Oral Defence

Question 1

Re-state the aim and outline the method(s) in your project

Answer 1

1. Identify the current adoption and use of digital health interventions by hand therapists in Australia.
2. Explore the hand therapists’ percieved barriers and enablers to the utilisation of these digital health interventions.

For context, digital health interventions were defined in this study as services or treatment processes delivered via technological platforms such as mobile applications and wearable technology. Preliminary research on the use of digital health interventions in musculoskeletal management has found they often yield comparable or improved results for client health outcomes, treatment adherence and satisfaction. However there was limited research into the perspectives of the practitioners providing the care, such as Australian hand therapists.

To address the targeted study aims we employed a cross-sectional research design using an online survey. The questions of the online survey were underpinned by Roger’s Diffusion of Innovation Theory, specifically the five innovation attributes. We also took an embedded mixed methods approach by supplementing the quantitative data with a small amount of qualitative, free-text questions.

49 Australian hand therapy practitioners that met inclusion criteria were recruited to complete the survey which was disseminated via the Australian Hand Therapy Associations email list and eNewsletter.

Quantitative data was analyzed using descriptive statistics via IBM SPSS software and qualitative data was analyzed using conventional content analysis via Nvivo software.

Question 2

Define Digital Health Interventions

Answer 2

Digital health interventions are services and treatment processes delivered via technological platforms such as mobile applications and wearable technology.

Question 3

Provide a summary of your conclusion

Answer 3

In addressing the first research aim, results revealed the majority of therapists in this study had adopted and were actively using digital health interventions within their practice, primarily for the purpose of home exercise programs and graded motor imagery intervention. Of the participants who reported not having the option to adopt DHIs, an overwhelming majority still expressed high intentions to adopt these tools sometime in the future. These results suggest that there may be a high uptake of digital health interventions among Australian hand therapists.

In regard to the second research aim, key barriers to the use of digital health interventions that were identified by therapists included cost-related inconveniences for both therapists and clients and excess time often required to navigate and use the technology successfully. On the other hand, the potential of DHIs to improve client adherence and access to therapy were highlighted as key enablers. Additionally, the majority of therapists in this study believed that there was a high level of compatibility of digital health interventions with hand therapy, specifcially intervention provision.

Overall, despite the identified barriers, the findings of this study have alluded to a positive acceptance and a strong initiative for hand therapists in Australian to continue adopting and using digitial health interventions in their practice.

Question 4

What research or lack of research informed your study aims?

Answer 4

With continual technological advancements being made in society, the use of digital health interventions are becoming increasingly accepted as an adjunct to traditional service delivery methods. In-fact, digital health interventions are increasingly being utilised in the management and rehabilitation of musculoskeletal conditions, including those of the upper limb. Preliminary research in this area has shown when compared to traditional service delivery DHIs are yielding comparable or improved results for client health outcomes, treatment adherance and satisfaction.

However, despite client outcomes and perspectives being studied, there is a considerable gap in research exploring the perspectives of the therapists using these tools. Understanding the perspectives of Australian hand therapists, and whether or not they are actively using digital health interventions in their practice, can help academics, digital health creators and other hand therapists understand whether these tools are viable options for intervention provision.

Question 5

Who may the results of your study be significant to? (4)

Answer 5

1. Developers of digital health interventions (for the future development of these technologies)
   This data can support DHI creators to know what aspects of these tools that hand therapists endorse and what aspects may actually serve as barriers to their adoption. Digital health creators can use this to then make their products more suited to those using them in practice.
2. Academics and future researchers (so that they know what to study in more depth)
   Such as whether personal characteristics can impact the adoption and utilisation of these tools. For example, whether digital knowledge and confidence influences a person’s choice to adopt.
3. Hand therapists
   By informing them about what other hand therapists are employing in their practice and what their perspectives are on digital health interventions. This can help determine whether digital health options are a viable option as effective intervention tools.
4. Decision makers and key stake holders of hand therapy buisnesses/organisations. Assist decision-makers in ensuring their successful implementation in routine health practice. This data can encourage decision-makers to think about and evaluate how the use of digital health interventions may both positively and negatively affect their business. For example, when assessing the cost of implementing a digital health intervention tool, it is important for decision-makers to think about who will actually be paying for these interventions and the affect this may have.

