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Accepted methods of enquiry to address qualitative research questions are focus groups and interviews, enabling access to the experiences, opinions, and perspectives of participants. However use of these methods with people with dementia is problematic because this condition can impair verbal communication in addition to other domains. These challenges can have a significant impact when trying to obtain insight from an individual through conversation and discussion. As researchers, we should be creating alternative methods that place equal importance on behaviour that is non-verbal as well as verbal. This contribution highlights the need for the advancement of creative qualitative methods drawing on lessons learned of the benefits and challenges during the development of a novel approach to support the use of visual methods in dementia research. By focussing on all that is retained and done well, emphasising individual strengths and abilities, offers an increasingly prevalent alternative to existing loss-deficit models that have characterised dementia research in the past. This approach highlights the importance and appropriateness of visual methods in enabling meaning and transparency throughout the research process from ethical approval and consent procedures through to the collection, analysis, dissemination, and impact of the research data. [ABSTRACT FROM AUTHOR]

Background: Health policy promotes post-diagnostic support for people affected by dementia. Evidence suggests psychosocial interventions can effectively support people living with dementia after diagnosis. Yet, what influences uptake of psychosocial interventions by people with early dementia is poorly understood. This research aimed to identify influences on uptake of psychosocial interventions by people with early dementia. Methods: Sixteen face-to-face semi-structured interviews with people with early dementia, either alone or with a family member(s), were completed. Twelve staff participated in semi-structured interviews or a focus group. Thematic analysis and triangulation enabled identification of overall themes across different participant groups and interview types. Main Findings: Four overarching themes influencing uptake were identified: (1) adjusting to a diagnosis, (2) appeal of activities and perception of benefit, (3) service and societal context, and (4) relationships and communication. Individual responses to diagnosis, experiences of dementia and dementia services influenced uptake. Group interventions were discussed the most by all participants. Group interventions offering social contact, peer support, information, enjoyable activities and mental stimulation were valued. However, group interventions specifically aimed at people with dementia did not appeal to all. Ability to travel and convenience of locations were important. Continuing with community activities not focused on dementia was valued. Stigma around dementia appeared to discourage uptake. Emotional and practical support from family was key to facilitating uptake as were the relationships between people with dementia and staff. Conclusion: A complex interplay of individual, service and societal influences affect uptake of psychosocial interventions by people with early dementia. How interventions and which services can enable people with early dementia remain engaged in their everyday lives needs consideration. Further research examining uptake of specific interventions commonly offered to people living with early dementia is needed. Involving people with early dementia in designing interventions aiming to support them is paramount. [ABSTRACT FROM AUTHOR]

Introduction: Opportunities to participate with enjoyable activities is one of the most frequently reported unmet needs by the person living with dementia. Enabling and intuitive technologies may offer accessible ways to engage with such activities. Objectives: To explore how tablet computers might encourage participation in enjoyable activities by people with moderate levels of dementia and to consider how such technologies might be incorporated into the repertoire of activities currently provided through day care settings. Methods: A focused visual ethnographic approach was developed specifically to meet the research objectives. Twelve participants attending a community day care centre and nine supporters (both volunteers and paid staff) consented to take part in the research. Technology facilitated group activity sessions took place twice a week for a period of four weeks and all were video recorded. Findings: Video analysis demonstrated that the majority of people with dementia found the technology an effective means of participating in enjoyable activities. Analysis also revealed the extent to which participation relies on the existence of effective support. It showed how maintaining focus on retained strengths and abilities enabled the group overall to meet and often exceed their own and others perceived capacity to participate. Finally, analysis confirmed the importance of enjoyment of activities 'in the moment' and the need for those supporting people in the moderate stages of dementia to acknowledge and work with this. Conclusion: The use of tablet computers to enhance participation in sociable and enjoyable activities in day care settings is realistic and achievable if supported appropriately. [ABSTRACT FROM AUTHOR]

