ATRAS: WP3Understanding barriers and facilitators to acceptance of ATs

Jane Burridge, Caroline Ellis-Hill, Ann-Marie Hughes,Sara Demain and Lucy Yardley

Exhibition of upper limb technologies for

rehabilitation exhibition 2009

7th October from 10:30 for healthcare professionals

8-9th October for patients and carers

At Building 45, University of Southampton

Buffet lunch provided

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WP3 team• Caroline Ellis-Hill

• Lucy Yardley

• Ann-Marie Hughes

• Sara Demain

• Jane Burridge

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Introduction to WP3 • Investigation into the users’ views on ATs

• Barriers to ATs from users’ perspective

• Interactive Exhibition – plans

• Focus groups

• Questionnaire

• Field studies

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WP 3 - Objectives

To explore:

►Participants’ perceptions of how AT addresses theirneeds

►Participants’ perceptions of the barriers to using ATs

►Positive and negative aspects of including ATs within a

clinical service

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Purpose• To inform the decision about what ATs are tested in

the RCT

• To inform the design of the RCT

• Information will be added to the systematic review so that the choice is made on:

– Clinical evidence

– Users’ views

• Critical issue – how is the information generated from WP3 integrated into the decision making process

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Study Methods• 1) Qualitative design (geographic boundaries)

– Interactive exhibition recruit for focus groups

– Focus groups inform questionnaire study

2) Quantitative questionnaire study (national)

- Provide data on acceptability of ATs in service provision

– Inform design of the clinical trials

• 3) Usability field trials

– Qualitative (observation and interview)

– Quantitative (questionnaire)

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Qualitative design

• Interactive Exhibition

• Focus groups (6-8) – purposive sampling

– Patients

– Carers

– MD healthcare professionals

– Managers, budget holders and commissioners

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Questionnaire

• Designed, piloted, revised, piloted, final version

• Target Audience: Patients and Carers (150-200), MD healthcare professionals (75-100), Managers, budget holders and commissioners (30-60)

• Method: phone, email (Website), paper

• Advertised: UK stroke units, rehab centres, stroke clubs and GP practices

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Questionnaire analysis• Generate quantitative data concerning the issues identified in

the qualitative study

• Analysis will aim to indicate critical factors in the RCT design generated from the classes of responders:

– Patients and carers (e.g. where the intervention should take place, how long each day is reasonable to ‘practice’)

– Healthcare professionals (e.g. time post-stroke of intervention, selection of patients, training / ease of application)

– Managers / Budget holders (e.g. cost/patient)

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Usability field trials

• Evaluate ATs from patient and clinician perspective

• Qualitative interview (n=12)

• Questionnaire developed, piloted and trialled at the end of clinical trial

• Video of patients using technology

• Patient diaries

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Qualitative component of the Clinical Trial

• Interviews – patients and clinicians using AT

• Observation – videos record of people using AT

• Participant Diaries – document usage and problems

• Data → Questionnaire design

– Sent to all trial participants at end of study

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WP3 Gantt chart Interaction Exhibition Oct 7-9

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How the output of WP3 will be used to inform the trial design

• Transforming textual data into metrics

• Done partly but not wholly by the questionnaire

• Identifying the bottle-necks

– e.g. comfort of ATs, ease of wear, cosmetic etc. It might be important for to consider these factors in the specific choice of ATs evaluated in the trial

– e.g. robots are great but in a gym or own home -if this was identified the trial design would need to consider how the intervention was monitored

– Softer issues e.g. patients love it but therapists unconvinced. This would indicate a need for a culture change among therapists and would need to be considered / addressed prior to the clinical trial

• Bottom line – until we gather the data we cannot identify the critical factors relating to users’ perceptions and preferences

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Qualitative research – a quick introduction

• Quantitative research

– material reality

– physical properties

– measurable

• Qualitative research

– social reality

– concepts, ideas, beliefs

– not measurable

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Qualitative research – a quick introduction

– Understanding meanings

– Meaning of objects or events is as important as the ‘facts’ of the event because meaning influences thoughts and actions

– Subjective meanings therefore affect the material world

– Talk to people and observe their actions

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Focus groups

“a way of collecting qualitative data, by engaging a small number of people in an informal group

discussion, focussed on a particular topic or set of issues” (Wilkinson, 2003)

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Focus groups• Facilitated by researcher - flexible topic schedule

• Group dynamics important

– participants asking questions of each other,

– seeking clarification from each other,

– probing for greater depth (Finch and Lewis, 2003)

• Analysis

– identify key themes and concepts

– understand how these relate to each other and the topic under investigation

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Purposive Sampling – • Quantitative research

• Aim: generalise to whole populations

• Strategy: select statistically representative sample of people/objects/events

• Sample: matches proportions in population

• Qualitative research

• Aim: understand phenomenon

• Strategy: select people/objects/events from whom we can learn the most

• Sample: people/objects/events with a range of experiences and opinions. Deliberately try and include outlying views and people with expertise.

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Purposive sampling • Example Focus group 1 – People who have had a

stroke

– Have/have not used AT

– Different genders

– Levels of ability

– Time since stroke

– Age groups

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Purposive sampling • Example Focus group 1 – Health care professionals

– Which professionals?

– Different levels expertise?

– Experts in one or other form UL AT?

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Analysis - thematic• Identifying themes and relationships between them

Purpose:

1. Understand phenomenon inductively (→ publications)

2. Questionnaire validity

– Content: what questions we ask

– Language: using the precise terms used by focus group participants

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Focus group formats• People with stroke x 2

– Existing/previous users of AT– Those who have never used an AT

• Carers/family of people with stroke (naïve and experienced)

• Coal-face health professionals (therapists, medics, engineers)

• Managers/Budget holders (different professions)

• Commissioners

• Option for interviews if necessary

– Commissioners– People with cognitive/language deficits