Fortune Jennifer, Manikandan Manjula, Harrington Sarah, Hensey Owen, Kerr Claire, Koppe Sebastian, Kroll Thilo, Lavelle Grace, Long Siobhán, MacLachlan Malcolm, Nolan Denis, Norris Meriel, O'Reilly Jason, Owens Mary, Walsh Aisling, Walsh Michael, Ryan Jennifer M
School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
Public and Patient Involvement (PPI) Partner, Cork, Ireland.
BMC Health Serv Res. 2024 Mar 11;24(1):323. doi: 10.1186/s12913-024-10652-6.
Using digital technologies to provide services and supports remotely may improve efficiency and accessibility of healthcare, and support people with disabilities to live independently. This study aimed to explore the experience of using digital technologies to access and provide disability services and supports during the Covid-19 pandemic, from the perspective of people with disabilities, families and service providers.
Using a multiple case study design, we purposively sampled three cases based on service user characteristics and geographical reach of the service. We conducted semi-structured interviews with 40 service users and service providers. Topic guides and analysis were informed by the Consolidated Framework for Implementation Research (CFIR). Analysis followed a largely deductive approach, using the CFIR constructs as a coding framework. A summary memo was developed for each case. Influence and strength of each construct was rated to identify constructs that influenced implementation of digital technologies. Ratings were compared across services to identify facilitators and barriers to implementation.
Service users and providers were positive about using digital technologies to access and provide disability services and supports remotely. Advantages over in-person delivery included reduced travel time, increased opportunity for peer support and peer learning, more choice and opportunity to participate in activities, and an enhanced sense of self while accessing services from the secure environment of their home. The urgency to identify new modes of service delivery to meet the needs of service users during Covid-19 was a strong facilitator but did not necessarily result in successful implementation. Other factors that were strong facilitators were the use of adaptations to enable service users to access the online service, service users' willingness to try the online service, service users' persistence when they encountered challenges, and the significant time and effort that service providers made to support service users to participate in the online service. Barriers to implementation included the complexity of accessing online platforms, poor design quality of online platforms, and organisations prioritising in-person delivery over online services.
These findings may allow service providers to leverage facilitators that support implementation of online disability services and supports.
利用数字技术远程提供服务和支持可能会提高医疗保健的效率和可及性，并帮助残疾人独立生活。本研究旨在从残疾人、家庭和服务提供者的角度，探索在新冠疫情期间使用数字技术获取和提供残疾服务及支持的体验。
采用多案例研究设计，我们根据服务使用者特征和服务的地理覆盖范围有目的地抽取了三个案例。我们对40名服务使用者和服务提供者进行了半结构化访谈。主题指南和分析以实施研究综合框架（CFIR）为依据。分析主要采用演绎法，将CFIR构建作为编码框架。为每个案例编写了一份总结备忘录。对每个构建的影响和强度进行评级，以确定影响数字技术实施的构建。对各服务的评级进行比较，以确定实施的促进因素和障碍。
服务使用者和提供者对使用数字技术远程获取和提供残疾服务及支持持积极态度。与面对面服务相比，优势包括减少出行时间、增加同伴支持和同伴学习的机会、更多参与活动的选择和机会，以及在从家中安全环境获取服务时增强的自我意识。在新冠疫情期间，确定新的服务提供模式以满足服务使用者需求的紧迫性是一个强大的促进因素，但不一定导致成功实施。其他强大的促进因素包括采用适应性措施使服务使用者能够访问在线服务、服务使用者尝试在线服务的意愿、服务使用者在遇到挑战时的坚持，以及服务提供者为支持服务使用者参与在线服务所付出的大量时间和精力。实施的障碍包括访问在线平台的复杂性、在线平台的设计质量差，以及组织优先考虑面对面服务而非在线服务。
这些发现可能会使服务提供者利用支持在线残疾服务及支持实施的促进因素。
