http://informahealthcare.com/idt ISSN 1748-3107 print/ISSN 1748-3115 online Disabil Rehabil Assist Technol, 2014; 9(5): 421–431 ! 2014 Informa UK Ltd. DOI: 10.3109/17483107.2014.900574

ORIGINAL RESEARCH

Disabil Rehabil Assist Technol Downloaded from informahealthcare.com by University of Newcastle on 09/25/14 For personal use only.

Getting it ‘‘right’’: how collaborative relationships between people with disabilities and professionals can lead to the acquisition of needed assistive technology Patricia Johnston1, Leanne M. Currie2, Donna Drynan3, Tim Stainton1, and Lyn Jongbloed3 1

School of Social Work, 2School of Nursing, and 3Department of Occupational Science & Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada Abstract

Keywords

Purpose: The purpose of this study was to examine the impact of a consumer-led equipment and device program [Equipment and Assistive Technology Initiative (EATI) in British Columbia, Canada] from the perspective of program participants. The importance of collaborative assessments for obtaining the right assistive technology (AT) for meeting an individual’s needs is discussed in light of the program’s participant-centered ‘‘Participation Model’’, or philosophy by which the program is structured. Method: A cross-sectional survey with participants and semi-structured interviews were conducted with participants (18 years) who held a range of disabilities. The survey asked participants to rank their AT and to identify the method by which they obtained the technology [by self, prescribed by a health professional or collaborative (self and professional)]. Interviews addressed participants’ opinions about obtaining and using AT. Results: In total, 357 people responded to the survey (17% response rate) and 16 people participated in the interviews. The highest ranking AT was assigned to devices assessed via a collaborative method (self ¼ 31%, practitioner ¼ 26%, collaborative ¼ 43%; 2 (16, 180) ¼ 39.604, p50.001). Conclusions: Shared decision-making between health professionals and people with disabilities within the assessment process for assistive technology leads to what participants perceive as the right AT.

Abandonment, assessment, assistive technology, client-centered, consumer-driven, disability services, equipment, participation History Received 14 November 2013 Revised 25 February 2014 Accepted 28 February 2014 Published online 21 March 2014

ä Implications for Rehabilitation  

Collaborative decision-making can lead to the selection of assistive technology that is considered needed and right for the individual. Person-centered philosophy associated with assistive technology assessment is contributing to attaining ‘‘the right’’ AT.

Introduction People with disabilities may require assistive devices, technology and equipment to participate in employment, social and community activities that are important to them. These devices may support individuals with communication, vision and mobility needs. Although assistive devices are a key priority for individuals with disabilities, there continues to be a high level of unmet need in terms of accessing such assistive equipment [1,2]. This article describes the evaluation of equipment and assistive devices program in British Columbia, Canada, referred to as the Equipment and Assistive Technology Initiative (EATI), which operates from a consumer-driven model for the selection of assistive technology. The EATI program places no restrictions on what equipment can be obtained and provides opportunities for people with disabilities to self-assess and select the assistive

Address for correspondence: Patricia Johnston, PhD Student, School of Social Work, University of British Columbia, 2050 West Mall, Vancouver, BC, V6T 1Z2, Canada. E-mail: [email protected]

technology they believe will help them to overcome functional barriers to employment. This article describes EATI’s ‘‘Participation Model’’, the philosophy of using self-assessment and the degree to which program participants obtained what they believed to be the assistive technology they needed. The Model was further explored through an examination of the disuse (or abandonment) of assistive technology. Assistive technology usage Assistive technology (AT) can be any item, device or equipment intended to help someone overcome a functional barrier. AT can include generic or ‘‘universal design’’ devices or equipment that offers specific utility to people with disabilities as well as devices designed or custom built for an individual’s particular needs [3]. AT may be either low-tech (mechanical) or high-tech (electromechanical or computerized) and include equipment to ‘‘compensate for sensory function losses by providing the means to move, speak, read, hear, and manage self-care tasks’’ [4, p. 439]. AT is intended to facilitate participation in society for people with disabilities [5, p. 18].

Disabil Rehabil Assist Technol Downloaded from informahealthcare.com by University of Newcastle on 09/25/14 For personal use only.

422

P. Johnston et al.

Unfortunately, much of the AT provided through funding agencies is not always used. There is a large body of literature concerning disuse of AT (or abandonment1 of equipment) [6–8]. Disuse of AT is understood to be due to a host of reasons, ranging from an individual feeling uncomfortable or embarrassed with their AT, to an individual finding the device too heavy or awkward to use [9,10]. Studies have found the disuse of AT may be ‘‘as low as 8% or as high as 75%’’ where an average disuse of one-third of all prescribed AT appears to be most common [4,7]. The potential for disuse of prescribed assistive devices is of great concern in an ‘‘environment where there is an increased need for cost containment and accountability in the provision of AT’’ [6]. For this reason, programs that provide AT hold a vested interest in finding the right devices and equipment for each individual. The ‘‘better the match of AT and user, the more effective is the use of limited resources’’ [11, p. 1329]. Finding the right AT to meet an individual’s needs may greatly reduce the disuse of AT and consequently, better support people with disabilities. Obtaining the right fit Determining the right AT for an individual can be challenging due to a number of variables, such as an individual’s personal preferences and individual-specific impairments [4,7,12]. Although there are theoretical models to guide the assessment and provision of AT, and to ‘‘match’’ individuals to assistive devices [4,13,14], there is no consensus regarding how service delivery models should function [9,15]. Within this context, health professionals, such as occupational therapists, have traditionally performed a key role in assessing and prescribing AT. For those professionals who conduct AT assessments, a collaborative relationship with the consumer often unfolds [12]. This has stemmed from a perspective that stresses the assessment of consumer preferences, knowledge, experiences and resources as well as self-esteem and competence as important to the overall assessment process [16,17]. In practice, such as within the field of occupational therapy, a client-centered approach attempts to reduce practitioner power, increase consumer choice and increase the partnership between the consumer and the professional to facilitate a collaborative relationship [18]. Unfortunately, people with disabilities do not always report the services they receive ‘‘meet this aspiration’’ [18,19]. This may be due to the philosophical underpinnings of professionals, which can influence their decision-making [12]. Most notably, emphasis on ‘‘the value of the information the client and their family bring into the decision making process varies’’ [12, p. 22]. Indeed, a providercentered/controlled approach continues to occur despite research indicating it is important that the ‘‘process of equipment prescription [should] be centered on the evaluation of the client’s environmental and personal needs rather than on diagnosis alone’’ [20, p. 72]. Yet, without consumer involvement people with disabilities ‘‘may feel disempowered in not being provided the right piece of technology’’ and the likelihood for a lack of use of the assistive device or equipment may be greater [9, p. 316]. How an individual perceives his/her need for AT can be different from the need for AT as determined by a health professional. Differing perspectives held by individuals and professionals concerning what AT is needed can lead to frustration based on the ‘‘different expertise that they [bring] to the procurement process’’ [21, p. 170]. Frustration and ‘‘non-agreement between the client and the therapist regarding equipment recommendations’’ has been found to have a negative impact on the use 1

This article has chosen to use the term ‘‘disuse’’ rather than ‘‘abandonment’’ as it represents ‘‘a more neutral description of the phenomenon’’ [10, p. 232].

