KWAZO,a new instrument to assess the quality of service delivery in assistive technology provision

Purpose.?Currently no well validated instrument exists to assess the quality of the assistive technology delivery from the client's perspective. An instrument was developed called KWAZO, consisting of seven questions related to accessibility, knowledge, coordination, efficiency, flexibility and influence of the user. KWAZO, meaning “quality of care”, can be completed by the clients without any assistance. In this study, the feasibility, internal consistency and convergent validity of KWAZO were examined.

Method.?The data stem from a large monitoring study into non-use of and satisfaction with assistive technology (n = 4637) using a mailed questionnaire. Feasibility was tested by studying the rate of non response for each of the questions. To test convergent validity the KWAZO total score was compared to answers on a question about overall satisfaction with service delivery of D-QUEST.

Results.?Only few missing values were seen (3.1 – 7.5%). Cronbach's alpha was good (0.89), indicating that KWAZO reliably measures one concept. Convergent validity was shown by a moderately strong correlation between KWAZO and the D-QUEST question (0.54; p < 0.001). A difference of about 2.5 points seems to reflect a relevant difference in user satisfaction.

Conclusions.?KWAZO is a new questionnaire to assess the quality of an assistive technology provision process from a client's perspective. KWAZO has decent measurement properties and its self-report format makes it an easy-to-use tool for assessment of the quality of assistive technology provision.     

Providing assistive technology in Italy: the perceived delivery process quality as affecting abandonment

Purpose: The study brings together three aspects rarely observed at once in assistive technology (AT) surveys: (i) the assessment of user interaction/satisfaction with AT and service delivery, (ii) the motivational analysis of AT abandonment, and (iii) the management/design evaluation of AT delivery services. Methods: 15 health professionals and 4 AT experts were involved in modelling and assessing four AT Local Health Delivery Service (Centres) in Italy through a SWOT analysis and a Cognitive Walkthrough. In addition 558 users of the same Centres were interviewed in a telephone survey to rate their satisfaction and AT use. Results: The overall AT abandonment was equal to 19.09%. Different Centres' management strategies resulted in different percentages of AT disuse, with a range from 12.61% to 24.26%. A significant difference between the declared abandonment and the Centres' management strategies (p?=?0.012) was identified. A strong effect on abandonment was also found due to professionals' procedures (p?=?0.005) and follow-up systems (p?=?0.002). Conclusions: The user experience of an AT is affected not only by the quality of the interaction with the AT, but also by the perceived quality of the Centres in support and follow-up.

• Implications for Rehabilitation

• AT abandonment surveys provide useful information for modelling AT assessment and delivery process.

• SWOT and Cognitive Walkthrough analyses have shown suitable methods for exploring limits and advantages in AT service delivery systems.

• The study confirms the relevance of person centredness for a successful AT assessment and delivery process.

     

Assistive technology provision: towards an international framework for assuring availability and accessibility of affordable high-quality assistive technology

Abstract

Purpose: This is a position paper describing the elements of an international framework for assistive technology provision that could guide the development of policies, systems and service delivery procedures across the world. It describes general requirements, quality criteria and possible approaches that may help to enhance the accessibility of affordable and high quality assistive technology solutions.

Materials and methods: The paper is based on the experience of the authors, an analysis of the existing literature and the inputs from many colleagues in the field of assistive technology provision. It includes the results of discussions of an earlier version of the paper during an international conference on the topic in August 2017.

Results and conclusion: The paper ends with the recommendation to develop an international standard for assistive technology provision. Such a standard can have a major impact on the accessibility of AT for people with disabilities. The paper outlines some the key elements to be included in a standard.

• Implications for Rehabilitation

• Assistive technology is a key element in rehabilitation, but many people have no access to affordable AT solutions. The recommendations in the paper aim to inform policies, systems and service delivery procedures on how to improve access to AT across the world.

     

A population approach to understanding children's access to assistive technology

Purpose.?To determine whether service delivery system factors, including having a quality medical home, access to therapeutic services, or enrolment in early intervention/special education services, are associated with meeting children's needs for assistive technology (AT).

Method.?Data were analysed for children 0–17 years of age participating in the 2001 US National Survey of Children with Special Health Care Needs who required AT services (N = 18,372) and a subgroup of children needing assistive devices typically provided by rehabilitation professionals (N = 4429). AT needs included vision or hearing aids or care, communication or mobility devices, or other medical equipment. Unmet need was defined as not receiving all needed services. Estimates were generated of the per cent of children needing and having unmet needs for services. Associations between the medical home, therapy and education variables and having an unmet need for AT were assessed using logistic regression.

