Exploring barriers to participation and adoption of telehealth and telecare within the Whole System Demonstrator trial: a qualitative study.
Exploring barriers to participation and adoption of telehealth and telecare within the Whole System Demonstrator trial: a qualitative study.
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DOI：
10.1186/1472-6963-12-220
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发表时间：
2012-07-26
影响因子：
2.8
通讯作者：
Newman SP
中科院分区：
文献类型：
--
作者：
Sanders C;Rogers A;Bowen R;Bower P;Hirani S;Cartwright M;Fitzpatrick R;Knapp M;Barlow J;Hendy J;Chrysanthaki T;Bardsley M;Newman SP
远程保健（TH）和远程护理（TC）干预措施越来越重视支持老年人的自我保健;然而，评价研究往往报告不参与的比例很高，这一点并没有得到很好的理解。本文报道了一项定性研究，该研究嵌套在英国的一项大型随机对照试验中：全系统演示器（WSD）项目。它从拒绝参与或退出试验的人的角度探讨了TH和TC的参与和采用障碍。对22名在解释干预措施后拒绝参加试验的人（n = 19）或退出干预措施的人（n = 3）进行了定性半结构化访谈。参与者从四个试验组（糖尿病、慢性阻塞性肺病、心力衰竭或社会护理需求）中招募;所有人都来自三个试验区（康沃尔、肯特、东伦敦）。在首次解释试验和干预措施的家访中，还通过跟踪8名卫生和社会护理工作人员访问23人进行了观察。实地观察访问的笔记，并探讨一起采访记录，以引出关键的主题。在以下主题中确定了与不参与和退出试验相关的TH和TC采用障碍：对设备技术能力和操作的要求;对身份、独立性和自我护理的威胁;对服务中断的期望和经历。受访者担心需要特殊技能来操作设备，但这些通常是基于误解。答复者的观点往往被解释为与积极老龄化和自力更生有关的身份认同的潜在威胁，以及干预措施可能破坏自我照顾和应对的观点。最后，参与者不愿意冒险对往往价值很高的现有服务进行可能具有破坏性的改变。这些调查结果的看法，对身份和服务的干预措施的潜在破坏超出了更普遍的期望，对隐私的关注和不喜欢的技术阻止吸收。这些见解对卫生和社会保健工作人员有影响，表明更详细的信息和讨论时间可能是有价值的，特别是在介绍方面。似乎特别重要的是，潜在的接受者有机会讨论他们的期望，这种意见可能有益地反馈到设计和执行中。
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. 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. 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. 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.
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影响因子：
5.4
作者：
May, C;Gask, L;Esmail, A
通讯作者：
Esmail, A
影响因子：
5.4
作者：
Nicolini, Davide
通讯作者：
Nicolini, Davide
影响因子：
105.7
作者：
Featherstone, K;Donovan, JL
通讯作者：
Donovan, JL
影响因子：
4.7
作者：
Finch, T;Mort, M;Mair, F
通讯作者：
Mair, F
制定和评估复杂的干预措施：新的医学研究委员会指南。
DOI：
10.1136/bmj.a1655
发表时间：
2008-09-29
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Craig P;Dieppe P;Macintyre S;Michie S;Nazareth I;Petticrew M;Medical Research Council Guidance
通讯作者：
Medical Research Council Guidance