The use and non-use of assistive technology in Italy: Preliminary data

Purpose. The present pilot study aims to analyse the relationship between the reasons of assistive technology (AT) use/non-use and the levels of user satisfaction of Italian users/patients in order to identify which features better predict AT non-use in the Italian Territorial Health Service Providers (THSPs) AT assessment process. Method. Between November 2010 and January 2011, a telephone structured interview with open- and closed-ended questions was administrated to 430 THSP users/patients who have received a hearing aid or a stairlift at least one year before. Results. Findings show a 25% of AT non-use and a strong correlation (p<.001) between AT non-use and the AT users/patients' dissatisfaction reasons - adjustments and personalisation, safety, and comfort. Of particular interest is the fact that users/patients tend to not use the AT if the follow-up provided by the THSP is dissatisfactory. A strong correlation (p<.001) is also founded among the AT satisfaction, measured by the QUEST 2.0, and some reasons of non-use; the users, indeed, claimed that they are likely to not use the AT when they are not satisfied by: i) The AT dimension or the weight, since it was hard to make it work and it did not help users/patients to perform better; ii) The AT personalisation, since they had to require more assistance than was really necessary and the AT did not help them to achieve their goals; iii) The AT safety, since users/patients had to spend a lot of energy using the AT, so involving other people (caregivers) who complained about the AT; in other cases, conversely, the safety dissatisfaction was linked to a low degree of transportability and storability of the aids; iv) The AT simplicity of use and effectiveness, since the AT did not help users/patients to perform better; v) The AT comfort, since AT required a lot of training and assistance in use, did not help to achieve users/patients goals, was not comfortable and/or was difficult to wear. Conclusion. Our data clearly show that the users' satisfaction of AT and of service providers are strongly correlated to the AT non-use, by suggesting that just a user-driven process of AT assignation process, centred on the user/patient needs and expectations might reasonably prevent the AT non-use and abandonment. The 25% of AT non-use estimated in this survey is slightly lower compared to the range of percentages usually reported by international studies that is rated from 29% to 33%. Albeit our findings suggest that there is a lower percentage of non-use than in other health systems, the AT non-use level remains high (about one quarter of the ATs assigned are not used), becoming a significant economic loss for the Italian National Health System.