Disabil Rehabil Assist Technol, 2014; 9(5): 421–431

of the AT [20, p. 71]. This may be because the perspective some professionals bring to the relationship can place some people with disabilities in a passive role, rather than position them as active participants in the AT selection process [21]. In this way, a professional’s position and expertise can silence the knowledge gained through the careers, life experiences and social relationships of those with disabilities. Disability movement organizations question professional controls; they advocate a new approach in which consumers of services have the power to decide what services they will access, the right to monitor service provision and to change services if they so wish [22,23]. Participation model for funding AT In Canada, provincial governments are responsible for delivering health, social and education services to their residents and the federal, provincial and territorial governments collectively have recognized the need for government to support programs that offer ‘‘assistive aids and devices’’ [24]. Yet, a lack of organization concerning assistive technology has resulted in a disjointed approach to the provision of AT [25]. This is true in the province of British Columbia (BC), which had no universal equipment and assistive device program for people with disabilities until recently; in 2004, a coalition of 34 community organizations formed the Provincial Equipment and Assistive Devices Committee (PEADC) and aimed its efforts at improving coordination and funding for such equipment. By 2008, the Personal Supports Program Working Group, consisting of PEADC and representatives from five BC government ministries developed a plan for personal supports, equipment and devices for people with disabilities in BC. This group articulated a vision for providing AT built on shared values and developed the person-centered Participation Model, which was based on a philosophy for consumer involvement in the selection of assistive technology [26]. This focus led to the development of the EATI in 2009. Through a unique partnership, the Government of British Columbia’s Ministry of Social Development and the BC Personal Supports Network (BCPSN) deliver the EATI program. The EATI program funds assessment, trialing, acquisition of and/or training with, assistive devices for people with disabilities who have employment-related goals. Funded by the federal government’s Labour Market Agreement, this program relies on the Participation Model as its anchor to enable program participants to move toward employment. By providing eligible2 program participants with the opportunity to assess their own needs and determine what AT would best work for them, EATI encourages participants to meet their functional needs and overcome barriers. Although clinical or professional support can be an important part of the self-assessment process for many participants, a professional or prescriptive assessment is only required by EATI under certain conditions, such as when consumers request power mobility equipment (i.e. scooters or motorized wheelchairs) due to issues of liability3. This is not to suggest the clinician is not an

2

To be eligible for EATI funding the individual must be: a person with a disability who has an employment-related goal, which includes volunteering, 18 years of age or older, a BC resident, unemployed or employed with low skills and looking to upgrade, ineligible for employment insurance, able to demonstrate a need for AT and unable to access funding through other provincial government programs or private insurers. Some of these criteria exist because the program receives funding through the Federal ‘‘Labour Market Agreement’’. 3 The only criteria that must be met for self-assessing one’s needs are: (1) the individual has been living with their disability for some time, (2) the individual has used assistive devices previously and (3) the individual is familiar with the types of assistive devices available to help them achieve their employment-related goals [27].

Getting it right: assistive technology

Disabil Rehabil Assist Technol Downloaded from informahealthcare.com by University of Newcastle on 09/25/14 For personal use only.

DOI: 10.3109/17483107.2014.900574

important part of the assessment process, but instead to offer many of the program’s participants an alternative to the prescriptive process. This alternative approach is particularly well suited to the self-assessment process in certain circumstances and for certain devices. For example, when participants aim to replace a device that is broken, or out of date; or when participants already have familiarity with a certain device through their friends; family or volunteer work. Not all AT, nor all program participants, may be appropriate for self-assessment. In some situations beyond motorized devices, a professional may be needed to provide further support and/or assessment in the selection or prescription of AT. For example, the support of an audiologist or optician may be sought if hearing aids or glasses are being requested. To support the individual in their involvement with EATI, front-line caseworkers referred to as Navigators work directly with program participants to explore employment goals and develop applications for the selected AT. Navigators support participants in the exploration of their employment goals and AT choices. They also work as advocates for each program participant to access the requested funding by facilitating the AT attainment process. This in part is related to the organization of the program and the approval, or adjudication, of requests that occurs with the government partners. Unlike most programs that provide AT, EATI does not maintain a list of approved devices that participants must select from. Instead, and in keeping with consumer control and choice, participants select the device or equipment they believe they need to move toward employment and not necessarily the least expensive device. Navigators work with all participants to complete their applications for AT regardless of the type of assessment conducted. They can be, however, more involved with those participants who conduct self or collaborative assessments. Evaluation of the program The purpose of this study was to evaluate the program. The evaluation aimed to explore the impact of the Participation Model on individuals with disabilities in British Columbia who received AT through the EATI. The study focused on how participants understood and experienced the self-assessment process as this process is the foundation of the program’s intent to place them at the center of decision-making control. Further, the study aimed to assess if participants received the AT they believe they needed. Receiving the right AT was then examined in light of reported disuse of AT, the assessment type, and the involvement of participants within the AT selection process. A mixed method approach was utilized to explore the experiences of program participants who had obtained assistive technology through EATI. A survey was offered and interviews were held with program participants. This study commenced following approval by the University of British Columbia’s Behavioural Research Ethics Board (BREB).

