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Layton N, Harper K, Martinez K, Berrick N, Naseri C. Co-creating an assistive technology peer-support community: learnings from AT Chat. Disabil Rehabil Assist Technol 2021:1-7. [PMID: 33977806 DOI: 10.1080/17483107.2021.1897694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Inclusion is a core philosophy for health practitioners and human service users, and co-production is a way to achieve inclusion. Australia's assistive technology (AT) community seeks to include and amplify the voices of service and product users at multiple levels. Implementation of genuine partnerships for inclusion is however challenging. This paper describes the iterative co-design process undertaken to structure and deliver a peer-led information and support program, enabling AT users and supporters to build their AT decision making capability and share their expertise with each other and the broader community. METHODS A living labs approach was grounded in co-design principles and drew on the peer education, AT competency and capability-building knowledge base. Methods included embedding intersectional capabilities within the service, and the engagement of over 600 people in design thinking and program iterations through surveys, focus groups, journey mapping and think tanks. RESULTS A national, peer-led, co-designed online community for AT users was established and has been running since 2017. The community of 5000 users contribute to a peer-led information and support initiative geared to share expertise and build AT decision making capability. CONCLUSIONS Service delivery by the AT user community and for the AT user community requires a commitment to co-design, and an engagement with concepts of risk, competency, scope of practice and capability. The learnings from AT Chat have implications for AT services on this journey everywhere.Implications for rehabilitationActive co-design of AT services meets human rights and good practice benchmarks required by contemporary services.Foregrounding AT users within program design and delivery, brings a range of positive outcomes and possibilities for the way services are delivered.AT users have substantial untapped potential which brings tangible outcomes for other AT users, health professionals, service provider organizations and for society.Development of paid roles and pathways to recognize the skills of AT users, and indeed AT communities has potential to improve AT user self-efficacy as well as to contribute to the AT workforce.
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Affiliation(s)
- Natasha Layton
- RAIL Research Centre, Monash University, Frankston, Australia.,Swinburne University of Technology, Hawthorn, Australia
| | - Kristy Harper
- Independent Living Assessment Incorporated, Perth, Australia
| | | | - Neil Berrick
- Independent Living Assessment Incorporated, Perth, Australia
| | - Chiara Naseri
- Independent Living Assessment Incorporated, Perth, Australia.,Curtin University School of Physiotherapy & Exercise Science, Bentley, Australia
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Auger C, Mortenson WB, Jutai JW, Seguin-Tremblay N, Chenel V, Guay M. Older adults' use of an online decision support system: Usability and stability of assistive technology recommendations. Assist Technol 2020; 34:316-325. [PMID: 32865488 DOI: 10.1080/10400435.2020.1815251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Online decision support systems (DSS) may help older adults self-select assistive technology (AT) by offering recommendations. User interactions with DSSs may change the recommendations they receive. OBJECTIVE We evaluated recommendations stability and usability of an online DSS. METHODS Middle-aged and older adults (n = 43) were observed while using the DSS. The stability of DSS recommendations (ATs and advice) was compared between two time points, using a three-point scale: no, partial, or full agreement. Usability was coded, referencing ISO standards. RESULTS Half (51%) of participants received AT recommendations from the DSS in both sessions, with full (14%) or partial (12%) agreement. All but one participant received advice, and almost all of them had full (40%) or partial (56%) agreement between sessions. Many of the usability issues appear to be the result of the users inaccurately measuring their environment, challenges in understanding the questions being asked, and improperly making selections from the system. DISCUSSION Strict AT matching rules versus generic advice, and usability issues, likely reduced the matching rate and stability of AT recommendations. CONCLUSION It appears that some users may require assistance with the system, and we suggest changes to the DSS format and content to improve stability and usability.
