The ADAPT Research Team, CCCU

Prof Eleni HatzidimitriadouSharon Manship Dr Maria Stein

Dr Rachael MorrisDr Gayaneh Szenkovits

Assistive Technology (AT) Training for Healthcare

Professionals

Lunchtime Research Seminar, Faculty of Health and Wellbeing, CCCU 15th January 2020

CON

TEXT

• Ageing societies and chronic disabilities are irrevocable trends in EU, leading to loss of autonomy and a breakdown of social relations

• Key role of innovative Assistive Technologies (AT), including Social Assistive Robotics (SAR) and smart EPW as effective tools to empower disabled and aged people and improve social inclusion

• Existing barriers in the uptake of AT (standardization, interoperability, limitedinvolvment of users, lack of healthcareprofessional trainings)

ADAP

T

• Call for project : INTERREG VA FMA • Duration : 48 months• T0 : January 01st 2017• TEND : June 30th 2021• Budget : ≈8,7M€• Lead partner : ESIGELEC• Partnership

• 16 partners : 8 FR / 8 UK• Large scale of competencies:

• Universities• Hospitals• Health networks and economic clusters• SMEs and Charity

MAP

PIN

G O

F TH

E PA

RNTE

SHIP

Université PJV

INSA Rennes

University of Kent

UniversityCollege of

London

Canterbury Christ Church University

ERGOVIE

ESIGELEC

SME and Charity

Breizh PC

Kent Surrey Sussex Academic HealthScience Network

Academics

Hospitals

Health networks and economiccluster

Plymouth Hospital

CHU de Rouen / IFE

Pôle TES

Kent Canterbury Hospital + Health and

Europe Center

Cornwall Mobility

Pôle St Hélier

OU

R PR

OJE

CT S

TRAT

EGY

1. Framework of innovation for making the deployment of the solutions easier, including :• Developments from TRL 4 to 8 integrating industrials

requirements• Cost effective products• Standardization issues

2. A set of training materials to cover a large scale of healthcare professionals

3. Co-construction and continuous integrationprocess to improve the solutions to meet the user’s/stakeholder’s needs

1. EPW Simulator platform using virtual reality Immersive experience to the user of the smart

EPW Train the users to drive in everyday life Professionals will assess the suitability of the

EPW for particular patients and environments andgain understanding from the user perspective

2. Smart EPW to compensate for user disabilitiesthrough driving assistance technologies andreport users’ health Benefit to severely disabled users Enable health professionals to monitor changes in

user health

WH

AT W

E AR

E DO

ING

3. Training of healthcare professionals in AT Address a gap in the current healthcare education. Project platforms (EPW simulator + smart EPW) will be

captured in training protocols for the benefit of usersand healthcare provider

4. Formalized agreements between researchinstitutions and companies built through 20 eventsranging from local to international meetings Promoting and disseminating ADAPT’s results, creating

synergies, identifying points of convergence forcommon studies

Boost R&D and favour the spread of innovative ADAPT'sAT to the market

WH

AT W

E AR

E DO

ING

WP T1INSA RENNES / UCL

EPW Simulator Virtual Reality

Platform

WP T2UPJV / EKHUFT

Smart and Connected

Robotic EPW

WP T3CCCU / BREIZH PC

Training of Healthcare

Professionals in Assistive

Technologies

WP T4CORNWALL MOBILITY

Economic Development in the Cross Border Area – Technology

Transfer

WP M : PROJECT MANAGEMENTESIGELEC – IRSEEM / HEC

WP C : COMMUNICATIONESIGELEC – IRSEEM

ADAPT Project Work Packages

9

WP

#T3

–LE

AD:

CCCU

ACTIVITY LEADER DELIVERABLES DATESTART / END

T3.1Crossborder benchmarking AT service training and Survey of

Needs of health prof. regarding AT

CM

Benchmarking and Literature Review ReportReport on results from the survey of knowledge, attitudes and training needs of healthcare professionals

01.2017 / 01.2018

T3.2Development of the AT training

programmes for healthcare professionals

CCCU 4 Training packages for differentqualifications of healthcare professionals

08.2017 / 06.2018

T3.3Development of ‘Train the Trainer’

PackageIRSEEM ‘Train the Trainer’ package 01.2018 /

06.2019

T3.4 Delivery of Training Sessions CHU

Number of students/professionals trained in UK/France (680)

Training hours in UK and France (576)