Methods As of December 2012, all of the 2051 people who engaged with EATI to receive AT were targeted to participate in this study. A survey was developed and participants could take it online, in paper format or by telephone. The online survey was embedded within a website designed specifically for this study. Anyone 418 years of age, who had connected with EATI to access assistive technology, was eligible to participate in the survey. There were no additional inclusion or exclusion criteria. A link to the survey was sent via email by program administrative staff on behalf of the researchers to everyone who provided an email address to EATI. Those who had not provided an email address received

423

a hardcopy paper version of the survey by mail at their home address. Individuals could review the consent form and complete the survey online, return the paper version of the survey in the stamped envelope provided or contact the research team to have the survey conducted with them by telephone. Survey design A survey was designed to examine the assessment process for obtaining AT from the perspective of program participants. The survey included questions relating to the AT participants received and the type of assessments performed: self-assessment, professional assessment or a collaborative assessment. Self-assessments were defined as those that involved program participants determining their own needs and selecting the AT they believed would best work for them. This type of assessment may have involved the program participant considering his/her past experience, and/or incorporating suggestions from family members, professionals, vendors and friends in order to determine what AT to request through EATI. Professional assessments were defined as those in which an individual met with a health professional to determine the AT needed and obtained a prescriptive assessment. Collaborative assessments were defined as those when participants chose to incorporate the information from a professional prescriptive assessment into their selection of AT. Collaborative assessments represent a working relationship focused on determining the best AT for the individual – where the professional places the individual at the center of the assessment process and the assessment involves the individual’s input, concerns and preferences. The first half of the survey was designed to learn the type of assessment method used to attain AT, overall satisfaction with the AT and if the AT was continuing to be used by the participant (to assess abandonment). Survey respondents were asked to reflect on how they had assessed, or how their needs were assessed, for the AT they received through EATI. After reviewing definitions for each type of assessment, participants were asked, ‘‘How did you identify or determine your need for this assistive technology (device, equipment or solution)?’’ Other questions included ‘‘Do you believe this assessment led to the assistive technology you needed?’’ Participants were also provided the opportunity to respond to statements concerning the impact of AT on employment and life-variables using Likert scales (Table 1). For some, taking this survey may have involved thinking about more than just one device or piece of equipment they received through EATI over the course of a few years. Therefore, requesting information within the survey concerning all the AT program participants may have constituted an overly complex and time-consuming process. This approach would not have been appropriate for surveying those who received only one device or piece of equipment. Thus, the survey requested respondents to provide information concerning the AT that had been most useful to them. To do this, information concerning a participant’s most useful top three (or fewer) devices or pieces of equipment was requested. In this way, the survey provided respondents the ability to rank each of their devices in order of utility, offering additional information to the research. As some people received only one device or piece of equipment, there were fewer responses regarding the second most useful AT and again even less for the third most useful AT. Unfortunately, this approach had one limitation. For those who obtained only one AT, it would have been ranked as #1 or most useful, limiting the ability to truly assess ranking. Given this, an analysis was performed to determine if any difference in ranking was associated with the removal of those who received only one AT. Additionally, determining what constitutes a singular AT or device, or counted

424

P. Johnston et al.

Disabil Rehabil Assist Technol, 2014; 9(5): 421–431

Table 1. Survey questions.

Table 2. Demographics of survey respondents. Survey questions

Disabil Rehabil Assist Technol Downloaded from informahealthcare.com by University of Newcastle on 09/25/14 For personal use only.

Employment goals

Life goals

My assistive technology has helped me . . .  Use the Internet  Learn new skills  Work on my resume  To take training  Get a job  To communicate  Move closer to becoming employed  To volunteer  Upgrade my skills  Develop employment skills  To attend interviews  To demonstrate my skills to potential employers  Reach my employment goals Since receiving my assistive technology . . .  I am able to get out in the community more  I am able to participate in fun things or hobbies  I feel more confident  I am able to do more things at home  I have more energy  I am able to care for myself better  I am able to care for others better  Other impacts on your life since receiving assistive technology? Please describe:

as one device, is a very subjective concept. For example, a computer with a monitor, mouse, printer and scanner can be understood by different people as anywhere from one to five items. Respondents were advised to ‘‘count’’ their AT as they understood it. Survey data was entered into SPSS Statistics Version 20.0 (Armonk, NY) [28]. Descriptive statistics were performed. Chi-square or Wilcoxon rank sums were performed on categorical data and t-tests or ANOVAs were performed on continuous dependent variables. Interviews Program participants who had obtained assistive technology through EATI were also invited to sign up to participate in a semistructured interview. This invitation was provided alongside the survey to everyone who had engaged with the EATI program as of December 2012. Those who obtained AT through EATI could sign up online by reading the consent form and providing their contact information. For those that received the survey and invitation in the mail, they could return a consent form to the research team or contact the research team by email or telephone to express their interest in participating in the interview. A list of all those who were interested in being interviewed was compiled and numbered. Data on whether a person who completed the survey also participated in an interview was not collected. A random number generator (http://www.randomizer.org/) was used to identify potential participants [29]. Participants were contacted and, if eligible, an interview was conducted either in person or by telephone. Interviews involved questions pertaining to six areas: (1) description of AT obtained by the participant, (2) the process of obtaining AT through EATI, (3) the AT assessment, (4) impact of the AT on the participant’s employment goals, (5) impact of AT on the participant’s life goals and (6) overall perspective of EATI. Participants were asked to describe the AT they received and the assessment process they completed to attain AT through questions such as ‘‘How did you know you needed this AT?’’ Questions also included, ‘‘Would you have selected the same assistive technology or chosen something different?’’ when

Participants

Age, Mean (SD) Age group (in years) 18–29 30–44 45–64 65

Male n ¼ 107 (48%)

Female n ¼ 118 (52%)

51.03 (13.5) n (%) 7 (6) 24 (22) 64 (58) 15 (14)

53.26 (14.5) n (%) 9 (7) 18 (15) 67 (52) 32 (25)

Percentages have been rounded.

participants reported obtaining a professional assessment and ‘‘What do you think of having that choice to assess your own needs?’’ when a self-assessment was completed. Participants were also asked to expand on how, if at all, the AT they received impacted their employment or life goals. All interviews were audio-recorded, transcribed and coded using NVivo Version 10 (QSR International, Burlington, MA) qualitative data analysis software. Data were analyzed using thematic analysis, which requires data be examined and coded based on patterns and themes. Latent level thematic analysis was also used to ‘‘identify or examine the underlying ideas, assumptions, and conceptualizations – and ideologies that are theorized as shaping or informing the semantic content of the data’’ [30, p. 84]. Data collection ceased when saturation was attained.

Findings A total of 2051 EATI people with disabilities were contacted. About 1571 were contacted by email and 480 were provided surveys (with an invitation to participate in an interview) in the mail. In total, 408 responses to the survey were received; 322 responses were received online, 63 by mail and 23 via telephone. After the data were cleaned and duplicates removed, a sample of 357 people who reported applying to EATI for assistive technology was examined. This constituted a response rate of 17.4%. About 182 program participants indicated interest in being interviewed and a total of 16 interviews were held.4 Participants Table 2 indicates the number of participants, sex, age and age range obtained for participants within the survey. Of all of the survey respondents, including those who had applied to EATI, but had not yet received their AT, and those who may have applied for AT but were ineligible for services, 76.2% had received AT through EATI at the time of the survey. Of this sample, participants held a range of educational backgrounds. For example, 35.9% held up to and including a high school education and 63.6% held some certificate or college or university education. Survey respondents lived throughout the province of British Columbia with 54.4% living within the urban Vancouver and Fraser Valley regions. Interviews were conducted with 9 (56.2%) male participants and 7 (43.7%) female participants. Slightly more than half (56.2%) of the participants lived in the central urban regions of Vancouver and the Fraser Valley of British Columbia and the remaining (43.7%) lived throughout the rest of the province. Interview participants had been involved with EATI for a range of time; some had only recently received their AT (within 3 months prior to the survey), whereas others had received devices and equipment when the program was first created in 2009 and others 4

Interviews ceased when saturation was attained.

