ATRAS: WP3 Understanding barriers and facilitators to acceptance of ATs Jane Burridge, Caroline...
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Transcript of ATRAS: WP3 Understanding barriers and facilitators to acceptance of ATs Jane Burridge, Caroline...
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
3
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
5
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
15
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