Exploring barriers to participation and adoption of telehealth and telecare within the Whole System Demonstrator trial: a qualitative study
Author(s)
Whole System Demonstrators team
Type
Journal Article
Abstract
Background
Telehealth (TH) and telecare (TC) interventions are increasingly valued for supporting self-care in ageing populations; however, evaluation studies often report high rates of non-participation that are not well understood. This paper reports from a qualitative study nested within a large randomised controlled trial in the UK: the Whole System Demonstrator (WSD) project. It explores barriers to participation and adoption of TH and TC from the perspective of people who declined to participate or withdrew from the trial.
Methods
Qualitative semi-structured interviews were conducted with 22 people who declined to participate in the trial following explanations of the intervention (n = 19), or who withdrew from the intervention arm (n = 3). Participants were recruited from the four trial groups (with diabetes, chronic obstructive pulmonary disease, heart failure, or social care needs); and all came from the three trial areas (Cornwall, Kent, east London). Observations of home visits where the trial and interventions were first explained were also conducted by shadowing 8 members of health and social care staff visiting 23 people at home. Field notes were made of observational visits and explored alongside interview transcripts to elicit key themes.
Results
Barriers to adoption of TH and TC associated with non-participation and withdrawal from the trial were identified within the following themes: requirements for technical competence and operation of equipment; threats to identity, independence and self-care; expectations and experiences of disruption to services. Respondents held concerns that special skills were needed to operate equipment but these were often based on misunderstandings. Respondents’ views were often explained in terms of potential threats to identity associated with positive ageing and self-reliance, and views that interventions could undermine self-care and coping. Finally, participants were reluctant to risk potentially disruptive changes to existing services that were often highly valued.
Conclusions
These findings regarding perceptions of potential disruption of interventions to identity and services go beyond more common expectations that concerns about privacy and dislike of technology deter uptake. These insights have implications for health and social care staff indicating that more detailed information and time for discussion could be valuable especially on introduction. It seems especially important for potential recipients to have the opportunity to discuss their expectations and such views might usefully feed back into design and implementation.
Telehealth (TH) and telecare (TC) interventions are increasingly valued for supporting self-care in ageing populations; however, evaluation studies often report high rates of non-participation that are not well understood. This paper reports from a qualitative study nested within a large randomised controlled trial in the UK: the Whole System Demonstrator (WSD) project. It explores barriers to participation and adoption of TH and TC from the perspective of people who declined to participate or withdrew from the trial.
Methods
Qualitative semi-structured interviews were conducted with 22 people who declined to participate in the trial following explanations of the intervention (n = 19), or who withdrew from the intervention arm (n = 3). Participants were recruited from the four trial groups (with diabetes, chronic obstructive pulmonary disease, heart failure, or social care needs); and all came from the three trial areas (Cornwall, Kent, east London). Observations of home visits where the trial and interventions were first explained were also conducted by shadowing 8 members of health and social care staff visiting 23 people at home. Field notes were made of observational visits and explored alongside interview transcripts to elicit key themes.
Results
Barriers to adoption of TH and TC associated with non-participation and withdrawal from the trial were identified within the following themes: requirements for technical competence and operation of equipment; threats to identity, independence and self-care; expectations and experiences of disruption to services. Respondents held concerns that special skills were needed to operate equipment but these were often based on misunderstandings. Respondents’ views were often explained in terms of potential threats to identity associated with positive ageing and self-reliance, and views that interventions could undermine self-care and coping. Finally, participants were reluctant to risk potentially disruptive changes to existing services that were often highly valued.
Conclusions
These findings regarding perceptions of potential disruption of interventions to identity and services go beyond more common expectations that concerns about privacy and dislike of technology deter uptake. These insights have implications for health and social care staff indicating that more detailed information and time for discussion could be valuable especially on introduction. It seems especially important for potential recipients to have the opportunity to discuss their expectations and such views might usefully feed back into design and implementation.
Editor(s)
Sanders, C
Rogers, A
Bowen, R
Hirani, S
Cartwright, M
Fitzpatrick, R
Knapp, M
Barlow, J
Hendy, J
Chrysanthaki, T
Bardsley, M
Newman, S
Date Issued
2018-07-26
Date Acceptance
2012-07-10
Citation
BMC Health Services Research, 2018, 12
ISSN
1472-6963
Publisher
BioMed Central
Journal / Book Title
BMC Health Services Research
Volume
12
Copyright Statement
© 2012 Sanders et al.; licensee BioMed Central Ltd. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Sponsor
Department of Health
Engineering & Physical Science Research Council (EPSRC)
Grant Number
51001NM
EP/I029788/1
Subjects
Science & Technology
Life Sciences & Biomedicine
Health Care Sciences & Services
Telehealth
Telecare
Patients' perspectives
Non-adoption
Non-participation
Barriers
Qualitative research
Whole System Demonstrator
RANDOMIZED-TRIAL
HOME TELECARE
OLDER-PEOPLE
TECHNOLOGY
HEALTH
CARE
TELEMEDICINE
RECRUITMENT
PROFESSIONALS
PERSPECTIVES
Adult
Aged
Aged, 80 and over
Diffusion of Innovation
Female
Health Knowledge, Attitudes, Practice
Health Services Needs and Demand
House Calls
Humans
London
Male
Middle Aged
Patient Dropouts
Qualitative Research
Self Care
Telemedicine
1117 Public Health And Health Services
0807 Library And Information Studies
Health Policy & Services
Publication Status
Published
Article Number
220
Date Publish Online
2012-07-26