Net gains

The
internet is seen as irrelevant by many social care workers. But a project set
up by Loughborough University aims to discover what care workers need from the
web so it can become a useful work tool, writes David Poulson.

In
1998, the European Commission funded an innovative research and development
project called Discus (distance information, support and communication for
European carers).

The
project was innovative in that its objective was to use the internet as a means
of providing practical support to professional care workers -Êpreviously
computers had been mainly used by care managers to schedule work activities
such as duty rosters and diaries.

What
also made Discus particularly interesting was the knowledge that for many of
its users, this would be the first exposure they would have to computers. This
in turn meant that considerable care would be needed in developing the project,
to ensure that in addition to meeting the needs of care workers the services
would also be easy to use.

The
logic behind the Discus project was the likelihood that the ageing population
would put increased pressure on care services, and that technology might be an
effective way of supporting care workers.

Access
to information was seen as a critical issue, along with the ability to
communicate effectively with colleagues. For these reasons the project
concentrated on developing an information system covering the practical aspects
of care and developing e-mail facilities to support care workers. Such a system
was seen as particularly useful in supporting staff in rural areas, where
access to conventional means of support might be limited.

Because
the project was funded as a European initiative it was also important to ensure
that work had some relevance across Europe. Project partners were based in
Italy, Greece, the UK and the Netherlands, and it was agreed to develop a
common platform that could be tailored to the needs of other countries.

Early
phases of the project work involved identifying the needs for such a system by
interviewing care workers and other care professionals in the different
countries.

A
total of 119 care workers were interviewed in the four countries involved
during a three-month period in late 1998. Most were hands-on care workers,
providing care to individuals in their own homes. Emphasis was also placed on
interviewing those with responsibility for the practical aspects of care, and
did not explicitly include workers providing specialist medical support such as
nurses.

Considerable
overlaps were found in the skills and attributes of the care workers consulted.
They were characterised by not having high levels of education, and experience
of using computers was also generally low.

Female
employees predominated in the sector and they were often working part-time. In
most countries a clear distinction was also made between the medical aspects of
care, which required more specialist staff to provide support, and more basic
care related to cleaning the home, personal hygiene and feeding.

Poor
access to information was also a common theme, and in some cases low levels of
training for professional carers was reported.

The
care workers interviewed wanted information, on a variety of topics, that could
be provided by a computerised information resource. These included:

–
Advice on basic care, cleaning, personal hygiene and feeding.
– Information on illnesses, disease, disability, ageing, and diversity of
symptoms.
– Medication and side-effects.
– Individual rights, dignity and self-respect.
– Cultural awareness: working with ethnic groups.
-Legislation, legal responsibilities, eligibility criteria (and how these can
change).
– Directories of other agencies and services.
– Health and safety.
-Communication skills and how to deal with difficult clients.
– Use of care equipment.
– Sources of expert knowledge.
– Training available.
– Activities and places for older and disabled people to visit.

This
information was used to develop a prototype Discus information system, which
provided information on a range of care topics, such as moving and handling,
common diseases and disorders, care equipment and the duties and
responsibilities of carers. In addition to text and images, the system made use
of video clips to illustrate care practice. A simple menu-driven interface was
also designed to make the system easy to use for care workers.

This
prototype was evaluated with a sample of care workers in the UK, and the
information used to refine the design. It was generally well received, and no
major problems with learning to use it were reported.

However,
there were some minor difficulties, most of these attributable to care workers’
lack of basic familiarity with computers. Using the mouse caused some
difficulty – particularly the action of clicking and dragging as a combined
activity – and future systems may rely less on the mouse as an input device.

The
prototype information system was truly multimedia based, consisting of text,
images and video materials. Short video clips were included as a way of
illustrating care procedures, and these proved to be an important way of
imparting information, with considerable added value over text and conventional
illustration. As a result of these evaluation activities, additional materials
were also added to the system with particular emphasis on increasing the
multimedia content. The resulting system contained:

–
More than 60 video clips.
– More than 200 care images.
– Eighty text files covering topics such as practical aspects of care; diseases
and disorders; working as a carer; and care equipment and services.

The
video clips were seen as being particularly important as they made it very
clear what procedures were being endorsed, and in a way which was impossible to
provide by other means apart from face-to-face communication. While such video
clips were not a substitute for conventional training, they were seen as a
useful way of rapidly sharing changes in care procedure.

A
refined version of this system was used as the basis for national language
versions of the Discus information system in Ancona, Italy and the island of
Samos in Greece. These have been operational since January 2001.

As
with the earlier evaluation work the results have been very encouraging, with
all users wishing to see future developments of the system. This was
particularly the case with regard to the care implications of particular
diseases and disorders.

Some
interesting national differences were also noted however, due to differences in
local care resources. The most significant of these was the finding that at the
Greek site users wanted to have information on how to make simple aids, as many
commercial products were either not available or prohibitively expensive.

Other
desirable developments would be the provision of much more specific local
information on care services available and on particular clients. This would
include:

–
Information on other care services locally and how to gain access to them.
– Information on clients’ rights to services, along with national and local
legislation.
– Background of the client (family, friends, relationships, medication,
previous employment, hobbies).
– The client’s physical and mental abilities. This was a particular concern
when dealing with clients with cognitive and emotional problems who might also
be aggressive.

In
summary, Discus has been an interesting opportunity to explore the use of new
technology in a sector that traditionally has made little use of such
resources.

The
results have been very positive, showing that care workers can be encouraged to
use the internet to assist them in day-to-day activities, and that there are
clear areas of application for such systems to develop. The potential for such
technology to support training initiatives has been demonstrated, with video
particularly valuable in illustrating and sharing care procedures.

The
development of a fully functional prototype information system has also proved
to be an important advance in its own right. Potential users are often only
able to fully appreciate the potential for such technology when they are given
access to a working demonstration. This has also proved to be an effective
means for creating awareness of the project, with the result that a Dutch
language version is to be developed from the internal development resources of
one of the participants.

The
generic prototype proved to be an effective basis for local Discus initiatives,
and is now available to other European care organisations at a reasonable cost.

For
more information about Discus go to www.lboro.ac.uk/research/husat/discus-web

David
Poulson is a research fellow in the research school in ergonomics and human
factors at Loughborough University.