Non-use of provided assistive technology devices, a literature overview

Outline

Introduction Methods Results Discussion Strategies to reduce non-use of provided

assistive technology

Introduction a solid theoretical framework is not yet available if large numbers of devices are not being used

resources are not being spent efficiently problems might not be solved optimally professionals in assistive technology service delivery w

ant to do their job well adherence (or compliance) with medical interventi

ons what degree non-use can be viewed as non-adh

erence and, based on that, we will see what strategies might be useful to prevent non-use

Methods

compare the definitions of non-use used in the various publications

listed the determinants identified, categorising them into four groups personal (client) factors factors related to the device intervention-related factors factors related to the user’s environment

Methods (cont.)

some basic literature on adherence with medical interventions is reviewed

non-adherence can be categorised into six groups intra-psychological factors characteristics of the disability environmental factors practical matters the client-professional relation the communication between client and profession

al

Results

Results from separate studies can hardly be compared

Definition of non-use Determinants of non-use of assistive technology

devices Personal (client) factors Factors related to the device Factors related to the user’s environment Intervention-related factors Determinants of adherence with medical

interventions

Definition of non-use

a device to be abandoned (or not used) when it has been replaced by a different type of device (e.g. when a cane has been replaced by a walking frame)

The device is not used at all; The device is not used full-time; The device is not used voluntarily; The device is not used at the time of questioning; The device is not used frequently; The device is not used for a substantial part of the day; The device is not used at any given point post-discharge; The average use is low; The device has not been used at least three times since prescription; The device is not used correctly; The device is not used for (all) the activities it was prescribed for.

Determinants of non-use of assistive technology devices on the effectiveness of prescribed devices in developing

or restoring function in activities of daily living or work roles

being concerned about how individuals would respond to assistive devices and an awareness of clients at times not valuing assistive devices to the extent therapists did

However, this concern has not lead to research into aspects beyond aesthetics and usability of devices.

The role of psychosocial aspects remains a frontier of knowledge.

Studies into non-use of assistive devices show an analogue development.

Personal (client) factors

rejection of obvious assistive devices is more common among people with slowly progressing disabilities

often influences the rate of use of assistive devices in a negative way, because the devices keep reminding the user of his disability

If a disability gets more severe, a device might no longer be sufficient

multiple devices

Factors related to the device

poor quality an unpleasant appearance will evoke nega

tive reactions on the other hand, if a device is portable, li

ghtweight and easy to use, it will be used more often and for a longer period of time

Factors related to the user’s environment social circle supports them in using the de

vice assistive devices might be adapted more o

ptimally to individual needs of a client concerning funding of assistive devices

Intervention-related factors

When users’ opinions are considered in the selection process, devices are more likely to be retained

correct provision process and installation follow-up service

Determinants of adherence with medical interventions A distinction can be made between short-term a

dherence and long-term adherence Five important characteristics of short-term adhe

rence Supervision/guidance A curative goal Outcome can be evaluated Complaints/symptoms serve as ‘cues’ Recovery serves as reward

long-term adherence

Discussion

Strategies to reduce non-use of provided assistive technology A training of professionals in conversation

and communication skills can be very helpful.

The user’s condition has improved or got worse or the environment has changed. This type of non-use can be managed by intro

ducing a recycling system. A training program can compensate a shor

tage of cognitive skills.