08.2018 /04.2020

T3.5Evaluation of Training EKHUFT Evaluation Reports for Training 08.2017 /

03.2021

Literature Review: Challenges Encountered in the Adoption of Assistive Technology (AT)

and Training of Healthcare Professionals

Purpose of the Literature Review

To understand the challenges encountered by professionals in adoption/use of Assistive Technology (AT) in healthcare practice in UK and France

To explore if/how training of healthcare professionals (HCPs) in AT practice takes place in UK and France

To inform the relevant work package activities (WP3.2.1 and WP3.2.2) of ADAPT project: Online survey of HCPs in relation to their knowledge,

experiences and training needs of AT

Development of AT training materials for HCPs

Literature Review Methodology Narrative literature review approach

Search of databases in UK/FR Academic Search Index, BDSP (Base de données en Santé

Publique), Cairn, CINAHL, Documentation EHESP/MSSH (Ecole des Hautes Etudes en Santé Publique/Maison des Sciences Sociales et Handicap), Google Scholar, Pubmed, Social Sciences Citation Index

Inclusion criteria: Search terms: assistive technology, AT provision, training,

healthcare professional/s, health, technology autonomy, gerontechnology, electric powered wheelchairs, socially assistive robotics, virtual reality, simulation

Language: English/French; Date of publication: 1990 onwards

Thematic analysis undertaken to elicit key points

Summary of Literature Review Sources (n=79)

Country N Type ofResearch

N Type of Source

N Key focus N

UK 20 Practice report/ perspective

18 Journal article 48 AT training/ education

29

France 19 Evaluation/ survey

10 Report 11 Barriers in use of AT

15

USA/Canada 27 Qualitative 9 Online source 11 Background 12

Europe* 7 Guest Editorial 2 Book 6 Evaluation of AT 10

Australia 3 Systematic Review

2 Conference paper 3 AT principles/ practice

6

Unknown 2 Literature Review

2 Abandonment of AT

3

UK/France 1 Case Study 2 Opportunities/ access to AT

2

RCT 1 Impact of AT 2

Action Research 1

*Papers were from Sweden, Italy, Switzerland, Netherlands

Findings from the Review –Overall themes

1. Barriers to adopting AT solutions2. Training of HCPs3. Barriers to training in AT practice

Barriers to adopting AT solutions

Inadequate information about appropriate AT solutions

Complexities relating to financing/funding, acquisition and prescription/ recommendation of devices

Obtrusiveness and stigmatisationexperienced when using AT

The above challenges contribute to abandonment of AT

Training of healthcare professionals

Need for HCPs to be aware of availability and application of AT devices

Lack of knowledge of healthcare regarding AT solutions

Shortfalls in communication amongst professional groups and between HCPs/users

Strong need for evaluation and assessment tools regarding the benefits of AT

Barriers to training in AT practice

Different AT terminology/definitions across disciplines

Inconsistent provision and quality of AT training

Lack of evaluation of training

Lack of access to professional help in area of AT

Lack of resources and funding

Shortage of qualified professionals to teach

Increasingly rapid development of technologies

Conclusions Technology that enhances reablement/rehabilitation

will increase in future - growing need for HCPs to be aware of availability and application of AT devices

Challenges in availability, assessment and provision of appropriate AT leads to isolation of users, loss of independence, abandonment of devices

Support, training and education for HCPs/AT users is vital in adoption and use of devices

Need for comprehensive education, ongoing assessment and evaluation in AT field

Paucity of studies examining content and impact of AT training and longer term outcomes – further research and evidence required

An Online Survey of AT Knowledge and Experiences of

HCPs in the UK and France

Background to Survey

Literature Review Findings

Review themes informed survey thematic areas

Benchmarking Exercise

Mapping of relevant healthcare services and training of key professional groups in UK and French survey regions

Purpose of the Survey

To inform the development of the training programme to be designed for the purposes of the ADAPT project

Survey Development

Survey Design:

Existing studies

Project Team Expertise

Pilot of draft survey to refine content and presentation

• Arthanat, S., Elsaesser, L.J. and Bauer, S. (2016) ‘A survey of assistivetechnology service provisions in the USA’, Disability and Rehabilitation: AssistiveTechnology, 12(8), pp 789-800.

• De Joode, E.A., Van Boxtel, M.P.J., Verhey, F.R. and Van Heugten, C.M. (2012)‘Use of assistive technology in cognitive rehabilitation: Exploratory studies of theopinions and expectations of healthcare professionals and potential users, BrainInjury, 26(10), pp 1257-1266.

• Long, T.M., Woolverton, M., Perry, D.F. and Thomas, M.J. (2007) ‘Training needsof paediatric occupational therapists in assistive technology’, American Journal ofOccupational Therapy, 61, pp 345-354.

