Specific technology

App based monitoring technology that links the patient into specialist care for regular follow up and monitoring of wound. Two way communication with pictures of progressing wounds and characteristics such as pain or ooze allows wound care specialists to respond and update treatment plans without having to leave the rural area (Barakat‐Johnson et al., 2022)

Cultural / Ethical considerations

With any new technology the safety, security and reliability must be ensured current studies suggest that there is a lack of studies confirming these factors are currently present (Shi et al., 2022).

Culturally farmers view themselves as self-sufficient, resilient and have a sense of duty to the farm. They have lower healthcare coverages and may struggle with "disposable income" to spend on healthcare. Being able to take time for non-critical healthcare is seen as a big barrier as they feel like the farm cannot function without their physical presence (Droullard et al., 2017).

Call to Action

Advocate for funding and implementation of a wound care monitoring interface such Tissue Analytics ( www.tissue-analytics.com ) to specifically address chronic wound care for farmers in rural Colorado.

Aim to receive written support from 3 appropriate organizations and 2 state officials within 6 months. Organisations such as USDA Rural development office, Wound Healing Society, National Rural Health Association, FQHCs in the target areas.

Leverage efforts from existing organizations with a common goal to reduce duplication of efforts and promote like-minded goals.

Reducing health care burden while allowing rural farmers to remain on the farm not only increases health care access, it reduces chronic health and costs to the farmer such as transport (Barakat‐Johnson et al., 2022).

A pilot program can be assessed 3 months after securing approval and funding at a pilot site with quarterly progress reviews to determine effectiveness and scope for expansion.

EBP Resources

Wounds International - Local resource wound treatments: evidence summaries for resource-limited settings (Haesler, 2023)

Association for the Advancement of wound care ( www.aawconline.org/professional-resources )

Wound, Ostomy, and Continence Nurses Society ( www.wocn.org/clinical-resources)

References:

Barakat‐Johnson, M., Kita, B., Jones, A., Burger, M., Airey, D., Stephenson, J., Leong, T., Pinkova, J., Frank, G., & Ko, N. (2022). The viability and acceptability of a virtual wound care command centre in Australia. International Wound Journal, 19(7), 1769-1785.

Droullard, D. J., Tinc, P. J., & Sorensen, J. A. (2017). “I would go if my arm were hanging off”: A qualitative study of healthcare-seeking behaviors of small farm owners IN Central New York State. Journal of agricultural safety and health, 23(1), 67-81.

Haesler, E. (2023). Local resource wound treatments: evidence summaries for resource-limited settings. Wounds International, 14(2), 16-22.

Shi, C., Dumville, J. C., Juwale, H., Moran, C., & Atkinson, R. (2022). Evidence assessing the development, evaluation and implementation of digital health technologies in wound care: A rapid scoping review. Journal of Tissue Viability, 31(4), 567-574.

Specific Technology

Real-time tele-lactation services available as: One demand, scheduled or a mixture of the two provided to postpartum mothers at 24hrs, 48hrs, 72hrs, and between 7 and 14 days is recommended to increase and support exclusive breastfeeding. Services can be provided via existing tele/video platforms such as whatsapp, zoom, teams, messaging or secure EHR. Scheduled or mixed services have a significant improvement in exclusive breastfeeding (Iamchareon & Maneesriwongul, 2025).

Cultural/Ethical Considerations

While studies agree that while tele-lactation is an effective method of providing care some mothers have expressed concerns regarding security, who will have access to the sessions, nipple exposure, and concerns over effectiveness. All these factors should be considered when offering tele-lactation services. Alternatives include websites, and text message support. Tele-lactation is shown to be effective across sociodemographic groups (Louis-Jacques et al., 2021).

Call to Action

Advocate for secure services connected with culturally and well-educated specialists. Secure services are critical to ensure safety and comfort. Pre and post assessments of medicaid eligible mothers in the target region with an aim to increase usage of tele-lactation services by 25% within 3 months. Overall goal of increasing exclusive breastfeeding for the first 6 months of life in accordance with WHO recommendations. Partner with Colorado Breastfeeding Coalition (www.cobfc.org), Northern Colorado Breastfeeding Coalition (www.nocobreastfeeding.org) and Midwifery Care in Colorado (www.nursemidwivesofcolorado.org) for support, link to specialists and relevant stakeholders. This plan aligns with the WHO and best practice to support and encourage breast feeding for the first 6 months.

EBP resources

Academy of Breastfeeding Medicine (www.bfmed.org)

Colorado Dept of PHE Breastfeeding resources (https://cdphe.colorado.gov/breastfeeding)

USPSTF Recommendation Statement of Breastfeeding ( Recommendation: Breastfeeding: Primary Care Behavioral Counseling Interventions | United States Preventive Services Taskforce )

References

Iamchareon, T., & Maneesriwongul, W. (2025). The effectiveness of real-time telelactation intervention on breastfeeding outcomes among employed mothers: a systematic review and meta-analysis. BMC Pregnancy and Childbirth, 25(1), 341.

