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Abstract
Introduction Care aides are health workers who deliver hands-on care to patients across the healthcare continuum. The use of technology in healthcare delivery is increasing, and evidence regarding how care aides’ attitudes may either facilitate or hinder the adoption of healthcare technologies is lacking.
The aim of the proposed scoping review is to examine available evidence regarding care aides’ attitudes towards the adoption of innovation and factors that may influence the sustainable use of technology in healthcare delivery. Published studies, grey literature and review articles that identify a method for the review, conference abstracts and website publications regarding the attitude, uptake and sustainable use of technology in care delivery by care aides will be included. For abstracts that have resulted in publications, the full publications will be included. The search for evidence commenced in June 2023 and will end in March 2024.
Methods and analysis The Joanna Briggs Institute (JBI) method will be used to conduct the review. The CINAHL, Cochrane Library, EMBASE, MEDLINE, ProQuest, PubMed, SCOPUS, PROSPERO, Web of Science and JBI Evidence Synthesis databases will be searched using keywords for publications within the last 20 years to examine trends in health technology and attitudes of care aides towards innovation over the last two decades. A search of grey literature and websites will be conducted. The reference list of the retrieved articles will be used to identify additional literature. The search results will be exported into a literature management tool for screening and analysis. Article screening will be performed by two authors and if a third is needed to resolve any differences. Data analysis will be guided by two theoretical frameworks.
Ethics and dissemination No ethics approval is required. The findings will be disseminated in a peer-reviewed journal and presented in conferences.
Registration details https://doi-org.ezproxy.u-pec.fr/10.17605/OSF.IO/CZQUP
- Nursing Care
- Quality in health care
- Patient-Centered Care
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Strengths and limitations of this study
The inclusion of a grey literature search and inclusion of relevant data will reduce publication bias and strengthen review findings.
The use of the Joanna Briggs Institute method will contribute to a transparent and reproducible review.
Evidence from a variety of sources will be synthesised and guided by two theoretical frameworks.
The use of theoretical frameworks to guide data extraction may limit the scope of data extracted to the framework domains.
The use of Google Translate and DeepL for non-English articles may prove inadequate to describe factors influencing attitudes, especially culture-specific influences.
Introduction
Healthcare technology involves the use of devices for health promotion, prevention and management.1 Technological solutions have the potential to decrease health inequalities and enhance the delivery of healthcare services.2 The use of smartphone applications for remote monitoring, adaptive technologies in managing mobility and sensory impairments and teleconference could reduce health inequities among patients.2 The assessment and management of health conditions, such as urinary incontinence, can be improved with appropriate innovative technology.3 The potential benefits of application of technological solutions in healthcare include the prevention of complications, workload reduction and improvements in the delivery of quality care.4 5 Despite the potential advantages, the decision to adopt technology can be dependent on how it is perceived by potential users, which may be influenced by their beliefs and attitudes and the context to which it is introduced.6 As part of the context, it is important to consider the timing of the introduction of the innovation, as the adoption of technology may be facilitated when timing is perceived to be appropriate.6
Care aides (also known as personal support workers or nursing assistants) comprise an essential component of the workforce and are integral in the delivery of quality care to patients/service users.7 Care aides are unregulated health workers required to have some high school education or complete a healthcare aide certificate college programme.8 They work in a variety of healthcare settings providing basic care to patients and assisting nurses.8 Ensuring care aides have appropriate training and education may contribute to positive attitudes that facilitate better management of health conditions.9 10 Factors that may influence the attitude of care aides towards the implementation and sustainable use of innovative practices such technological solutions include its usability, patient safety, fear of job loss, time constraints and incorporating the solution into their existing heavy workload.11 12 In addition, adoption and sustainable use of innovation can be influenced by the inclusion of end users of the innovation.13 Successful uptake and sustainment of innovative technology require consideration of both the technology and its users.13
The attitudes of care aides to the uptake and adoption of health-related technology or factors relating to sustainable use are underexplored. Hence, this scoping review seeks to examine and synthesise available evidence regarding care aides’ attitudes towards the adoption and sustainable use of technology in the delivery of care and services through the lens of a framework and innovation theory.
