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E-HEALTH ON THE THRESHOLDOF ACCEPTANCEEUROPEAN DIFFERENCES IN THE USE OF ASSISTED LIVING TECHNOLOGIES
CARE AND TECHNOLOGY SPEARHEAD
CREDITS
Authors: Helianthe Kort (HU) and Matti Groot
(Verklizan) on the basis of the report
Acceptance of Assisted Living Technologies
in Europe by Roderick Udo MSc (Utrecht),
Nikki Holliday MSc (Coventry), Thijs van
Houwelingen MSc (Utrecht) and Laura Vadillo
Moreno MSc (Madrid).
Text processing: Jolanda Keesom, Arnhem
Editing: Jurgen Mollema and Maaike Smole
Vormgeving: Studio Vrijdag
ISBN/EAN: 978-90-8928-078-7
NUR: 981
This is the eighth publication in a series
produced by the Care and Technology
Spearhead. These brochures can be
downloaded from the website www.zent.hu.nl
For further details, please contact
The following publications have already
appeared in this series:
• Zichtbaar beter inrichten, by M. Sinoo.
ISBN 978-90-8928-058-9
• Co-design: samen de technologie in de zorg
verbeteren, by R. van der Lugt, F. Verhoeven
and A. Cremers. ISBN 978-90-8928-061-9
• De maatschappelijke business case:
toegevoegde waarde voor zorgtechnolo-
gische innovaties, by E. Huisman and
G. Lanting. ISBN 978-90-8928-062-6
• Beeldzorg bevorderen: een kwestie van
ervaring opdoen, by T. van Houwelingen
and A. Barakat. ISBN 978-90-8928-0664
• TASTE: het succes van zelfmanagement
ontrafelen, by Dr J. Trappenburg.
ISBN 978-90-8928-071-8
• Blijven lopen na een beroerte: Feedback
op het nachtkastje, by Dr Anita Cremers,
Fred Montijn, Michiel Punt Msc, Dr Harriët
Wittink and Marieke Zielhuis.
ISBN/EAN: 978-90-8928-0732
• Data in digitale dossiers: Wat mag en kan
er met gegevens van mensen?, by Dr Ellen
Gerrits, Frank Buijs, Prof. Mia Duijnstee,
Bolinda Hoeksema, Dr Johan Versendaal
and Freek Zuidweg.
ISBN/EAN: 978-90-8928-078-7
ABOUT THIS STUDYThis study on the use of Assisted Living Technologies (ALT) in Europe
is a joint project of the Verklizan Group, Utrecht University of Applied
Sciences, Coventry University, Universidad Politécnica de Madrid and
Beuth Hochschule für Technik Berlin. The final report on the study
appeared in February 2014 under the title Acceptance of Assisted
Living Technologies in Europe. The present brochure is an edited
summary of that report.
CONTENTS
FOREWORD
E-HEALTH CHALLENGES
THE USE OF ALT IN EUROPE
PRACTICAL OBSTACLES TO THE USE OF ALT
PSYCHOLOGICAL OBSTACLES TO THE USE OF ALT
ALT EDUCATION
AN APPROPRIATE BUSINESS MODEL
CONCLUSIONS AND RECOMMENDATIONS
REFERENCES
04
05
08
10
15
19
22
24
26
4
Although technology applications known under the general name of ‘e-Health’
have already been widely used in the healthcare sector for several decades, they
still remain somewhere between the application and the acceptance phase. In
this context, the term ‘application phase’ means that the concept in question
has been thoroughly tested and is widely used, but there are still all kinds of
obstacles to its general acceptance.
Koert van Mensvoort gave a theoretical description of how technology evolves
to a level where it is taken for granted in his lecture Pyramid of Technology,
how technology becomes nature in seven steps (2013). Verklizan’s practical
experience confirms the theoretical model developed by Van Mensvoort. As a
supplier of an open platform for monitoring centres, Verklizan observed that
technology applications in the field of Assisted Living Technologies (ALT), such
as IT-based alarm systems, were used to a different extent by its various
customers. It therefore asked researchers in a number of universities to look for
explanations for the observed differences in the use of e-Health applications,
including ALT, throughout Europe.
