Exploring the factors that influence the decision to adopt and engage with an integrated assistive telehealth and telecare service in Cambridgeshire, UK: a nested qualitative study of patient ‘users’ and ‘non-users’

Abstract

BackgroundThere is a political drive in the UK to use assistive technologies such as telehealth and telecare as an innovative and efficient approach to healthcare delivery. However, the success of implementation of such services remains dependent on the ability to engage the wider population to adopt these services. It has been widely acknowledged that low acceptance of technology, forms a key barrier to adoption although findings been mixed. Further, it remains unclear what, if any barriers exist between patients and how these compare to those who have declined or withdrawn from using these technologies. This research aims to address this gap focusing on the UK based Cambridgeshire Community Services Assistive Telehealth and Telecare service, an integrated model of telehealth and telecare.MethodsQualitative semi-structured interviews were conducted between 1st February 2014 and 1st December 2014, to explore the views and experiences of ‘users’ and ‘non-users’ using this service. ‘Users’ were defined as patients who used the service (N = 28) with ‘non-users’ defined as either referred patients who had declined the service before allocation (N = 3) or had withdrawn after using the ATT service (N = 9). Data were analysed using the Framework Method.ResultsThis study revealed that there are a range of barriers and facilitators that impact on the decision to adopt and continue to engage with this type of service. Having a positive attitude and a perceived need that could be met by the ATT equipment were influential factors in the decision to adopt and engage in using the service. Engagement of the service centred on ‘usability’, ‘usefulness of equipment’, and ‘threat to identity and independence’.ConclusionsThe paper described the influential role of referrers in decision-making and the need to engage with such agencies on a strategic level. The findings also revealed that reassurance from the onset was paramount to continued engagement, particularly in older patients who appeared to have more negative feelings towards technology. In addition, there is a clear need for continued product development and innovation to not only increase usability and functionality of equipment but also to motivate other sections of the population who could benefit from such services. Uncovering these factors has important policy implications in how services can improve access and patient support through the application of assistive technology which could in turn reduce unnecessary cost and burden on overstretched health services.

Selecting the most suitable classification algorithm for supporting assistive technology adoption for people with dementia: A multicriteria framework

“…These factors included usefulness, usability, affordability, accessibility, technical support, social support, emotion, independence, experience, and confidence. When considering the adoption and continued use of assistive technologies, this multifaceted view of adoption has been supported (Cook et al, ). When modelling the decision of older adults to use assistive technologies, for example, four themes were identified: acceptance of old age/health condition; previous knowledge and awareness of the equipment available; “perceived usefulness of equipment”; and “attitudes and perceptions towards assistive technology.” Considering the continued engagement and usage of assistive technologies, four related themes were identified: “usability,” “usefulness of equipment,” “functionality of equipment,” and “threat to identity and independence.”…”

Hidden Work and the Challenges of Scalability and Sustainability in Ambulatory Assisted Living

“…However, the optimism that has accompanied various initiatives designed to promote the scaling up of assisted living services pilots and demonstrate their sustainability has not been justified by results (Sanders et. 2012;Bentley et al 2014;Cook et al 2016;Merkel and Enste 2016;Greenhalgh et al 2017). Scalability implies that services may be rolled out at multiple sites with minimal adaptation to local settings and service user needs, with "plug and play" representing the ideal scenario ; sustainability implies that costs of running and maintaining the service over time is consistent with the resources available.…”

“…However, while such policy interventions may be well-motivated, in practice there is a substantial gap between the vision and the realities of assisted living technologies and services adoption . Recent UK studies suggest that potential users-i.e., dementia sufferers (clients) and their carers of assisted living technologies are often reluctant to adopt them and/or abandon or disable them after their initial experiences (Sanders et al 2012;Clark et al 2011;Bentley et al 2014;Cook et al 2016). Such outcomes must cast doubt on whether the policy ambitions of delivering assisted living solutions at scale and sustainably are achievable Agbakoba et al 2016;Merkel and Enste 2016).…”

Patient Perceptions of Google Glass in the Outpatient Dermatology Setting

“…The key facilitators were positive attitude toward usability and reliability of the technology (Cook et al, 2016).…”

“…Their aim was to understand the impact of health information technology (HIT) on provider-patient interaction in designing better EHRs. The authors found physicians spent more time looking at the EHR screen than paper records and less time looking at the patient.The use of technology can provide patients with health information to increase their participation in care, decision-making and improve health outcomes but concerns with privacy and patients' aversion to change contribute to their slow adoption of technology Cook et al (2016). looked at the barriers and facilitators which influence patient's decisions to adopt technology.…”