Background
Telecare: factors influencing ‘user’ adoption and engagement
Service profile | Description | |
---|---|---|
Electronic assistive technology | Standalone | Individual pieces of electronic equipment that enhance a service user’s independence by prompting and reminding. They do not send alerts to either a carer or monitoring centre. Items include medication reminders, task prompting and orientation devices. |
Telecare | Telecare standalone | Standalone telecare is similar to connected telecare. The main difference is that the sensors and detectors are NOT connected to a monitoring call centre but are programmed to link to pagers or mobile phones carried by a carer. The variety of sensors and detectors is similar to that of connected telecare and includes for example, bed and chair leaving alarms, fall detectors, epilepsy or enuresis monitors, door contact, flood, gas and smoke detectors and temperature extreme sensors. There are also proximity alarms, GPS positioning/tracking and buddy systems. The standalone telecare solutions avoid the costs associated with monitoring call centres but do require an informal or formal carer who can provide a 24-hour response to the alerts. |
Telecare connected | This equipment includes wired and wireless sensors and detectors that are programmed through a base unit telephone or call system to raise an alarm to the monitoring centre. The monitoring centre then tries to contact nominated key holders or emergency services and can provide advice and reassurance via the phone for the service user. The variety of sensors and detectors are similar to that of standalone telecare and includes for example, bed and chair leaving alarms, fall detectors, epilepsy or enuresis monitors, flood, gas and smoke detectors and temperature extremes. Activity monitoring is also possible via PIR and door monitors in the home environment or via watches or straps worn by the individual. There is normally a charge for the services of the monitoring call centre but this may be subsidised via the local authority housing services or can be subscribed to privately. | |
Telehealth | Telehealth connected | This involves a home telehealth monitor and peripherals for measuring vital signs that are connected via a telephone line/blue tooth and automatically transmits the data to a monitoring clinician via a secure and confidential website. The monitoring clinician reviews the trends of the readings and signs/symptoms to instigate a treatment plan to stabilise the long-term condition. The vital signs that are most frequently monitored are temperature, heart rate, blood pressure, SPO2, weight, blood glucose and the most common conditions are COPD, heart failure, hypertension and diabetes. |
Telehealth standalone | Service users take their own readings using calibrated equipment, for example, weighing scales, thermometer, blood pressure cuff or blood glucometer. The service users then manually transmit this data via e-mail, telephone or text, to the monitoring centre who record this onto a clinical system and instigates appropriate responses according to the plan made in advance. The vital signs that are most frequently monitored are temperature, heart rate, blood pressure, SPO2, weight and blood glucose and the most common conditions are COPD, heart failure, hypertension and diabetes. |
Telehealth: factors influencing ‘user’ adoption and engagement
An integrated theoretical approach to adoption and engagement
Rationale and aims
Method
Setting
Participants and methods
‘Users’ (patients)
Participant | Service profile | Gender | Age | Medical condition | Equipment |
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Beatrice | Telecare- connected | Female | 62 | Epilepsy | Pendant and Pager, wrist worn fall detector |
John | Standalone | Male | 69 | Parkinson’s disease | Pivotell medication reminder with dispenser, large dossett box |
Roger | Standalone | Male | 75 | Parkinson’s disease | Wrist worn medication reminder |
Thomas | Telecare- standalone | Male | 70 | Parkinson’s disease | Dossett Box, Wrist worn medication reminder, Pendant and Pager |
Alice | Standalone | Female | 76 | Risk of falls | Pivotell medication reminder and dispenser |
Penny | Telehealth- standalone | Female | 74 | Chronic obstructive pulmonary disease | Telehealth: Temperature and pulse (standalone) |
Tim | Telehealth- standalone | Male | 67 | Chronic obstructive pulmonary disease | Telehealth- Temperature and pulse (standalone) |
Henry | Telecare- standalone | Male | 90 | Stroke | Mobile Phone-Tracker |
Marie | Standalone | Female | 59 | Physical disability | Pill reminder |
Louise | Telecare- standalone | Female | 35 | Epilepsy, myalgic encephalomyelitis | Pendant and Pager |
Andrew | Telehealth- standalone | Male | 66 | Chronic obstructive pulmonary disease | Telehealth- temp and pulse (standalone) |
Loretta | Telecare- standalone | Female | 66 | Multiple sclerosis | Pendant and Pager |
Kelly | Telecare- connected | Female | 39 | Epilepsy | Pendant and Pager, Smoke alarm (with lifeline) |
Cathy | Telecare- connected | Female | 53 | Epilepsy | Wrist worn epilepsy sensor |
Sheila | Standalone | Female | 47 | Heart attack | Pivotell medication reminder and dispenser |
Tracey | Standalone | Male | 46 | Irritable bowel syndrome/depression | Pivotell medication reminder and dispenser |
