From leadership research to district action: Telepresence avatar use for children with cancer in schools: a study on barriers and facilitators

AI-assisted editorial implementation guide. Proposed district actions are separate from the original authors’ findings and recommendations. Independent peer review of this guide is not asserted.

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Evidence and transfer

Education-related source: verify which participants, institutions and outcomes were actually studied before district adoption. Source publication type: research-article. License and identity checks do not establish study quality or causality.

Original authors’ abstract, reproduced under the source license:

Purpose Children with cancer often face psychosocial and educational challenges due to prolonged school absences. Telepresence avatars offer the possibility of maintaining virtual classroom participation. This study examines perceived barriers and facilitators to the implementation of telepresence avatars in schools from the perspectives of teachers and supplements these findings with parent perspectives. Methods A cross-sectional teacher survey was conducted, complemented by an exploratory qualitative parent-interview component. For the survey, 5,019 schools were contacted via e-mail. Teachers' perceptions were assessed via a quantitative questionnaire, including descriptive analyses and group comparisons based on experience with pediatric cancer and/or prior use of telepresence avatars. To illustrate implementation experiences from the family perspective, three parents of children with cancer who had used a telepresence avatar were interviewed. Results Teachers (N = 298) reported moderate technical and organizational barriers to telepresence avatar use. Significant differences in perceived barriers were observed across experience profiles, with the lowest overall barrier levels reported by teachers with combined experience in pediatric cancer and telepresence avatar use, and the highest levels among teachers without prior experience. Key facilitators included technical resources, organizational support, leadership endorsement, and training. The interviews with parents illustrated the potential role of telepresence avatars in maintaining academic and social participation during treatment, while also pointing to practical challenges such as technical instability, unclear responsibilities, and administrative procedures. Conclusion Telepresence avatars have the potential to support the social and academic participation of children with cancer during school absences. However, successful implementation seems to depend on contextual and organizational conditions rather than on the technology itself. Clinical Trials Register drks.de, Identifier: DRKS00036745 (registered on May 15, 2025).

Study methods

A cross-sectional teacher survey with an exploratory qualitative parent-interview component was employed to provide a more comprehensive understanding of the barriers and facilitators of telepresence avatar use from the perspectives of teachers and affected families. In the survey component, teachers completed a questionnaire designed to assess perceived barriers and facilitators to telepresence avatar use in school. In the exploratory interview component, interviews with parents whose children had used the avatar were conducted.

Limitations

Recruitment was conducted at the school-level and internal forwarding to individual teachers could not be tracked. Therefore, an individual-level response rate could not be calculated, and respondent and non-respondent characteristics could not be compared. Participation was voluntary, which may have introduced substantial self-selection bias. In particular, the comparatively high proportion of teachers reporting experience with pediatric cancer and/or telepresence avatars suggests that experienced teachers may have been more likely to participate which limits representativeness. In addition, not all German federal states were represented, restricting generalizability. The cross-sectional design precludes causal interpretation, and school-level confounding and survivorship bias are also possible. Group sizes differed across experience profiles, and the subgroup with experience only with telepresence avatars was small. Findings involving this subgroup should therefore be interpreted as exploratory, although sensitivity analyses supported the overall pattern. The parent interviews were based on a very small exploratory sample of three families and should therefore be interpreted only as illustrative contextual material. Finally, although internal consistency of the overall barrier index was high, the questionnaire was purpose-developed and has not yet undergone comprehensive psychometric validation; therefore, the composite score should be interpreted as a descriptive implementation-oriented index rather than as a validated latent construct, and future studies should further examine the instrument's validity and reliability.

A 90-day district inquiry

Days 1–15 · Appraise. Read the source methods, recruitment, comparator, outcomes and limitations. Record how the study setting differs from your district and which claim the design can support.
Days 16–30 · Design. Choose one school improvement question with teachers. Protect a short shared planning cycle, agree an instructional change and use a common rubric for examining student work. Agree participation, privacy protections, baseline and stopping rules before starting.
Days 31–60 · Observe. Collect the pre-agreed measures, keep a log of implementation changes and invite confidential voluntary feedback. Preserve existing support for staff and learners.
Days 61–90 · Decide. Review implementation fidelity, teacher time and independently scored student work against a recorded baseline. Examine access differences and competing explanations before attributing changes to leadership. Make a dated decision to stop, revise or extend the inquiry.

Board decision brief

Present the local problem, source setting, evidence limits, intervention, responsible owner, total cost, measured changes and uncertainty. Separate staff perceptions, implementation measures and student learning outcomes.

Attribution and reuse

Friederike Carlotta Grabowski; Jana Dördelmann; Britta Exner; Fabian Simon Frielitz. Telepresence avatar use for children with cancer in schools: a study on barriers and facilitators. Frontiers in Digital Health (2026-07-09). https://doi.org/10.3389/fdgth.2026.1867390

Prepared 2026-11-07. Source authorship and DOI are preserved. The abstract and source passages are attributed extracts; this editorial guide is offered under the same CC BY 4.0 license.