Identifying Motives for Implementing eHealth by using Activity Theory

Experiences of using surveillance cameras as a monitoring solution at nursing homes: The eldercare personnel's perspectives

BACKGROUND

As the number of older people increases, so does the need for care. However, the workforce in eldercare cannot increase at the rate required to match the needs. Welfare technologies, such as surveillance cameras, can replace physical visits and be used at night to monitor older people in order to keep them safe, while not disturbing their sleep. The aim of the paper is to analyze obstacles and opportunities associated with implementation and use of surveillance cameras at nursing homes from the perspectives of the practitioners who use the technology, their working environment and the conditions of the older people with cognitive impairment who live in nursing homes.

METHODS

Individual semi-structured interviews were conducted with the eldercare personnel at nursing homes to understand their experiences of implementation and use of surveillance cameras. The transcribed interviews were analyzed using qualitative content analysis. The consolidated criteria for reporting qualitative research (COREQ) was used as a guidance tool.

RESULTS

The results show that the eldercare personnel experienced lack of adequate information, education and support related to using surveillance cameras. Several benefits are highlighted, such as better working environment and that the residents were not unnecessarily disturbed at night. However, the results also show that it is important to clarify that surveillance cameras cannot replace the human presence.

CONCLUSIONS

The conclusions from this study are the importance of prerequisites for implementation, and that using surveillance cameras contributed to improvements in the working environment at night and created possibilities to maintain security and integrity for older people living in nursing homes.

"It depends on the people!" - A qualitative analysis of contextual factors, prior to the implementation of digital health innovations for chronic condition management, in a German integrated care network

Objective

Integrated care and digital health technology interventions are promising approaches to coordinate services for people living with chronic conditions, across different care settings and providers. The EU-funded ADLIFE project intends to provide digitally integrated personalized care to improve and maintain patients' health with advanced chronic conditions. This study conducted a qualitative assessment of contextual factors prior to the implementation of the ADLIFE digital health platforms at the German pilot site. The results of the assessment are then used to derive recommendations for action for the subsequent implementation, and for evaluation of the other pilot sites.

Methods

Qualitative interviews with healthcare professionals and IT experts were conducted at the German pilot site. The interviews followed a semi-structured interview guideline, based on the HOT-fit framework, focusing on organizational, technological, and human factors. All interviews were audio recorded, transcribed, and subsequently analysed following qualitative content analysis.

Results

The results of the 18 interviews show the interviewees' high openness and motivation to use new innovative digital solutions, as well as an apparent willingness of cooperation between different healthcare professionals. Challenges include limited technical infrastructure and large variability of software to record health data, lacking standards and interfaces.

Conclusions

Considering contextual factors on different levels is critical for the success of implementing innovations in healthcare and the transfer into other settings. In our study, the HOT-fit framework proved suitable for assessing contextual factors, when implementing IT innovations in healthcare. In a next step, the methodological approach will be transferred to the six other European pilot sites, participating in the project, for a cross-national assessment of contextual factors.

Implementation of eHealth Technology in Community Health Care: the complexity of stakeholder involvement

Background

The implementation of any technology in community health care is seen as a challenge. Similarly, the implementation of eHealth technology also has challenges, and many initiatives never fully reach their potential. In addition, the complexity of stakeholders complicates the situation further, since some are unused to cooperating and the form of cooperation is new. The paper’s aim is to give an overview of the stakeholders and the relationships and dependencies between them, with the goal of contributing this knowledge to future similar projects in a field seeing rapid development.

Methods

In this longitudinal qualitative and interpretive study involving eight municipalities in Norway, we analysed how eHealth initiatives have proven difficult due to the complexity and lack of involvement and integration from stakeholders. As part of a larger project, this study draws on data from 20 interviews with employees on multiple levels, specifically, project managers and middle managers; healthcare providers and next of kin; and technology vendors and representatives of the municipal IT support services.

Results

We identified the stakeholders involved in the implementation of eHealth community health care in the municipalities, then described and discussed the relationships among them. The identification of the various stakeholders illustrates the complexity of innovative implementation projects within the health care domain—in particular, community health care. Furthermore, we categorised the stakeholders along two dimensions (external–internal) and their degree of integration (core stakeholders, support stakeholders and peripheral stakeholders).

Conclusions

Study findings deepen theoretical knowledge concerning stakeholders in eHealth technology implementation initiatives. Findings show that the number of stakeholders is high, and illustrate the complexity of stakeholders’ integration. Moreover, stakeholder integration in public community health care differs from a classical industrial stakeholder map in that the municipality is not just one stakeholder, but is instead comprised of many. These stakeholders are internal to the municipality but external to the focal actor, and this complicating factor influences their integration. Our findings also contribute to practice by highlighting how projects within the health care domain should identify and involve these stakeholders at an early stage. We also offer a model for use in this context.