Verklizan has studied this question in cooperation with four knowledge institu-
tions, under the supervision of a steering committee representing a wide range
of disciplines including sociology, business studies, engineering and gerontech-
nology. The findings are in line with Van Mensvoort’s theory of the technology
pyramid. It has been found that e-Health is still regarded as a new, artificial
approach that does not really belong in the healthcare sector, because it has not
yet proved possible to integrate these technology applications into the fields of
nursing and care as they are taught in the various training colleges. There are
also cultural barriers to more extensive use of e-Health, and it is not yet clearly
evident what the benefits of this approach are. A public-private partnership, like
the one set up for the present study of the use of Assisted Living Technologies in
various European countries, is needed to deal with these barriers to the wider
use of e-Health. The study has provided input for Verklizan’s corporate strategy,
and has helped the participating knowledge institutions to gain a better
understanding of possible ways of improving the use of ALT.
Helianthe Kort
Utrecht University of Applied Sciences
FOREWORD
M D W D VW info side-effects
take one once a day with water
5
E-HEALTH CHALLENGESTechnology applications in the healthcare sector intended to help people to maintain
an independent lifestyle for longer – known under the general name of e-Health – are
not yet widely accepted by the population as a whole. Studies have shown that
insufficient attention is often paid to the user’s viewpoint during the introduction of
such applications. The Care and Technology Spearhead of Utrecht University of Applied
Sciences therefore sees its task in the present study as not only exploring the obstacles
to greater use of e-Health by healthcare providers and their clients but also as pointing
out factors that can enhance the acceptance of this approach.
THE TECHNOLOGY PYRAMID New technologies have to pass through various stages before they are widely
used and accepted, from the tentative initial phase to the point when their use is
taken for granted as an almost natural part of everyday life; the mobile phone is
a good example of this evolution. Koert van Mensvoort from Eindhoven
University of Technology developed the Pyramid of Technology in 2013 by
analogy with Maslow’s hierarchy of needs. As shown in Fig. 1, Van Mensvoort
distinguishes six stages in this process, from the initially envisioned concept or
‘cradle’, via the operational, application and acceptance phases to the stage
when the new technology is considered to be vital, that in which it becomes
invisible and finally that when it is ‘naturalized’ or completely taken for granted.
At present, e-Health has long been at the third level, the application level. There
appear however still to be too many obstacles to its passage to the next level,
at which it will be fully accepted by the general population.
REASONS FOR THE STAGNATIONIn the interests of further progress, it is important to discover why healthcare
providers and their clients find it difficult to accept e-Health technologies in their
work and daily life. The study by Kort and Van Hoof (2012) showed that the
initial Dutch telecare projects were perceived as focusing too strongly on
organizational factors while tending to neglect use factors. This was not only a
matter of the differences between the ability of successive generations to use
technology, but also of issues relating to regulations and legislation, education
and training.
Fig. 1: The technology pyramid proposed by Van Mensvoort,
Eindhoven University of Technology, 2013.
A British study of the relationship between people’s willingness to use e-Health
and the associated reduction in costs had the disappointing result that no
difference was found between the group who received e-Health and the group
given conventional care.
German researchers found that elderly patients were actually less willing to use
e-Health after suffering cardiovascular complaints – probably because they had
more need of face-to-face contact due to their more uncertain state of health.
The crucial role played by healthcare providers in determining the acceptance
level of e-Health was underlined by the ‘PETZ’ study carried out in the depart-
ment of Demand-driven Care at Utrecht University of Applied Sciences (Van
Houwelingen and Barakat, 2013). This study showed that healthcare profession-
als were only willing to use e-Health technologies if their clients could handle
them, derived real benefit from them and if the costs involved were not exces-
sive. Healthcare providers were also more likely to recommend the use of
e-Health if their colleagues also used these technologies. As far as the elderly
patients in question were concerned, they were much more likely to use
e-Health if the technologies involved motivated them to take care of themselves
better and were useful in this connection.
Level 1Envisioned
Level 2Operational
Level 3Applied
Level 4Accepted
Level 5Vital
Level 6 Invisible
Level 7 Naturalized
THE ROAD TO ACCEPTANCEImportant factors for stimulating the acceptance of e-Health in the healthcare
sector are that potential users know what e-Health is and can recognize an
e-Health application when they see one; that the design is self-explanatory so
that people can easily use the application in question; and that training in use
of the application is available. This applies in principle to all potential users
throughout the world.
