Exploring factors that affect the uptake and sustainability of videoconferencing for healthcare provision of older adults in care homes

Background: There are currently 421,100 people aged over 65 living in care homes (Age UK, 2017). With an increasingly ageing population, it is likely that the need for care homes will increase across the country (Smith et al., 2015). This will necessitate the development and assessment of innovative methods for delivering efficient healthcare in care homes (NHS England, 2014a). A rapidly developing and increasingly popular method of delivering health care is videoconferencing, and this has shown promise in addressing these challenges (Hex and Wright, 2015). This thesis aims to explore factors that affect the uptake and sustainability of videoconferencing in care homes in Yorkshire and the Humber, to establish what works for whom, and in which circumstances and respects. Methods: A literature review was conducted to identify the technological terms underpinning this study. This was followed by a scoping review (Chapter 3), which was undertaken to establish the current research available on the use of videoconferencing for remote healthcare provision in care homes globally (Newbould et al., 2017). Guided by findings from these reviews, a survey (Chapter 4) was developed to identify care home manager's knowledge of and attitudes towards videoconferencing, and to map current provision in care homes in Yorkshire and the Humber. The survey findings were used to identify three care homes for a realistic evaluation, based on comparative case studies (Chapter 5). Results: The scoping review found a wide range of applications for videoconferencing technology in care homes, with the most common being assessment of resident health. Additionally, most of the research was identified as originating from countries with large, sparsely populated geographical areas. The survey found that videoconferencing was rated highly for most aspects, apart from accessibility, which was considered a problem by one care home. The majority of respondents that had not had experience were distrustful of the technology. However, respondents that did have experience reported being happy with the service provided. However, one of the main drivers of uptake appears to be access to services currently available and perceived relative advantage. From the in-depth case studies (Chapter 6), it was established that where change efficacy (perceived ability to affect change) and change commitment (shared vision to implement change) were high, there was a supportive context for uptake and sustainability. Factors that affected change efficacy and change commitment appeared to be care home culture, research champions, and access to knowledge, training, and expertise. Discussion: The findings from the thesis demonstrate that videoconferencing is a viable tool where certain organisational prerequisites exist. The thesis suggests that more research should be undertaken to address the readiness of care homes to implement new interventions. Additionally, there needs to be more funding and greater focus on policy for getting research knowledge into practice.