Getting it right: assistive technology

DOI: 10.3109/17483107.2014.900574

still had received their AT just over a year prior to the survey. Some participants were also in the process of obtaining additional assistive technology through EATI. Themes identified within the interview data closely mirrored the topic areas associated with the survey and for this reason, have been interwoven within the findings. Themes included assessment type, type of AT received and usage (e.g. ‘‘AT is right’’, ‘‘AT is not quite right’’).

Disabil Rehabil Assist Technol Downloaded from informahealthcare.com by University of Newcastle on 09/25/14 For personal use only.

Technology received Survey participants received a range of AT from EATI. In total, 244 devices or pieces of equipment were analyzed. Many survey respondents reported receiving multiple items. The majority of this AT was categorized as either computer and computer accessories (i.e. laptop, printer, rolling cart for large monitor, etc.) or mobility-related AT (i.e. wheelchairs, scooters, stair lift, prosthetics or mobility accessories such as bike lights, wheelchair wheels, walking poles, etc.). Other categories included:  Communication AT (i.e. iPad, Dragon Naturally Speaking software, telephone box hearing system, equipment to answer the telephone from a distance, equipment to dial the operator, etc.).  Vision AT (i.e. sunglasses, specialty lenses, Braille note taker, Braille display, Trekker Breeze GPS, etc.).  Learning AT (i.e. all computer software not including Dragon Naturally Speaking, Jaws or Zoomtext or a Live Scribe pen, etc.).  AT for the home (i.e. custom desk, office chair, ceiling lift, ramp, automatic door opener, etc.).  Hearing AT (i.e. hearing aids, FM receiver, tape recorder, bed-shaking alarm clock, blue tooth, etc.).  Driving AT (i.e. driving lessons, hand controls, six-way power seat, van conversion, modified brakes, etc.).  Medical AT (i.e. blood pressure watch, BiPAP machine, foam wedge, etc.). Interview participants also commented on receiving multiple devices and equipment. For example, one participant described receiving ‘‘quite a long list’’ due to having multiple disabilities. This included hearing aids, Q-Link and Quattro Bluetooth devices, a computer, JAWS and Zoomtext software, a scanner, an Anybook recorder and a Booksense XT. Assessment methods to acquire AT Interview participants indicated experiencing different types of assessments for the different devices and equipment they received; many indicated working with a health professional for one device (professional assessment), whereas self-assessing their needs for another or different device. For example, one participant described self-assessing his/her needs for specialized computer equipment and software and requesting a professional assessment for a vehicle (van) conversion. For some participants, friends and community members helped them decide what they needed. Others commented on involving professional assessors, for example, ‘‘they have a professional—so they’ve seen me. They know where my limits are’’. Obtaining different assessments for different AT by interview participants was consistent with the findings of the survey. Survey respondents reported using self, professional and collaborative assessments when they obtained multiple assistive devices. Self-assessments were conducted in just over one-third of all assessments reported and were just slightly less common than collaborative assessments. Frequencies and chi-square results for the different assessment types in relation to the ranked AT are noted in Table 3. As Table 3 indicates, there was a statistically significant difference between frequencies of AT ranked as #1 (most useful)

425

Table 3. Frequencies of assessment type by AT ranked #1, #2 and #3. Type of assessment Rank (n) AT ranked as #1 (180) AT ranked as #2 (82) AT ranked as #3 (52) Total (314)

Self n (%) 55 31 21 107

(30.6) (37.8) (40.4) (34.1)

Professional n (%) 47 19 17 83

(26.1) (23.2) (32.7) (26.4)

Collaborative n (%) 78 32 14 124

(43.3) (39) (26.9) (39.4)

p Value 0.001 0.295 0.546

by assessment type with higher ranking being assigned to devices assessed via a collaborative method, 2(16, 180) ¼ 39.604, p50.001. The proportional differences between the assessment method and the AT ranked as #2 was not statistically significant, 2(14, 82) ¼ 16.312, p ¼ 0.295, nor was it for AT ranked #3, 2(14, 52) ¼ 12.753, p ¼ 0.546. An analysis of those who received only one AT was performed. About 52% of survey respondents received more than one AT (n ¼ 93) and the remaining 48% reported only one (n ¼ 86). There was no proportional difference between those who received only one AT and the type of assessment conducted for the AT ranked #1, 2(2, 179) ¼ 1.864, p ¼ 0.394. Chi-square analyses for AT ranked #2, 2(2, 87) ¼ 4.235, p ¼ 0.120 and AT ranked #3, 2 (2, 54) ¼ 1.350, p ¼ 0.509 also indicated no difference, which suggests the ranking of AT by survey participants is useful for examining assessment types. As the majority of interviews participants received more than one AT, it was not possible to assess for proportional difference concerning their assessments between those who received one and those who received multiple AT. For all of assistive technology ranked as #1 (most useful), professionals most commonly assessed mobility AT. This was consistent with the interview findings as participants expressed the benefit of seeking out a professional assessor for their expertise with mobility AT when needed. As an example, one participant stated, ‘‘I went through my OT and she gave me some sort of physical testing that took a couple of hours. And she says, ‘Okay, enough is enough. You need to get a scooter’’’. Self-assessments were most common for computers and visionrelated AT (Figure 1). Of all the AT ranked #1 (most useful), mobility AT was most commonly ranked #1, n ¼ 67 (37.2% of total). Mobility AT was described very positively within the interviews with participants as well. For example, ‘‘hey come over with the wheelchair. And you try it out. Actually, they try you out on different wheelchairs and see which one works the best. . . I thought it was just amazing. I loved it right from the very beginning’’. Computers, n ¼ 36 (20% of total) were the next most commonly ranked AT followed by communication AT, n ¼ 2, (11.7% of total). Interview participants also described their computers positively. For example, one participant stated: When it physically arrived and I went and picked it up and opened the box, I just couldn’t believe it. That I—I had a laptop! And it’s portable. I don’t have to pack up five pieces of the other computer to take with me to go somewhere. It’s just awesome. Like, I couldn’t—I knew I was getting it, but actually seeing it and touching it made it more real. Although mobility AT were most often ranked as #1, the AT ranked as #2 (or second most useful) differed slightly. For AT ranked #2, self-assessments were again common for computers and vision-related AT. This was confirmed within the interviews. With the support of the Navigator within the self-assessment process, participants came to determine AT they found useful. For

426

P. Johnston et al.

Disabil Rehabil Assist Technol, 2014; 9(5): 421–431

70

Collaborativee

60

Professional

50

Self

40 30 20

Disabil Rehabil Assist Technol Downloaded from informahealthcare.com by University of Newcastle on 09/25/14 For personal use only.