Nevertheless, the developers and suppliers of e-Health technology in Europe
report large differences in the use of this technology throughout the continent.
In order to discover the reasons for these differences, Verklizan commissioned
a study of the acceptance of e-Health in various European countries.
7
My complaint
Head
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Shoulder L.
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Leg L.Leg R.
Chest
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THE USE OF ALT IN EUROPE
FACTORS THAT ENCOURAGE AND DISCOURAGE THE USE OF ALTThis uncertainty led Verklizan, supplier of software for monitoring centres, to
commission researchers from various disciplines and various European countries
to carry out a study of the factors encouraging and discouraging the use of ALT
in order to gain a better insight into the overall low acceptance of these
technologies.
Verklizan hopes that the results of this study will enhance its cooperation with
clients and trading partners in marketing their products and services, so as to
be able to offer more elderly patients the ALT services they need.
STUDY DESIGN AND STUDY METHODSThis exploratory study was performed in the UK, the Netherlands, Germany and
Spain, with the objective of generating new ideas and pointers for researchers,
companies and government bodies at various levels about relevant factors that
need further investigation. First of all, a literature survey relating to the following
four points was carried out:
• practical aspects of ALT of importance to users;
• psychological aspects of ALT of importance to users;
• training in the use of ALT;
• business models used by ALT companies.
8
Wide differences in the use of Assisted Living Technologies (ALT), as e-Health
technologies are often called, have been found across Europe (Kubitschke, 2010).
Only 3 per cent of potential users in the 65+ age group in Germany and the Nether-
lands are found to use these technologies, as compared with 6 to 10 per cent in the
Scandinavian countries and 15 per cent in the UK. The reasons for these differences
are unclear. Are people not being given enough information about these technologies,
do they distrust them, do healthcare professionals discourage their use, or do the
technologies fail to meet the needs of people with disabilities?
9
The researchers then drew up a questionnaire, translated it into the relevant
languages and sent it to 2460 experts in four different stakeholder groups
(companies producing ALT technology, companies providing ALT services,
educational institutions and healthcare institutions). A total of 361 persons filled
in the questionnaire and returned it to the researchers. The results were analysed
by a descriptive method, and the outcomes for the various countries were then
compared.
Due to the width of the topic studied, the low response rate and the limited
funds and time available for the study, it was not possible to investigate the four
points mentioned above in depth, to set up case studies or to prove specific
hypotheses. The investigation did, however, yield sufficient data to be regarded
as a pilot study.
10
LITERATURE SURVEYIt is assumed on the basis of a review of the international scientific literature in
this field that the practical obstacles to the use of ALT by the elderly or by
people with a physical disability may be related to:
• the extent to which products adequately meet the needs of the elderly;
• user involvement in the development of the product or service;
• the accessibility of the technology (in this report, the term ‘accessibility’ is
used to refer to problems potential users may have in actually using the
product or service in question because of visual, auditory, physical, intellectual
or cognitive disabilities);
• the availability of user training facilities;
• the attitude of the user’s social environment;
• the perceived utility;
• the user’s own attitude to the product or service in general.
DECISIVE FACTORSThe study carried out on behalf of Verklizan shows that the factor that is most
decisive for acceptance of ALT by users in all four countries is the perceived
safety, followed by reduction in anxiety (see Fig. 2). In all countries, unfamiliarity
with the potential utility of ALT is found to be the greatest obstacle to its use.
Recommendations by family were seen in all countries to be the most important
trigger for acceptance. In addition, suggestions by social services were found to
play an important role in influencing acceptance of ALT in the UK and the
Netherlands, while healthcare professionals only play a significant role in the UK.
