Te Boekhorst Karlijn E, Kuipers Sanne J, Ribbers Gerard M, Cramm Jane M
Socio-Medical Sciences Department, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
Rehabilitation Medicine Department, Erasmus University Medical Centre, Rotterdam, The Netherlands.
BMC Health Serv Res. 2025 Jan 4;25(1):21. doi: 10.1186/s12913-024-12044-2.
Rehabilitation technology is a growing field, but the sustainable implementation of these technologies, particularly in home settings, is lacking. The aim of this study was to explore the factors influencing the uptake of stroke rehabilitation technology among various stakeholders, including developers, healthcare professionals, individuals who had strokes, strategic experts, management and innovation staff, health insurers, and the National Health Care Institute.
In total, 22 semi-structured interviews were conducted with a purposive stakeholder sample. The Non-adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework was used as the theoretical basis for the interview design. The interview content was analysed to generate (sub)themes representing factors influencing the implementation of home-based rehabilitation technology. These (sub)themes were organised according to the NASSS framework domains to ensure a systematic and theoretically grounded analysis.
Ten influencing factors emerged, nine of which fell within six of the seven NASSS domains. These factors include: (1) the unpredictable aftermath of stroke, (2) technology (mis)alignment with care delivery processes and end users' preferences, (3) disparities in the assessment of technology's value, (4) differences in commercial and university developers' interests, (5) patient group capabilities, (6) perceived workload, (7) formal implementation plans in rehabilitation centres, (8) laws and regulations, and (9) the financial system. The factor that did not align with a single NASSS domain was: (10) the fragmentation of responsibilities among diverse stakeholders.
This study shows that the sustainable implementation of home-based rehabilitation technology faces several challenges across multiple domains of the NASSS framework. Effective collaboration among stakeholders is crucial for addressing these challenges but is currently hindered by fragmented responsibilities. To improve collaboration, it is essential to clearly define the roles and responsibilities of all stakeholders. Additionally, national-level policies adopting a systems approach are necessary to align these responsibilities and foster effective collaboration.
康复技术是一个不断发展的领域，但这些技术的可持续实施，尤其是在家庭环境中的实施，仍存在不足。本研究的目的是探讨影响包括开发者、医疗保健专业人员、中风患者、战略专家、管理和创新人员、健康保险公司以及国家医疗保健机构在内的各利益相关者采用中风康复技术的因素。
对一个有目的的利益相关者样本进行了总共22次半结构化访谈。非采用、放弃、扩大规模、传播和可持续性（NASSS）框架被用作访谈设计的理论基础。对访谈内容进行分析，以生成代表影响家庭康复技术实施的因素的（子）主题。这些（子）主题根据NASSS框架领域进行组织，以确保进行系统且基于理论的分析。
出现了十个影响因素，其中九个属于NASSS七个领域中的六个。这些因素包括：（1）中风不可预测的后果；（2）技术与护理提供流程及最终用户偏好的（不）匹配；（3）对技术价值评估的差异；（4）商业开发者和大学开发者利益的差异；（5）患者群体能力；（6）感知到的工作量；（7）康复中心的正式实施计划；（8）法律法规；（9）金融系统。与单个NASSS领域不匹配的因素是：（10）不同利益相关者之间责任的分散。
本研究表明，家庭康复技术的可持续实施在NASSS框架的多个领域面临若干挑战。利益相关者之间的有效合作对于应对这些挑战至关重要，但目前因责任分散而受到阻碍。为了改善合作，明确界定所有利益相关者的角色和责任至关重要。此外，需要采用系统方法的国家层面政策来协调这些责任并促进有效合作。
