Skype on Wheels: Implementation of video-calls to reduce feelings of loneliness and social isolation for older people living in care
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Background: Older people in care may be lonely with insufficient contact if families are unable to visit. Face-to-face contact through video-calls may help reduce loneliness, but little is known about the processes of engaging older people living in care in using video-calls. Aims: 1-To explore how to normalise the use of video-calls within the care environment, 2-To examine how video-call communication for older people might reduce loneliness and social isolation. Sub aims: 3- To identify the barriers and facilitators to using video-calls within a care environment for older people, care staff and social contacts, 4-To explore how staff and social contacts’ attitudes towards using video-calls change after implementation. Design: A mixed methods approach of ethnography and feedback forms using collaborative action research (CAR) methodology included five core steps taken across two cycles of research: (1) Recruitment of older people and relevant social contacts. (2) Planning how best to implement the intervention. (3) Implementation of video-calls. (4) Reflection to identify barriers to and benefits of using video-calls. (5) Re-evaluation to tackle the identified barriers. Intervention: The video-call intervention comprised a wheeled device (Skype on Wheels (SoW) that could hold an iPad or tablet and telephone handset and used Skype to provide a video-call service for residents and their social contacts. In cycle two, Skype TV (STV) was an additional form of delivering video-calls on a larger screen and trialled alongside SoW. Methods cycle one: Seven care homes and one community hospital in the South West of England participated. Care staff (n=32) were collaborators who implemented the intervention by agreeing the intervention, recruiting older people without dementia (n=34) and their distant family (n=19), and setting up video-calls. Ethnographic data included field notes and reflective diaries on observations and conversations with care staff, older people and family which were maintained over 15 months and analysed using thematic analysis. Results cycle one: Four care homes implemented the intervention. Eight older people (23%) with their respective family contacts made use of video-calls. Older people were able to use SoW with assistance from care staff and enjoyed the use of video-calls to stay better connected with distant family. However, five barriers towards implementation were staff turnover, risk averseness, the SoW design, lack of family commitment, and staff attitudes regarding technology. Methods cycle two: Four care homes continued to cycle two. This consisted of three key activities to address the identified barriers in cycle one to improve implementation. Namely; 1- focus groups to allow residents (n=28) to aesthetically personalise SoW, 2- video-calls using SoW between school pupils (n=4) and residents (n=20) to build new social contacts and trial the use of a prompt sheet to improve the quality of conversations, and 3- inter-care home video-calls using SoW and STV between residents (n=22) across care homes to increase socialisation. Residents with dementia but with the mental capacity to consent (n=7) were included in cycle two. Additionally, the usability, content and face validity, and usefulness of scales to measure outcomes of loneliness (CELS), social isolation (LSNS-R and LSNS-6), well-being (SWEMWBS) for residents, and staff attitudes towards technology (ATTS) were tested. Scales were given at baseline and follow-up (6 months) and were analysed for simple descriptive statistics. Field notes on observations, feedback forms and structured interviews with residents, social contacts and care staff were maintained over 10 months and analysed using thematic analysis. Results cycle two: Personalisation of SoW and an alternative method of accessing through STV, along with introducing a non-familial social contact to video-call increased the uptake of participation from residents, and helped retain residents in the intervention over a longer period. The use of a ‘prompt’ sheet with school pupils improved the quality of conversations between older people and pupils. All residents with dementia were capable of participating in all activities and found them beneficial, even though they did not always remember using video-calls between sessions. Care staff attitudes towards video-calls improved after acting as a ‘facilitator’ during activities. Exploration of the usefulness of scales to measure key outcomes concluded that the LSNS-6 and CEL scales are useful and appropriate for residents with dementia, or who are end of life. However, the SWEMWBS was not useful, and the ATTS needed further exploration with care staff. Conclusion: These findings suggest that video-calls for residents with and without dementia can to some extent be normalised within a complex long-term care home environment over some months, whereas it was not feasible in a community hospital because of the short patient stays. However, it is still unclear how effective video-calls are in reducing loneliness and social isolation within care. The current research suggests that care homes adopt implementation activities in the order of 1- residents to aesthetically personalise video-call technology, 2- allow residents to engage in non-familial social contacts to become familiar and improve acceptability and 3- help residents accustomed to video-calls to reconnect with distant family members.