Exploring barriers to participation and adoption of telehealth and telecare within the Whole System Demonstrator trial: a qualitative study

Abstract

BackgroundTelehealth (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.MethodsQualitative 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.ResultsBarriers 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.ConclusionsThese 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.

Telecare Call Centre Work and Ageing in Place

“…However, uptake has fallen significantly short of levels desired by policymakers (Vasunilashorn et al 2012). Recent UK studies show evidence of reluctance by intended users to adopt and evidence of the benefits being sustainable is mixed (Sanders et al 2012). Despite this, recent affordances and socio-material properties of the particular technologies relevant to our study.…”

Factors that influence older people’s engagement with digital health technology

“…OIder users' understanding of the function of devices such as modems and routers can influence their engagement, particularly with home telehealth equipment such as online applications provided on an iPad or smart phone (Sanders et al 2012;Doyle et al 2014). However, more recent studies suggest that a lack of prior technological knowledge is not a barrier to DHT uptake and it is the design that is the important factor (Middlemass et al 2017), with older users preferring simple user interfaces (Doyle et al 2014), and preferring avoidance of excessive text in large blocks and medical jargon (Algeo et al 2017).…”

“…However, it is also important to acknowledge that there are some prevailing attitudes among older people that indicate severity of illness and age are factors in engaging with DHT, with some feeling people need to have a high level of need or be "ill enough" to warrant use of DHT devices (Sanders et al 2012;Doyle et al 2014;Lie et al 2016) and that certain interventions such as web-based programmes are for younger age groups (Currie et al 2015). Such perceptions are important to consider and manage if DHT is to be encouraged among older people.…”

Self Management and Telehealth: Lessons Learnt from the Evaluation of a Dorset Telehealth Program

“…Much previous the research into telehealth has focused on operational issues such as cost effectiveness (2, 10), effective working practices (11,12) and barriers to adoption (13). Where patients' experiences were considered the focus was often on the reassurance afforded by using telehealth (14).…”