Overcoming the barriers to Mainstreaming Assisted Living Technologies (MALT): Methodological and practical issues in observing and effecting change in telehealth services

Abstract

Background: The successful mainstreaming of assisted living technologies remains an important policy and commercial concern within the UK. Despite this, local telehealth services have not developed at the pace and scale anticipated. This project, funded by the Technology Strategy Board through the Assisted Living Innovation Platform, aims to understand and seeks ways to overcome the financial, organisational and operational barriers to mainstreaming telehealth. Aim: To highlight and reflect on the methodological and practical issues in conducting participatory research in collaboration with telehealth services. Methods: Within the MALT study, a multi-disciplinary consortium of research organisations are collaborating with telehealth services in four specific sites in the Yorkshire and Humber region. The research is composed of two phases: phase 1 involves producing detailed qualitative case studies to identify barriers and facilitators to successful delivery of telehealth, with a view to developing ‘change projects’; the implementation and delivery of which will be explored through action research in phase 2. Results: The role of the research team in participatory action research is one of partnership and collaboration. However, there is a consultative element to projects of this nature, as the researchers work alongside stakeholders using the findings from phase 1 to inform the telehealth change projects to initiate and evaluate in phase 2. While participatory research methods are useful for understanding and evaluating change, this partnership approach blurs the role of researchers, who may be seen as imposing change by encouraging sites to look at ways to expand or improve their existing service at a time when cost effectiveness and patient benefit remain unclear. The pace of development regarding the wider use of assisted living technologies also has implications for this research project, given the growing consensus that telehealth should form only one part of a wider menu of digital options that clinicians use with their patients to promote selfmanagement. This broad approach to technology adoption underpins the Department of Health’s 3 Million Lives initiative, which can also be seen as an additional top down pressure at the local level International Congress on Telehealth and Telecare 2013, London, July 01-03, 2013. 2 International Journal of Integrated Care –Volume 13, 20 November –URN:NBN:NL:UI:10-1-115704– http://www.ijic.org/ to drive forward adoption and upscaling. This makes for complex, yet interesting, case studies within a context of wider structural and commissioning changes for NHS primary care, and equivocal evidence on the effectiveness of telehealth. Conclusion: The MALT study highlights the complexity of telehealth service re-design and the importance of the shifting policy emphasis and technological advancements. Crucially, as local services respond to these developments, the changes can be reactive and organic, and difficult to capture as the research moves forward. It is therefore crucial for the research team to maintain close and regular contact with participants to ensure the ongoing relevance of data collection, analysis and recommendations, and to manage the sometimes competing expectations for the research among different stakeholders. Maintaining this relationship is an integral aspect of the research, however the blurring of researcher roles requires careful reflection on both the extent of and limits to the role played in service development.