Theoretical framework
This work is informed by two theoretical perspectives. First, the Consolidated Framework for Implementation Research (CFIR), a guide for assessing potential barriers and facilitators in the adoption of innovation, which includes five domains of innovation, individual, characteristics, inner and outer settings.14 15 Under the outer setting domain, attitudes are described as a construct that includes sociocultural values and beliefs that influence the implementation of innovation.14 This construct definition will guide the exploration of data collection on the attitudes of care aides towards the adoption of innovation.
Second, Roger’s innovation diffusion theory discusses essential conditions in the uptake and sustainment of innovation and identifies four elements that should be considered: innovation, social system, communication channels and time.6 13 Innovation is defined as concepts or objects that people identify as new, including technology, while social systems are described as individuals or groups in which diffusion of innovation occurs (table 1).13
Theoretical frameworks
Different technologies used in the delivery of care such as sensors, smartphones, handheld devices, body worn, wearable devices and electronic monitoring systems will be examined to identify care aides’ attitudes towards their uptake and usage, as well as barriers to their successful and sustained implementation. The adoption and sustainable use of technology can be dependent on various factors, which are identified as constructs under five domains (innovation, individual, characteristics, inner and outer settings) in the CFIR, including innovation source, design, innovation relative advantage, attitudes, policies and laws, communications, culture, compatibility, funding, planning, engagement, innovation deliverers and recipients.14 However, responses to these factors/constructs may elicit a combination of subjective perception and objective facts.15 The CFIR will guide the gathering of evidence from a variety of sources that speak to factors influencing care aides’ attitudes towards the adoption and sustainment of technology based on its domains and constructs.14 Rogers identified five characteristics which influence the adoption of technological innovation; its relative advantage, compatibility, complexity, trialability and observability; these will be examined in the scoping review.13 Rogers explains that if an innovation is perceived to be advantageous, compatible with values and past experiences, simple to use and understand, easy to try with little uncertainty, and with observable results, there are higher chances that the innovation will be adopted.13 Hence, how these characteristics may influence the adoption of technology by care aides will be examined in the proposed scoping review.
Care aides make a significant contribution in the delivery of care, and their essential role as members of the healthcare team require that they are considered in the introduction of health technology, as attitudes towards innovation held by this group will influence adoption.13 16 Articles that focus on care aides’ attitude to using different technologies for patients/service users across the healthcare continuum (private homes, long-term care facilities/nursing homes, hospitals, hospices and communities) will be explored to facilitate the gathering of diverse information regarding the topic.
Review question(s)
The scoping review questions were developed using the participants’ concept and context framework.17
What is known about the attitudes of care aides towards uptake and sustainment of technology?
What factors influence the attitudes of care aides towards the uptake and sustainable use of technology in the delivery of healthcare?
Eligibility criteria
Participants
Inclusion criteria
This scoping review will consider research studies of any method, government reports, abstracts from scientific conferences and review articles that identify a method for the review (meta-synthesis, systematic, scoping and narrative reviews) focusing on care aides’ (also identified as formal caregivers or carers/nursing assistants/support workers) perspectives of and attitudes to the use of innovation/technology in the delivery of care in any healthcare setting. To ensure evidence from different cultural settings is included, the review will include articles from different countries and in languages other than English.
Exclusion criteria
Reports on health workers who are not care aides will be excluded.
Concept
Adoption of technologies in the delivery of healthcare by care aides.
Context
All healthcare settings including private homes, long-term care/nursing homes, hospitals, hospices and community settings.
Types of sources
Studies of any method (qualitative, quantitative, mixed methods, randomised control trial, observational, experimental, pilot and feasibility trial) published in peer-reviewed journals, technology reports, government documents and abstracts from scientific conferences that include care aides in technology adoption in any healthcare setting will be included. Systematic reviews, meta-analyses and narrative reviews in which article selection based on systemic search and inclusion criteria is described will also be included. Articles written in language other than English will be included and translated to English using Google Translate (https://translate.google.com/). For validity purposes, another language translator DeepL (https://www.deepl.com/en/translator) will be used, and both translations will be compared before the inclusion of the evidence in the scoping review.