10 0 ADL

Comm m.

Compu ter

Driv ving

Hearin g

Learnin g

Medica l

Mobilit y

Vision

Collaborative

6

6

9

5

11

0

1

33

7

Professional

1

7

7

0

6

0

1

22

2

Self

2

7

20

4

0

2

0

12

8

Note: ADLs – Activitiies of Daily Livinng Figure 1. Type of AT ranked as #1 by frequencies of assessment type.

example, one participant described how the Navigator ‘‘helped’’ as the individual ‘‘did get some discussion through the resource centre up here, because I mean these people have dealt with this for years. And there were suggestions made, you know, ‘What do you think of this device?’. . .we managed to come up with the [needed] items’’. Collaborative assessments, however, were most common for AT related to activities around the home and visionrelated AT (Figure 2). Consistent with the interview participants’ experience, this use of collaborative assessments was explained by one participant who stated: ‘‘I felt a proper assessment would have been more beneficial for my needs – that would be done by professionals plus input from me and my parents – who know me better than anyone’’. Of the AT ranked #2 (second most useful), vision AT represented (23.2% of total ranked #2, n ¼ 19), followed closely by ADL’s (20.7% of total, n ¼ 17). Computers and communication AT (both 14.6%) were the next most commonly ranked AT as second most useful. Consistent with this finding and highlighting the value placed on computers and communication devices, one interview participant stated, ‘‘it became apparent that the iPad was my best friend’’. Mobility AT (9.8%), hearing AT (7.3%), learning AT (7.3%) and medical AT (2.4%) were ranked #2 less often. Finally, for AT ranked as #3 (or third most useful), selfassessments were most common for vision and communicationrelated technology. Although still involving other people, such as friends and family members and the Navigator, one interview participant explained, ‘‘we never really do things totally in isolation. . .I purchased [software through EATI] on the basis of other people telling me that that’s what worked for them’’. Collaborative assessments were most commonly conducted for vision, computer and mobility-related devices, whereas hearing, driving and medical AT were assessed exclusively by professionals (Figure 3). Of all the AT ranked #3 (third most useful), vision AT (n ¼ 14, 26.9% of total ranked at #3), followed closely by computers (n ¼ 12, 23.1% of total), were most commonly identified by survey participants. Communication AT (21.2%), mobility AT (13.5%), learning AT (9.6%) and hearing and driving AT (both 1.9%) were ranked #3 less often.

As described earlier, the Navigator holds an important role facilitating the AT attainment process. As a frontline caseworker, but someone who does not provide prescriptive assessments, the Navigator is involved in all assessments, but often more involved in the self-assessment and collaborative-assessments. A surprising finding from the interviews was the importance of this relationship to program participants. The Navigator was perceived as extremely supportive and helpful, particularly during the selfassessment and collaborative assessment processes. This involvement by the Navigator was overwhelmingly reported as a positive element in their experience. For many, it was the support of the Navigators that helped to make the self-assessment process a positive experience. As one participant stated: [The Navigator] just walked me through everything . . . made it sound very simple, because it—to me, I was just intimidated all to pieces . . . I’m trying to get back into the workforce and this was all very overwhelming for me. Like, [the Navigator] just talked me through it . . . sent me papers, had highlighted on places that I needed to sign and little notes where I needed to read and stuff. [The Navigator] just was super. Another participant reiterated, ‘‘I think the self-assessment was fine. I was very well supported by [a Navigator], who was very thorough with helping me through the process’’. Some participants, however, required more support and guidance than what the Navigators could offer, but were still interested in participating within the assessment process. For these individuals the collaborative assessment was often described as appropriate. For example, one participant explained, ‘‘I accepted the [professional] advice that was given. Yeah, I think that was the way it went, that she advised me that it should be an advantage to me and so it proved’’. This statement highlights how the professional’s involvement was seen as ‘‘advice’’, offering the participant an opportunity to engage in the process and the decision-making associated with the AT assessment process. Overall, the survey findings were consistent with how interview participants described assessments they experienced

Getting it right: assistive technology

DOI: 10.3109/17483107.2014.900574

30

427

Collaborattive Professionnal Self

25

20

15

10

Disabil Rehabil Assist Technol Downloaded from informahealthcare.com by University of Newcastle on 09/25/14 For personal use only.

5

0 ADL

Com mm.

Hearring

Learning

Medical

Mobbility

Vision

Collaborative

9

5

Computer Driving 2

0

2

1

1

5

7

Professional

4

2

2

0

3

3

1

0

4

Self

4

5

8

0

1

2

0

3

8

Note: ADLs – Activitiies of Daily Livinng

Figure 2. Type of AT ranked as #2 by frequencies of assessment type.

30

Collaborattive Professionnal

25

Self

20 15 10 5 0 ADL

Com mm.

Computer Driving

Hearring

Learning

Medical

Mobbility

Vision

Collaborative

0

2

4

0

1

1

0

3

4

Professional

0

3

Self

4

1

1

3

1

0

4

0

6

4

0

0

1

0

4

6

Note: ADLs – Activitiies of Daily Livinng Figure 3. Type of AT ranked as #3 by frequency of assessment type.

and the types of AT they received. For example, self-assessments were often used for computer and computer-related equipment and for assistive devices to support vision. For those participants who were aware of the AT they required, a self-assessment was described as a useful means for achieving AT. Interview participants routinely explained that conducting a self-assessment for something, such as a magnifier (vision-related AT), was appropriate because they had been long aware of it through volunteer work. Given the specific challenges associated with certain disabilities, however, such as those who possess brain injuries, some interview participants felt the process of the selfassessment was a greater challenge. Themes associated with the distinctly positive and negative aspects to each assessment type

were developed from the interviews (Table 4). The following represents the interview response themes concerning the positive and negative aspects associated with the different types of assessments: Obtaining the right assistive technology Given the range of AT and the types of assessments conducted, the question of whether the AT obtained through the Equipment and Assistive Technology Initiative (EATI) lead to the right AT must be asked. To answer this question, survey respondents were asked if the assessment they obtained or conducted led to the AT they needed. Table 5 indicates the percentage of survey

428

P. Johnston et al.

Disabil Rehabil Assist Technol, 2014; 9(5): 421–431

Table 4. Positive and negative aspects of assessments. Professional (prescriptive) assessment

Disabil Rehabil Assist Technol Downloaded from informahealthcare.com by University of Newcastle on 09/25/14 For personal use only.