Louis-Jacques, A. F., Schafer, E. J., Livingston, T. A., Logan, R. G., & Marhefka, S. L. (2021). Modesty and security: attributes associated with comfort and willingness to engage in telelactation. Children, 8(4), 271.

Specific Technology

Virtual reality based cardiac rehab is shown to be as effective as traditional rehab at improving cardiorespiratory function and more effective at improving anxiety and depression (Wang et al., 2025). Non immersive devices such as xbox kinect and nintendo wii has a low risk of adverse events such as cyber-sickness and temporo-spatial disorientation as well as a relative low cost of implementation (Peinado-Rubia et al., 2024).

Cultural / Ethical considerations

When designing a virtual rehab system, or implementing it consideration needs to be given to the cost, the ease of use, the availability of training, the comfort of the patient with new technologies, digital literacy and connectivity / bandwidth of the devices (Golbus et al., 2023).

Call to Action

Advocate for virtual cardiac rehab to be included in CMS reimbursement for rural patients. Within 6 months identify and secure support from 2 stakeholders and an elected representative. Stakeholders could include American Heart Association, American Association of Cardiovascular and Pulmonary Rehabilitation and CDPHE. Government officials could include Senator Hickenlooper and Senator Benet. This call to action is keeping with the existing evidence and advice from recommending bodies. Initial engagement and support should be accomplished by June 2026.

EBP Resources

Standards for cardiac telerehabilitation (Scherrenberg et al., 2025).

Digital Technologies in Cardiac Rehabilitation: A Science Advisory From the American Heart Association (J. R. Golbus et al., 2023).

Core Components of Cardiac Rehabilitation Programs: 2024 Update: A Scientific Statement From the American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation (Brown et al., 2024).

References:

Brown, T. M., Pack, Q. R., Aberegg, E., Brewer, L. C., Ford, Y. R., Forman, D. E., Gathright, E. C., Khadanga, S., Ozemek, C., Thomas, R. J., on behalf of the American Heart Association Exercise, C. R., Secondary Prevention Committee of the Council on Clinical, C., Council on, C., Stroke, N., Council on, L., Cardiometabolic, H., Council on Quality of, C., & Outcomes, R. (2024). Core Components of Cardiac Rehabilitation Programs: 2024 Update: A Scientific Statement From the American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation. Circulation, 150(18), e328-e347. https://doi.org/10.1161/CIR.0000000000001289

Golbus, J. R., Lopez-Jimenez, F., Barac, A., Cornwell, W. K., 3rd, Dunn, P., Forman, D. E., Martin, S. S., Schorr, E. N., & Supervia, M. (2023). Digital Technologies in Cardiac Rehabilitation: A Science Advisory From the American Heart Association. Circulation, 148(1), 95-107. https://doi.org/10.1161/cir.0000000000001150

Golbus, J. R., Lopez-Jimenez, F., Barac, A., Cornwell, W. K., Dunn, P., Forman, D. E., Martin, S. S., Schorr, E. N., Supervia, M., on behalf of the Exercise, C. R., Secondary Prevention Committee of the Council on Clinical, C., Council on Lifelong Congenital Heart, D., Heart Health in the, Y., Council on Quality of, C., Outcomes, R., Council on, C., & Stroke, N. (2023). Digital Technologies in Cardiac Rehabilitation: A Science Advisory From the American Heart Association. Circulation, 148(1), 95-107. https://doi.org/10.1161/CIR.0000000000001150

Peinado-Rubia, A. B., Verdejo-Herrero, A., Obrero-Gaitán, E., Osuna-Pérez, M. C., Cortés-Pérez, I., & García-López, H. (2024). Non-Immersive Virtual Reality-Based Therapy Applied in Cardiac Rehabilitation: A Systematic Review with Meta-Analysis. Sensors (Basel), 24(3). https://doi.org/10.3390/s24030903

Scherrenberg, M., Falter, M., Abreu, A., Aktaa, S., Busnatu, S., Casado-Arroyo, R., Dendale, P., Dilaveris, P., Locati, E. T., Marques-Sule, E., Neunhaeuserer, D., Pedretti, R., Perone, F., Salzwedel, A., Wilhelm, M., & Bäck, M. (2025). Standards for cardiac telerehabilitation. Eur Heart J, 46(38), 3714-3737. https://doi.org/10.1093/eurheartj/ehaf408

Wang, S., Jiang, J., Zhang, C., Lv, M., Xu, H., Meng, H., & Guo, L. (2025). Effect of Virtual Reality-Based Cardiac Rehabilitation on Mental Health and Cardiopulmonary Function of Individuals With Cardiovascular Disease: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil, 106(6), 949-960. https://doi.org/10.1016/j.apmr.2024.11.005