Question 6

Why did you use a cross-sectional study design? (4)

Answer 6

1. Observational study - just looking at the specific characteristics and perspectives of hand therapists at one point in time. Non-experimental and not comparing two groups.
2. Fairly simple and in-expensive to carry out.
3. Cross-sectional studies can facilitate the establishment of foundational data for future research.
4. Cross-sectional studies can enable the collection of both qual and quan data.

Question 7

Why did you choose to do a survey rather than interviews? (5)

Answer 7

1. Fairly simple and inexpensive to carry out.
2. Can collect data across a range of variables in a shorter period of time.
3. Greater outreach (we are expecting a higher response rate). If we did a qualitative study, we would have limited our outreach.
4. To form the basis for future, more focused interviews. Having this foundational data can help other researchers form more focused questions for interviews.
5. Doesn’t require the collection of participants identifying data to maintain anonymity.

Question 8

Why did you use a theory and how did you use it? (4+2)

Answer 8

1. Rogers Diffusion of Innovation Theory provided a theoretical basis to strengthen our research process and guide us.
2. Rogers’ DOI theory has been widely used across implementation science to explain how technology-based innovations, such as DHIs, are adopted and disseminated among social systems.
3. Multiple studies have applied the five attributes specifically for the exploration of the enabling and hindering factors that have impacted the successful integration of technology-based innovations in routine health practice.
4. Through applying these attributes it assisted us in identifying how hand therapists perceive the factors impacting the utilisation of DHIs unique to their practice.

• We chose to only use the five innovation attributes to focus on factors of digital health interventions specifcally as a starting point for research in this area. These leaves room for future researchers to study more enviornmental or personal factors as highlighted in the qualitative data.
• We used it by employing the concepts underlying the attributes to inform survey questions and items in which we then presented our results to these questions under the mapped Roger’s heading.

Question 9

Why did you use a purposive sampling approach?

Answer 9

As this was a cross-sectional study, we wanted to capture the perspectives of hand therapists who were actively using or genuinely considering using digital health interventions in their practice.

We wanted to ensure we were gathering data from qualified hand therapists with experience in this field, as this was pour target population.

Question 10

Explain your inclusion criteria.

Answer 10

• Have more than 1 year of experience practicing hand therapy in Australia (to ensure they had ample experience in hand therapy and understood the demands of the profession)
• Have at least 50% of caseload in HT (So that they were actively practicing as a hand therapist and answered the survey questions in relation to their hand therapy practice).
• OT or physiotherapist registered with Aphra (to ensure they were qualified health professionals).

Question 11

How did you gain informed participant consent?

Answer 11

To obtain informed consent, we first provided participants with an information sheet outlining the research and what we would be doing with their data. After reading this, participants were invited to move to the survey in which they were immediately required to tick a consent box. If they ticked this, they were able to move on to the rest of the survey. However, if they did not tick, they were unable to access the rest of the survey.

Question 12

How did you ensure confidentiality? (4)

Answer 12

1. To ensure anonymity and confidentiality during the research process all data was analysed and reported on a group level, maintaining confidentiality with no individual responses being reported.
2. No identifying data was collected.
3. All electronic data collected was also de-identified and stored on a password-protected computer in Curtin’s R Drive. Only authorised individuals, including student researchers and project supervisors, possessed the passwords to access the data. Data will be stored for a maximum of five years and will be deleted at the end of this period.
4. The emails for the incentive were collected in a seperate survey and were kept separately

Question 13

Explain the process for recruiting the participants

Answer 13

Participants were recruited using purposive sampling, as we wanted to research participants who had specific characteristics to address the gap in current literature. We followed an inclusion criteria to ensure this.

We then approached the Australian Hand Therapy Association to assist in disseminating our survey. This was because a large majority of members in this association were currently registered and practicing hand therapists in Australia. We were granted permission to disseminate the survey through the email list and AHTA news letter over a period of 8 weeks. Once this time was over, we cleaned the data obtained and ensured those who completed the survey did in-fact meet the inclusion criteria. For example, participants who selected less than 1 years experience in hand therapy had their results removed from the final analysis.

Question 14

Why did you use descriptive statistics to analyse your research? (2)

Answer 14

1. The aim of this study was to describe and identify current hand therapy practice in regard to digital health interventions and thus descriptive statistics were most applicable in achieving this aim. We were not aiming to compare two groups nor test any variables.
2. They adhered to the methodology of descriptive cross-sectional study.