Results.?An estimated 49% of children with special health care needs require AT services. Twelve per cent require AT services typically provided by rehabilitation professionals. Of the latter group, 14% had unmet needs. The likelihood of having unmet AT needs was greater for children lacking a quality medical home (a.O.R. = 3.27 [95% C.I. = 2.29–4.66]) and/or those not receiving needed therapy services (a.O.R. = 3.52 [95% C.I. = 2.25–5.48]) than for children whose medical home and therapy service expectations were met. Enrolment in early intervention/special education was not associated with having unmet needs for AT.

Conclusions.?Promoting quality care within a complex service delivery system is critical to meeting the AT needs of children and their families. Changes in the structure and processes of care, including facilitating access to a quality medical home and needed therapy services would likely increase access to needed AT.     

Ethics and assistive technology service provision

A review of ethical issues that arise in assistive technology service provision suggests that in order to provide effective assistive technology-related services, rehabilitation professionals need to take into account a variety of ethical considerations inherent in consumer-responsive service provision.     

Assistive technology access and service delivery in resource-limited environments: introduction to a special issue of Disability and Rehabilitation: Assistive Technology

This special issue addresses access to and service delivery of assistive technology (AT) in resource-limited environments (RLEs). Access to AT is complicated not simply by limited funds to purchase AT, but by larger ecosystem weaknesses in RLEs related to legislation and policy, supply, distribution, human resources, consumer demand and accessible design. We present eight diverse articles that address various aspects of the AT ecosystem. These articles represent a wide range of AT, many different countries and different research methods. Our goal is to highlight a topic that has received scant research investigation and limited investment in international development efforts, and offer an insight into how different countries and programs are promoting access to AT. We encourage researchers, funders and non-profit organizations to invest additional effort and resources in this area.     

Multiple stakeholder perceptions of assistive technology for individuals with cerebral palsy in New Zealand

Background: This study sought to gain an understanding of the experiences and perspectives of assistive technology from different stakeholders in technology adoption, in the New Zealand context.

Methods: A focus group was held with individuals with cerebral palsy (n?=?5), service providers (n?=?4), caregivers (n?=?3) and a biomechanical engineer. The data recordings from the focus group were transcribed and coded using thematic analysis.

Results: Themes emerged around barriers imposed by the assessment process and training in assistive technology procedures, the influence of family members, the environment that assistive technology is used in, and psychosocial aspects of being able to participate and integrate into society.

Conclusion: The results are similar to other literature, suggesting new innovations and changes are in dire need, to improve assistive technology experiences for all stakeholders.

• Implications for Research

• Service providers for assistive technology desire more effective training and support of existing and emerging technologies.

• Although the set procedure for acquiring assistive technology in New Zealand is comprehensive, incorporating multiple perspectives, it is difficult to follow through in practice. More innovative procedures are needed.

• The movement of Universal Design is significantly improving the perception of individuals with disabilities, and has enabled greater social inclusion. More assistive technology developers need to ensure that they incorporate these principles in their design process.

     

A survey of assistive technology service providers in the USA

This study investigates perspectives of assistive technology service (ATS) providers regarding their education and training, interdisciplinary standards of practice, use of a common language framework, funding policies, utilization of evidence and outcomes measurement. A survey underpinned by AT legislations and established guidelines for practice was completed by 318 certified AT providers. More than 30% of the providers reported their education and training as inadequate to fulfil four of the seven primary roles of ATS. Nearly 90% of providers expressed awareness of the International Classification of Functioning, Disability and Health (ICF) domains for interdisciplinary communication. However, only 45% felt that they could effectively utilize the ICF in their documentation. About 75% of the providers acknowledged the lack of a recognized standard for the provision of services. Prevailing inadequacies in funding were negatively impacting the quality of ATS, as expressed by 88% of respondents. Translation of evidence to practice was identified as a major challenge by 41% of service providers. Providers were predominantly documenting outcomes through informal interviews (54%) or non-standard instruments (26%). Findings support the need for strengthening professional curriculum, pre-service and in-service training and an established standard to support effective, interdisciplinary AT services and data collection to support public policy decisions.

• Implications for Rehabilitation

• This study validates the need to strengthen education and training of AT service providers by enhancing professional curriculum as well as their engagement in pre-service and in-service training activities.

• This study draws attention to health care funding policies and practices that critically impact the quality of AT services.

• This study signifies the need for an established interdisciplinary standard among AT professionals to support effective communication, service coordination and outcomes measurement.

