Background
Acquired brain injury
Assistive technology
Problems with implementation
Brain in Hand
Behaviour change wheel
Rationale
Aims
-
Explore the barriers and enablers, and the potential use of BiH technology in clinical practice with ABI survivors.
-
Identify possible adaptations of the technology to meet the needs of the ABI population.
-
Determine if the BCW could be used as model for stakeholder engagement.
Method
Stage 1: Identify stakeholders and develop a format for engagement
Stage 2: Piloting the engagement format
Stage 3: The engagement process
Results
Stage 1: Identify stakeholders and develop a format for engagement
Total = 50 | Age | Gender | ||||
---|---|---|---|---|---|---|
18–30 | 31–50 | 51+ | Male | Female | ||
ABI survivors (n = 20) | n | 3 | 9 | 8 | 15 | 5 |
% total
|
6%
|
18%
|
16%
|
30%
|
10%
| |
Carers (n = 5) | n | 1 | 0 | 4 | 2 | 3 |
% total
|
2%
|
0%
|
8%
|
4%
|
6%
| |
Professionals (n = 25) | n | 2 | 12 | 11 | 4 | 21 |
% total
|
4%
|
24%
|
22%
|
8%
|
42%
| |
Overall | n | 6 | 21 | 23 | 21 | 29 |
% total
|
12%
|
42%
|
46%
|
42%
|
58%
|
Stage 2: Piloting the engagement format
Stage 3: The engagement process
-
A formal presentation followed by a discussion with 30 professionals (therapists, case managers, solicitors) at an ABI meeting.
-
Three informal presentations, to discuss and demonstrate BiH to two groups of therapists treating neurological patients (six per group), an ABI technology user group, and at a day centre (Headway) specifically for people with brain injury.
-
An exhibition stand at a lay stroke conference where information was provided to delegates (stroke survivors, carers and professionals) on a 1:1 basis. The environment was not suitable for questionnaire completion. Some delegates took questionnaires home, but none were returned. Suggestions for improvement and any comments about the technology were noted on the day.
Results from discussion and questionnaires
Capability
Enablers | ABI | Carers | Professionals | Barriers | ABI | Carers | Professionals | ||
---|---|---|---|---|---|---|---|---|---|
Capability | Physical ability to use smartphone | ● | ● | ● | Capability | Visual and physical impairment | ● | ● | ● |
Competent at using smartphone | ● | ● | ● | Lack of technical skill | ● | ● | |||
Awareness of their problems | ● | ● | Poor literacy skills | ● | |||||
Able to use strategies | ● | ● | Cognitive problems e.g. switching between screens | ● | ● | ||||
Opportunity | Have a smartphone | ● | ● | ● | Opportunity | Cost and competition from other apps | ● | ● | ● |
Having the opportunity to personalise use | ● | ● | ● | Losing smartphone and battery problems | ● | ||||
Enables users to record symptoms as they happen | ● | ● | Technology not reliable e.g. loss of information if phone updated | ● | ● | ||||
Computerised record of use (e.g. to track goal attainment) | ● | Incapability with existing systems i.e. will it sync with computer diary | ● | ● | |||||
Offers opportunity to self-monitor and alter use | ● | ● | Work place restriction not allowing use | ● | ● | ||||
Motivation | Using a phone seen as ‘normal’ behaviour i.e. reduced stigma | ● | Motivation | No interest in the use of technology or existing systems in place e.g. paper diary | ● | ● | ● | ||
Potential to be personalised to individual needs | ● | ● | ● | Do not see a use for it | ● | ● | ● | ||
Motivated if they can see a use for it e.g. problem and solution system | ● | ● | ● | Feeling the app is too complicated for them to use or learn to use | ● | ||||
Feeling confident to use the app | ● | Loss of motivation and disengagement with rehabilitation process | ● | ||||||
May allow the user to feel like they are taking control of their life again | ● | ● | Feeling as though they are being monitored | ● | |||||
Do not want to use paper diary | ● | Too time consuming to set up/edit | ● | ● | ● | ||||
Too many reminders may be annoying | ● | ● | ● | ||||||
Lack of existing evidence/use in the ABI population | ● | ● | ● |
Opportunity
BCW component | Question/statement | Response options | Frequency | % total responses |
---|---|---|---|---|
Capability | Would you feel confident using the app?
Number scale of 1 (Definitely not) to 5 (Definitely) used.
| Definitely or almost | 22/24 | 92% |
Maybe or somewhat | 2/24 | 8% | ||
How appropriate is the app for a person with an ABI?
Number scale of 1 (Inappropriate) to 5 (Appropriate) used.
| Appropriate | 6/25 | 24% | |
Almost | 11/25 | 44% | ||
Maybe | 7/25 | 28% | ||
Less | 1/25 | 4% | ||
Motivation | When seeing the app for the first time, did it make you want to use of it?
Number scale of 1 (Definitely not) to 5 (Definitely) used.
| Definitely or almost | 17/25 | 65% |
Maybe or less | 6/25 | 23% | ||
Definitely not | 2/25 | 8% | ||
What is/are the most appealing parts of the app? | Structured diary | 30/41 | 73% | |
Personalised problems and solutions | 26/41 | 63% | ||
Traffic light system | 22/41 | 54% | ||
Monitoring progress | 15/41 | 37% | ||
Feedback online | 13/41 | 32% | ||
Mentor/support | 12/41 | 29% | ||
Can you see a use for the app? | Yes | 39/41 | 95% | |
No | 2/41 | 5% | ||
What do you think the app could target or aid? | Memory problems | 39/41 | 95% | |
ADL | 35/41 | 85% | ||
Independence | 33/41 | 80% | ||
Managing routine | 31/41 | 76% | ||
Problem solving | 26/41 | 63% | ||
Self confidence | 25/41 | 61% | ||
Anxiety/stress management | 24/41 | 59% | ||
Behaviour monitoring | 23/41 | 56% | ||
Anger/irritability | 14/41 | 34% | ||
Goal setting | 13/41 | 32% | ||
Depression | 12/41 | 29% | ||
Opportunity | Would you pay for the app? | Yes | 9/37 | 24% |
Maybe | 20/37 | 54% | ||
No | 8/37 | 22% | ||
How long do you think you (or someone with ABI) would use the app for? | 0–6 months | 6/32 | 15% | |
6–12 months | 6/32 | 15% | ||
12+ months | 20/32 | 49% | ||
Don’t know | 9/32 | 22% | ||
How appropriate is the training (i.e., ease of learning) to use the app?
Number scale of 1 (Inappropriate) to 5 (Appropriate) used.
| Appropriate | 3/15 | 20% | |
Almost appropriate | 8 /15 | 53% | ||
Maybe | 3 /15 | 20% | ||
Less | 1 /15 | 7% | ||
How appropriate is the app when navigating different screens?
Number scale of 1 (Inappropriate) to 5 (Appropriate) used.
| Appropriate | 4/20 | 20% | |
Almost | 12/20 | 60% | ||
Maybe | 4/20 | 20% |