PRACTICAL OBSTACLES TO THE USE OF ALTUse of ALT in Europe is still limited, despite the enormous advances in the technologi-
cal possibilities offered by such systems and the beneficial effect they can have on the
quality of life. Even in the UK, where the government subsidizes the use of ALT more
than in other European countries, no more than 15 per cent of potential users actually
use such systems. This is why one of the topics dealt with in this study was the
existence of practical obstacles to the use of ALT.
seeing others successfully use
ALT services
seeing others successfully use
ALT services
11
As regards information about ALT products and training in their use, such
information and training was found to reach producers, suppliers and users’
relatives more easily than the users themselves. It follows that information and
training should be aimed not only at end-users but in particular at relatives,
social workers and healthcare professionals.
The acquisition and service costs for ALT services were found to be one of the
most significant obstacles to the introduction of ALT in healthcare institutions in
the Netherlands and the UK.
Fig. 2: Summary of the relevance of the reasons for end-users to use ALT in various countries, according to service providers and healthcare institutions.
UK
SPAIN
THE NETHERLANDS
GERMANY
greater safety
feeling alone
feeling less anxious
recommended by family
seeing others successfully use
ALT services
greater safety
feeling alone
feeling less anxious
recommended by family
seeing others successfully use
ALT services
greater safety
feeling alone
feeling less anxious
recommended by family
seeing others successfully use
ALT services
greater safety
feeling alone
feeling less anxious
recommended by family
seeing others successfully use
ALT services
12
producers
UK NETHERLANDS
providers producers providers
% a
nsw
ers
by
stak
eho
lder
s 100
90
80
70
60
50
40
30
20
10
0
User testing Internal quality standards
Annual user satisfaction survey
System for dealing with complaintsand comments
LACK OF QUALITY STANDARDSIt is clear that there needs to be more information about the utility of ALT in
society in general. A multidisciplinary approach to the development of new ALT
solutions that takes this factor into account is desirable. Dutch ALT producers
are found to be more likely to involve users in the improvement of products and
services than those in the UK (see Fig. 3). No conclusions about the actual
quality of these products and services may be drawn from this fact. It may
however be stated that the lack of standards and procedures for involving users
in the development process and the lack of service quality models are obstacles
to the improvement of products and services.
Fig. 3: What do ALT producers and providers do to improve the quality of their products and services?
13
INFORMATION AND TRAININGThe relative importance of unawareness of
the potential benefits of ALT and fear of
technology as reasons for not using ALT
varies from country to country among the
countries surveyed. Fear of technology
appears to be the least relevant in the
Netherlands. Particularly in Spain, contact
with others who know about ALT appears to
make a difference to the extent to which the
technology is used. This is an argument for
improving the supply of information about
ALT.
According to ALT producers and providers,
users need to be trained to use the technolo-
gy. This is particularly true in Spain. Opinions
are divided on this subject in the UK; in
Germany, only a small proportion of users
are considered to need training, while
opinions are evenly spread over the whole
spectrum in the Netherlands (see Fig. 4).
These differences may be due, for example,
to the ease with which the technology can
be used and the varying roles played by
relatives and healthcare professionals in
encouraging use of ALT. Training becomes
more important the more the user is
expected to master the technology.
Providing more examples of use of ALT
and sharing experience may help in this
connection.
Fig. 4: Relative importance of various ways for users to learn how to use ALT products and services, according to healthcare institutions.
40
35
30
25
20
15
10
5
0
Explanation by family/friends
% a
nsw
ers
by
stak
eho
lder
s
0-10%
10-30%
30-60%
60-80%
80-100%
60
50
40
30
20
10
0
Own efforts
% a
nsw
ers
by
stak
eho
lder
s
% of users
% of users
% of users
0-10%
10-30%
30-60%
60-80%
80-100%
40
35
30
25
20
15
10
5
0
Training by producer/provider
% a
nsw
ers
by
stak
eho
lder
s
0-10%
10-30%
30-60%
60-80%
80-100%
UK NETHERLANDS
14
People may also be more willing to undergo training if they are given informa-
tion about the equipment in advance and have the opportunity to try out a
product or service before buying it.
ACCESSIBILITYThe importance attached to accessibility by the various stakeholders has been
found to vary quite considerably (see Fig. 5). Healthcare institutions regard this
factor as very important, producers and suppliers less so. This may influence
their views on the ease of use of products and services.
The fact that ALT producers and providers pay relatively little attention to
accessibility may perhaps be explained by the fact that many people are unable
to use ALT as a result of being disabled. If more work were done on modifying
the equipment to take their specific needs into account, that could improve the
accessibility for people who at the moment do not use ALT.