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Affiliation(s)
- Claudine Auger
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montréal, Canada.,School of Rehabilitation, Université de Montréal, Montréal, Canada
| | - W Ben Mortenson
- Department of Occupational Science & Occupational Therapy, University of British Columbia, Vancouver, Canada
| | - Jeffrey W Jutai
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada.,LIFE Research Institute, Ottawa, Canada
| | | | - Vanessa Chenel
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montréal, Canada.,School of Rehabilitation, Université de Montréal, Montréal, Canada
| | - Manon Guay
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Canada
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Guay M, Latulippe K, Auger C, Giroux D, Séguin-Tremblay N, Gauthier J, Genest C, Morales E, Vincent C. Self-Selection of Bathroom-Assistive Technology: Development of an Electronic Decision Support System (Hygiene 2.0). J Med Internet Res 2020; 22:e16175. [PMID: 32773380 PMCID: PMC7445614 DOI: 10.2196/16175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 04/28/2020] [Accepted: 06/03/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A clinical algorithm (Algo) in paper form is used in Quebec, Canada, to allow health care workers other than occupational therapists (OTs) to make bathroom adaptation recommendations for older adults. An integrated knowledge transfer process around Algo suggested an electronic version of this decision support system (electronic decision support system [e-DSS]) to be used by older adults and their caregivers in search of information and solutions for their autonomy and safety in the bathroom. OBJECTIVE This study aims to (1) create an e-DSS for the self-selection of bathroom-assistive technology by community-dwelling older adults and their caregivers and (2) assess usability with lay users and experts to improve the design accordingly. METHODS On the basis of a user-centered design approach, the process started with content identification for the prototype through 7 semistructured interviews with key informants of various backgrounds (health care providers, assistive technology providers, and community services) and 4 focus groups (2 with older adults and 2 with caregivers). A thematic content transcript analysis was carried out and used during the creation of the prototype. The prototype was refined iteratively using think-aloud and observation methods with a clinical expert (n=1), researchers (n=3), OTs (n=3), older adults (n=3), and caregivers (n=3), who provided information on the usability of the e-DSS. RESULTS Overall, 4 themes served as the criteria for the prototype of the electronic Algo (Hygiene 2.0 [H2.0]): focus (safety, confidentiality, well-being, and autonomy), engage, facilitate (simplify, clarify, and illustrate), and access. For example, users first pay attention to the images (engage and illustrate) that can be used to depict safe postures (safety), illustrate questions embedded in the decision support tool (clarify and illustrate), and demonstrate the context of the use of assistive technology (safety and clarify). CONCLUSIONS The user-centered design of H2.0 allowed the cocreation of an e-DSS in the form of a website, in line with the needs of community-dwelling older adults and their caregivers seeking bathroom-assistive technology that enables personal hygiene. Each iteration improved usability and brought more insight into the users' realities, tailoring the e-DSS to the implementation context.
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Affiliation(s)
- Manon Guay
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, QC, Canada.,Center for Research on Aging, Sherbrooke, QC, Canada
| | - Karine Latulippe
- Department of Teaching and Learning Studies, Université Laval, Quebec, QC, Canada
| | - Claudine Auger
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
| | - Dominique Giroux
- Center of Excellence on Aging Quebec, Quebec, QC, Canada.,Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, QC, Canada.,VITAM - Centre de recherche en santé durable, Quebec, QC, Canada
| | | | - Josée Gauthier
- CIUSSS de la Mauricie-et-du-Centre-du-Québec, Trois-Rivières, QC, Canada
| | | | - Ernesto Morales
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, QC, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec, QC, Canada
| | - Claude Vincent
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, QC, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec, QC, Canada
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Hamm J, Money AG, Atwal A, Ghinea G. Mobile three-dimensional visualisation technologies for clinician-led fall prevention assessments. Health Informatics J 2019; 25:788-810. [PMID: 28816091 PMCID: PMC6769285 DOI: 10.1177/1460458217723170] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The assistive equipment provision process is routinely carried out with patients to mitigate fall risk factors via the fitment of assistive equipment within the home. However, currently, over 50% of assistive equipment is abandoned by the patients due to poor fit between the patient and the assistive equipment. This paper explores clinician perceptions of an early stage three-dimensional measurement aid prototype, which provides enhanced assistive equipment provision process guidance to clinicians. Ten occupational therapists trialled the three-dimensional measurement aid prototype application; think-aloud and semi-structured interview data was collected. Usability was measured with the System Usability Scale. Participants scored three-dimensional measurement aid prototype as 'excellent' and agreed strongly with items relating to the usability and learnability of the application. The qualitative analysis identified opportunities for improving existing practice, including, improved interpretation/recording measurements; enhanced collaborative practice within the assistive equipment provision process. Future research is needed to determine the clinical utility of this application compared with two-dimensional counterpart paper-based guidance leaflets.