     

Abandonment of assistive products: assessing abandonment levels and factors that impact on it

Purpose: To investigate the levels and factors that influence the abandonment of assistive products by users of a local reference rehabilitation center.

Methods: This observational study involved users who received services and assistive products provided by our center of rehabilitation. Users were identified using the records of the center and their responses about the abandonment were collected through face-to-face interviews.

Results: The abandonment level of assistive products was 19.38%. 83.5% of the users use at least one of the assistive products they have received. Rigid and folding frame wheelchairs, with and without postural support devices, as well as shower wheelchairs, presented the lowest abandonment levels, followed by canes and lower limb orthoses. Upper limb orthoses, Knee Ankle Foot Orthosis(KAFO), walkers, crutches and lower and upper limb prostheses all presented higher abandonment levels.

Conclusion: The simultaneous use of mutiple assistive products, users perception on the importance of using them, and completing the rehabilitation treatment were found to impact on the short and long-term use of products. The study offers inputs to decision making and planning for assistive technology provision in developing countries with regard to expected demand and service delivery.

• Implications for Rehabilitation

• Data about the abandonment of assistive products in Sao Paulo, Brazil, could assist informing decision making on provision and servicing of these products in similar settings.

• The strong correlation found between abandonment levels and the simultaneous use of multiple devices should be taken into account by health professionals when prescribing assistive products and providing guidance to users.

• The need for follow up on the use of assistive products after discharge from rehabilitation treatment becomes strikingly clear, as data show that completing treatment is significantly relevant when evaluating abandonment levels.

• As assistive products users’ perception about the importance of using these devices is shown to be significant in explaining abandonment, it is mandatory that health and rehabilitation professionals take it into account when providing guidance and training users.

     

Stakeholder views addressing the development and uptake of powered wheelchair assistive technology

Purpose: The objective of this research is to identify stakeholder views with regard to the development of effective powered wheelchair assistive technologies more suited to the user and carer needs, whilst also meeting the requirements for other stakeholders, such that developers can be better guided towards producing solutions which have a better chance of getting to the market place and hence to the end user.

Method: A questionnaire was designed to collect the views of all stakeholders and circulated to a statistically representative number of them. The question rating data were then checked for correlation between groups, and within groups, to establish validity.

Results: The 74 stakeholders across the eight classes who responded had a good correlation between each other, with a cross class “Pearson’s correlation” ranging between 0.7 and 0.95, and the “Fleiss’s Kappa reliability of agreement” within each class ranging between 0.07 and 0.36.

Conclusions: This research has identified that all stakeholders should be involved in the development of the technology and that some may benefit in 'role-reversal' to help understand user problems and stakeholder concerns more clearly. Cost was a significant barrier to the uptake of appropriate technology, and training of users and carers was a major issue. Furthermore, development should not increase user isolation and the impact on the user must be monitored for 'quality of life'. Technical support and training should be given to the user and their carers, and equipment must be adaptive to meet the changing needs of the user.

• Implications for Rehabilitation

• Improved acceptance and use of technology by the user and their carers.

• Reduced rejection of appropriate provision.

• Improved mobility and interaction with others.

• Improved quality of life for users and carers.

     

Influences on selection of assistive technology for young children in South Africa: perspectives from rehabilitation professionals

Abstract: Selection of assistive technology for young children is a complex process. Within a context with limited resources, such as South Africa, research is needed to determine the factors influencing the assistive technology selection process, as these could ultimately either facilitate or hinder the availability and accessibility of affordable, adaptable, acceptable, and high quality assistive technology for this age group.

Method: Two asynchronous online focus groups were conducted with 16 rehabilitation professionals to identify the factors they perceived to influence the selection and provision of assistive technology to young children within the South African context.

Data analysis: A process of deductive thematic analysis was followed by inductive analysis of the data. Components of the Assistive Technology Device Selection Framework were used as themes to guide the deductive analysis, followed by inductive analysis to create subthemes.

Discussion: The important role of the professional was highlighted in negotiating all the factors to consider in the assistive technology selection and provision process. Adaptation of the Assistive Technology Device Selection Framework is suggested in order to facilitate application to low resourced contexts, such as South Africa.

• Implications for rehabilitation

• Assistive technology selection is a complex process with factors pertaining to the users (child and family) of the assistive technology, as well as the rehabilitation professional recommending the assistive technology influencing the process.

• Although it may be an important factor, the availability of financial resources to purchase assistive technology is not the only determining factor in providing appropriate assistive technology to young children in contexts with limited resources.