• Nieboer, M.E., van Hoo, J., Van Hout, A.M., Aarts, S. and Wouters, E.J.M. (2014)‘Professional values, technology and future health care: The view of health careprofessionals in The Netherlands’, Technology in Society, 39, pp 10-17.

• Somerville, N.J., Wilson, D.J., Shanfield, K.J. and Mack, W. (1990) ‘A survey ofthe Assistive Technology Training Needs of Occupational Therapists’, AssistiveTechnology, 2, pp 41-49.

Survey Methods

Survey structure:

37 open/closed/multiple-choice questions

4 main sections

Circulation – June-November 2018

UK: 237 emails (mapped organisations), plus 56 NHS trusts (portfolio study)

FR: 1180 professionals/institutions

Ethics Approval:

UK (Local / NHS HRA)

FR (Not required)

Online Delivery:

Bristol Online Survey (BOS) (UK)

Google Forms (FR)

• Age / Gender / Profession / Qualifications / geographical location / work remit (e.g. hospital) / years qualified / AT organisation membership

Demographics

•Overall AT knowledge on AT service provision

Knowledge

•Current experience and how AT is used in practice

Experiences of working with AT

•Current level of training and training requirements

Training needs

Survey Participant Demographics

Total sample within ADAPT regions = 429: UK* =167 / FR = 262

* Total Sample in UK = 965 (findings from overall UK sample to be reported elsewhere)

46.6%

6.5%2.3%

22.1%

7.6%

FR Professions

OT Physio SLT

Nurse Audiologist Orthotist

Prosthetist Doctor Counsellor

Scientist Technologist Education

Manufacturer Researcher Other

34.1%

16.8%16.8%10.8%

11.4%

UK Professions

OT Physio SLT

Nurse Audiologist Orthotist

Prosthetist Doctor Counsellor

Scientist Technologist Education

Manufacturer Researcher Other

Survey Participant Demographics

82.8%

17.2%FR

Female Male

89.2%

10.8%UK

Female Male

17.4%

21.3%

31.1%

26.3%

UK

18-29 30-39 40-49

50-59 60-69 70+

17.9%

32.8%23.3%

21.4%FR

18-29 30-39 40-49

50-59 60-69 70+

29.3%

48.5%

11.4%

UK

Doctorate MastersBachelors DiplomaOther

13.0%

75.2%

FR

Doctorate MastersBachelors DiplomaOther

Gender Years of Qualification

Age Level of Education

66.5%

UK

<2 2-4 4-6 6-8 8-10 10+

62.2%

FR

<2 2-4 4-6 6-8 8-10 10+

Survey Participant Demographics

30.5%

14.1%7.3%

27.1%

FR

Hospital Community Charity

Private Education Self-employed

Membership of AT Organisation:

Percentage of professionals who are members of AT organisations is higher in France (10.3%) than the UK (2.3%)

Type of Health Care Service

9.0%

66.5%

UK

Hospital Community Charity

Private Education

Findings – Knowledge of AT

86.2%

7.8% 6.0%

94.3%

3.8% 1.9%

StronglyAgree/Agree

Don't Know Strongly Disagree/ Disagree

AT helps people complete difficult tasks

UK France

52.7%

42.5%

3.0% 1.2%

82.4%

15.3%

1.9% 0.4%

Always/On aregular basis

Sometimes Don't Know No

Use of AT relies on support from carers, family and professionals

UK France

Findings – Knowledge of AT

93.3%

6.0%0.6%

42.8%

3.4%

53.8%

StronglyAgree/Agree

Don't Know Disagree

AT provides more autonomy

UK France

p<.001 p<.001

45.5%

20.4%

34.1%

84.7%

11.8%3.4%

Strongly Agree/Agree Don't Know Strongly Disagree /Disagree

AT is provided by trial and error

UK France

Findings – Knowledge of AT

p<.001

28.8%

18.5%

52.7%

71.8%

13.4% 14.9%

Strongly Agree/Agree Don't Know Strongly Disagree /Disagree

AT refers exclusively to technologically-advanced electronic devices

UK France

Findings – Experiences of AT practice

Those who can prescribe AT include:

UK France

Findings – Experiences of AT practice

13.2%

46.7%

6.6%

33.5%

21.2%

75.5%

2.1% 1.2%

Yes, in depth To a lesser degree Don't know No

Knowledge to compare and choose AT

UK France

A third of all HCPs did not know if AT users had access to adequate resources/support (UK 35.5%; FR 27.5%)

A third of HCPs felt capable of monitoring continued effective use of AT (UK 38.9%; FR 34.8%)

HCPs in both countries would benefit from interdisciplinary clinical standards (UK 80%; FR 77.1%)

Conclusions

Knowledge and application of AT was varied between UK and France - possibly due to differences in health care provision and support mechanisms

Survey findings suggest HCPs recognised value of AT for users’ improved care but had low confidence in their ability to choose appropriate AT solutions and monitor continued use, and would welcome AT interdisciplinary clinical standards.