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Ruest M, Bourget A, Delli-Colli N, Guay M. Algo Used by Homecare Nonoccupational Therapists Selecting Bathing Assistive Technology: Enhancing Standardization by Exploring Clinical Reasoning. Occup Ther Health Care 2017; 31:20-33. [PMID: 28094591 DOI: 10.1080/07380577.2016.1270481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Algo is a clinical decision algorithm developed to support nonoccupational therapists in establishing assistive technology recommendations to enable physically disabled adults to perform their hygiene at home. This study aimed to explore the in-depth clinical reasoning of nonoccupational therapists using Algo to pinpoint the items leading to disagreements regarding recommendations. A multiple-case study was conducted with eight nonoccupational therapists trained to use Algo and filmed while using it with six standardized clients. Explicitation interviews were conducted for the conflicting recommendations. Identifying the key reasoning skills to develop in Algo users has led to three recommendations to enhance standardization with seniors.
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Affiliation(s)
- Mélanie Ruest
- a Health Sciences Research Programs, Faculty of Medicine And Health Sciences , Université de Sherbrooke , Sherbrooke, Quebec , Canada.,b Research Centre on Aging , Health and Social Services Centre - University Institute of Geriatrics of Sherbrooke , Sherbrooke, Quebec , Canada
| | - Annick Bourget
- c School of Rehabilitation , Faculty of Medicine and Health Sciences, Université de Sherbrooke , Sherbrooke, Quebec , Canada
| | - Nathalie Delli-Colli
- d School of Social Work , Faculty of Arts, Humanities and Social Sciences, Université de Sherbrooke , Sherbrooke, Quebec , Canada
| | - Manon Guay
- b Research Centre on Aging , Health and Social Services Centre - University Institute of Geriatrics of Sherbrooke , Sherbrooke, Quebec , Canada.,c School of Rehabilitation , Faculty of Medicine and Health Sciences, Université de Sherbrooke , Sherbrooke, Quebec , Canada
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Abendstern M, Hughes J, Tucker S, Clarkson P, Challis D. Self-Assessment and Personalization in Occupational Therapy Services: A Managerial Perspective on the Challenges and Opportunities of a Service Innovation. Br J Occup Ther 2014. [DOI: 10.4276/030802214x14122630932395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Introduction: This article examines the introduction of self-assessment in occupational therapy services, focusing on the impact of new tools and approaches on professional culture and practice. Method: Qualitative data were collected via interviews with managers of five pilot projects and analysed using a mixture of predetermined and emergent themes. Findings: Within the implementation process, challenges and opportunities were identified, including the development of web-based assessment tools, extending the roles of staff groups not previously engaged in assessment, and refocusing the duties of qualified staff on the most complex cases. The involvement of staff in the design of new tools, bespoke training courses, and the use of ‘champions’ were reported to be effective means of supporting them through the change process. The development of new ways of delivering services through new technology was found to be in its infancy. Conclusion: Self-assessment complemented professional practice in occupational therapy services. It enabled the skills of qualified staff to be used appropriately whilst ensuring that people with needs requiring simple interventions had greater opportunity than previously to take charge of their situation and to receive a timely service that was tailored to their needs. New technology required further development to enhance service delivery.
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Affiliation(s)
- Michele Abendstern
- Research Associate, Personal Social Services Research Unit (PSSRU), University of Manchester, Manchester
| | - Jane Hughes
- Lecturer in Community Care, Personal Social Services Research Unit (PSSRU), University of Manchester, Manchester
| | - Sue Tucker
- Research Fellow, Personal Social Services Research Unit (PSSRU), University of Manchester, Manchester
| | - Paul Clarkson
- Research Fellow, Personal Social Services Research Unit (PSSRU), University of Manchester, Manchester
| | - David Challis
- Professor of Community Care and Director, Personal Social Services Research Unit (PSSRU), University of Manchester, Manchester
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Clarkson P, Brand C, Hughes J, Challis D, Tucker S, Abendstern M. Cost effectiveness of pilot self-assessment sites in community care services in England. AUST HEALTH REV 2014; 37:666-74. [PMID: 24160485 DOI: 10.1071/ah13056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 08/19/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Self-assessment has been advocated in community care but little is known of its cost effectiveness in practice. We evaluated cost effectiveness of pilot self-assessment approaches. METHODS Data were collected from 13 pilot projects in England, selected by central government, between October 2006 and November 2007. These were located within preventative services for people with low-level needs, occupational therapy, or assessment and care management. Cost effectiveness, over usual care, was assessed by incremental cost-effectiveness ratios (ICERs), in British pounds per unit gain in assessment satisfaction. A public-sector perspective was adopted; the provider costs of the agencies taking part. RESULTS At 2006-07 prices, including start-up and on-going costs, only three pilots demonstrated cost effectiveness. Two pilots in assessment and care management had ICERs of £3810 and £755 per satisfaction gained, well below a benchmark from a trial of usual assessment of £18296 per satisfaction gained. When extrapolating uptake to numbers accessing assessments over 1 year, one occupational therapy pilot, of £123/satisfaction gained, also fell below this benchmark in sensitivity analysis. There was less evidence for preventative services. CONCLUSIONS AND IMPLICATIONS Most pilot projects were not cost effective. However, self assessment is potentially cost effective in assessment and care management and occupational therapy services. Better quality cost data from pilot sites would have permitted more detailed analysis. Measuring downstream effects in terms of users' well being from receipt of self-assessment would also be beneficial.