Mary | Telecare- connected | Female | 85 | Epilepsy | Fall detector, bed sensors |
Philip | Standalone | Male | 92 | Risk of falls, cognitive impairment | Pivotell medication reminder and dispenser |
Carole | Telecare- standalone | Female | 49 | Physical disability | E-Pill reminder |
Helen | Telecare- connected | Female | 79 | Cerebral palsy | Wrist worn fall detector |
Grace | Telecare- standalone | Female | 78 | Multiple sclerosis | Pendant and Pager |
Norma | Telecare- connected | Female | 85 | Risk of falls | Bed and chair leaving alarm, wrist worn fall detector |
Gloria | Telehealth- connected | Female | 72 | Chronic obstructive pulmonary disease | Connected telehealth - temperature, pulse, SPO2 |
Susan | Telecare- connected | Female | 70 | Parkinson’s disease, risk of falls | Bed leaving alarm, pendant and pager |
Clive | Telecare- standalone | Male | 73 | Head injury | Memominder |
Steve | Telehealth- connected | Male | 66 | Chronic obstructive pulmonary disease | Weight, blood pressure and SPO2 and questionnaire |
Irma | Telecare- connected | Female | 71 | Risk of falls | Fall detector |
Howard | Standalone | Male | 62 | Parkinson’s disease | Pendant and Pager, wrist worn fall detector |
‘Non-users’ (withdrawn/declined)
Participant | Service profile | Gender | Age | Medical condition | Equipment |
---|---|---|---|---|---|
Barry | Telecare standalone | Male | 59 | Stroke | Pendant and pager |
Arthur | Telehealth standalone | Male | 92 | Chronic Obstructive Pulmonary Disease | Telehealth: Pulse & temp |
Casey | Nonea
| Female | 32 | Myalgic Encephalomyelitis | Nonea
|
Joan | Telecare standalone | Female | 49 | Multiple Sclerosis | Pendant and pager |
Jean | Telecare standalone | Female | 82 | Falls | Pendant and pager |
Margaret | Telehealth standalone | Female | 75 | Chronic Obstructive Pulmonary Disease | Pulse Oximeter |
Ken | Standalone | Male | 66 | Parkinson’s | Wrist worn medication reminder |
Jim | Nonea
| Male | 52 | Pancreatitis | Nonea
|
Ian | Telehealth- standalone | Male | 69 | Chronic Obstructive Pulmonary Disease | Oxygen and temp equipment |
Edith | Standalone | Female | 92 | Congenital palsy osteoporosis | Dossett Boxa
|
Della | Telecare- standalone | Female | 68 | Parkinson’s Disease | Medical arm |
James | Telecare-standalone | Male | 24 | Brain injury | Bed leaving alarm kit |
Interview process
Recruitment and sampling
The interview guide
Framework method
Ethics, consent and permissions
Results
Theme | Sub-theme | ATT service factors ‘Users’ | ATT service factors ‘non-users’ |
---|---|---|---|
Decision to use the ATT service at point of referral | Acceptance of old age/health condition | • Most ‘users’ accepted they had a need for equipment • Perception that equipment symbolised a transition to ‘getting old’ | • Most ‘non-users’ did not accept they had a need for equipment • Many non-users stated they went along with the referral to please others |
Previous knowledge & awareness of service & equipment | • Only two users had heard of ATT service before referral • Previous knowledge related to knowing of others who had used the service • Main source of information was ‘referrer’ who was most commonly a community health care professional supporting them with specialist care • Users’ often discussed the decision to use the service with the referrer, often a healthcare professional before making the decision • Had a preference for receiving information about service face-to face • ‘Users’ generally felt in charge of the decision to use the service | • None of the non-users had heard about ATT service before referral • Main source of information was ‘referrer’ who was most commonly a community health care professional supporting them with specialist care • Had a preference for receiving information about service face-to face • Some ‘non-users’ felt that they did not have enough information to make an informed decision and some feeling of being ‘pressurised’ • Many ‘non-users’ went along with the referral to keep the referrer happy, particularly their healthcare specialist | |
Perceived usefulness of equipment | • “Users’ perceived that the ATT equipment would be useful • TH equipment was viewed as useful to monitor health • TC equipment perceived as useful to communicate with carer, remind them to take medication, to get help in an emergency | • Non-users did perceive the equipment as useful or feel that it would add any value | |
Attitudes and perceptions towards ATT equipment | • Many ‘users’ felt that they would find the equipment easy to use and felt that they had the confidence to use it. • Older patients demonstrated more apprehension than younger ‘users’ | • Many older patients lacked confidence and experience to use technology • Viewed equipment/technology as time consuming • Equipment was viewed as complex and difficult to use • Concerns around functionality and/or support with functionality from service | |
Engagement and use of ATT service | Usability | • Users overall found equipment relatively easy to use and set up • Pendant and pager, fall detectors and TH equipment viewed as easy to use • There were some difficulties for older patients who were using medication reminders and changing batteries • Some ‘users’ fund instructions difficult to follow | • Found equipment difficult to use and/or difficult to set up • TH users found equipment inconvenient e.g. readings at a set time • Some TC users found equipment time consuming and inconvenient e.g. stocking up medication reminders • Instructions difficult to follow |
