Virtual Reality in Residential Aged Care: a study of adoption and system complexity.

Virtual Reality (VR) has been increasingly adopted by residential aged care facilities (RACFs) for enriching residents’ experiences. RACFs are sensitive settings with complex sociocultural elements, thus aged care providers might experience challenges when introducing new technologies. This paper presents findings from a descriptive analysis of survey responses exploring the complexity brought about by adopting VR in RACFs. By understanding technology-in-use as socio-technical systems, this study draws on the work of Greenhalgh et al. to understand how the adoption of health-care technologies is influenced by complexity across seven domains: condition, technology, value proposition, adopter(s), organization(s), wider system, and adaptation over time. The paper details the design of a new survey instrument. Results indicate that it is challenging to sustain a VR program within RACFs due to the complexity arising from residents’ conditions and the technology itself, and the complicated challenges involving staff who facilitate VR activities and those who provide training

Co-designing a dashboard of predictive analytics and decision support to drive care quality and client outcomes in aged care: a mixed-method study protocol

IntroductionThere is a clear need for improved care quality and quality monitoring in aged care. Aged care providers collect an abundance of data, yet rarely are these data integrated and transformed in real-time into actionable information to support evidence-based care, nor are they shared with older people and informal caregivers. This protocol describes the co-design and testing of a dashboard in residential aged care facilities (nursing or care homes) and community-based aged care settings (formal care provided at home or in the community). The dashboard will comprise integrated data to provide an 'at-a-glance' overview of aged care clients, indicators to identify clients at risk of fall-related hospitalisations and poor quality of life, and evidence-based decision support to minimise these risks. Longer term plans for dashboard implementation and evaluation are also outlined.MethodsThis mixed-method study will involve (1) co-designing dashboard features with aged care staff, clients, informal caregivers and general practitioners (GPs), (2) integrating aged care data silos and developing risk models, and (3) testing dashboard prototypes with users. The dashboard features will be informed by direct observations of routine work, interviews, focus groups and co-design groups with users, and a community forum. Multivariable discrete time survival models will be used to develop risk indicators, using predictors from linked historical aged care and hospital data. Dashboard prototype testing will comprise interviews, focus groups and walk-through scenarios using a think-aloud approach with staff members, clients and informal caregivers, and a GP workshop.Ethics and disseminationThis study has received ethical approval from the New South Wales (NSW) Population & Health Services Research Ethics Committee and Macquarie University's Human Research Ethics Committee. The research findings will be presented to the aged care provider who will share results with staff members, clients, residents and informal caregivers. Findings will be disseminated as peer-reviewed journal articles, policy briefs and conference presentations

Success and failure in eHealth

Introduction In the field of eHealth, there seems to be a gap between promising research and clinical reality. This master thesis aims to give insight in patterns that can be found regarding the possible outcome in terms of success and/or failure. An in-depth review of workflow will be done, to get an understanding of the implications of eHealth on workflow. Methods Using a systematic article search, papers have been collected regarding the subject of this thesis. Through multiple search strategies, one final search string has been formulated. This final search string led to 903 papers. These papers have been assessed on relevance using qualitative methods. This resulted in 258 papers, which have been categorised by topic, entity and success or failure. After categorisation, the topic of workflow has been selected for an additional in-depth full-text review. Results The categorisation led to 27 categories. The categories are separated among the following entities: patient, health professional, health system and all. The first three have been separated in terms of success and failure as well. This led to a quantitative overview of different categories, for different actors in terms of success and failure. Workflow appeared to be essential for the possible success or failure of eHealth implementations. It is important to include workflow in the design of the tool as well. Conclusion Different categories show a unique combination in success and failure, and to what entity they belong. The category costs appeared to be mostly based on the health system and is attributed to failure. Therefore it is a pre-requisite for the implementation of eHealth. Other categories like quality healthcare and user expectations seem to target on success. The category legal was smaller than anticipated, which could have been caused by categories that are closely linked to each other

Barreiras e facilitadores à utilização da plataforma digital LEAVES: Um estudo qualitativo com profissionais de saúde e utilizadores