Self-assessment Positive aspects

 Appropriate when participants knew what AT was  Professionals were aware of what participants needed or when the participant was able to required participate in the task of exploring his/her options  Help from the Navigator made the self-assessment process manageable for most participants  Provided an opportunity for participants to research what they may require  Relationship with the navigator was particularly helpful to the process

Negative aspects

 For some people with certain disabilities, the application process (paperwork) was perceived as complex  Some participants required additional support beyond what could be offered by a navigator  Without face-to-face involvement with a professional, some participants experienced a sense of disconnection from the AT procurement process

Collaborative assessment  Participants appreciated being advised of what AT options were available to them  Incorporating family members and friends’ suggestions into the assessment was useful for some participants because ‘‘they know me better than anyone’’  Provided an opportunity for participants to research what they may require  Relationship with the Navigator was particularly helpful to the process

 Can limit the opportunity for participants to provide input into the assessment

Table 5. Frequencies of received the ‘‘Right’’ AT by assessment type. Self n (%) Right AT AT Ranked #1 AT Ranked #2 AT Ranked #3 Total

57 34 19 110

(93.4) (91.9) (90.5) (91.9)

Professional n (%) Not right 4 3 2 9

(6.6) (8.1) (9.5) (8.1)

Collaborative n (%)

Right AT

Not right

Right AT

43 24 17 84

5 1 2 8

78 35 16 129

(89.6) (96) (89.5) (91.7)

respondents that reported receiving the right AT in light of the type of assessment conducted. As Table 5 indicates, collaborative assessments were more commonly conducted for AT ranked #1 and #2 and only used slightly less often for AT ranked #3. Participating in a collaborative assessment almost always led to the right AT being obtained by the participant. It is possible that those who indicated they did not receive the right AT, and yet ranked their assistive technology as #1 (or most useful), may also represent those who received only one device. For the AT ranked as #2 and #3, those who conducted collaborative assessments obtained the right assistive technology for their needs 100% of the time. However, chi-square results did not indicate a statistically significant difference between receiving the needed AT and the assessment type for AT ranked #1 [2 (2, 188) ¼ 5.239, p ¼ 0.073], AT ranked #2 [2 (2, 97) ¼ 2.992, p ¼ 0.224] or AT ranked #3 [2 (2, 56) ¼ 1.738, p ¼ 0.419]. Overall, the findings indicate that regardless of the type of assessment, the right assistive technology was largely obtained (94.4% overall). These findings were consistent with the information obtained from interviews with program participants as well. Regardless of the type of assessments the large majority of participants obtained what they considered to be the right AT. One participant described receiving what s/he believed to be the right AT for their needs in the statement: And, you know, it was totally amazing because by the time I got the chair and had been fitted for the chair a couple of times, and did a trial for the chair, you don’t realize there can be a chair that actually supports your body and can be modified for your body, and parts of your body that actually works. I mean, I just love this chair. I’m sitting in it now.

(10.4) (4) (10.5) (8.3)

(98.7) (100) (100) (99.6)

Not right

p Value

1 (1.3) – – 1 (1.3)

0.073 0.224 0.419

This participant also described the process of obtaining this particular assistive equipment and involvement of a health professional as part of a collaborative assessment: EATI sent off a note to [a certain organization], who has the occupational therapist. We meet up, then there’s a requisition that goes back and forth. And that’s approved. Then once that’s approved that’s given to the people [a company] who make the chair. They go ahead and make the chair, and when it’s finished they tell me. And the bill comes to EATI and they pay it. When asked if the professional, the participant and the Navigator worked together to attain this AT, the participant stated, ‘‘Oh, absolutely’’. This comment represents the positive and shared process that can occur between a program participant and a health professional resulting in the procurement of the best possible AT for an individual’s needs. Perhaps most interesting in this statement is the smoothness of the procedures, the roles all parties play and the understanding of the process by the participant, due to his/her positioning at the center of decision making. Usage Individuals who reported not obtaining the right AT for their needs were very few in number. Additionally, 93.93% reported still using the items they obtained. For those who indicated they were no longer using their AT (n ¼ 25 or 9.4% of the 266 survey respondents who reported receiving AT), this was most often reported to be because their AT ‘‘needed an adjustment or change’’, they were ‘‘unable to try the AT out first’’ before requesting it and or they required some ‘‘additional training’’ in order to use it. By following up on this lack of use within the

Getting it right: assistive technology

Disabil Rehabil Assist Technol Downloaded from informahealthcare.com by University of Newcastle on 09/25/14 For personal use only.

DOI: 10.3109/17483107.2014.900574

interviews it was learned that occasionally assistive technology could not be trialed or tested out due to it being new on the market. As one participant described, ‘‘These hearing aids that I have, these particular models, came out on the market in October. . .And I received them in December so they’re brand, brand new on the market’’. This same participant further explained how this led to challenges pairing certain technology with his/her new AT. S/he stated: ‘‘Well I couldn’t, my old hearing aids were not Bluetooth, so I couldn’t try any of these products until I actually had the new hearing aids and discovered it. So, those two products have been returned to the vendor’’. Although cutting-edge technology may not be available to be trialed, as this participant explained, ‘‘the best piece of equipment for me’’ was eventually obtained. Additionally, some interview participants did state that they required additional training and one individual commented on selecting a device (a scooter) that did not fit on public transit and therefore, s/he was unhappy with the AT. Overall, however, the large majority of participants commented on being highly satisfied with the AT they received.

Discussion EATI program participants in this study most commonly participated in collaborative assessments. Given that an overwhelming majority of participants obtained what they believe to be the right AT to meet their needs, it is not surprising that the percentage of individuals who also report continuing to use their AT is so high. It is of interest that when a collaborative assessment was completed, the assessment almost always led to AT the program participant needed. This finding is consistent with research that found an interdisciplinary approach to assessment ‘‘that directly involves the patient and family, decreases the rate of device abandonment’’ [8]. Thus, the involvement of people with disabilities within the selection and assessment process may be important to obtaining the right AT because ‘‘there are personal and psychosocial characteristics that predict predisposition to use a given assistive technology and its subsequent match with the user’s needs and preferences’’ [11, p. 1329]. Although McCormack and Collins (2010) and Kjelberg, Kahlin, Haglund and Taylor (2012) both raise concerns surrounding collaborative relationships suggesting people with disabilities do not always experience the client-centered approach as it is intended, the results from this study call such concerns into question [18,19]. The findings from this study indicate the framework and underlying philosophy of the program contribute to truly collaborative relationships being formed. Thus, such concerns can be refuted. That said, it may be the case that previous studies have conflated the involvement of consumers within the professional assessment process with what this study served to delineate as a collaborative assessment. Collaborative assessments through EATI result in the final decision for AT being left with the consumer. This may represent why participants in this study reported their involvement so positively – it truly represented a collaborative approach. Whether the requirement of a professional’s prescription impacts the relationship and outcome of collaborative work may be useful to ascertain within future research for greater understanding of this issue. Although no statistically significant relationships were found between the type of AT and the assessment completed, the data suggests certain AT may be better suited to particular assessment types. The higher frequency of certain AT such as computers, communication and vision-related AT (e.g. iPads, GPS and computers) attained through self-assessment process may suggest participants had increased familiarity with them. It may also reflect that as relatively similar generic items are obtained by