Actual usefulness of equipment | • Most participants felt that the equipment was suitable to meet an unmet need • TC users found equipment useful and met an unfulfilled purpose • TH users felt equipment was useful as it enabled them to monitor their health and check readings were within the set parameters | • Majority of non-users stated that they did not find the equipment useful and was cited as a core reason for non-engagement • Reasons related to no perceived need or a change of need • Some felt equipment did not meet specific requirements | |
Functionality of equipment | • TH users felt equipment was reliable and were confident it would work as intended/readings were accurate • TC users felt confident equipment would work in an emergency • Some issues surrounded equipment functionality but valued instant support | • Concerns relating to functional equipment • Felt unsupported to deal with technical issues • Unsure what to do when equipment was not functioning properly | |
Threat to identity and independence | • Perceived stigma to using equipment in public • Acceptance of getting older or that life cannot continue the same | • Concern about loosing independence and being dependent on others |
Theme 1: decision to use (or not use) the ATT service at point of referral
Acceptance of old age/health condition
‘It is actually coming to terms with getting old I think, before you can ask for help you have got to accept that you need it.’ (Sheila, 53, Standalone ‘user’).
‘I thought that it would make out that I am old. You see up here (points to head) I am still 17 but the body, well the body is giving way.’(Susan, 70, Telecare connected, ‘user’)“It makes you feel old. It challenges your independence and having to rely on people all the time because stupid little things that you could do before…I was going I don’t need anything.’(Mary, 85, Telecare connected, ‘user’)
Previous knowledge and awareness of service and equipment
‘They did send me some leaflets to describe the assistive technology stuff…and they had clearly written them themselves and put in some clip art to help you through which was nice. Errm, and I felt that they were plain English type language, so you know not perhaps working to the maximum of my intellect, but something that everyone would understand you know pretty straight forward and user friendly, it was good to have something with a telephone number’(Louise, 35, Telecare standalone, user)
‘Maybe I got a leaflet, you see when you get your hospital letter there are loads of leaflets saying about this thing and that thing I would much rather talk to someone I haven’t got the patience to go through all of that’(Jim, 52, declined ‘non-user’)
‘It was me, it was solely me because I thought, I thought about everything and if there was something wrong that I couldn’t get to the bottom of then I thought it would help’(Gloria, 72, Telehealth connected, ‘user’)
‘I had a nurse come and see me about every three months, she has done for many years now and then she suggested that it might be helpful because I said I wasn’t taking my pills rigidly. She said we can get over that by giving you a beeper so it was just a case of doing what she said really’(Ian, 69, Telehealth standalone, withdrawn ‘non-user)‘If someone is enthusiastic about it I have to say yes because I am not one of those, I just accepted it is a good idea at the time to please the person who suggested it’(Della, 68, Telecare standalone, withdrawn ‘non-user’)
Perceived usefulness of equipment
Attitudes and perceptions toward ATT equipment
Theme 2: engagement and use of the ATT service
Usability
‘It was a pig, it really was hard work, and I mean you have got to have a science degree to work it’(Thomas, 70, Telecare standalone, ‘user’)‘I couldn’t open the damm thing. I still can’t but I can do the rest now, but this is really confusing, err button one and then when you carry on it doesn’t make it clear that you always use button one first and then onto the others, I think that’s how you do it but I’ll know when I open it and do it. But it’s not really clear that that’s what you do’.(Tracey, 46, (Telehealth/Telecare) Standalone, ‘User’)
‘Well you know I did find that I was coping with it until the batteries went and then it’s just been frustration ever since’(Marie, 59, Standalone, ‘user’)
‘It is easy yep, it is easy, just having to ring up, either somebody takes your readings when you ring up you get the telephone message after the tone, you leave your readings and they take it from there so it’s very straight forward. I mean if you can phone you can use the service can’t you it’s not rocket science’(Andrew, 66, Telehealth standalone, ‘user’)‘To be honest it’s a bit obvious it just rings through to the lifeline and then with the fall thing you know it’s obvious it will detect if you fall, that’s why it’s called a fall monitor, so you know it’s not rocket science’(Kelly, 66, Telecare connected, ‘user’)‘It’s not complicated, it literally tells you what to do. It tells you to stand on the scales, press this, answer your questions, you press yes or no, you know it’s a no brainer, any sort of 6 or 7 year old could do it you know’(Steve, 66, Telehealth connected, ‘user’)
