080616

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Non-use of provided assistive technology devices, a literature overview

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080616

  1. 1. Non-use of provided assistive technology devices, a literature overview
  2. 2. Outline <ul><li>Introduction </li></ul><ul><li>Methods </li></ul><ul><li>Results </li></ul><ul><li>Discussion </li></ul><ul><li>Strategies to reduce non-use of provided assistive technology </li></ul>
  3. 3. Introduction <ul><li>a solid theoretical framework is not yet available </li></ul><ul><li>if large numbers of devices are not being used </li></ul><ul><ul><li>resources are not being spent efficiently </li></ul></ul><ul><ul><li>problems might not be solved optimally </li></ul></ul><ul><ul><li>professionals in assistive technology service delivery want to do their job well </li></ul></ul><ul><li>adherence (or compliance) with medical interventions </li></ul><ul><li>what degree non-use can be viewed as non-adherence and, based on that, we will see what strategies might be useful to prevent non-use </li></ul>
  4. 4. Methods <ul><li>compare the definitions of non-use used in the various publications </li></ul><ul><li>listed the determinants identified, categorising them into four groups </li></ul><ul><ul><li>personal (client) factors </li></ul></ul><ul><ul><li>factors related to the device </li></ul></ul><ul><ul><li>intervention-related factors </li></ul></ul><ul><ul><li>factors related to the user’s environment </li></ul></ul>
  5. 5. Methods (cont.) <ul><li>some basic literature on adherence with medical interventions is reviewed </li></ul><ul><li>non-adherence can be categorised into six groups </li></ul><ul><ul><li>intra-psychological factors </li></ul></ul><ul><ul><li>characteristics of the disability </li></ul></ul><ul><ul><li>environmental factors </li></ul></ul><ul><ul><li>practical matters </li></ul></ul><ul><ul><li>the client-professional relation </li></ul></ul><ul><ul><li>the communication between client and professional </li></ul></ul>
  6. 6. Results <ul><li>Results from separate studies can hardly be compared </li></ul><ul><li>Definition of non-use </li></ul><ul><li>Determinants of non-use of assistive technology devices </li></ul><ul><li>Personal (client) factors </li></ul><ul><li>Factors related to the device </li></ul><ul><li>Factors related to the user’s environment </li></ul><ul><li>Intervention-related factors </li></ul><ul><li>Determinants of adherence with medical interventions </li></ul>
  7. 7. Definition of non-use <ul><li>a device to be abandoned (or not used) when it has been replaced by a different type of device (e.g. when a cane has been replaced by a walking frame) </li></ul><ul><li>The device is not used at all ; </li></ul><ul><li>The device is not used full-time ; </li></ul><ul><li>The device is not used voluntarily; </li></ul><ul><li>The device is not used at the time of questioning; </li></ul><ul><li>The device is not used frequently; </li></ul><ul><li>The device is not used for a substantial part of the day; </li></ul><ul><li>The device is not used at any given point post-discharge; </li></ul><ul><li>The average use is low; </li></ul><ul><li>The device has not been used at least three times since prescription; </li></ul><ul><li>The device is not used correctly; </li></ul><ul><li>The device is not used for (all) the activities it was prescribed for. </li></ul>
  8. 8. Determinants of non-use of assistive technology devices <ul><li>on the effectiveness of prescribed devices in developing or restoring function in activities of daily living or work roles </li></ul><ul><li>being concerned about how individuals would respond to assistive devices and an awareness of clients at times not valuing assistive devices to the extent therapists did </li></ul><ul><li>However, this concern has not lead to research into aspects beyond aesthetics and usability of devices. </li></ul><ul><li>The role of psychosocial aspects remains a frontier of knowledge. </li></ul><ul><li>Studies into non-use of assistive devices show an analogue development. </li></ul>
  9. 9. Personal (client) factors <ul><li>rejection of obvious assistive devices is more common among people with slowly progressing disabilities </li></ul><ul><li>often influences the rate of use of assistive devices in a negative way, because the devices keep reminding the user of his disability </li></ul><ul><li>If a disability gets more severe, a device might no longer be sufficient </li></ul><ul><li>multiple devices </li></ul>
  10. 10. Factors related to the device <ul><li>poor quality </li></ul><ul><li>an unpleasant appearance will evoke negative reactions </li></ul><ul><li>on the other hand, if a device is portable, lightweight and easy to use, it will be used more often and for a longer period of time </li></ul>
  11. 11. Factors related to the user’s environment <ul><li>social circle supports them in using the device </li></ul><ul><li>assistive devices might be adapted more optimally to individual needs of a client </li></ul><ul><li>concerning funding of assistive devices </li></ul>
  12. 12. Intervention-related factors <ul><li>When users’ opinions are considered in the selection process, devices are more likely to be retained </li></ul><ul><li>correct provision process and installation </li></ul><ul><li>follow-up service </li></ul>
  13. 14. Determinants of adherence with medical interventions <ul><li>A distinction can be made between short-term adherence and long-term adherence </li></ul><ul><li>Five important characteristics of short-term adherence </li></ul><ul><ul><li>Supervision/guidance </li></ul></ul><ul><ul><li>A curative goal </li></ul></ul><ul><ul><li>Outcome can be evaluated </li></ul></ul><ul><ul><li>Complaints/symptoms serve as ‘cues’ </li></ul></ul><ul><ul><li>Recovery serves as reward </li></ul></ul>
  14. 15. long-term adherence
  15. 16. Discussion
  16. 18. Strategies to reduce non-use of provided assistive technology <ul><li>A training of professionals in conversation and communication skills can be very helpful. </li></ul><ul><li>The user’s condition has improved or got worse or the environment has changed. </li></ul><ul><ul><li>This type of non-use can be managed by introducing a recycling system. </li></ul></ul><ul><li>A training program can compensate a shortage of cognitive skills. </li></ul>

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