429

many people without disabilities and widely perceived as useful and socially desirable, participants did not feel as compelled to involve a professional in the assessment process. This is consistent with the literature, which indicates social implications and stigma, simplicity and ease of use and esthetics are important factors associated with the continued use of AT [6,7]. Additionally, the increasing use of self-assessments, yet decreasing use of collaborative assessments, within the ranking of AT as #1, #2 and #3 (Table 3) may suggest participants attained the more necessary or essential items with the support of a professional – often by way of a collaborative assessment. It appears there may be AT attained through the self-assessment process, which was less useful to participants than what was obtained through collaborative assessments. This, however, cannot be supported through the qualitative interviews, as an equivalent level of detailed information about each specific piece of assistive technology was not collected. It is important to note that a rather consistent level of AT assessed by professionals was ranked as #1, #2 and #3 (Table 3). Yet, professional assessments made up the least amount of assessments conducted. As expected, the higher number of professional assessments associated with mobility devices is likely due to the requirement by EATI for participants requiring power-operated mobility AT to obtain a professional (or prescriptive) assessment. The higher ranking of mobility devices may also reflect the difficulty individuals with disabilities encounter in accessing AT within the community related to mobility, as opposed to a lesser need for medical devices, which may be more widely available and accessible through community organizations. Interestingly, the difference between those who did not receive the right AT through a self-assessment, and those that did not receive the right AT through a professional assessment, regardless of the ranking of AT, was negligible (51%). This is interesting given the traditional focus and long-standing use of professional assessments. It may suggest people with disabilities and professionals bring an equal level of expertise to decision-making for AT. It may also suggest that decision making by either a sole program participant or health professional can be limited in ability to select the right AT. It does not, however, suggest there is no role for health professionals within the assessment process or that health professionals in any way undermine the AT selection process. Rather it may indicate that some people with disabilities, who possess a heightened awareness of their own needs, in combination with a thorough knowledge of AT specific to their disability, can be best served by a self-assessment. This is consistent with research concerning the many factors that influence AT decision-making [10,12]. This could hold policy implications and may lead to cost savings within agencies that require professional assessment and prescribe AT to all consumers. EATI provides an opportunity for program participants to select the type of assessment for AT.5 Findings from this study suggest that this flexibility, or not approaching all assessments for AT in a ‘‘uniform’’ way, may be of benefit to AT consumers. The ‘‘differing values and priorities’’ of professionals as well as the knowledge, understanding of AT and the background of the participant should be factored into a flexible approach to assessing AT [12]. Although a statistically significant difference between types of assessments was not evident, such a high rate of receiving the right AT through collaborative assessments (99.5% of all reported cases) may suggest that collaborative working relationships can be particularly beneficial to the AT selection process. 5

See footnote 2.

Disabil Rehabil Assist Technol Downloaded from informahealthcare.com by University of Newcastle on 09/25/14 For personal use only.

430

P. Johnston et al.

These findings appear to provide support for the Participation Model, which involves program participants in decision-making concerning their needs. So few individuals within this study who reported not using their AT suggests the incorporation of participants’ perspectives can hold a positive effect on selection of the right AT. This is consistent with literature in the field [4,31]. Reported usage of AT within this study of EATI participants stands in stark contrast to programs that experience up to a 75% rate of AT disuse by participants [4,7,31]. Unfortunately, this study was not able to determine if obtaining the right AT was a result of the Participation Model, but rather the study suggests it is likely that EATI program participants are obtaining the right AT in part due to their participation in the process. Thus, the Participation Model may be a critical component of an effective approach to AT assessment and selection.

Limitations Ranking items within the survey posed limitations as previously mentioned. However, this method also offered an informal means to gauge the usefulness of AT received in light of the assessment conducted. Although the rankings can be useful to highlight how respondents experienced their assistive technology, the subjectivity of the rankings and the inability to formally identify how individuals sought to rank the AT must be noted. Additionally, the low response rate may have resulted in response bias; it is possible that only participants who were satisfied with their AT responded to the survey. Methods to ensure a representative sample should be identified for future research. Although this study found the vast majority of participants were continuing to use the AT they obtained through EATI, this finding cannot be directly attributed to the type of assessment conducted or the type of AT obtained. Although the positive relationships and support provided by Navigators was described in relation to the self-assessment and collaborative assessments, it is possible that follow-up provided by EATI had an effect on participants continuing to use their AT. This however, was not examined within this study. Future research concerning follow-up by program staff after the provision of AT may offer greater insight into the degree of disuse of AT. The few reports of disuse may also be related to the involvement of Navigators who hold experience with AT themselves. Navigators are people with disabilities and can offer firsthand information concerning types of AT to program participants. It is possible this serves to steer participants away from AT that may not be so widely used and towards AT that is well received by people with similar disabilities, however, this was not examined within this study. Examining ‘‘peer support’’ during the assessment process could be useful to future research, particularly given the relationship between personal factors, such as ‘‘social circle support’’ and disuse of AT [10]. One additional aspect to any discussion concerning the disuse of AT is that not all ‘‘abandonment’’ should be perceived as negative or representing an individual obtaining AT that does not meet their needs. Instead, there can be ‘‘‘good’ non-use, [or] the abandonment of a device that no longer fits the needs of the user’’, for example, when the ‘‘user’s condition has improved. . .or the environment has changed’’ [10, p. 237]. Finally, this evaluation was unable to survey health professionals and those who work with people with disabilities to obtain their perspectives on the degree of usage associated with the self-assessment, the professional assessment and the collaborative assessment. This may have provided a more comprehensive understanding of the assessment process and the degree of AT use.