Introduction Health policy promotes living well with dementia. Occupational therapists deliver interventions to support people with dementia and family carers to live well. This study aimed at identifying influences on uptake of a community occupational therapy intervention by people with dementia and carers, as little evidence about this topic exists. Method Seventeen semi-structured, paired interviews with people with dementia and carers were conducted as part of the 'Valuing Active Life in Dementia' research programme. A secondary, qualitative analysis of these interviews explored influences on uptake of the intervention. Findings Four main themes were identified: 'Grabbing at straws and keen to take part'; 'We're trying to put a routine in'; 'We didn't know what to expect', and 'Give it a go'. Factors identified as potentially influencing uptake included whether the intervention was perceived as potentially meeting needs for support and activity, and whether participants were struggling to adjust or cope. Conclusion Despite limited expectations or apprehension, uptake of this intervention was demonstrated. Understanding why people with dementia and carers accept intervention offers can inform what occupational therapists provide and how it is offered. Further research is required to determine the occupational therapy interventions people with dementia and carers might find supportive at different stages of the disease trajectory. [ABSTRACT FROM AUTHOR]

Despite reported benefits of Telecare use for older adults, uptake of Telecare in the United Kingdom remains relatively low. Non-users of Telecare are an under-researched group in the Telecare field. We conducted 22 qualitative individual semi-structured interviews to explore the views and opinions of current non-users of Telecare regarding barriers and facilitators to its use, and explored considerations which may precede their decision to accept, or reject, Telecare. Framework analysis identified a number of themes which influence the outcome and timing of this decision, including peace of mind (for the individual and their family), the strength and composition of an individual's support network, the impact of changing personal and health circumstances, and lack of communication about Telecare (e.g. advertising). A cost–benefit decision process appears to take place for the potential user, whereby the benefit of peace of mind is weighed against perceived 'costs' of using Telecare. Telecare is often perceived as a last resort rather than a preventative measure. A number of barriers to Telecare use need to be addressed if individuals are to make fully informed decisions regarding their Telecare use, and to begin using Telecare at a time when it could provide them with optimal benefit. Although the study was set in England, the findings may be relevant for other countries where Telecare is used. [ABSTRACT FROM AUTHOR]

Introduction: To develop occupational therapy's evidence base and improve its clinical outcomes, occupational therapists must increase their research involvement. Barriers to research consumption and leadership are well documented, but those relating to delivering research interventions, less so. Yet, interventions need to be researched within practice to demonstrate their clinical effectiveness. This study aims to improve understanding of challenges and enablers experienced by occupational therapists who deliver interventions within research programmes. Method: Twenty-eight occupational therapists who participated in the Valuing Active Life in Dementia (VALID) research programme reported their experiences in five focus groups. Data were analysed thematically to identify key and subthemes. Results: Occupational therapists reported that overwhelming paperwork, use of videos, recruitment and introducing a new intervention challenged their research involvement, whereas support, protected time and a positive attitude enabled it. The impact of these challenges and enablers varied between therapists and organisations. Conclusion: Challenges and enablers to research involvement can be identified but must be addressed within individual and organisational contexts. Multifaceted collective action to minimise challenges and maximise enablers can facilitate clinicians' involvement in research. Using this approach should enable occupational therapists to increase their research involvement, thus demonstrating the clinical effectiveness of their interventions. [ABSTRACT FROM AUTHOR]

Challenges were encountered when attempting to analyse video based data during a project exploring touch screen computer technology with people living with dementia. In order to inform the analytic process, a scoping review of published evidence was undertaken. Results of the scope illustrated the use of various techniques when analysing visual data, the most common of which was the transcription of video into text and analysed using conversation analysis. Three additional issues emerged in the course of the review. First, there is an absence of detail when describing the ethical implications involved when utilising visual methods in research. Second, limited priority is given to providing a clear rationale for utilising visual methods when audio or field notes may have been a viable alternative. Third, only 40% of reviewed articles clearly stated a chosen methodology. The conclusions of the review illustrate a lack of consistency across studies in the overall reporting of research methods and recommend that authors be explicit in their reporting of methodological issues across the research process. [ABSTRACT FROM PUBLISHER]

