A Model of Web-based Follow-up to Reduce Assistive Technology Abandonment

The literature on assistive technology (AT) claims two main factors affect AT non-use: the perceived user interaction with the device and the quality of the AT service delivery process as experienced by the user. In particular, the first factor depends on: (i) how much the user’s needs have been met, (ii) the extent of the psychomotor skills needed to use the equipment, (iii) the attributes of the AT’s functioning, and/or (iv) training and support provided during and after delivery of the AT. If one or more of these aspects of interaction with the AT is perceived as problematic, users tend to abandon the device. The second factor, regarding the quality of the service delivery as experienced by users, during and after the AT assignation process, has been found to be strictly correlated with AT abandonment: the more the problems experienced during and after delivery, the more users are likely to abandon the AT. In Italy, Federici and Borsci (2011) systematically analyzed the two factors described above, in order to estimate the rate of AT non-use and to clarify the relationship between this rate and the user satisfaction about the Umbria Region AT Service Delivery Systems. Findings showed an average dropout rate equal to 18.12% of AT non-use, which is lower than the international data estimated at around 33%. In particular, the lowest level of non-use (11.35%) is related to ATs delivered within a well-designed process of assignation, focused on the users’ needs. On the opposite, the highest level of non-use (24.34%) concerns those ATs, such as stairlifts and hearing aids, provided by AT service delivery systems much more focused on reducing the costs of public spending. These latter systems are also characterized by not providing a follow-up service. Moving from these pivotal results, the aim of this work is to discuss a Web-based follow-up model developed to overcome hearing aid non-use in the Umbria Region AT Service Delivery System. It is organized into two Units of Local Health Service (ULHS). For each one of them, the current hearing aids delivery process consists of four phases: (i) A first user audiometric test evaluates whether the user matches criteria for a hearing aid assignation. Then, (ii) the otolaryngologist defines a range of hearing aid models suitable for the patient’s needs and starts a trial period. In this period, (iii) the patient is given one month to test the different models suggested by the otolaryngologist in specialized centers. When the patient has identified the preferred aid, (iv) a second audiological visit is scheduled with the otolaryngologist who evaluates the appropriateness of the product selected by the patient and prescribes the AT. The prescription guarantees a full refund by the ULHS of the cost of the hearing aid. In line with the current objective of the Umbria Region’s ULHS to digitize their services, a Web-based Follow-up Model (WFM) helps to overcome the limitations of the current hearing aid delivery process, which still follows paper-based procedure, making it difficult to monitor the quality of the delivery service and evaluate the post-assignment outcome. Based on information technology, the WFM is easily manageable through a web platform (www.laregionetisente.org): an accessible system was implemented by an interactive user-centered design process, whose usability has been constantly improved by UX methodology (Borsci et al. 2013). The WFM provides a support and monitoring service, by which both professionals and patients are constantly informed about the delivery process. The WFM allows the otolaryngologist to easily check the patient’s profile, and set up and manage their appointment schedule. The patient’s profile contains all related demographic information, medical history, and appointment schedule, which the physician can constantly update. Likewise, patients can read their clinical assessment outcomes and are provided with a reminder service, keeping them constantly up to date with their appointment schedule and hearing aid delivery status. Moreover, the WFM returns the hearing aid perceived quality of use and satisfaction of each patient immediately after the aid has been delivered and three and six months later. This follow-up information is automatically digitally processed based on data obtained by five questionnaires self- or interviewer-administered to the patient. The model presented here can help to improve the appropriateness of national health services (Lavis & Anderson 1996) while at the same time increasing patient satisfaction. Since improving training and support, and reducing problems experienced during and after the AT delivery process are correlated with AT abandonment, we expect that the WFM might reduce the dropout rate. In this way, our model can not only drive down costs but also avoid the economic meltdown caused by inefficient health-care services.