Fig. 5: Influence of “accessibility” (user problems in using technology due to visual, auditory, physical, intellectual or cognitive disabilities) as a reason for rejecting the product (accor-ding to providers of products and services).
0-10% 10-30% 30-60% 60-80%
% a
nsw
ers
by
stak
eho
lder
s 50
45
40
35
30
25
20
15
10
5
0
SPAIN (11) GERMANY (10)UK (63) NETHERLANDS (30)
IMPACT ON USER IDENTITY Healthcare professionals and companies engaged in the production and
provision of ALT in the UK and the Netherlands agree that people who want to
remain independent and who have a positive attitude to the aging process are
more likely to use ALT. This is in line with the finding from the literature survey
that there is a greater likelihood that people who value independence and
autonomy will use ALT to maintain their identity. The various stakeholders further
agreed that the provision of information about health and positive aging can
encourage people to use ALT, possibly because it can focus attention on the
benefits of these technologies in helping them to keep their independence.
ALT may help them to stay in their own home for longer, which is important
because one’s identity and self-image are closely linked with one’s own home
and the surroundings one is used to (see Fig. 6).
PSYCHOLOGICAL OBSTACLES TO THE USE OF ALTThe decision whether to use ALT can depend on whether it is perceived as matching
the user’s identity and as a source of support or a threat. In the case of elderly people,
their tendency to regard modern technology as too complicated in general may
withhold them from using it. The attitude of healthcare professionals can also influence
the extent to which ALT is used – especially when they see it as a threat to their own
role and are afraid that they may lose face-to-face contact with clients if ALT is intro-
duced. There were no striking differences between the countries involved in the study
as far as psychological issues are concerned.
15
16
Strongly agree
Agree Neither agree nor disagree
Disagree StronglyDisagree
Percentage response of ALT service providers to the statement that the perceived stigma attached to the use of ALT may be an obstacle to successful use
65
60
55
50
45
40
35
30
25
20
15
10
5
0
SPAIN
GERMANY
UK
NETHERLANDS
Fig. 6: Percentage response of healthcare professionals to the statement that clients who have a positive view of aging are more likely to use ALT. (UK: n=76; NL: n=17; D: n=13; Sp: n=5.)
Fig. 7: Percentage response of ALT service providers to the statement that the perceived stigma attached to the use of ALT may be an obstacle to successful use. (UK: n=54; NL: n=25; D: n=3; Sp: n=11.)
Strongly agree
Agree Neither agree nor disagree
Disagree Stronglydisagree
Percentage response of healthcare professionals to the statement that clients who have a positive view of aging are more likely to use ALT
50
45
40
35
30
25
20
15
10
5
0
SPAIN
GERMANY
UK
NETHERLANDS
17
STIGMATIZING EFFECTNot all stakeholders agree that providing more information about use of ALT will
increase the extent to which these technologies are used – for example because
use of such equipment may be seen as stigmatizing and the design of the
equipment may be regarded as too unattractive (see Fig. 7).
THREAT TO PROFESSIONALS?The response to the statement that healthcare professionals regard ALT as a
threat to their professional identity varies from one stakeholder group to the
other. Companies that provide ALT services tend to agree with this statement
more than the healthcare professionals themselves, who predominantly do not
regard ALT as a threat (see Fig. 8).
Strongly agree
Agree Neither agree nor disagree
Disagree StronglyDisagree
Percentage response of healthcare professions to the statement that they worry that ALT may threaten their professional identity
60
55
50
45
40
35
30
25
20
15
10
5
0
SPAIN
GERMANY
UK
NETHERLANDS
Fig. 8: Percentage response of healthcare professions to the statement that they worry that ALT may threaten their professional identity. (UK: n=76; NL: n=17; D: n=13; Sp: n=5.)
18
UK Netherlands Germany Spain
Percentage of respondents from educational institutions who believe that nurses are worried that more use of ALT will cause them to lose face-to-face contact with their patients
60
55
50
45
40
35
30
25
20
15
10
5
0
Educational institutions, especially those in the Netherlands and the UK, indicate
their belief that healthcare professionals are concerned that increasing use of
ALT will lead to loss of face-to-face contact with their clients, which they regard
as important (see Fig. 9).