Inevitable challenges for workforce development – need to:

Explore further reasons for variations between countries

Implementation of training in response to training needs

Training Needs and Development of Online AT Training for HCPs in UK and

France

Background

Part of the ADAPT Project is the development of AT training for HCPs to enable them to use AT effectively in practice.

The focus of the presentation is twofold:

Present survey results that refer to training needs of HCPs in both UK and France who indicate their training needs for AT

Present the process of development of online AT training for health care professionals in UK and France

Education and Training Needs Access to AT specific training – Big issue!

Majority of survey respondents had no specific AT training or in-service in both countries

12.6%

65.9%

21.6%16.4%

46.9%

36.6%

Yes No Don’t know

In-service AT training

UK

France

6.6%

93.4%

18.7%

81.3%

Yes No

AT training qualifications

UK

France

Total sample = 429; UK =167, France = 262

Barriers to AT training More than half of survey respondents identified

organisational barriers to AT training including lack of local training funding constraints in both countries

27.5%

19.2%

36.5%

22.8%

61.7% 62.9%

25.6%33.6%

38.5%

22.9%

50.0%55.7%

Onlineresources

Publishedresources

Ongoing CPD Nationaltraining

Local training Funding fortraining

UK France

Total sample = 429; UK =167, France = 262

AT Education and Training Priorities

Priority needs Specific detail UK France

Knowledge of AT devices & services

Different types of AT, availability, suitability & operation

94% 81.3%

Customisation of AT Adaptation of devices, EB applications 30.1% 65.3%

Holistic assessment of client needs

How to assess comprehensively to increase client satisfaction , reduce abandonment? Follow-up assessment?

25.3% 53.4%

Client/carer/family education about AT

Client/user interface, carer involvement, support & training

28.3% 56.5%

To bridge gaps in knowledge and identified training needs of healthcare professionals in Assistive Technologies

ADAPT AT training is an online interactive programme which starts by introducing Foundations of AT and moves on to specialist Units, e.g. AT for Mobility, Communication, Evidence-Based Practice.

Purpose of ADAPT AT Training

UNDERPINNING FRAMEWORK: The biopsychosocial model of World Health Organisation’s (WHO)

International Classification of Functioning, Disability and Health (ICF) framework underpin development of content.

ICF shifts focus from disability to health and functioning, in line with a social model of rehabilitation.

Contextual Factors

Underpinning Framework of Training Units

Biopscyhosocial Model of Disability(Engel 1977)

Conceptual Interaction

International Classification of Health and Disability(WHO 2001)

embedded

Pilot of Unit 1 – analysis of feedback and further refinement of content, presentation and mode of delivery

Launch of Unit 1 in April 2019 in UK – CCCU students and HCP academics.

Embedded evaluation questionnaire in each Unit

6 month follow-up evaluation questionnaire – find out usefulness & application of training in workplace

Process of development of Training Units

• Learning Outcomes –Content layout

• Format -Evaluation

Development of Content

• Interactive Text –short presentations

• Self-Reflection points

Delivery and e-learning

tools

• Workshops with partners

• Advisory Stakeholder Group

Feedbackprocess

Aim 75 participants - 59 signed up for training, 35 completed

ADAPT AT Training – UK & French Advisory Groups

East Kent Hospitals University NHS Foundation Trust

Cornwall Mobility

University of Kent

Centre for Independent Living Kent

Chailey Clinical Service

Service Users

Family Carers/Personal Assistants

CCCU Staff Disabilities Network

Kent Physical Disability Forum

UK Adapt group members

Unit 1: Foundations of AT

Coursesites e-learning platform

Moodle e-learning platform

Unit 1: Foundations of AT

PowtoonMicrosoft Sway

ADAPT AT Training Units

Knowledge of AT Devices & services

Customization of AT

Holistic Assessmentof client needs

Client/carer/family education around AT

Identified training needs

Ove

rvie

w o

f U

nits

Work in progress

Concentrating on developing content for other units in collaboration with the French – similar main content adjusted to suit UK/French training needs

Upcoming meeting with French in UK to discuss/finalise content for unit 2 and 3.

Transfer all training content to Moodle