On Wednesday the 8th May 2019 we ran a workshop on 'Identifying facilitators and barriers for monitoring physical frailty at home using technology' at Westfield Health. Dr Phil Joddrell who organised the workshop provides us with a brief outline:
A consequence of the UK’s ageing population is that a substantial number of people become frail, where a gradual decline of functioning can lead to serious complications. Early identification and intervention is key to delaying, or even preventing, further deterioration. A research team comprising health and academic partners in Sheffield is developing a system to identify and monitor frailty in people’s homes using technology. This will enable people to implement positive changes, and support clinicians by integrating with routine health and social care services.
A workshop was held in May 2019 with a range of stakeholders representing service users, healthcare providers, health professionals and technology industry experts, with the remit of identifying facilitators and barriers for the development and implementation of the at-home frailty monitoring system.
In the first phase of the workshop, attendees were asked to describe the features that would make the system successful from their perspective, and identify potential benefits. There were several overlapping themes between the different groups of stakeholders, namely that: the system should facilitate early identification of decline, thus enabling intervention to improve and prevent further deterioration; it should allow for data sharing, with the intention of promoting integrated practice; and that usability will be instrumental to the system’s chances of success and adoption. In addition to these overlapping themes, service users identified improved familial relationships as a benefit of an effective system; health authority representatives highlighted the potential benefits for relatives and carers, as well as supporting independent living; and the clinicians suggested that the system could be used for monitoring adherence to various programmes, e.g. rehabilitation or exercise.
In the second phase, the focus was on the potential barriers that might prevent the system from being effective. Overlapping themes between the groups included non-adoption or non-adherence by the user due to a variety of reasons including lack of interest or motivation; the costs associated with all aspects of the system (i.e. production, installation, purchase, maintenance, etc.); and data privacy concerns (although, interestingly, this was not raised by the potential service users). Isolated themes limited to single groups included the potential stigmatisation caused by the terminology used to describe or market the system, discussed by clinicians; and the possibility of the information generated by the system having negative impacts on the users, highlighted by the service users themselves.
For the workshop’s third and final phase, solutions to the aforementioned barriers were proposed and then ranked. The top priority solutions selected by the attendees were: to create an unobtrusive system taking advantage of daily activities and existing equipment; to incorporate a social aspect to the system, allowing users to communicate and even compare performance against family and friends; to implement creative cost-saving solutions such as subsidised use and reimbursement upon return of the devices; to ensure transparency and clarity when communicating how the generated data is shared, and to obtain consent and permissions; to consider avoiding the term ‘frailty’ entirely to reduce stigma; and to provide education alongside the data to minimise the risk of having negative impacts.
The next stage of this research will be to organise a consortium featuring representatives of each of the involved groups and develop a proposal to a national or European funding body to develop and evaluate the at-home frailty monitoring system. This process will be heavily informed and influenced by the priorities ascertained from this workshop.