‘It is difficult to use for people like me with Arthritis I mean, it’s [the button] quite small and on occasions I have had to press it three times. I had to get my nail inside it you know to actually push it so it is difficult’(Mary, 85, Telecare connected, ‘user’)‘It would be better to have a button than a thing to push, you have a lot of pressure going on your thumb and fingers, see I can’t bend my fingers…I could not just press the thing, they’re very hard to press I couldn’t use it at all I have no strength in me’(Grace, 78, Telecare standalone, ‘user’)
‘I don’t agree with the fact that I’ve got to ring up every morning for a few weeks and the chap said “oh no it could be months…I don’t think I would continue to use it because you have to ring up every morning, at a decent time in the morning and I’m not good in the morning you know 8–9 o’clock time in the morning. Damn it I’m 92 years old and you don’t feel good first thing in the morning and you don’t know how long that’s going to last’(Arthur, 92, Telehealth standalone, withdrawn ‘non-user’)‘I thought I would be able to, erm, phone in to check my pulse, erm, I used to read it on the monitor for the pulse as well as the oxygen but, erm, I phoned up every day when I could, but I found it too difficult to phone up every day. I used to end up worrying about it, when I got up it was too early because I was supposed to phone between 9 and 1 and then we went out sometimes and I would forget to phone up’(Margaret, 75, Telehealth standalone, withdrawn ‘non-user’)
‘It’s a bit of a kerfuffle and because I don’t have a regular bedtime and some of those are my bedtime ones you now, not regular down to within the hour. I have to eat before I can take some of these meds and if I don’t get up I don’t want to eat straight away…I hate filling it up because you have everything you take, which Is in that bag’(Sheila, 53, Standalone, ‘user’)
Actual usefulness of equipment
‘Basically its useful to a lot of people, you see people every day that you know you’ll say to them you don’t look well today and I say to them because I’m ill and I know what people look like and I’ll say are you taking your medication? And all of a sudden, they say no I haven’t taken it for two days’(Sue, 46, Telecare standalone, ‘user’)‘The bed sensor is marvelous to me, because I know that I can get in that bed and if I had a seizure, which isn’t very often thank goodness, I know that I am going to be safe, so yeah, it makes me feel safer so it’s very useful, very useful indeed’(Carly, 39, Telecare connected, ‘user’)
‘I didn’t need it anymore, simple as that. The carer went and within two hours of having my plaster cast off I was in hospital so I was looked after there. I only needed it a short time, a week really whilst the carer was here’(Jean. 82. Telecare standalone, withdrawn ‘non-user’)‘I couldn’t see the benefit of it, because I mean I go and have my blood pressure taken once a year at the surgery and you know I have been satisfied with that. I couldn’t see the point, as far as I was concerned, I didn’t see any personal benefit it was wasn’t going to make any difference to my life. I mean what is the benefit of ringing up with my blood pressure. Mines been fairly regular for the past two or three years and I think that’s why I am negative’(Arthur, 92, Telehealth standalone, withdrawn ‘non-user)
-
Having a mechanism on the pressure mat so that it goes off automatically to alert the carer that the patient has got up from bed straight away,
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A GPS watch rather than taking a phone, which the ‘user’ might forget,
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Reduce sensitivity of some of the equipment,
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Improve the medication reminders so that more medication can be stored, making the alarm louder,
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Improving the range of the pendant and pagers,
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Improve usability e.g. larger buttons, removal of difficult catches, making equipment more portable.
Functionality of equipment
‘Yeah its accurate cause I got my own funnily enough, I got my own CPO 2 or whatever it is oxygen thing and I always match cause I calibrate mine with theirs and when I go into hospital I calibrate mine with the machine so I know mines ok, so it must be fairly good equipment’(Steve, 66, Telehealth connected, ‘user’)
‘It’s spot on. Yes, it works very well. Like I’ve got mine set to go off in the evening and often I am driving so it beeps and I have to get off at the next available stop and take my medication but without fail it always goes off’(Roger, 75, Standalone, ‘user’)
Threat to identity and independence
‘You get embarrassed because you don’t want to take it out cause people will think “oh you’re taking all those tablets”’(Carole, 49, Standalone, ‘user’)‘I wouldn’t want to take it out with me, if I do go out for the day I just take the tablets I need in my handbag because you don’t want to be in the middle of Marks and Spencer’s and pull this thing out’(Sheila, 53, Standalone, ‘user’)