Question 15

Explain the process for quantitative data analysis (4)

Answer 15

1. Transferred data from qualtrics to IBM SPSS Software
2. Cleaned data - naming variables
3. Statistical consults using the resources provided by curtin
4. Put data into tables to clearly see any trends in the data and identify any major or outlying factors deemed as enablers and barriers.

Question 16

Why did you choose to complete conventional data analysis?

Answer 16

The purpose of two-opened ended questions were to capture any further factors hand therapists believed acted as barriers/enablers to DHI use that may not reflect the theory. Therefore, we chose a conventional content analysis given its flexibility and capacity to directly reflect participants free-text responses to ensure the unique perceptions upheld by therapists in this study were explored and reported transparently.

Question 17

Explain the process for qualitative data analysis (5)

Answer 17

1. Extracted data from Qualtrics to Nvivo10 software
2. Cleaned data
3. Engaged in familiarisation
4. 2 researchers engaged in the coding scheme developed inductively (open-coding)
   - Axial coding - related meaning codes, subcategories → categories. The second 2 researchers member-checked this and confirmed. The supervisors then looked over and confirmed.
5. Summative count (frequencies of codes allocated to categories). This was used purely to help us identify the most commonly reported barriers and enablers.

Question 18

Why did you not compare participants who had the option versus those who didn’t? (2)

Answer 18

1. It wasn’t part of our research aim/objectives
2. Very small number of people in the “no option” group. Statistically underpowered.

Question 19

What did you consider when interpreting your results?

Answer 19

• Collaborative analysis between 6 members of the research team
• Conceptualize/interpret the results meaning in context of the theory (i.e., what hand therapists perceived as advantageous indicated enablers to practice)
• Considered how the qual data complemented or further explained quan data (i.e., time-related costs was highly rated on the 5-point Likert scale as a barrier to DHI utilisation and a key free text category that emerged from qual data was time-intensive to use DHIs).
• Considered how study results reflected or contradicted existing literature and were interpreted on their basis in literature.

Question 20

What are the limitations of your research? (3)

Answer 20

1. Studies low response rate of 4.9% - limits generalisability of findings to wider Australian HT population.
2. Developed our own data collection instrument to adhere to targeted study aims and ensure specificity to HT practice. However, reliability and validity of the outcome measure is undetermined which in turn may increase potential bias. In an attempt to mitigate such challenges - published survey guidelines, field-testing and a validated theory were employed during survey development.
3. Only using one part of the theory

Question 20

What are the strengths of your research? (4)

Answer 20

1. Australia-wide perspective
2. Provides preliminary evidence (first study to identify Australian hand therapists utilisation of DHIs / explore hand therapists perspectives regarding their use.
3. Collected both quantitative and qual data.
4. Using a theory

Question 21

What should future research investigate?

Answer 21

• Further defining use: Given our study results demonstrated high adoption among therapists in this study further investigation into the frequency of use, purpose of use, clientele characteristics and common conditions hand therapists are employing DHIs for will be key to further defining their usage in hand therapy practice.
• Rogers’ one part of the theory - more comprehensive understanding of DHI. Person-related characteristics: future studies should investigate other components of the theory on the innovation-decision process specifically the characteristics of the adopter, given a key category that emerged from qualitative data was a lack of knowledge and confidence when utilising DHIs. This finding relates directly to the characteristics of the adopter, which is one of the four key determinants Roger proposes influences an individual’s choice to adopt an innovation. Future studies should investigate these person-related characteristics with the intent of determining how they may impact the adoption of DHIs by HTs in Australia.
  External factors: when adhering to the studies aim the chosen unit of analysis were hand therapists as individuals meaning the effects of external factors on DHI adoption were not explored. Future research of these factors through investigation of the decision-makers/administrators, may be imperative given a small group reported not possessing the option to utilise DHIs.
• Other theories?

Question 22

Why did you use a conventional content analysis if you used a theory for the quantitative data?

Answer 22

1. The nature of the qualitative questions were open-ended and we wanted to keep the essence of participant answers.
2. We wanted to provide participants the option to bring up factors that were not related to the theory or at least the five innovation attributes.
3. To make sure any pre-concieved ideas or themes did not influence how we interpreted the data.

Question 23

How did you ensure trustworthiness when analysing qualitative data?

Answer 23

1. Credibility by ensuring all members of the research team were involved throughout the analysis.
2. Dependability as audited and ensured by our supervisors.
3. Confirmability through peer checking and reflexivity.