FURTHER RESEARCH IS NEEDEDAlthough the present study confirms the main psychological factors influencing
the use of ALT as reported in the literature at a qualitative level, further quantita-
tive research is needed to permit measurement of the effect of such factors and
determination of the relationships between them.
Fig. 9: Percentage of respondents from educational institutions who believe that nurses are worried that more use of ALT will cause them to lose face-to-face contact with their patients. (UK: n=39; NL: n=12; D: n=11; Sp: n=10.)
19
LACK OF A COMPLETE CURRICULUMThere are no universities in any of the four countries surveyed that offer students
complete courses in the use of ALT. In fact, rapid technological advances in this
field mean that the existing courses are at risk of lagging behind day-to-day
practice (see Fig. 10).
RESPONSIBILITYThere are considerable differences of opinion in all countries surveyed about
who is responsible for training healthcare professionals in the use of ALT.
Educational institutions want to make such training compulsory, but believe
that the healthcare organizations should share the responsibility. It would seem
to be an obvious solution that healthcare professionals who have already
completed their professional training should be trained in the use of ALT by
their employers. It is however uncertain how often this actually occurs in
practice. Significant differences have been found between the UK, the Nether-
lands and Germany on this point (see Fig. 11).
Providers of ALT technologies also train healthcare professionals in the use
of ALT. This occurs slightly less in the UK than in the other countries surveyed
(see Fig. 12).
ALT EDUCATION Healthcare professionals can play an important role in optimizing the use of ALT, but
they can only do this if they have knowledge of the way these technologies can be
implemented in the healthcare sector. Far from all healthcare professionals are found
to be motivated to acquire such knowledge, however. One contributing factor in this
context may be the lack of adequate educational resources in this field.
My complaint
Head
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Waist
Shoulder L.
Shoulder R.
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20
Fig. 10: Percentage of nursing colleges in the four countries surveyed already offering or planning to offer courses on personal alarm systems and/or screen-to-screen telecare systems.
Fig. 11: Self-reported scores of healthcare organizations for the extent to which they train their healthcare professionals in the use of ALT.
UK Netherlands Germany Spain
80
75
70
65
60
55
50
45
40
35
30
25
20
15
10
5
0
Already offer courses on personal alarm systems
Already offer courses on screen-to-screen telecare systems
Courses on personal alarm systems offered or planned for the future
Courses on screen-to-screen telecare systems offered or planned for the future
Percentage of nursing colleges
UK
Note: The reported scores range from 1 (rarely, 0–10% of staff) to 5 (always, 81–100% of staff)* The results for Spain were not included, because of the low response rate for this country
Netherlands Germany
3.50
3.00
2.50
2.00
1.50
1.00
0.50
0
21
COOPERATION AS A SOLUTIONCooperation with regard to ALT education that also involves the ALT providers
would seem to be the best option. After all, all parties have an interest in
providing proper training: it will allow producers to sell more products, educa-
tional institutions to improve their curricula and healthcare organizations to
promote the use of ALT. In addition, cooperation in the field of training could
yield extra benefits in other directions:
• it could help ALT providers and healthcare organizations to make the benefits
of ALT more clear;
• it could motivate healthcare organizations to look at things from the client’s
perspective rather than that of technological efficiency;
• it could help healthcare organizations to promote the use of ALT and to let
end users make recommendations;
• it could give suppliers and healthcare organizations practical awareness of
ALT, to be embedded in care pathways;
• it could help ALT technology providers to improve their relationships with
experts and specialists;
• it could help ALT service providers to improve the technical support they
offer;
• it could improve ALT providers’ basic knowledge about how ALT works and
what its benefits are;
• it could help nursing colleges and healthcare organizations to understand
their own role better.
Fig. 12: Self-reported scores of ALT providers for the extent to which they train healthcare professionals in the use of ALT.
UK Netherlands Germany Spain
3.50
3.00
2.50
2.00
1.50
1.00
0.50
0
Note: The reported scores range from 1 (rarely, 0–10% of staff) to 5 (always, 81–100% of staff)
22
Fig. 13: Percentage of Dutch and British companies with an operative quality management system.
