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Many people with long term - chronic - conditions need a lot of support in their daily lives. A wide range of assistive technologies are designed to help, including wheelchairs, hearing aids, and electronic devices. But people often give up using them.
Researchers wanted to identify the main reasons why. They found common barriers to use among people with all kinds of chronic conditions.
The findings suggest that the design and provision of assistive technologies must change. The researchers suggest that users must be more involved in the design process. A shift in emphasis is needed from the clinician being the expert, to more patient-specific solutions with designs and decisions based on each person’s needs. Change at the level of government, industry and commissioners will be required to achieve this, but also among clinicians and the users themselves.
What’s the issue?
About 15 million people in England have a chronic condition, which can be managed but not cured. They are most common in older people and in more deprived groups and are usually life-long. They have a negative impact on the person’s quality of life. They include diseases (such as diabetes, arthritis, epilepsy), mental health conditions (such as depression, schizophrenia) and physical disabilities (such as blindness, joint disorders, loss of limbs).
Acute medicine, for injuries or diseases which can be cured or fixed, once accounted for most medical care. There has been a shift and half of all GP appointments now relate to chronic conditions; their care is estimated to cost £7 in every £10 of total health and social care expenditure. But healthcare is still based on a model that assumes people will recover.
Those with chronic conditions instead need to actively collaborate in their own care and self-manage their health over the long term. So-called assistive technologies can help people live independently and take part in society. They can reduce distressing symptoms and maximise the user's health and wellbeing.
Assistive technologies include a diverse range of devices such as prosthetics (artificial body parts such as a leg for after amputation), hearing aids, mobility aids such as wheelchairs and walking sticks, memory/planning aids, communication aids for people unable to use their own voice, and devices to help people use household items.
Yet up to seven in ten people abandon their assistive technology. In some cases, this is because their condition has improved, but it can also be because the technology does not meet their needs. The researchers wanted to identify the barriers that prevent people with chronic conditions using assistive technologies.
The researchers reviewed published studies on assistive technologies from around the world. They focussed on research into the barriers to use by adults with chronic conditions. They analysed 40 papers covering a wide range of health conditions such as dementia, stroke and impaired mobility. The studies included a mixture of assistive technologies.
The research team identified six main barriers to the use of assistive technologies:
- Design and function, including lack of user and therapist involvement in the design process, lack of options for customising it, high purchase and maintenance costs, and not being easy to use. Some technologies were too big or heavy for the user to carry, or to use in their home. Others could not be used in certain environments, for example, if sunlight caused glaring on a screen.
- Information and awareness, including a lack of training or instructions, lack of user knowledge about products and services, and health professionals not knowing enough about the technology available.
- Service provision, including a lack of person-centred care. Users wanted to choose their own equipment; they became frustrated when they were not involved in the decision. The application process involved paperwork, which could be a barrier, and delays sometimes meant that the technology arrived after the user’s condition had deteriorated too far for them to use it.
- Psychological barriers, such as a user’s previous disappointment with the technology, or the feeling that it was annoying, awkward or not appropriate for them.
- Support network, including negative views, and a lack of encouragement to use the technology, from family and carers. Users wanted information on how to use the technology from those with similar conditions but felt there was a lack of opportunities to access peer support.
- Societal barriers, such as stigma. The negative attitudes of others could make people feel vulnerable and self-conscious about using technologies in public. Infrastructure – for example where paths lack access ramps, shops have narrow aisles, or public transport is poorly designed – can be a barrier. Users were concerned that they are not represented at policy level and that government recognition of assistive technologies is lacking.
The researchers say the barriers are interconnected and cannot be resolved independently of each other. A well-designed device that overcomes the ‘function’ barrier will not on its own increase access unless psychological, societal and other barriers are also taken into account.
Why is this important?
This research suggests that services need to better reflect the shift towards promoting long-term self-management for people with chronic conditions. Assistive technologies need to be designed in partnership with users to create devices that better meet individuals' needs. Users need to be able to customise devices; designers and those who prescribe them could encourage creative problem-solving. People with chronic conditions need accurate and accessible information about the technologies available to them.
The way researchers gauge the success of assistive technologies also needs to be addressed. Research should take the experiences and opinions of users into account and look at the impact on their overall health and wellbeing.
On a wider scale, barriers to using assistive technologies in the urban environment need to be addressed in planning and building.
People with chronic conditions already customise standard household devices and personalise their assistive technologies. They adapt kitchen equipment and use their smartphones and tablets for home-made telecare systems. Further research could explore how much this at-home customisation improves health and wellbeing.
This research team is beginning to apply co-design principles into a healthcare setting. Starting on a small scale, they are working with three people in need of customised assistive technology. These potential users have identified the main challenges they face in their daily lives. The researchers are working with them to design useful assistive technology tools.
You may be interested to read
The full paper: Howard J and others. Exploring the barriers to using assistive technology for individuals with chronic conditions: a meta-synthesis review. Disabil Rehabil Assist Technol. 2020;14:1-19
Funding: This research was supported by Health and Care Research Wales through the Research for Public Patient Benefit Scheme.
Conflicts of Interest: The study authors declare no conflicts of interest.
Disclaimer: NIHR Alerts are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that views expressed in NIHR Alerts are those of the author(s) and reviewer(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.