| Study Objectives and SignificancesAssistive technology (AT) is a term that include assistive, adaptive, and rehabilitative devices and technology for people with disabilities in order to perform functions that might otherwise be difficult or impossible. About60%-80%of disabled people can improve their quality of life through AT application. However, the proportion of Chinese disabled people who own AT devices is very low, as compared with developed countries. There is huge potential for further development.In recent years, the Party and government has introduced a number of policies to promote development in the AT field. The funding growth is significant, and the AT service system has been built up around urban and rural areas. The Municipality of Shanghai is leading in the practice of AT provision in China, transforming from simply distribution to matching and adaptation. Since2010, AT matching and adaptation with government subsidy was offered to person with severe disability, low-income disabled people, or households with multiple disabled members. To implement such policy, the needs and outcomes assessment of AT provision is a must. The needs and outcomes assessment help measure the present performance and improve the quality of service, in order to meet disabled people’s demand in a timely fashion.There are currently few researches on AT service in China. There is urgent need for researches on AT matching and adaptation as well as needs and outcomes assessments to support current practice. This study aims to establish a scientific and operational process for AT needs and outcomes assessment, and provide technical support and reference for AT services in the Municipality of Shanghai and other parts of China.Material and MethodsBased on the matching person and technology model and the process management theory, this research established the process of AT needs evaluation and adaption. Project evaluation and the normative gap analysis were performed to compare the actual condition and expected condition of the disabled persons who received the assistive technology matching and adaptation. Qualitative and quantitative analyses were also performed to assess the effectiveness of the assistive technology adaptation.Main sources of this study include literature review, field survey and in-depth interview. Through analysis of literature and consultation with experts, this study established the process and scheme for the needs assessment, and developed the methodology, tools, and implementation plan for the outcome assessment. Field survey and in-depth interview provided information for the needs and the outcomes assessment.Epidata3.0, Microsoft Excel2007and SPSS16.0software were used to analyze the data. Descriptive statistics were produced for all related data, and the paired samples t-test was used to compare the score of scales before and after the AT adaptation.Results1. Research on the needs of AT provision in Shanghai MunicipalityThrough the needs assessment in the two pilot districts in Shanghai, disabled persons who would get AT adaptation in2010were screened out, and provided with the matched technologies. Improvement was made on assessment process and tools. Next, all disabled people in the other16districts were screened for assistive technology needs. The results show that there are a total of2278people with severe disability, living by the subsistence allowances and without any AT device; more than4000people with severe disability and living by the subsistence allowances; and17469people with severe disability and low income. The three groups are the potential targets who need prioritized support through the policy.2. Development of the methodology of AT outcomes assessmentThe research was based on the potential outcomes of the assistive technologies. It sought for the guidelines for the evaluation, that is, focusing on the changes of the disabled persons’functions; considering the interactions of disabled person, AT service delivery and environment; operationalizing a multi-stakeholder approach to outcomes research. As a result, we developed the framework of AT outcomes assessment as the status of AT users, AT services delivery and the environment for AT using, as well as their contents. The relevant outcomes assess tools were developed with the principles of being scientific, appropriate, concise, understandable and operable. Then we combined some existed scales and self-designed questionnaires to form the tool for the assessment. After the peer review and modification, the assessment tools and evaluate scheme were established.3. Research on the outcomes of AT provision in Shanghai MunicipalityAll the disabled people acquired the AT services in two pilot districts were surveyed by our outcomes assess tool, and a total of326valid questionnaires and12in-depth interviews were completed. Most respondents are physically disabled people, the proportion of persons with severe disability is relatively high, and about30%respondents are living by the subsistence allowances or with low-income. This result reflected the policy’s principles. Most customs are satisfied with the matched AT devices and barrier-free retrofitting (91.1%and91.2%). Although there are some unchangeable barriers,72.4%and78.5%of customs agreed the AT matching and adaptation can improve their outdoor and indoor activity abilities. In terms of activities of daily living, the respondents’scores on most items are improved, the total score of BI scale rose from55to61(p=0.00). Meanwhile, every dimension in SF-12scale score has improved significantly.On the other hand, most primary caregivers of the disabled people are their parents (79.0%).67.6%of caregivers are older than50, whose care burden is very heavy. After AT matching and adaptations, their time spent on taking care of the disabled people is significantly shortened.78.5%of caregivers agreed the amount of labor is decreased;70.7%and78.2%felt their psychological burden and the total burden were reduced, while56.4%caregivers believe that their own health has improved, and49.2%believe that the relationship with the cared is improved. The qualitative interviews also support such result. In conclusion, the AT adaptation improved the daily living and activities abilities as well as the quality of life for the disabled persons, and reduced the burden of their caregiver. The outcomes of the AT service are generally satisfactory.Conclusion1. There are currently few researches on AT service in China. Further researches on AT matching and adaptation needs and outcomes are necessary and urgent to support current practice.2. The needs assessment found that only a limited number of people in the16districts qualify for the AT adaptation policy. Therefore, AT devices should be provided by the need assessment, rather than by annual planed targets. Meanwhile, the policy needs to expand its coverage, so that more disabled people can enjoy the benefits.3. The methodology and tool of AT outcomes assessment developed in this research helps to solve the current technical bottlenecks. After applying such methodology and tool to assess the AT outcomes in two pilot districts, the results show the outcomes of the AT matching and adaptation in2010are generally satisfactory. Future research could focus on the improvement of current methodology and tool, the development of professional and independent assessment mechanism, and the expansion of assessment scope to other16districts. |
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