INFORMATION ABOUT USERS Since insufficient data are available for Spain and Germany, only the details of
the business models for technology producers and technology service providers
from the UK and the Netherlands are compared with one another (see Fig. 13).
In the UK, where 15% of people aged 65 or over use ALT – five times as much as
the 3% found in the Netherlands – many companies admit that they do not know
who uses their products or services. All the Dutch companies surveyed believe
that they do know who their users are. At the same time, British companies
regard doctors as more of an obstacle to the use of ALT than Dutch companies.
AN APPROPRIATE BUSINESS MODELThe results of this exploratory study of the factors promoting and hindering the use
of ALT can best be translated into a dynamic business model that takes the roles of
both users and healthcare professionals into account.
User satisfaction survey
Complaints & comments handling system
User testing Quality standards
100
90
80
70
60
50
40
30
20
10
0
%
UK Services
NL Services
UK Producers
NL Producers
23
It may be asked whether there is a link between these differences and the extent
to which the business models used by the companies involved take ALT users
into account.
LEAN LAUNCH PADThe Lean Launch Pad is a good business model for companies providing ALT
products and services because it can combine the different aspects considered
in this study – the practical and psychological user perspectives and the need for
training in the use of ALT. This model allows companies to make use of an
iterative design process, using both feedback from customers and trials. This
may result in a market-based approach that is appreciated by end-users and
their relatives, healthcare professionals and doctors, thus leading to increased
use of ALT.
24
THE ROLE OF HEALTHCARE PROFESSIONALSComparison of the Dutch results with those for the UK shows that healthcare
professionals play a bigger role in initiating the use of ALT technologies in the
UK. In the Netherlands, potential users and their family are more likely to be the
first to raise this topic. This difference may be explained by the differences
between the healthcare systems in the two countries. The government plays a
much greater role on the healthcare market in the UK, via the National Health
Service (NHS). In the Netherlands, on the other hand, the healthcare market is
privatized and individualized.
WORTH INVESTIGATIONThere are differences of opinion between the various stakeholders on the value
of providing information about ALT. It may be useful to study in greater depth
the reasons why some do not think this is such a good idea.
Another topic on which respondents in the various countries surveyed disagreed
was the extent to which the stigmatizing effect of use of the equipment, or even
ugly design of the equipment, could discourage people from using ALT soluti-
ons. Such factors seems to have less of a deterrent effect in the Netherlands
than in the UK. This might also be an interesting topic for further research.
A third possible theme for future research is the influence of concerns that
healthcare professionals may have about the impact of ALT on their professional
roles. The present study did not indicate any marked differences between the
various countries surveyed in this respect.
WORKING TOGETHER TO PROVIDE ADEQUATE TRAININGIt was clear from the study that educational institutions in the UK pay most
attention to ALT in training courses for healthcare personnel. The Netherlands
CONCLUSIONS AND RECOMMENDATIONSIt is no easy matter, to put it mildly, to indicate all the factors that could explain the
differences in the use of ALT that may be observed between various countries. The
data collected within the restraints of this multidisciplinary study were not enough
to prove or disprove the hypotheses formulated on the basis of the literature survey.
It was possible, however, to determine which factors came into consideration for
further research.
25
comes a good second: Dutch nursing colleges hope that all nurses will be
trained in the use of ALT by 2020. Germany clearly lags behind, while not
enough data were collected for Spain to make it possible to draw conclusions.
It is recommended that companies, healthcare organizations and institutions,
nursing colleges and government bodies at various levels work together to
improve education and training in the use of ALT.
FOCUS ON USERSFurther research on business models should concentrate on the extent to which
users play a key role. Why, for example, do English companies sell more ALT,
while they themselves state that they do not always really know who their
customers are?
The Lean Launch Pad approach could inspire companies to change the way they
do things, thus finding ways of winning more customers for their services and
technologies.
RECIPE FOR SUCCESSFUL CORPORATE STRATEGIESThis study has yielded important insights into possible obstacles to the use of
ALT. Verklizan and its trading partners can make use of these insights to maintain
a competitive edge and at the same time to help to improve the quality of life of
potential users.
