“With a Touch of a Button”: Staff perceptions on integrating technology in an Irish service provider for people with intellectual disabilities

Barriers and facilitators influencing implementation of care technology for people with intellectual disabilities: A cross-sectional study among care professionals

BACKGROUND

Implementation issues often hinder reaching the potential of care technology to improve daily lives of people with intellectual disabilities. We investigated barriers to and facilitators of implementing different technology modalities (app/social robot/sensor/domotics) in long-term care.

METHOD

Care professionals (N = 83) from 12 Dutch disability care organisations completed a customised measurement instrument for determinants of innovations (MIDI) questionnaire.

RESULTS

Out of 27 determinants, 20 were identified as facilitators and 16 as barriers. We highlight common barriers: few colleagues who work with the technology; no (awareness of) formal ratification of technology use; no arrangements regarding turnover of staff using the technology; unsettling organisational changes; technological defects and limited IT preconditions.

CONCLUSIONS

The results, which could be combined and compared across study sites, provide insight into which implementation determinants were already well addressed, and where there is ground to gain when implementing care technology in disability care organisations.

User Requirements and Perceptions of a Sensor System for Early Stress Detection in People With Dementia and People With Intellectual Disability: Qualitative Study

BACKGROUND

Timely detection of stress in people with dementia and people with an intellectual disability (ID) may reduce the occurrence of challenging behavior. However, detecting stress is often challenging as many long-term care (LTC) residents with dementia and residents with ID have communication impairments, limiting their ability to express themselves. Wearables can help detect stress but are not always accepted by users and are uncomfortable to wear for longer periods. Integrating sensors into clothing may be a more acceptable approach for users in LTC. To develop a sensor system for early stress detection that is accepted by LTC residents with dementia and residents with ID, understanding their perceptions and requirements is essential.

OBJECTIVE

This study aimed to (1) identify user requirements for a garment-integrated sensor system (wearable) for early stress detection in people with dementia and people with ID, (2) explore the perceptions of the users toward the sensor system, and (3) investigate the implementation requirements in LTC settings.

METHODS

A qualitative design with 18 focus groups and 29 interviews was used. Focus groups and interviews were conducted per setting (dementia, ID) and target group (people with dementia, people with ID, family caregivers, health care professionals). The focus groups were conducted at 3 time points within a 6-month period, where each new focus group built on the findings of previous rounds. The data from each round were used to (further) develop the sensor system. A thematic analysis with an inductive approach was used to analyze the data.

RESULTS

The study included 44 participants who expressed a positive attitude toward the idea of a garment-integrated sensor system but also identified some potential concerns. In addition to early stress detection, participants recognized other potential purposes or benefits of the sensor system, such as identifying triggers for challenging behavior, evaluating intervention effects, and diagnostic purposes. Participants emphasized the importance of meeting specific system requirements, such as washability and safety, and user requirements, such as customizability and usability, to increase user acceptance. Moreover, some participants were concerned the sensor system could contribute to the replacement of human contact by technology. Important factors for implementation included the cost of the sensor system, added value to resident and health care professionals, and education for all users.

CONCLUSIONS

The idea of a garment-integrated sensor system for early stress detection in LTC for people with dementia and people with ID is perceived as positive and promising by stakeholders. To increase acceptability and implementation success, it is important to develop an easy-to-use, customizable wearable that has a clear and demonstrable added value for health care professionals and LTC residents. The next step involves pilot-testing the developed wearable with LTC residents with dementia and residents with ID in clinical practice.

Using welfare technology for individuals with intellectual disabilities. Expectations, experiences, and challenges of intellectual disability nursing students during clinical placement

PURPOSE

Little is known about how welfare technology (WT) is used in welfare services for people with intellectual disabilities. This study aimed to explore expectations, experiences, and challenges concerning the use of WT for people with intellectual disabilities among bachelor-level intellectual disability nursing students during clinical placement.

MATERIALS AND METHODS

A written reflection assignment (four open questions about using WT) was collected from 100 intellectual disability nursing students (30 males, 70 females). Four focus group discussions were also performed with 13 intellectual disability nursing students before and after their clinical placements.

