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Table 4 Overview of similarities and differences of barriers/facilitators across the participants for uptake and engagement

From: Exploring the factors that influence the decision to adopt and engage with an integrated assistive telehealth and telecare service in Cambridgeshire, UK: a nested qualitative study of patient ‘users’ and ‘non-users’

Theme

Sub-theme

ATT service factors ‘Users’

ATT service factors ‘non-users’

Decision to use the ATT service at point of referral

Acceptance of old age/health condition

• Most ‘users’ accepted they had a need for equipment

• Perception that equipment symbolised a transition to ‘getting old’

• Most ‘non-users’ did not accept they had a need for equipment

• Many non-users stated they went along with the referral to please others

Previous knowledge & awareness of service & equipment

• Only two users had heard of ATT service before referral

• Previous knowledge related to knowing of others who had used the service

• Main source of information was ‘referrer’ who was most commonly a community health care professional supporting them with specialist care

• Users’ often discussed the decision to use the service with the referrer, often a healthcare professional before making the decision

• Had a preference for receiving information about service face-to face

• ‘Users’ generally felt in charge of the decision to use the service

• None of the non-users had heard about ATT service before referral

• Main source of information was ‘referrer’ who was most commonly a community health care professional supporting them with specialist care

• Had a preference for receiving information about service face-to face

• Some ‘non-users’ felt that they did not have enough information to make an informed decision and some feeling of being ‘pressurised’

• Many ‘non-users’ went along with the referral to keep the referrer happy, particularly their healthcare specialist

Perceived usefulness of equipment

• “Users’ perceived that the ATT equipment would be useful

• TH equipment was viewed as useful to monitor health

• TC equipment perceived as useful to communicate with carer, remind them to take medication, to get help in an emergency

• Non-users did perceive the equipment as useful or feel that it would add any value

Attitudes and perceptions towards ATT equipment

• Many ‘users’ felt that they would find the equipment easy to use and felt that they had the confidence to use it.

• Older patients demonstrated more apprehension than younger ‘users’

• Many older patients lacked confidence and experience to use technology

• Viewed equipment/technology as time consuming

• Equipment was viewed as complex and difficult to use

• Concerns around functionality and/or support with functionality from service

Engagement and use of ATT service

Usability

• Users overall found equipment relatively easy to use and set up

• Pendant and pager, fall detectors and TH equipment viewed as easy to use

• There were some difficulties for older patients who were using medication reminders and changing batteries

• Some ‘users’ fund instructions difficult to follow

• Found equipment difficult to use and/or difficult to set up

• TH users found equipment inconvenient e.g. readings at a set time

• Some TC users found equipment time consuming and inconvenient e.g. stocking up medication reminders

• Instructions difficult to follow

Actual usefulness of equipment

• Most participants felt that the equipment was suitable to meet an unmet need

• TC users found equipment useful and met an unfulfilled purpose

• TH users felt equipment was useful as it enabled them to monitor their health and check readings were within the set parameters

• Majority of non-users stated that they did not find the equipment useful and was cited as a core reason for non-engagement

• Reasons related to no perceived need or a change of need

• Some felt equipment did not meet specific requirements

Functionality of equipment

• TH users felt equipment was reliable and were confident it would work as intended/readings were accurate

• TC users felt confident equipment would work in an emergency

• Some issues surrounded equipment functionality but valued instant support

• Concerns relating to functional equipment

• Felt unsupported to deal with technical issues

• Unsure what to do when equipment was not functioning properly

 

Threat to identity and independence

• Perceived stigma to using equipment in public

• Acceptance of getting older or that life cannot continue the same

• Concern about loosing independence and being dependent on others