Dissertação de mestrado apresentada no Ispa – Instituto Universitário para obtenção de grau de Mestre na especialidade de Psicologia ClínicaIntrodução: O luto pode ser visto como sendo uma dor ou um sentimento de pesar pela morte de outra pessoa, acompanhado por, entre outros, uma angústia e tristeza profundas. No caso da população mais idosa, a perda do/a cônjuge, vem acompanhada de um forte impacto na sua vida. O presente estudo teve como objetivo principal avaliar as barreiras e os facilitadores à utilização de uma ferramenta digital para apoio ao luto (LEAVES), junto de utilizadores e profissionais de saúde, com base no modelo explicativo do comportamento COM-B. Foi ainda objetivo do estudo, apurar junto dos Profissionais de Saúde se estes recomendariam a utilização do LEAVES. Método: Foi utilizada uma metodologia qualitativa, através de entrevistas e com recurso à análise temática reflexiva. Utilizou-se um guião de entrevista semiestruturado com recurso a categorias do modelo COM-B (Capacidade, Oportunidade e Motivação). A amostra consistiu em 13 participantes no total, sendo 7 Utilizadores e 6 Profissionais de Saúde. Desta forma, foram realizados dois tipos de entrevistas, em modo online, com recurso à plataforma ZOOM, tendo por base dois guiões diferentes. Resultados: No geral, verificou-se que, a maioria dos participantes, quer Utilizadores, quer Profissionais de Saúde, relataram mais barreiras associadas à Plataforma Digital LEAVES, em comparação com os facilitadores encontrados. As principais barreiras inseriram-se na componente da Motivação explicada pelo modelo COM-B, por exemplo: Extensa, Demasiada Informação, Literacia Digital, etc. Discussão: O presente estudo tem impacto na forma como se perceciona a intervenção digital em saúde no processo de luto dos idosos.ABSTRACT: Introduction: Grief can be seen as a pain or a feeling of regret over the death of another person, accompanied by, among others, deep anguish and sadness. In the case of the elderly population, the loss of a spouse is accompanied by a strong impact on their lives. The main objective of the present study was to evaluate the barriers and facilitators to the use of a digital tool to support grief (LEAVES), with users and health professionals, based on the explanatory model of COM-B behavior. It was also the objective of the study to find out from Health Professionals whether they would recommend the use of LEAVES. Method: A qualitative methodology was used, through interviews and using reflective thematic analysis. A semi-structured interview guide was used using categories from the COM-B model (Capacity, Opportunity and Motivation). The sample consisted of 13 participants in total, 7 Users and 6 Health Professionals. In this way, two types of interviews were carried out, in online mode, using the ZOOM platform, based on two different scripts. Results: Overall, it was found that most participants, whether Users or Health Professionals, reported more barriers associated with the LEAVES Digital Platform, compared to the facilitators found. The main barriers were included in the Motivation component explained by the COM-B model, for example: Extensive, Too Much Information, Digital Literacy, etc. Discussion: The present study has an impact on the way digital health intervention is perceived in the grieving process of the elderly

Challenges affecting e-Health adoption in South African public hospitals: a case of Edendale Hospital.

Masters Degree. University of KwaZulu-Natal, Durban.Information and Communication Technologies (ICT) plays a crucial role in improving healthcare by providing innovative and more efficient ways of accessing, communicating, and storing information. The use of ICT in healthcare is often referred to as e-Health. With the increase in costs of healthcare services and shortage of healthcare professionals in the public sector, it has become vital that healthcare organisations consider adopting e-Health. This is because e-Health enables healthcare organisations to provide services in a more efficient and cost-effective manner, and allows healthcare providers to streamline many of their processes. The adoption of e-Health in developing countries has shown numerous benefits. These benefits include, giving patients access to quality healthcare services; provide healthcare providers with the ability to make informed decisions, access to medical knowledge databases and best practices. However, the literature shows that the adoption of e-Health in South African public hospitals has been slow and has been characterised by number of challenges such as a lack of skills, lack of ICT infrastructure, lack of management support, and lack of policies and standards to support its adoption. Using Edendale hospital as a case study, this study therefore tries to understand the factors that affect e-Health adoption in the South African public hospitals. This study adopted a quantitative research approach using questionnaire surveys as means to collect data from a total of 265 respondents that represented the study’s sample. A descriptive approach was employed in this study, and questionnaires were used to obtain data from healthcare professionals. The data collected was analysed with the use of the SPSS software. During the analysis of the data, the results obtained were based on the descriptive and inferential statistics produced. Based on this study’s results, the healthcare professionals expect an e-health system to produce an accurate patient diagnosis, improve patients’ education regarding their health, ensure stronger data privacy and security and improve the quality of safety of healthcare centres. Healthcare professionals indicated that if these expectations are met by an e-Health system, then they will adopt and use it. Also, healthcare professionals indicated that if an e-Health system is web-friendly and easy to access and use, then they will adopt and use it. The study showed that the presence of facilitating conditions (such as access to the Internet and at a low cost, adequate ICT infrastructure, relevant computer skills training, government support and involvement of the hospital management) would encourage healthcare professionals to adopt and use an e-Health system