• Formalized support, such as reflective supervision or mentorship programs should be facilitated and utilized by recommending professionals.

• Home and school visits during assessment ensure a good match between assistive technology and users within the particular context.

• Facilitating the availability of assistive technology for trial during assessment and/or for a period afterwards will increase the likelihood that appropriate recommendations for assistive technology are made.

     

Using assistive technology for schoolwork: the experience of children with physical disabilities

Aim.?This study explored the experience of children with physical disabilities using assistive technology for participation with schoolwork to gain a greater understanding of their perspectives and subjective experiences.

Method.?A qualitative study involving thematic analysis of in-depth interviews of the child with a parent or significant adult. Purposeful sampling from a larger study recruited five children aged between 10 and 14 years, with differing physical disabilities who attended mainstream schools. All children used computer-based assistive technology.

Results.?All of the children recognised that assistive technology enabled them to participate and reduced the impact of their physical disability, allowing independent participation, and facilitated higher learning outcomes. Issues related to ease of use, social implications and assistive technology systems are discussed.     

Involving children in the development of assistive technology devices

Purpose.?To investigate the implementation of a web-based survey for involving children in the design of assistive technology devices within the primary school environment.

Method.?Children were recruited within their normal school environment. They completed tasks within the survey that sought to gather their personal preferences about assistive technology devices. From six primary schools, 257 children (mean age?=?9 years and 8 months, SD?=?1.51; 123 males, 134 females) including children with cerebral palsy (N?=?11), varying levels of deafness (N?=?7), global developmental delay (N?=?2) and Down's syndrome (N?=?1) participated. Observations were taken whilst the children completed the survey tasks.

Results.?All children were able to complete the tasks from the survey, although children with disabilities had higher completion times and most required a form of assistance from support assistants and/or sign language interpreters.

Conclusions.?The use of the web-based survey provided a novel means with which to involve children with and without disabilities in the design of assistive technology devices within a primary school environment. In order for the survey to be utilised more widely, issues that arose when involving children with disabilities need to be addressed.     

Systems thinking for assistive technology: a commentary on the GREAT summit

Abstract

The area of assistive technology has a long history of technological ingenuity and innovation. In order to ensure that the benefits of assistive technology are equitably distributed across the population and life course, it is necessary to adopt a systemic approach to the area. We describe examples of systems thinking and non-systems thinking across 10?Ps. These Ps are People (or users, as the primary beneficiaries of assistive technology), Policy, Products, Personnel, Provision (as key strategic drivers at systems level); and Procurement, Place, Pace, Promotion and Partnership (as key situational factors for systems). Together these Ps should constitute a framework for an “open” system that can evolve and adapt, that empowers users, inter-connects key components and locates these in the reality of differing contexts. The adoption of a stronger systems thinking perspective within the assistive technology field should allow for more equitable, more resilient and more sustainable assistive technology across high, middle- and low-income contexts and countries.

• Implications for Rehabilitation

• The progress of assistive technology provison has been hampered by disconnected initiatives and activities and this needs to be corrected.

• Systems thinking is a way of thinking about the connections between things and how these are influenced by contextual and other factors.

• By encouraging the providers and users of assitive technology to think more systemically we can provide a more cohesive and resilient systems.

• The user experience is the central component of systems thinking in assistive technologies.

     

Exploring assistive technology and post-school outcomes for students with severe disabilities

Purpose: This study sought to understand the extent to which students with severe disabilities receive assistive technology in school and out-of-school, and the relationship between receipt of assistive technology in school and post-school outcomes for these students. Method: This study was a secondary analysis of the National Longitudinal Transition Study-2 (NLTS2) from the USA. To analyze the data in this correlational study, researchers conducted frequency distributions, Chi Square Tests of Associations, significance tests and logistic regressions. Results: The main results suggest (a) receipt of assistive technology in school varied greatly by disability identification; (b) receipt of assistive technology post-school also varied by disability identification, but receipt was generally lower; and (c) few statistically significant post-school outcome differences existed between students who received assistive technology and those who did not. Conclusion: An under-utilization of assistive technology exists in practice in the USA for students with severe disabilities.

• Implications for Rehabilitation

• An under-utilization of assistive technology for secondary students and adults with severe disabilities likely exists.

• A need exists for improved collaboration between professionals in rehabilitation and professionals in schools to ensure continuation of needed services or aids, such as assistive technology.

• Additional research is needed to better understand the adult life (or post-school) outcomes of individuals with severe disabilities, factors from PK-12 schooling or post-school services that positively and negative impact those outcomes.