Agbesanwa, Funmi
(2021)
Exploring the barriers and facilitators in the uptake of a novel eMDS (Biodose ConnectTM) used to support medicines adherence.
PhD thesis, University of Nottingham.
Abstract
As the proportion of the older adult population increases rapidly worldwide, polypharmacy (the prescribing of multiple items to one individual) and consequently medication use continues to increase. Medication non-adherence is contributing to the wider economic burden on health and social services, consequently seeking out practices or methods to improve patients’ adherence to medicines should help to alleviate the issue.
Despite the long-standing reservations on the use of Monitored Dosage Systems (MDSs), they have been shown to play a role in supporting medication management for particular patients. Electronic MDSs (eMDSs) such as Biodose Connect™ (BC), offer a more enhanced approach in supporting adherence; with embedded remote monitoring and novel reminder features.
Very little qualitative research has been carried out on the use of eMDSs and even fewer have explored the use of these technologies within the home environment of the user, as well as its use within distinct services of care. This study used a qualitative case study methodology, to explore the barriers and facilitators in the development, use and adoption of the novel eMDS BC. Using a multiple method approach, three cases were explored in-depth. The first case study used observations, interviews and document analysis to explore the conceptualisation and development of the BC technology, specifically within the context of the BC technology suppliers, Protomed. The second case study similarly combined interviews and observations to investigate the factors influencing the acceptance and uptake of the BC technology; using the experiences and views of key stakeholders involved in a trial of the device within an assisted-living care organisation. Key stakeholders included service managers, care workers, a pharmacist and an innovation manager. Lastly, the third case study, explored the current drivers in using the eMDS technology within a domiciliary homecare service provider, using focus groups to engage with support workers and interviews to explore the views of care managers.
All interview data were transcribed verbatim, and together with observational field notes and documents, were thematically analysed using NVivo® 11 software. The analysis process consisted of a two-stage process of inductive thematic analysis and deductive theoretical mapping on to Greenhalgh’s descriptive framework: A New Framework for Theorizing and Evaluating Non-adoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies (NASSS).
This study identified several factors affecting the potential uptake of eMDS technologies incorporated into services of care. There was a persistent focus on the ‘hard’ technological attributes of the BC device, leading to a lack of consideration to the social world and organisational procedures that would exist around the technology. Furthermore, the unpredictable and complex issue of medication non-adherence also posed significant challenges to expectations of a standardised service delivery model.
Using the NASSS framework to inform the analysis and discussion of this study, allowed for the recognition of key areas of complexity: such as the value proposition of the technology as well as key attributes of the adopter system and care organisation. This research highlights areas where complexity needs to be reduced to encourage future technology adoption.
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