It may be concluded that a successful corporate strategy for ALT will include the
following elements:
• asking yourself whether you really know your customers;
• promoting a positive view of aging and independence;
• bearing in mind that ALT equipment design that has a stigmatizing effect can
put potential users off;
• working together with other stakeholders to improve ALT education and
training;
• describing your corporate strategy and business model from the viewpoint of
users and their families;
• drawing inspiration from the Lean Launch Pad approach, which uses an
iterative design process to market technologies or services.
REFERENCES
Houwelingen, Thijs van, and A. Barakat (2013)
Beeldzorg Bevorderen. Utrecht: Utrecht
University of Applied Sciences.
Kort, H. and J. van Hoof (2012) Telehomecare
in The Netherlands: Barriers to Implementation.
International Journal of Ambient Computing
and Intelligence, 64-73.
Kubitschke, L. and K.Cullen (2010)
ICT&Aging: European study on users, markets
and technologies – Final Report. European
Commission, Directorate General for
Information Society and Media.
Mensvoort, K.van (2013) Pyramid of
Technology. How technology becomes nature in
seven steps. Eindhoven University lectures,
NR.3, (2012 -2013) Eindhoven: Platform for
Academic Education (Eindhoven University of
Technology).
Verklizan (2014) Acceptance of Assisted Living
Technologies in Europe. Analysis of the major
differences in the adoption rates of Assisted
Living Technologies across Europe. Sliedrecht.
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27
UTRECHT UNIVERSITY OF APPLIED SCIENCES
Utrecht University of Applied Sciences (HU) delivers high-quality teaching and
research in the service of innovation and professionalization in professional
practice. This fast-growing, dynamic educational establishment is located in
Utrecht Science Park, near its knowledge-intensive strategic partners the
University of Utrecht (UU) and the Utrecht University Medical Centre (UMCU).
HU regards the development and dissemination of knowledge as among its core
tasks. As a result, it invests in demand-oriented applied research and the
dissemination and valorization of knowledge, and as a University of Applied
Sciences it makes a substantial contribution through teaching and research to
innovation in professional practice, and hence to the social and economic
development of the Utrecht/Amersfoort innovation hub.
HU research centres HU has six research centres. Various groups within a given research domain,
each headed by a Reader, combine to form a research centre. A single research
centre performs research on specific themes in consultation with professionals
from the field. Each research centre at HU has its own website, which provides
information about the individual fields of research, studies and projects together
with profiles of the Readers within the centre. An overview of the research
centres at HU may be found at www.onderzoek.hu.nl.
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Care and Technology Spearhead The Care and Technology Spearhead at HU focuses on research relating to two
current trends: the rapid aging of society and the rapid advances in technology.
The prevailing view in the field of healthcare and technology is that technology
applications can improve the quality of life of people who need healthcare
services. The other side of the coin is that technology, in particular IT, can
actually restrict the quality of life of such people. The problem is then how to
design and use such technology applications so as to get rid of practically all
impediments. In general, it is mainly older people and those with a chronic
disease need some form of healthcare. The Care and Technology Spearhead
focuses in particular on how the right combination of healthcare and technology
can be used to help people with a medical problem as well enhance prevention.
The Care and Technology Spearhead considers the following questions in particular:• How can the right combination of healthcare and technology minimize
restrictions on functioning in daily life and/or social interaction due to biologi-
cal aging or a chronic disease?
• How can the right combination of healthcare and technology improve support
for the client system when providing care for one’s fellow human beings?
• How can the right combination of healthcare and technology alleviate the
work of healthcare professionals and thus help them to provide healthcare
services matching the need?
• How can the right combination of healthcare and technology be implemented
in housing or residential environments so as to provide people who have a
need for healthcare with maximum support in making the most of their
abilities?
ContactsProf. Helianthe Kort, Director of the Care and Technology Programme
Maaike Smole, Care and Technology Manager
Healthcare Innovation Research Centre, Utrecht University of Applied Sciences
For further information, please E-mail [email protected] or visit the
website www.zent.hu.nl
Verklizan B.V., Stationspark 500, 3364 DA Sliedrecht
P.O. Box 284, 3360 AG Sliedrecht T: +31 (0)184 42 18 18