Disabil Rehabil Assist Technol, 2014; 9(5): 421–431

Future research Additional research is required to assess whether there is a statistically significant benefit to providing program participants the opportunity to identify AT they desire, rather than selecting devices and equipment from an already approved list. Such research is of interest because although pre-approved lists may work well for organizations and governments, they may work less well for program participants who must select the best device from a list of items that could not be quite right for their needs. Pre-approved lists may also translate into participants selecting from a range of outdated technology. EATI asserts it is advantageous to provide individuals the opportunity to select the device that best meets their needs and emphasizes benefits associated with the program’s ability to offer custom-created, ‘‘cutting-edge’’ and generic technology to participants. Research to gauge whether this is in fact the case should be considered in the future. Finally, a survey of health professionals and those who interface with people who have obtained AT through EATI could provide ancillary insight to the topics of assessment and usage.

Conclusion The EATI offers program participants funding and support for the procurement of AT in BC. The large majority of participants who responded to this study reported obtaining what they considered to be the AT they needed. The percentage of participants that continue to use their technology was also reported to be very high. In keeping with the Participation Model as the philosophy underlying EATI, the participant-centered approach is working to support people with disabilities to participate in the assessment and selection of AT to meet their needs. Just as AT is intended to increase participation of people with disabilities within society, a flexible approach to AT assessment appears to be contributing to this same goal.

Declaration of interest The authors report no declarations of interest. This study was funded by Social Sciences and Humanities Research Council (SSHRC) grant; Community-University Research Alliances (CURA); Funding and the Government of British Columbia who kindly provided support through Labour Market Agreement funding this project.

References 1. Gordon P, Kerzner L, Sheldon T, Hansen E. Ensuring inclusion and independence. Toronto, ON: ARCH Disability Law centre; 2007. 2. Lindsay S, Tsybina I. Predictors of unmet needs for communication and mobility assistive devices among youth with a disability: the role of socio-cultural factors. Disabil Rehabil 2011;6:10–21. 3. Vanderheiden GC. Redefining assistive technology, accessibility and disability based on recent technical advances. J Technol Hum Serv 2007;25:147–58. 4. Scherer MJ. Outcomes of assistive technology use on quality of life. Disabil Rehabil 1996;18:439–48. 5. Tower KD. Disability through the lens of culture. J Soc Work Disabil Rehabil 2003;2:5–22. 6. Kittel A, Di Marco A, Stewart H. Factors influencing the decision to abandon manual wheelchairs for three individuals with a spinal cord injury. Disabil Rehabil 2002;24:106–14. 7. Phillips B, Zhao H. Predictors of assistive technology abandonment. Assist Technol 1993;5:36–45. 8. Verza R, Lopes Carvalho ML, Batttaglia MA, Uccelli MM. An interdisciplinary approach to evaluating the need for assistive

DOI: 10.3109/17483107.2014.900574

9. 10. 11. 12. 13.

Disabil Rehabil Assist Technol Downloaded from informahealthcare.com by University of Newcastle on 09/25/14 For personal use only.

14. 15. 16. 17. 18. 19. 20.

technology reduces equipment abandonment. Mult Scler 2006;12: 88–93. Arthanat S, Simmons CD, Favreau, M. Exploring occupational justice in consumer perspectives on assistive technology. Can J Occup Ther 2012;79:309–19. Wessels R, Dijcks B, Soede M, et al. Non-use of provided assistive technology devices, a literature overview. Technol Disabil 2003;15: 231–8. Scherer MJ, Sax C, Venbiervliet A, et al. Predictors of assistive technology use: the importance of personal and psychosocial factors. Disabil Rehabil 2005;27:1321–31. Lahm EA, Sizemore L. Factors that influence assistive technology decision making. J Spec Educ Technol 2002;17:15–26. Cook AM, Polgar JM. Cook and Hussey’s assistive technologies: principles and practice. 3rd ed. St Louis (MO): Mosby Elsevier; 2008. Scherer MJ. Living in a state of stuck: How assistive technology impacts the lives of people with disabilities. 3rd ed. Cambridge, MA: Brookline Books; 2000. Adya M, Samant D, Scherer MJ, et al. Assistive/rehabilitation technology, disability, and service delivery models. Cogn Process 2012;13:S75–8. Scherer M, Jutai J, Fuhrer M, et al. A framework for modeling the selection of assistive technology devices (ATDs). Disabil Rehabil: Assist Technol 2007;2:1–8. Scherer MJ. Assessing the benefits of using assistive technologies and other supports for thinking, remembering and learning. Disabil Rehabil 2005;27:731–9. McCormack C, Collins, B. Can disability studies contribute to client-centered occupational therapy practice? Brit J Occup Ther 2010;73:339–42. Kjellberg A, Kahlin I, Haglund L, Taylor R. The myth of participation in occupational therapy: reconceptualizing a clientcentred approach. Scand J Occup Ther 2012;12:421–7. Wielandt T, Strong J. Compliance with prescribed adaptive equipment: a literature review. Brit J Occup Ther 2000;63:65–75.

Getting it right: assistive technology

431

21. Mortenson WB, Miller WC. The wheelchair procurement process: perspectives of clients and prescribers. Can J Occup Ther 2008;5: 167–75. 22. Prince M. Canadian disability activism and political ideas: in and between neo-liberalism and social liberalism. Can J Disabil Stud 2012;1:1–27. 23. Hutchinson P, Arai S, Pedlar A, et al. Role of Canadian user-led disability organizations in the non-profit sector. Disabil Soc 2007; 22:701–16. 24. Human Resources Development Canada. In Unison: A Canadian approach to disability issues. Ottawa: Human Resources Development Canada (HRDC); 1998. 25. Equipment and assistive devices for British Columbians with disabilities. Vancouver, BC: Provincial Equipment and Assistive Devices Committee (PEADC); 2004. Available from: http:// www.bccpd.bc.ca/docs/peadc_briefingnote.pdf [last accessed 10 Mar 2014]. 26. A participation model for personal support program for people with disabilities in British Columbia. Vancouver, BC: Provincial Equipment and Assistive Devices Committee (PEADC); 2006. Available from: http://bcpsn.vcn.bc.ca/wp-content/uploads/2011/11/ participation-model-summary.pdf [last accessed 10 Mar 2014]. 27. EATI Self-assessment form. Vancouver: British Columbia Personal Support Network. Available from: http://www.bcpsn.org/application-form/ [last accessed 10 Mar 2014]. 28. SPSS Software: predictive analytics software and solutions. Boston, MA: IBM. Available from: http://www-01.ibm.com/software/analytics/spss/ [last accessed 10 Mar 2014]. 29. Polit D, Beck C. Nursing research: Generating and assessing evidence for nursing practice. 9th ed. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins. 30. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006;3:77–101. 31. Martin JK, Martin LG, Stumbo NJ, Morrill JH. The impact of consumer involvement on satisfaction with and use of assistive technology. Disabil Rehabil 2011;6:225–42.