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Affiliation(s)
- Paul Clarkson
- Personal Social Services Research Unit (PSSRU), University of Manchester, Faculty of Medical and Human Sciences, Dover Street Building, Oxford Road, Manchester M13 9PL, UK
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Boniface G, Mason M, MacIntyre J, Synan C, Riley J. The Effectiveness of Local Authority Social Services' Occupational Therapy for Older People in Great Britain: A Critical Literature Review. Br J Occup Ther 2013. [DOI: 10.4276/030802213x13861576675240] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Introduction: Older people are the main users of adult social care services in Great Britain. Evidence suggests that occupational therapists employed by local authorities are providing interventions that promote and maintain older people's independence, and decrease dependency on other services. However, such evidence is disparate in nature and lacks synthesis. Method: This literature review systematically selected, critically appraised, and thematically synthesized the post 2000 published and unpublished evidence on the effectiveness and cost effectiveness of occupational therapy interventions for older people in social care services. Findings: Identified themes established: the localized nature of social care services for older people; organizational and policy impacts on services, and factors influencing effectiveness and cost effectiveness. Although occupational therapists are increasingly involved in rehabilitation and reablement, there is a continuing focus on equipment and adaptations provision. A high level of service user satisfaction was identified, once timely occupational therapy services were received. Conclusion: Overall, occupational therapy in social care is perceived as effective in improving quality of life for older people and their carers, and cost effective in making savings for other social and healthcare services. However, the complex nature of social care services makes it difficult to disaggregate the effectiveness of occupational therapy from other services.
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Affiliation(s)
- Gail Boniface
- Senior Lecturer, Cardiff University, Occupational Therapy, Cardiff
| | - Margot Mason
- Professional Team Lead for Occupational Therapy, Gloucestershire Care Services NHS Trust, Gloucester
| | - Jacqueline MacIntyre
- Team Leader — Physical Disability and Sensory Impairment, Inverclyde Council, Centre for Independent Living, Greenock
| | - Christine Synan
- Operational Manager — Maintaining and Regaining Independence, Health and Social Care, Cardiff County Council, Cardiff
| | - Jill Riley
- Lecturer, Cardiff University, Occupational Therapy, School of Healthcare Studies, Ty Dewi Sant Heath Park, Cardiff
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Guay M, Dubois MF, Desrosiers J, Robitaille J. Identifying Characteristics of ‘Straightforward Cases’ for which Support Personnel Could Recommend Home Bathing Equipment. Br J Occup Ther 2012. [DOI: 10.4276/030802212x13548955545576] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Introduction: The general consensus is that an occupational therapist should carry out the assessment for recommending home bathing equipment. Nevertheless, in response to a shortage of human resources, home-care occupational therapists in Quebec, Canada, frequently transfer the clinical task of recommending bathing equipment to support personnel in ‘straightforward cases’. However, there is no consensus on what constitutes such cases, and clinicians lack information on how to define a straightforward case. Objective: To characterise ‘straightforward cases’ when recommending bathing equipment in home-care occupational therapy. Design: The RAND/UCLA Appropriateness Method, combining a literature review with a three-round survey and one focus group meeting of nine occupational therapists. Results: Eight characteristics required for describing straightforward cases for bathing equipment recommendations were identified. They cover the three dimensions of the Canadian Model of Occupational Performance and Engagement: the occupation, the person, and the person's home environment. Conclusion: The literature review and collective opinion of experienced occupational therapists made it possible to agree on a common language to describe straightforward cases for bathing equipment. The characteristics identified will, it is hoped, support the critical thinking of clinicians deciding whether or not to transfer the task of recommending bathing equipment to support personnel.
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Affiliation(s)
- Manon Guay
- Assistant Professor, School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Marie-France Dubois
- Associate Professor, Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Johanne Desrosiers
- Professor and Director of the School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Judith Robitaille
- Research Assistant, Research Center on Ageing, Sherbrooke, Quebec, Canada
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