Methods and analysis
The Joanna Briggs Institute (JBI) method will be used to conduct the proposed scoping review, which is in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).17 18
Search strategy
A preliminary search performed on 11 June 2023 of CINAHL Plus (EBSCOhost) using the keywords, Care aide* and Care* and Technology*, revealed 388 records published between January 2008 and 2023. The search of articles over the past 15 years was conducted using additional keywords (nursing assistant, personal care worker, carer, caregiver and support worker) to facilitate the gathering of studies regarding health technology in a variety of healthcare settings.
In the last decade, healthcare settings have focused on technology.19 Searches of CINAHL, Cochrane, EMBASE, MEDLINE, ProQuest, PubMed, SCOPUS, PROSPERO and JBI Evidence Synthesis databases revealed that scoping reviews on the topic were lacking. A preliminary search of the WHO website was conducted, and technology reports, which included a report regarding the various benefits of assistive technology for health and the need to improve access to technology, were found.20 However, publications regarding care aides’ attitudes towards the adoption and sustainable use of technology were not found.
Research studies, reviews, abstracts and reports will be searched in databases and websites using the keywords (adoption, care aides, care delivery, technology, sustainable). Snowballing, which involves searching the references/citations of retrieved articles will be used to facilitate the gathering of additional relevant evidence.21 A librarian scientist will be involved in identifying an effective search strategy and conducting further searches. Data extracted from the included sources will be consistent with the review questions and inclusion criteria of the scoping review, data analysis will be descriptive, and the results will be presented in table form in line with the JBI method.16 Articles from the last 20 years will be included in the review to gather relevant articles and to reflect the trend of increasing applications of technology in healthcare.
Study/source of evidence selection
Search results will be exported onto a literature management tool, Covidence (Veritas Innovation, Melbourne).22 The search results and duplicates removed will be presented in the PRISMA-ScR chart to show the movement of sources.18 Two researchers will screen the titles and abstracts of the exported results, and agreement on inclusion will secure full-text review and extraction of findings based on the relevance to the review questions, objectives and inclusion criteria. In the event of disagreement, the third researcher will be involved to resolve this. The authors, year of publication, country, design, objective, sample size, settings, intervention (if any), summary of findings and limitations of the retrieved results will be included in the scoping review. In keeping with the JBI method and considering the likely heterogeneity of studies retrieved, there will be no formal assessment of the research quality.
Data extraction
Two researchers will be involved in the data extraction process by carefully going through the search results to retrieve relevant data to be included in the scoping review. Data extraction and analysis will be guided by two theoretical frameworks, which identify domains and characteristics influencing the adoption and sustainment of technology/innovation.13 14 The identifications of domains and characteristics from papers to be included in the review will be guided by definitions and explanations provided by the theoretical frameworks (Box 1).
Data extraction
Data to be extracted for the scoping review:
Author
Year of publication
Country
Objective
Study design
Participants/sample size
Settings
Intervention (if any)
Limitations
Findings
Note From Peters et al.17
Data analysis and presentation
Strategies to ensure quality analysis in the proposed review will include the use of three authors in the careful screening of search results, article selection and analysis of the methods of the articles, participants, settings, findings and conclusion sections.
Analysis will be guided by the CFIR framework14 and Roger’s diffusion theory, looking for patterns and key elements influencing the adoption of technology by care aides.
The review may help identify knowledge gaps with the introduction and use of innovations in healthcare technology, among a key group of workers who are directly involved in the delivery of care. Strategies supportive of successful implementation of innovation may be identified, which may impact the delivery of technology-based care delivery.
Ethics and dissemination
In accordance with the ethics committee policy, formal approval for a scoping review is not required as it involves analysis of previously collected data. The results of the review will be published in a high-impact journal with a focus on open-access publication. The results will be presented at university research days, national and international continence care conferences and workshops.
Ethics statements
Patient consent for publication
Footnotes
X @adrianwagg
Contributors MO: Preliminary database search, concept and design, manuscript writing, critical analysis, editing and final approval. KH: Concept and design, manuscript writing, critical analysis, editing and final approval. AW: Concept and design, manuscript writing, critical analysis, editing and final approval. AW is responsible for the overall content as guarantor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests AW reports research support from Essity Hygiene & Health. This review will contribute towards the thesis for the doctoral degree (PhD) award for MO.
Patient and public involvement Patients and/or the public were not involved in the design, conduct reporting or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.