RESULTS

Analysis of the assignments showed that "security and safety" technology was the most frequently used WT category for people with intellectual disabilities in the clinical placement settings in municipal welfare and day services. The students reported "Compensation and wellness" technology as the top category to promote the quality of services for people with intellectual disabilities. However, people with intellectual disabilities mostly used WT for "Social contact". Students were mainly positive towards WT and believed it could improve the service quality and the everyday lives of this group. However, the students requested to learn more about WT and ethical issues regarding WT before clinical placement. Additionally, they experienced a lack of knowledge, focus, and awareness about technology in services for this group.

CONCLUSION

The findings suggest that although intellectual disability nursing students have a positive attitude towards using WT for people with intellectual disabilities, they require more skill training and ethical knowledge before entering clinical practice. IMPLICATIONS FOR REHABILITATIONStudents were mainly positive towards welfare technology and believed that it could improve the service quality and the everyday lives of people with intellectual disabilities.Before their clinical placement, intellectual disability nursing students requested to learn more about welfare technology and ethical issues regarding welfare technology."Security and safety" technology was the most used category for people with intellectual disabilities in the municipal welfare and day services."Social contact" technology was the most used category by people with intellectual disabilities.

Understanding the possibilities and limitations of assistive technology in health and welfare services for people with intellectual disabilities, staff perspectives

PURPOSE

Little is known regarding what assistive technology (AT) exists and how it is used in welfare services for people with intellectual disabilities (ID). This study aimed to explore healthcare staff's perspectives and insights regarding AT in daily support and welfare services for people with ID. We also sought to explore the associations between the use of AT and workplace-related factors and background characteristics (e.g., gender, age, and experience).

MATERIALS AND METHODS

Three focus group discussions were conducted with 11 informants (8 women, 3 men) working in home-based and day services. Also, 176 healthcare staff (43 men, 133 women) who worked in municipal home-based services and day services completed a questionnaire comprised of background questions and 14 items with a five-point answer scale.

RESULTS

Number of years using AT was positively associated with a positive attitude and use of AT among the staff. Staff were mainly positive towards AT and believed that it could represent various possibilities in the everyday lives of people with ID and their own service delivery. However, the staff expressed uncertainties and ethical concerns regarding AT, and they experienced a lack of knowledge, focus, and awareness about technology in services for this group. The quantitative results mainly showed positive associations between believing in AT's usefulness and using it in services for people with ID.

CONCLUSIONS

The findings indicate that providing equipment and resources, personal interests, and staff attitudes are essential factors in successfully implementing AT for people with ID.Implications for rehabilitationHealthcare staff have a positive attitude towards using AT for people with intellectual disabilities, but they also perceive uncertainty and ethical concerns.The staff believe that there is a broad range of AT devices and systems available that can support the independence and participation of people with intellectual disabilities.The staff need to receive more training and technical supports from their workplace and AT-related experience is associated positively with the use of assistive technology by the staff.

Measuring working alliance and technical alliance from the perspective of healthcare professionals working with people with mild intellectual disabilities: adaptation, factor structure and reliability

BACKGROUND

The establishment of a valuable and meaningful working alliance between people with mild intellectual disabilities (IDs) and healthcare professionals is critically important for improving both the quality of life and impact of therapy for people with mild IDs. Measuring the working alliance as a treatment or support component is therefore of utmost relevance. In light of the increased use of eHealth tools, it is also essential to measure the alliance using these tools, which is referred to as technical alliance. There was a lack of validation of these two measurements for healthcare professionals working with people with mild IDs, which this study sought to address.

METHOD

Both the validated Working Alliance Inventory - Short Form - MID (WAI-SF-MID) and Technical Alliance Inventory - Short Form - MID (TAI-SF-MID) for general patient populations were adapted for healthcare professionals working with people with mild IDs. A two-step approach was conducted to systematically adapt both measurements with an expert group of healthcare professionals. Confirmatory factor analysis was conducted to test a three-factor structure for both the WAI-SF-MID (N = 199) and the TAI-SF-MID (N = 139), and internal consistency was determined for both scales.

RESULTS

An acceptable-to-good model fit was found for both the WAI-SF-MID and the TAI-SF-MID; confirmatory factor analysis confirmed a three-factor model for both measurements. Cronbach's alpha and McDonald's omega were excellent for both total scales (≥0.90) and acceptable to good for sub-scales of both versions.

CONCLUSION

Both the WAI-SF-MID and the TAI-SF-MID are promising measurements for determining healthcare professionals' perspective on the (digital) working alliance with people with mild IDs.