Background: The increasing prevalence and associated cost of treating Chronic Obstructive Pulmonary Disease (COPD) is unsustainable, and focus is needed on self-management and prevention of hospital admissions. Telehealth monitoring of patients' vital signs allows clinicians to prioritise their workload and enables patients to take more responsibility for their health. This paper reports the results of a qualitative study embedded within a feasibility and pilot Randomised Controlled Trial (RCT) of Telehealth-supported care within a community-based COPD supported-discharge service. The aim of the study was to qualitatively explore the experiences of patients with COPD who had received either a Telehealth-supported or a specialist nursing intervention following their discharge from hospital after an admission for a COPD exacerbation.Methods: Patients were invited to either participate in semi-structured interviews or to complete a semi-structured self-administered questionnaire on completion of the intervention. Nine patients were interviewed (67 % female) and seventeen patients completed the questionnaires. In addition, three clinicians responsible for the delivery of both interventions were interviewed to obtain their perspectives on the new services.Results: Seven underlying themes emerged from the patient interviews and were further explored in the questionnaires: (1) patient demographics; (2) information received by the participants; (3) installation of the Telehealth technology; (4) Telehealth service functionality; (5) visits; (6) service withdrawal; and (7) service perceptions. Recipients of both services reported feelings of safety derived from the delivery of an integrated, community-based service.Conclusions: Although recipients of the Telehealth service received 50 % fewer home visits from the clinicians than recipients of a more traditional community-based nursing intervention, the patients were enthusiastic about the service, with some describing it as the best service they had ever received. This suggests that a Telehealth intervention is an acceptable alternative to a more traditional home nursing visit model for monitoring community-based patients with COPD following their discharge from hospital.Trial Registration: Current Controlled Trials ISRCTN68856013. [ABSTRACT FROM AUTHOR]

Background: Adoption of telehealth has been slower than anticipated, and little is known about the service improvements that help to embed telehealth into routine practice or the role of frontline staff in improving adoption. This paper reports on participatory action research carried out in four community health settings using telehealth for patients with Chronic Obstructive Pulmonary Disease and Chronic Heart Failure.Methods: To inform the action research, in-depth case studies of each telehealth service were conducted (May 2012-June 2013). Each service was then supported by researchers through two cycles of action research to implement changes to increase adoption of telehealth, completed over a seven month period (July 2013-April 2014). The action research was studied via observation of multi-stakeholder workshops, analysis of implementation plans, and focus groups.Results: Action research participants included 57 staff and one patient, with between eight and 20 participants per site. The case study findings were identified as a key source of information for planning change, with sites addressing common challenges identified through this work. For example, refining referral criteria; standardizing how and when patients are monitored; improving data sharing; and establishing evaluation processes. Sites also focused on raising awareness of telehealth to increase adoption in other clinical teams and to help secure future financial investment for telehealth, which was required because of short-term funding arrangements. Specific solutions varied due to local infrastructures, resources, and opinion, as well as previous service developments. Local telehealth champions played an important role in engaging multiple stakeholders in the study.Conclusions: Action research enabled services to make planned changes to telehealth and share learning across multiple stakeholders about how and when to use telehealth. However, adoption was impeded by continual changes affecting telehealth and wider service provision, which also hindered implementation efforts and affected motivation of staff to engage with the action research, particularly where local decision-makers were not engaged in the study. Wider technological barriers also limited the potential for change, as did uncertainties about goals for telehealth investment, thereby making it difficult to identify outcomes for demonstrating the added value over existing practice. [ABSTRACT FROM AUTHOR]

Aims To examine frontline staff acceptance of telehealth and identify barriers to and enablers of successful adoption of remote monitoring for patients with Chronic Obstructive Pulmonary Disease and Chronic Heart Failure. Background The use of telehealth in the UK has not developed at the pace and scale anticipated by policy. Many existing studies report frontline staff acceptance as a key barrier, however data are limited and there is little evidence of the adoption of telehealth in routine practice. Design Case studies of four community health services in England that use telehealth to monitor patients with Chronic Obstructive Pulmonary Disease and Chronic Heart Failure. Methods Thematic analysis of qualitative interviews with 84 nursing and other frontline staff; and 21 managers and key stakeholders; data collected May 2012-June 2013. Findings Staff attitudes ranged from resistance to enthusiasm, with varied opinions about the motives for investing in telehealth and the potential impact on nursing roles. Having reliable and flexible technology and dedicated resources for telehealth work were identified as essential in helping to overcome early barriers to acceptance, along with appropriate staff training and a partnership approach to implementation. Early successes were also important, encouraging staff to use telehealth and facilitating clinical learning and increased adoption. Conclusions The mainstreaming of telehealth hinges on clinical 'buy-in'. Where barriers to successful implementation exist, clinicians can lose faith in using technology to perform tasks traditionally delivered in person. Addressing barriers is therefore crucial if clinicians are to adopt telehealth into routine practice. [ABSTRACT FROM AUTHOR]

