Social and technical readiness for a telehealth assessment service for adults with complex wheelchair needs: A national survey of stakeholders

Abstract

Wheelchairs can significantly improve quality of life for those who need them, yet access to physiotherapists or occupational therapists specialising in wheelchair and seating assessment can be difficult, especially for Mäori. This paper reports on a national online survey that was undertaken as phase 1 of a mixed methods study of key stakeholders of the perceived social and technical requirements of a telehealth wheelchair assessment service for people with complex mobility needs. Key stakeholders included wheelchair users and their families, specialist and non-specialist assessors, technicians, and service managers. Responses (n = 114) indicated perceived shortcomings with current in-person assessment. Telehealth assessment was anticipated to improve service quality, particularly the timeliness of services (52/92, 57%) and prioritisation of the urgency of assessment (71/92, 77%). Preferences were for use of existing software rather than bespoke systems. Training in conducting assessment via telehealth was considered essential by most assessors (29/41, 71%). Internet connectivity was in place for most wheelchair users (43/47, 92%) but was inadequate for 29% (14/49) of assessors (pre-COVID-19). Mäori wheelchair users largely had infrastructure in place for telehealth assessment (10/11, 91%) and held positive expectations of it. Telehealth wheelchair and seating assessment is anticipated to improve the quality of care for wheelchair users with complex needs. Upgraded technical capability of public health services and robust training in conducting assessment via telehealth will be critical to successful uptake of this service. Specific needs for Mäori wheelchair users warrant further investigation.

Stakeholder perspectives of the sociotechnical requirements of a telehealth wheelchair assessment service in Aotearoa/New Zealand: A qualitative analysis

“…Concern that a shift to telehealth delivery could exacerbate these inequities has been expressed given the social determinants of health that disproportionately affect M aori (Gurney et al, 2021) as the result of colonisation (Paradies, 2016;Reid et al, 2019). Conversely, our earlier research indicated enthusiasm for telehealth among M aori, and better technology preparedness than many other groups (Graham et al, 2021). Thus, a shift to tele-delivered intervention requires an in-depth understanding of the experiences of M aori of receiving similar services, to determine how to provide a quality, culturally appropriate service for M aori users.…”

“…Consolidated Criteria for Reporting Qualitative Research (COREQ) was met in design, analysis and reporting (Tong et al, 2007). In Phase 1, a survey identified social perspectives and technical readiness for a TWA service (Graham et al, 2021). This current Phase 2 qualitative study with a subset of survey participants enabled in‐depth and context‐specific exploration of stakeholder perceptions of a TWA service, particularly in relation to UTAUT domains of perceived effort, social influences, and facilitating conditions.…”

“…Our recent survey of those involved in wheelchair assessment ( N = 114) suggests largely positive perceptions of tele‐delivered assessment among most stakeholders, particularly wheelchair users, with the primary expectation being faster access to specialist assessment (Graham et al, 2021). However, assessors ‘expectations of effort’ in learning to conduct assessment via technology were high.…”

“…Conducting complex assessments is highly specialised, with wheelchair funders in many countries requiring post‐professional qualification of registered occupational therapists (OT) or physiotherapists (PT) to authorise purchasing. Travel by either wheelchair users or assessors is prohibitive to timely wheelchair provision (Graham et al, 2021). A shift to tele‐delivery assessment could potentially address inequitable wheelchair provision and improve the quality of mobility outcomes.…”