Normalization of technology for social contact in a Norwegian care facility during COVID-19

BACKGROUND

The COVID-19 pandemic has seen unprecedented growth in the use of interactive technologies in care facilities for social contact between residents and their close contacts due to the need for social distancing. As the pandemic is transitioning into a new phase, there is a need to critically examine the new practices associated with technology usage.

OBJECTIVE

Our analysis is based on a case study of how a care facility in western Norway adopted a novel technology called KOMP. We empirically investigate the stability of practices with KOMP for maintaining social communication between residents and their relatives and consider whether these practices are likely to last beyond the pandemic. We draw on normalization process theory (NPT) to interpret our findings and critically examine how stable embedding of new technologies for social communication occurs under extraordinary circumstances.

METHODS

We conducted a case study based on participant observation and interviews, and the data were analyzed through inductive thematic analysis. Participants are health care professionals from a public care facility in western Norway.

RESULTS

Four major themes emerged from the data. The first revolved around the pressing need for communications between residents and relatives with a suitable tool. Second, staff showed engagement through motivation to learn and adapt the technology in their practices. A third theme centered on how staff and the organization could work effectively to embed KOMP in daily practice. Our fourth theme suggested that the professionals continuously assessed their own use of the technology.

CONCLUSION

From the perspective of NPT, practices with KOMP have been partially embedded by developing a shared understanding, engaging through cognitive participation, working collectively with staff and the organization, and reflexively monitoring the benefits of using KOMP. However, staff engagement with the technology was continuously threatened by factors related to diverging staff preferences, the burden of facilitating KOMP for residents with impaired cognitive and physical abilities, issues of privacy and ethics, and the technical skills of the residents' relatives. Our analysis suggests that caring practices via KOMP have become relatively stable despite barriers to engagement and are therefore likely to persist beyond the pandemic.

Improvised use of a digital tool for social interaction in a Norwegian care facility during the COVID-19 pandemic: an exploratory study

Background

Digital tools for social communication have been deployed in care facilities during the COVID-19 pandemic to facilitate social connectedness between older people and their next of kin in a safe manner. This study explores how and why health care professionals facilitate the ad hoc and prompt use of a technology for social communication, known as KOMP, in care facilities in western Norway to promote communication and social engagement among residents and their next of kin during the crisis.

Methods

To investigate the perspectives and practices of health care professionals, we conducted focus groups, individual interviews, and participant observation in public short- and long-term care facilities in western Norway. An explorative investigation with inductive content analysis was applied to analyse interview transcripts and fieldnotes from participant observation.

Results

The resulting qualitative data reveal that prompt implementation of interactive technology to cope with social distancing during the pandemic added new routines to the staff workload. Using this interactive technology entailed new forms of collaborative work among residents, next of kin, health care professionals and technology facilitators. Additionally, the staff articulated a sense of responsibility towards using KOMP as a meaningful and practical tool for social communication in an extraordinary period of reduced social contact.

Conclusions

Improvised implementation of KOMP as an interactive technology shapes work routines, introduces new tasks and creates additional responsibilities. Despite creative efforts by health care staff, however, using KOMP remains constrained by the physical and cognitive abilities of its users. We suggest that health care managers ask a deceptively simple question when introducing novel technologies in health care contexts, namely: what kind of invisible work do these devices entail?

Design and Redesign of the IACTA App, an Interactive Communication Tool Intended to Facilitate Young Children's Participation in Healthcare Situations

PURPOSE

To develop the storyboard of IACTA further, based on the child''s perspective, by testing and evaluating both re-designed and newly designed scenes.

DESIGN AND METHOD

A participatory design was used involving preschool children (n = 18) aged three to five who tested and evaluated evolving prototypes of the IACTA application. Think aloud and Active intervention were used to elicit verbal responses from the children. Additionally, observational protocols were used to capture, in a structured way, the children's interaction with the app.

RESULTS

By testing evolving prototypes, the children confirmed previous developments and challenged the newly added scenes of the app. By their interaction, important information regarding the children's ways of navigating the storyboard was obtained. Ways of becoming immersed in the storyboard and the eagerness of dealing with each scene provided information regarding likeability.