Innovation to enhance health in care homes and evaluation of tools for measuring outcomes of care: rapid evidence synthesis

Background Flexible, integrated models of service delivery are being developed to meet the changing demands of an ageing population. To underpin the spread of innovative models of care across the NHS, summaries of the current research evidence are needed. This report focuses exclusively on care homes and reviews work in four specific areas, identified as key enablers for the NHS England vanguard programme. Aim To conduct a rapid synthesis of evidence relating to enhancing health in care homes across four key areas: technology, communication and engagement, workforce and evaluation. Objectives (1) To map the published literature on the uses, benefits and challenges of technology in care homes; flexible and innovative uses of the nursing and support workforce to benefit resident care; communication and engagement between care homes, communities and health-related organisations; and approaches to the evaluation of new models of care in care homes. (2) To conduct rapid, systematic syntheses of evidence to answer the following questions. Which technologies have a positive impact on resident health and well-being? How should care homes and the NHS communicate to enhance resident, family and staff outcomes and experiences? Which measurement tools have been validated for use in UK care homes? What is the evidence that staffing levels (i.e. ratio of registered nurses and support staff to residents or different levels of support staff) influence resident outcomes? Data sources Searches of MEDLINE, CINAHL, Science Citation Index, Cochrane Database of Systematic Reviews, DARE (Database of Abstracts of Reviews of Effects) and Index to Theses. Grey literature was sought via Google™ (Mountain View, CA, USA) and websites relevant to each individual search. Design Mapping review and rapid, systematic evidence syntheses. Setting Care homes with and without nursing in high-income countries. Review methods Published literature was mapped to a bespoke framework, and four linked rapid critical reviews of the available evidence were undertaken using systematic methods. Data were not suitable for meta-analysis, and are presented in narrative syntheses. Results Seven hundred and sixty-one studies were mapped across the four topic areas, and 65 studies were included in systematic rapid reviews. This work identified a paucity of large, high-quality research studies, particularly from the UK. The key findings include the following. (1) Technology: some of the most promising interventions appear to be games that promote physical activity and enhance mental health and well-being. (2) Communication and engagement: structured communication tools have been shown to enhance communication with health services and resident outcomes in US studies. No robust evidence was identified on care home engagement with communities. (3) Evaluation: 6 of the 65 measurement tools identified had been validated for use in UK care homes, two of which provide general assessments of care. The methodological quality of all six tools was assessed as poor. (4) Workforce: joint working within and beyond the care home and initiatives that focus on staff taking on new but specific care tasks appear to be associated with enhanced outcomes. Evidence for staff taking on traditional nursing tasks without qualification is limited, but promising. Limitations This review was restricted to English-language publications after the year 2000. The rapid methodology has facilitated a broad review in a short time period, but the possibility of omissions and errors cannot be excluded. Conclusions This review provides limited evidential support for some of the innovations in the NHS vanguard programme, and identifies key issues and gaps for future research and evaluation. Future work Future work should provide high-quality evidence, in particular experimental studies, economic evaluations and research sensitive to the UK context. Study registration This study is registered as PROSPERO CRD42016052933, CRD42016052933, CRD42016052937 and CRD42016052938. Funding The National Institute for Health Research Health Services and Delivery Research programme