2 Theoretical background and review of literature
2.2 Product selection framework
2.2.1 ATD Frameworks
Dr. Marcia Scherer and colleagues have made significant contributions in the area of ATD selection through research and practice with the Matching Person and Technology (MPT) model. The MPT model suggested that considerations of the person, the milieu and the technology are necessary for a best “match” during the selection process. These three focused areas originally emerged from a grounded theory study with 10 adults with physical disabilities (five participants with spinal cord injury and five with cerebral palsy) (Lenker & Paquet, 2003). Of significance is that the MPT system of instruments
(Scherer, 1998; Scherer & Craddock, 2002) have advanced and focused our
understanding of the pre-dispositions to matching a person and the technology and these are mentioned shortly. A summary of the MPT assessment process and instruments may be found in Scherer et al. (2005, p. 1322, Table I). An example of one MPT instrument is the Assistive Technology Device Predisposition Assessment - Consumer form (ATDPA – C). It provides a section which asks the consumer to rate 10 general, non-disability specific items relating to “how do you feel about using the device?” (Scherer, 1998).
Although Scherer's approach has been heavily promoted, there has been limited
published evidence that using the MPT makes a measurable difference in outcomes from device selection. Overall, there have been a dearth of well-controlled studies on the effectiveness of selection frameworks. Recently, Scherer, Jutai, Fuhrer, Demers, and DeRuyter (2007) proposed a framework for modeling the selection of ATDs (Figure 2-1).
Figure 2-1: Framework for modeling the selection of ATDs (Scherer et al., 2007).
The two sets of pre-disposition factors expressed in this framework include
environmental (cultural and financial priorities, legislation and policy, attitudes of key others) and personal factors of the consumer and the provider (resources, knowledge and information, expectations, personal preferences and priorities). “Together, these
environmental and personal factors create the context in which ATD decision-making and device selection for a given individual occurs” (Scherer et al., 2007, p. 4). Objective needs (e.g., walk 50 feet on a smooth surface) are normally determined by the provider, whereas subjective needs (e.g., desire to move independently) are decided by the
consumer (Scherer et al., 2007). The authors posit that the selection framework feed into an additional framework (not included here) which may be useful for modeling short and longer term ATD outcomes (Fuhrer, Jutai, Scherer, & DeRuyter, 2003). Together the MPT and the framework provided a comprehensive modeling of the selection of ATDs. They also created an excellent backdrop in situating the area of focus for the current dissertation. That is, the development of a low vision product selection instrument based on what persons with low vision deem as important considerations for product selection
for occupational performance. In other words, the goal of the current work was not to replace the MPT but rather, to gain a better understanding of LV participants’
perspectives (e.g., personal factors) that may influence product selection. These factors can then be operationalized as LV domain specific items that may supplement more generic items found in the MPT.
In terms of utility, Lenker and Paquet (2003) suggested that the MPT is a useful heuristic tool for ATD provision given its broad applicability, much like the HAAT model. The HAAT model focuses on capturing the components of the human, the activity and the assistive technology used within a context. “The human component includes physical, cognitive, and emotional elements; activity includes self-care, productivity and leisure; assistive technology includes intrinsic and extrinsic enablers; and the context includes physical, social cultural and institutional contexts.” (Cook & Polgar, 2008, p. 36.)
to the foreground. In the HAAT model, activity is analogous to occupation as previously defined. The HAAT model is arguably less developed and less tested for ATD selection because the model and its respective components have not been operationalized.
However, as Lenker and Paquet (2003) suggested, the HAAT’s “all-encompassing nature affords possibilities as a reference framework upon which outcomes research can be based.” (p. 4). Given the exploratory nature of the research presented in the current dissertation, the use of the HAAT model served to minimally acknowledge the dynamic negotiation between these key components to ensure that they were not overlooked. The HAAT model provided a method to organize the relevant literature identified in the scoping review of LV product selection (below), and as well, suggested possible content, especially the context for which the LV-PSI was administered.
Finally, Gitlin’s model (1998) depicted the person’s use of a device as following a career path from the initial use of the device as a ‘novice user’ (e.g., in the hospital) to an ‘early user’ (home use for 1-6 months), to an ‘experienced user’ (home use for 7-12 months) and then finally as an ‘expert user’ (home use for 1 years and beyond). The model is grounded on a biopsychosocial framework which helps to examine “the interplay of functional, psychological, and social conditions that contribute to device use at home.” (p. 119). A purposeful sampling of three patients with mobility disabilities from a larger study of older rehabilitation clients (N = 250) was used to illustrate the model. The key offering of the model is the idea that device needs change over time from being a ‘novice user’ to an ‘early user’ and beyond. The model depicts that device needs emerged in a linear fashion as a function of increased time use and exposure to the device. As such, an expert user may have accumulative experiences and insight from having gone through discrete stages of his device use career path. In the qualitative part of the current research, experienced and expert users, as defined by Gitlin (1998), were purposely sampled for the focus groups conducted. Furthermore, it was expected that by including experienced or expert users as opposed to novice users, the research would be able to leverage their specialized knowledge of having had opportunities to select and obtain LV products by themselves through the health care system, private insurance, and/ or work insurance. In addition, having used ATD or products to accommodate their LV for an
depth experiences of successes or failures associated with product selection.