CONCLUSIONS

Overall, this article presents a participatory design process in which preschool aged children were involved in testing and evaluating prototypes of the re-designed IACTA app. In the process, the children provided their perspective on the design and content and eventually, based on their feedback, IACTA was proven to be an age-appropriate tool.

PRACTICAL IMPLICATIONS

Children are frequent visitors to healthcare services. Lack of knowledge might trigger fear and anxiety, whereas information provides understanding. Interactive, mobile solutions enable children to receive information within paediatric healthcare contexts. The IACTA application intends to provide children a situated understanding that facilitates their participation in healthcare situations.

Developing numeracy skills using interactive technology in a play-based learning environment

BACKGROUND

The purpose of this study was to measure the impact of interactive technology in the form of mathematical applications (apps) delivered using iPads on kindergarten children's learning of number sense in a play-based learning environment. Secondly, factors influencing the use of interactive technology in a play-based environment were examined. This technology was introduced to a small (n = 13) rural kindergarten classroom using an experimental design embedded in a mixed methods approach.

RESULTS

The teacher was keen to introduce technology to her class but was self-described as a beginner in using iPads for personal or teaching tasks. Small gains were noted between the control and intervention groups but they were not significant. Further, children were observed collaborating which supported prior research. Another observation was related to attention span, when an app became too challenging children would abandon the app or use a trial and error method to move to the next level. Lastly, when given choice, children were drawn to creative and entertaining apps rather than apps that were more pedagogically accurate but less creative. Although there was not a large gain in achievement, using interactive technology promoted student collaboration and engagement in a play-based learning environment.

CONCLUSIONS

Small gains in mathematics achievement and high levels of engagement suggest that using interactive technology in the kindergarten classroom enhances learning of mathematics. Factors influencing the use of interactive technology included the quality of the app such that creative and fun apps promoted children's engagement in learning mathematics. The level of difficulty of an app was a second factor influencing children's use of interactive technology. If the difficulty level was too challenging, children became disengaged with the app.

A protocol for a cluster randomized trial comparing strategies for translating self-management support into primary care practices

BACKGROUND

Advanced primary care models emphasize patient-centered care, including self-management support (SMS), but the effective use of SMS for patients with type 2 diabetes (T2DM) remains a challenge. Interactive behavior-change technology (IBCT) can facilitate the adoption of SMS interventions. To meet the need for effective SMS intervention, we have developed Connection to Health (CTH), a comprehensive, evidence-based SMS program that enhances interactions between primary care clinicians and patients to resolve self-management problems and improve outcomes. Uptake and maintenance of programs such as CTH in primary care have been limited by the inability of practices to adapt and implement program components into their culture, patient flow, and work processes. Practice facilitation has been shown to be effective in helping practices make the changes required for optimal program implementation. The proposed research is designed to promote the translation of SMS into primary care practices for patients with T2DM by combining two promising lines of research, specifically, (a) testing the effectiveness of CTH in diverse primary-care practices, and (b) evaluating the impact of practice facilitation to enhance implementation of the intervention.

METHODS

A three-arm, cluster-randomized trial will evaluate three discrete strategies for implementing SMS for patients with T2DM in diverse primary care practices. Practices will be randomly assigned to receive and implement the CTH program, the CTH program plus practice facilitation, or a SMS academic detailing educational intervention. Through this design, we will compare the effectiveness, adoption and implementation of these three SMS practice implementation strategies. Primary effectiveness outcomes including lab values and evidence of SMS will be abstracted from medical records covering baseline through 18 months post-baseline. Data from CTH assessments and action plans completed by patients enrolled in CTH will be used to evaluate practice implementation of CTH and the impact of CTH participation. Qualitative data including field notes from encounters with the practices and interviews of practice personnel will be analyzed to assess practice implementation of SMS.

DISCUSSION

This study will provide important information on the implementation of SMS in primary care, the effectiveness of an IBCT tool such as CTH, and the use of practice facilitation to assist implementation.

TRIAL REGISTRATION

Registered with ClinicalTrials.gov - ClinicalTrials.gov ID: NCT01945918 , date 08/27/2013. Modifications have been updated.