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

SpeerpuntZenT@hu.nl

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

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05

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10

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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

Throat

Waist

Shoulder L.

Shoulder R.

Leg L.Leg R.

Chest

Belly

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

Throat

Waist

Shoulder L.

Shoulder R.

Leg L.Leg R.

Chest

Belly

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 SpeerpuntZenT@hu.nl 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