Background
Methods
Focus group participants and design
The devices
Group 1: Telecare base units and associated sensors | |
Tynetec Reach | Home base unit and sensor hub |
Tunstall Lifeline Vi | Home base unit and sensor hub |
Bogus caller/intruder alarm | Door entry alarm |
Passive infra-red sensor | Room occupancy/motion sensor |
Group 2: Pill dispensers | |
Pivotell – Altec 169 MHz | Automated dosette box for dispensing medication. Can relay data to home base unit |
Group 3: Personal alarm types | |
Alarm (basic) e.g. Tunstall MyAmie, Amie+ | Wrist worn, pendant or brooch |
Group 4: Falls monitor | |
Tunstall | Atmospheric pressure + accelerometer, includes manual alarm |
Group 5: Mobile alarms/GPS tracking devices | |
GeoCare | Tracking device, alarms sent to designated personal number(s), no falls detection |
MobileHelp | Mobile personal alarm, no falls detection |
buddi | Personal alarm, falls detection, GPS tracking, geofencing |
Numera Libris | Speakerphone to response centre, falls detection, tracking |
Group 6 Telehealth/ measurement of physical functioning | |
BP monitors | Electronic blood pressure monitors with digital displays |
Pulse oximeter | Finger-based probe connected to hand-held monitor providing digital display of heart rate and blood oxygen levels |
Ear thermometer | Digital tympanic membrane thermometer |
Focus group data analysis
The interviews
Sample group | Interviewees |
---|---|
User groups | 2 |
County Council related | 4 |
Research related organisations | 7 |
Private company specialists | 4 |
Manufacturers and/or distributors, including: Telecommunications industry Trade associations | 4 |
Health related, including professional bodies | 6 |
Total: | 27 |
Interview guide
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What are your views regarding the current uptake of telecare/telehealth devices?
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What are the barriers to device uptake?
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What are your views regarding user involvement in device development?
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What are your views on access and supply of devices?
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How can device uptake be promoted in the future?
Interview data analysis
Results
Desirable device characteristics
Aesthetic appearance
“I think it's predominantly aesthetics, I mean most of the equipment, with the exception of a few, is turned out in a sort of clinical white box type structure” (Interviewee 015)
…One of the issues is the ugliness of some telecare equipment. And this is a general issue for the market place responding to older people, as consumers to understand that they like anybody else would like to have something attractive in their home… What one tends to get is incredibly functional off-putting things, which have a big stigmatising label…(Interviewee 006)
…I think the technologies are still very clunky… There's nothing cool about them, and the choices. I've always taken the view that if your grandchild doesn’t want it then I don’t want it either… It all matters, and it's in their home. They don’t actually want the appearance of their home to change… And that means more choices…(Interviewee 001)
Interviewee 010: Even on a very practical level… you may aspire to use it, but the fact they’ve buried it under six layers means they're not going to be able to use it if they're on the floor.NC: Is that related to stigma, burying it under layers?Interviewee 010: I think it is, yeah… There was an element of, especially when it came with all these other ugly bits of equipment that ruined the look of their house… I think that was a bit of an issue for people… who like to be quite well turned out and the idea of it looking a bit jarring with the way they usually like to dress and present themselves…
Practicality and ease of use
…I think it's confidence that it will actually do what it says, what you want it to. I think it's confidence in understanding how it works, that you can use it. I think it's also confidence that you won't have someone come round and decry it…(Interviewee 018)
…Intuitive (devices) that's the most important thing… Design is actually really important. You know there were plenty of tablet computers before the iPad, but they never took off did they? Once they produced one that actually worked and was easy to work everyone had one. And I think that's true of these types of devices…(Interviewee 021)
…What's beginning to disturb me a little bit is that as these devices you're putting round, are getting more and more complex, sophisticated, and multi-functional, there must be an equal multiple in the number of false alarms that you get. My worry is with this GPS and interaction, with all sorts of other functions as well, you might end up with relatives dashing up and down the M1 to see somebody who is perfectly all right, and in Tesco, but you think they’ve fallen downstairs. I'm just a bit worried if we’re not too careful… the scientists tend to get sort of carried away with their technology, and want to add more and more bells and whistles… That device (a mobile alarm, tracking device) worries me; I think you need at least a PhD in something or other before you master that one…(Bedfordshire focus group participant)
…You know if it's not working right, for example, the bed sensors if they're not working right straight away the customer says “take it out, I don’t want it, I don’t want it”. We found a lot of the carers, family and relatives were saying “it's okay we’ll adjust it, lets have a go”. But no, the actual person using it didn’t want it at all…(Interviewee 004)
The lack of focus on end-user needs
…We really do have to think in terms of a change in service paradigms to get away from the awful situation in which service providers are offering particular ranges of kit or equipment, and services that accord with their management needs, or accord with their particular preconceptions about how products should be designed and used to give them the data that they need, as opposed to actually thinking much more from the user or indeed the carer perspective, and thinking about what they need… One of the important things here is to escape from outside of the straightjacket of thinking that is around older people, and to think much, much more widely in terms of what you, I, or indeed an 18 year old might want to help them manage their diabetes, or their lifestyles, or their health…(Interviewee 008)
…We’re making the people fit the equipment that we can get, rather than having an issue for the service user and finding equipment to fit the user…(Interviewee 020)
…Taking a kind of a mauve coloured, or whatever it is that the colour of these NHS plastic boxes and giving it to someone for their telehealth or their telecare solution is the least likely way of succeeding in deploying something. You know, at least if it looked like something that people had designed with the manufacturer, and felt right then it might have a better chance of being actually adopted, used, and left on display in someone’s front room…(Interviewee 019)
…The myth that we need to explode in this is citizens or patients resistance to technology… Most people are incredibly receptive and equally this nonsense that because you're 75 or 80 you can't use technology. There are some 75 year olds who cannot, and there are some 25 year olds who cannot, but it's not an age specific issue. It comes down to how your technology is designed, the look and feel of it, and more importantly the service model…(Interviewee 025)
…If you fall upstairs and your base unit is downstairs then that is just a complete and total waste of time. You know, people want to wear it (the personal alarm) in the garden… I think these things are incredibly challenging… But I think at least getting the user perception… having those discussions with people is a massively good start…(Interviewee 013)
…I'm a strong supporter of involving users because at the end nobody can know better than them what they are ready to accept… More and more there is this kind of approach to… try to involve the user from the very beginning. Now you know that in reality that these kind of users you cannot just put them in front of a blank sheet and say “what would you like?” So fundamentally you have to develop prototypes, you need to have more caps in such a way that they can really express their opinion of something which is tangible that they can try and use… I think the development of products has to be an iterative process, which you try your first prototype, you get a feedback from the users, you improve it, and so on and so on…(Interviewee 007)
…There has to be end-users involved because one of the problems there is, of course, is you can come up with an absolutely fantastic idea that the clinician really likes or loves to use in the clinic, but it's that interface… The interface that goes on with the end-user has to be correct…(Interviewee 024)
…The main issue revolves around a very high degree of distrust between the various players. So player group one is the provider, which is generally NHS, though it should be local authority and is more and more becoming local authority. Group two are the clinicians. And group three are the actual patients. And of course all of those have to trust the supplier, but actually none of them do [laughs]… What we need is consensual collaborative solutions, not adversarial solutions…(Interviewee 023)
…I think an awful lot of technology that is out there at the moment has really not gone through proper user involvement in terms of design. And were it to, I think people would have to sit back and say “well, who are all the users in this system?” …Everybody that comes through my door I say the first question is, “who isn't this designed for?” And none of them can answer it…(Interviewee 012)