Purpose: Technology could support the self-management of long-term health conditions such as chronic pain. This article describes an evaluation of SMART2, a personalised self-management system incorporating activity planning and review, feedback on behaviour- and acceptance-based therapeutic exercises. Method: The SMART2 system was evaluated over a four-week trial in the homes of people in chronic pain. At conclusion, participants were interviewed to understand the experience of using and living with the SMART2 system as a therapeutic tool. Results: Qualitative analysis of the interviews found that participants liked the system and reported making associated changes to their behaviour. Goal setting and feedback were the most useful elements of the system. A third key and unexpected element was that by simulating some of the functions of a therapist, SMART2 also simulated some of the process of interacting with a therapist. Conclusions: People in chronic pain may experience positive outcomes when using a self-management system designed for behaviour change. Furthermore, some of the supportive aspects of the therapeutic context can be elicited by self-management technologies. [ABSTRACT FROM AUTHOR]

BACKGROUND: Issues relating to design and suitability of Telecare were raised twenty years ago. We explored the views of non-users of Telecare and examined whether design-related barriers exist today despite significant technological advances. OBJECTIVE: To examine the reasons why people choose not to adopt Telecare, with specific focus on reasons relating to design and suitability of the intervention. METHODS: Individual qualitative semi-structured interviews were conducted with people who were not using or had actively declined Telecare, a voice which is rarely heard in Telecare-barrier research. Framework analysis was used to identify existing and emergent themes for n=22 participants. RESULTS: Sub-themes relating to design and suitability of Telecare were explored: Stigma, i.e. Telecare as symbolising old age and lost independence; Design, including stigmatising aesthetics and inappropriate use; Alternative options, i.e. propensity to seek non-Telecare solutions; Awareness of the devices and service; and Cost. CONCLUSIONS: Barriers to Telecare use are similar for both users and non-users. Our results indicate that design-related barriers have yet to be addressed despite the technological revolution. The cost model of Telecare services is becoming more consumer-driven. Thus Telecare design needs to exploit technological advances in order to improve wellbeing and allow individuals their choice and independence. [ABSTRACT FROM AUTHOR]

Aim To synthesize qualitative and quantitative evidence of front-line staff acceptance of the use of telehealth technologies for the management of Chronic Obstructive Pulmonary Disease and Chronic Heart Failure. Background The implementation of telehealth at scale is a governmental priority in countries including the UK, USA and Canada, but little research has been conducted to analyse the impact of implementation on front-line nursing staff. Data sources Six relevant data bases were searched between 2000-2012. Design Mixed-method systematic review including all study designs. Review methods Centre for Reviews and Dissemination approach with thematic analysis and narrative synthesis of results. Results Fourteen studies met the review inclusion criteria; 2 quantitative surveys, 2 mixed-method studies and 10 using qualitative methods, including focus groups, interviews, document analysis and observations. Identified factors affecting staff acceptance centred on the negative impact of service change, staff-patient interaction, credibility and autonomy, and technical issues. Studies often contrasted staff and patient perspectives, and data about staff acceptance were collected as part of a wider study, rather than being the focus of data collection, meaning data about staff acceptance were limited. Conclusion If telehealth is to be implemented, studies indicate that the lack of acceptance of this new way of working may be a key barrier. However, recommendations have not moved beyond barrier identification to recognizing solutions that might be implemented by front-line staff. Such solutions are imperative if future roll-out of telehealth technologies is to be successfully achieved. [ABSTRACT FROM AUTHOR]

The Lifestyle Matters study was undertaken with 288 participants randomized to one of two study arms to understand whether the Lifestyle Redesign intervention could be implemented within the United Kingdom. The results will inform the use of such preventive interventions in occupational therapy practice. [ABSTRACT FROM AUTHOR]