Electronic assistive technology use and supported employment

BACKGROUND

Level of electronic assistive technology use by people with intellectual disabilities is lower than for other disability groups.

METHODS

In this mixed-methods exploratory study during the pandemic, staff (online survey) and executive administration (focus group) from a regional supported employment service provider in the Midwest US were surveyed about use of and barriers to use of electronic assistive technology for their clients with intellectual disabilities.

RESULTS

Forty percent of staff reported 'not' using any of the assistive technologies with their clients. Executive administration perceived that they should be providing technology resources to clients and staff. Both groups rated expense, access, and complexity as barriers to assistive technology use at the client's worksite.

CONCLUSIONS

Identifying the types of assistive technologies that can be most easily accessed and most cost-effective, including lower-cost consumer market devices, as employment supports for people with intellectual disabilities may be a first step in helping to overcome perceived barriers to use.

A Support Worker Perspective on Use of New Technologies by People with Intellectual Disabilities

People with intellectual disability access innovative technologies in disability community centres in Australia, under the guidance of support workers. This paper investigates the perspectives of 15 support workers and 5 managers across four community centres on the introduction and use of technology like tablets, video games, 3D printing, virtual reality and social robots. They had diverse views on who is responsible for facilitating, embedding and shaping technology for learning life skills and socializing. We found technology use to be driven by facilitator's knowledge (pre-existing, observed or trained), interests, the value they place on the interactions afforded by the technology and organization values. We discuss how future designs can emphasise communities of users while empowering individuals to achieve their goals. We suggest co-design strategies for assistive technology that involve support workers in the dual roles of proxy and co-user. We finally discuss how broader organisational factors can influence appropriation and use.

Enhanced participation or just another activity? The social shaping of iPad use for youths with intellectual disabilities

The use of smartphones and tablet devices in activities is believed to have great potential for enhancing the participation of people with intellectual disabilities. However, these technologies, in themselves, do not contribute to participation. What matters is how they are used. Employing the concept of domestication and insights gained from interviews with staff, this article examines conditions for the enhanced participation of youths with intellectual disability and how tablet devices are being integrated into social care settings, in particular.The findings reveal two approaches to tablet integration. In one approach, tablet use is an organized practice focused on technology acquisition, skills improvement and entertainment. In the other, it is integrated into existing practices as an aid to interpersonal communication. The organized digital activities create conditions for the youths to participate like non-disabled peers. The greatest potential for enabling participation with each other is when the youths themselves initiate the use of tablets.

Technology and Communication Considerations for Engaging Youth Receiving Supplemental Security Income (SSI) Benefits: Vocational Rehabilitation Counselor Perspectives

Technology has been shown to enhance daily activities, increase participation in individualized planning and supports, and accommodate the transition needs of students with disabilities. This study examined the benefits and challenges regarding technology use when providing transition services for youth and families receiving Supplemental Security Income (SSI) benefits. Specifically, it explored the nuances of employing technology to encourage engagement in Wisconsin Promoting the Readiness of Minors in Supplemental Security Income (WI PROMISE) services and foster communication between counselors and participants. This qualitative study used a constant comparative method for analyzing data collected through two focus groups of WI PROMISE counselors. Counselors identified technology as essential to maintaining contact with WI PROMISE participants as well as extant barriers including inconsistent access to the internet, financial expense, and insufficient training and support. Recommendations for using technology to communicate with transition-age youth and their families will be discussed.

eHealth in the support of people with mild intellectual disability in daily life: A systematic review

BACKGROUND

eHealth has recently made rapid progress in care, support and treatment. However, studies on the use of eHealth to support people with a mild intellectual disability in daily life are limited. A systematic review was conducted to provide an overview of this use of eHealth.

METHODS

Seven databases were searched for relevant studies and assessed according to the PRISMA guidelines. Descriptive analyses were deployed using the Matching Person to Technology model to evaluate the key areas contributing to successful eHealth use.

RESULTS

Most of the 46 studies included were small-scale case studies and focused on using eHealth to acquire daily living skills and vocational skills. In addition, several studies focused on eHealth use for self-support in daily living, and three studies focused on remote professional support.

CONCLUSIONS

eHealth offers opportunities to support people with mild intellectual disability in various different contexts of daily life. Scientific research on this topic is in its early stage, and further high-quality research is needed.