning, emotions, and perceptions about the self and technology. Intermediation also resulted in successful visits despite challenges.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Staff intermediaries made telehealth work for FQHC patients, and emotional support was crucial. Without prior training, staff discovered approaches that aligned with CLT and helped patients access technologies. Future healthcare intermediary interventions may benefit from the application of CLT in their design. Staff providing brief explanations about technical problems and solutions might help patients learn about technologies informally over time.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>CLT can help with developing intermediary approaches for facilitating telehealth access.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jamia\/ocad257","type":"journal-article","created":{"date-parts":[[2024,2,1]],"date-time":"2024-02-01T17:33:43Z","timestamp":1706808823000},"page":"832-845","source":"Crossref","is-referenced-by-count":14,"title":["Human technology intermediation to reduce cognitive load: understanding healthcare staff members\u2019 practices to facilitate telehealth access in a Federally Qualified Health Center patient population"],"prefix":"10.1093","volume":"31","author":[{"given":"Alicia K","family":"Williamson","sequence":"first","affiliation":[{"name":"School of Information, University of Michigan , Ann Arbor, MI, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9332-8512","authenticated-orcid":false,"given":"Marcy G","family":"Antonio","sequence":"additional","affiliation":[{"name":"School of Information, University of Michigan , Ann Arbor, MI, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7807-5235","authenticated-orcid":false,"given":"Sage","family":"Davis","sequence":"additional","affiliation":[{"name":"Covenant Community Care , Detroit, MI, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1519-8956","authenticated-orcid":false,"given":"Vaishnav","family":"Kameswaran","sequence":"additional","affiliation":[{"name":"School of Information, University of Michigan , Ann Arbor, MI, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tawanna R","family":"Dillahunt","sequence":"additional","affiliation":[{"name":"School of Information, University of Michigan , Ann Arbor, MI, United States"},{"name":"College of Engineering, University of Michigan , Ann Arbor, MI, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5855-9972","authenticated-orcid":false,"given":"Lorraine R","family":"Buis","sequence":"additional","affiliation":[{"name":"School of Information, University of Michigan , Ann Arbor, MI, United States"},{"name":"Department of Family Medicine, School of Medicine, University of Michigan , Ann Arbor, MI, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1200-9515","authenticated-orcid":false,"given":"Tiffany C","family":"Veinot","sequence":"additional","affiliation":[{"name":"School of Information, University of Michigan , Ann Arbor, MI, United States"},{"name":"Department of Health Behavior and Health Education, School of Public Health, University of Michigan , Ann Arbor, MI, United States"},{"name":"Department of Learning Health Sciences, School of Medicine, University of Michigan , Ann Arbor, MI, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,1,31]]},"reference":[{"issue":"18","key":"2024040320004530600_ocad257-B1","doi-asserted-by":"crossref","first-page":"1679","DOI":"10.1056\/NEJMp2003539","article-title":"Virtually perfect? 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