Stakeholders and contextual factors in the implementation of an assistive robot arm for persons with tetraplegia: a deductive content analysis of focus group interviews (Preprint)

Abstract

Tetraplegia imposes significant challenges on individuals, caregivers, and healthcare systems. Assistive technologies (AT) like assistive robot arms have shown to improve the quality of life of persons with tetraplegia, fostering independence in daily activities and reducing caregiver burden. Despite potential benefits, the integration of AT innovations into daily life remains difficult. Implementation science offers a systematic approach to bridge this know-do gap.

The objective of this review was to (1) identify and involve relevant stakeholders, (2) identify relevant contextual factors (barriers and facilitators), and (3) suggest a general outlook for the implementation of AT, specifically an assistive robot arm, within the everyday private life for persons with tetraplegia in Switzerland.

A qualitative design, involving three semi-structured online focus group interviews with eight stakeholder groups (affected person, engineering/technology, legal perspective, nursing/care, therapy, social counselling, social insurers, political perspective), was used. The interviews were analysed using the Focus Group Illustration Mapping (by Pelz et al. (2004)), and data aligned with the domains of the Consolidated Framework for Implementation Research (CFIR).

Three focus group interviews, comprising 22 participants, were conducted and data was mapped onto 21 constructs of CFIR domains. Identified barriers were the customisation to the users’ needs, safety concerns and financing issues of high AT costs. The collaboration with different stakeholders including political engagement proved crucial. Identified facilitators included the enhancement of autonomy for persons with tetraplegia, improvement of quality of life, reduction of caregiver dependency, and addressing healthcare labour shortages. The implementation outlook involved the formation of an experienced team, and the development of an implementation plan using Hybrid Type 1 and Type 2 designs incorporating qualitative and quantitative implementation and innovation outcomes.

The robot arm offers promising benefits in terms of improved participation for the users, while high costs and regulatory complexities for the assumption of costs limit its implementation. These findings highlight the complexities involved in implementing AT innovations and the importance of addressing contextual factors. A specific framework for the implementation of AT is needed to ensure the successful integration into the Swiss and comparable social and health insurance systems.