Los Bosques Aluviales, colinosos y de terrazas

In the previous sections of this chapter, barriers and facilitators are identified. The complete list of barriers and facilitators has been added as Appendix M. This section focusses on implementing facilitators to decrease barriers to implementation.

After identifying these barriers and facilitators, it is interesting to see how they can be used to improve the implementation of VR E-health technologies and applications in healthcare institutions. As stated by Villalba et al. (2013), barriers are aways present during implementation processes. However, introducing the right facilitators can reduce the barriers significantly and help the implementation of E- health. Therefore, as a company, incorporating as many facilitators as possible can help reduce the barriers that are associated with the implementation.

Through the literature review, direct observations and the interviews, it is apparent that all barriers are related to one another. This means that barriers influence and strengthen one another. They are also dependent on one another. Due to these complex relationships, it is difficult to diminish one single barrier. However, this also means that incorporating facilitators decrease multiple barriers at the same time.

Therefore, the identified facilitators are analysed. The facilitators are shown followed by the barriers they positively influence. Depending on the amount of barriers they positively influence and the amount of time or money needed to endorse them, a cost-efficiency can be estimated. Since this research focusses on companies conforming to practitioners, only the facilitators companies can incorporate are included. The other facilitators need to be incorporated within the practises themselves or in the broader healthcare system. Therefore, ‘Organisational Support’, ‘Decrease of Medicine’ and ‘Reorganisation of Healthcare Services’ are not included in this overview.

The overview of cost-efficient facilitators is shown in Table 4, rating from most cost-efficient to least cost-efficient. Table 4 can be used by companies to decide which facilitators they want to incorporate within their businesses.

Facilitators Affected Barriers Collaboration in

Design

Negative Pre-Misconceptions, Unaware of VR Advances, Lack of Clinical Evidence Base, Self-Efficacy, Incompatibility, Critical Staff, Absence of Ownership, Not Solving Problem

This is a highly effective facilitator and low in cost: from the beginning of development, practitioners need to be involved throughout the development process. However, only if this facilitator is incorporated at the beginning, the costs are low: otherwise, many alterations might be needed that cost a lot of money. Compatibility of

Content Lack of Transfer, Self-EIncompatibility, Critical Stafficacy, Practitioner-Patient Relationship, ff, Not Solving Problem

It is important to ensure that the content actually is compatible with the treatment of practitioners. This should be done at the beginning of the development phase and can be combined with ‘Collaboration in Design’.

Better Treatment Patients Unwillingness to Try, Lack of Transfer, Realism, Practitioner-Patient Relationship, Not Solving Problem

Depending on the improvement of the treatment, different barriers can be

overcome. However, these improvements usually require software alterations, that are quite expensive. Of course, the E-health application should already be of an added benefit in order for it to be successful. Therefore, this facilitator should always be endorsed by companies.

Raise Awareness Negative Pre-Misconceptions, Unaware of VR Advances, Patient’s

Unwillingness to Try, Practitioner-Patient Relationship, Overabundant Offer, Critical Staff, Unawareness of Patients

By raising awareness for the existence of the application, many barriers can be overcome or at least diminished. The effect on the barriers is not always very high, but this facilitator is crucial for the implementation. Moreover, if patient become aware of possible E-health solutions, they can also let their practitioners know. Also, being more aware of the application and its added benefits could increase the motivation of the patient.

Motivation of

Patients Patient’s Unwillingness to Try, Practitioner-Patient Relationship When a patient is excited to work with the technology, their treatment results can improve. As VR is an innovative and exciting tool, it depends on the quality and concept of the application, as well as on the awareness of the patient as described in the facilitator “Raise Awareness”.

Background

Company Lack of Clinical Base Evidence, Incompatibility, Overabundant OStaff, Not Solving Problem ffer, Critical

Having applications build from a medical motivation instead of a business motivation can improve the level of trust and accreditation of the application. Costs can be non-existent if the team has this background. Otherwise, it could be of added value to add a practitioner to the team. This can be low in costs or high in costs depending on the situation.

Facilitators

Community Negative Pre-Misconceptions, Unaware of VR Advances, Self-Efficacy, I Critical Staff, Fear of Replacement, Not Solving Problems

The same barriers are overcome as with ‘Recommendations’. However, by

establishing a community, more practitioners can help each other. This can also be a self-sustaining facilitator. The costs require time to build a community, but the return is high and it is a very cost-sufficient facilitator.

Recommendations Negative Pre-Misconceptions, Unaware of VR Advances, Self-Efficacy, Critical Staff, Fear of Replacement, Not Solving Problem

The same barriers are overcome like with ‘Community’. As practitioners state, they highly value the recommendations of their colleagues. A recommendation can take away some doubts. Since this could have a snowball effect, the company only needs to invest time in the beginning, making it a low-cost facilitator.

Novelty Patient’s Unwillingness to Try, Unawareness of Patients

When properly marketed, a practice can distinguish themselves and acquire more patients. The costs are low but the efficiency is also not very high. It can also be combined with other facilitators.

Knowledge

Transfers Eligibility of Patients, Self-EIncompatibility, Critical Staffffi, Fear of Replacement cacy, Time, Practitioner-Patient Relationship, By providing KT, practitioners earn about how to implement the application within their treatment. Since KT only has to be created once after which many

practitioners can use it, it is relatively low in costs.

Demonstrations Negative Pre-Misconceptions, Unaware of VR Advances, Lack of Clinical Evidence base, Self-Efficacy, Incompatibility, Overabundant Offer, Critical Staff, Fear of Replacement, Not Solving Problem

Providing demonstrations to companies can diminish many barriers early in the implementation process. Therefore, the return is very high. Since demonstrations cost a lot of time and it is not certain if the product is purchased, the costs are also high and risky. It could be explored if demonstrations of VR can be done in an online environment to reduce costs.

Training Negative Pre-misconceptions, Unaware of VR Advances, Self-Efficacy, Practitioner-Patient Relationship, Incompatibility, Critical Staff, Fear of Replacement

By providing training to the practitioners, they can become aware of the way it should be implemented. The costs are dependent on salaries of trainer. Participation on

Research Negative Pre-misconceptions, Unaware of VR Advances, Eligibility of Patients, Lack of Clinical Evidence Base, Self-Efficacy, Incompatibility, Critical Staff, Absence of Ownership, Not Solving Problem

Participation of practitioners can overcome a lot of crucial barriers. However, conducting research takes a lot of time and effort, also obtaining funds is part of this process. It is highly advised, but also costly.

Technical Support Reliability of Hardware, Self-Efficacy, Time, Practitioner-Patient Relationship, Incompatibility, Critical Staff

By providing continuous technical support, either in-house or online, practitioners gain confidence since they don't need to worry about technicalities. Costs are dependent on mean (in-house = high, online = lower).

Smooth

Distributions Negative Pre-Misconceptions, Patient’s Unwillingness to Try, Critical StaHygiene ff, Implementing this facilitator could be highly beneficial, since it provides the first impression to practitioners. Ensuring the entire process runs smoothly is costly due to logistics and services, but also has a high return.

Affected Barriers Facilitators

Table 4 above provides an overview of the cost-efficiency of facilitators that can be implemented or executed by the company. RelieVR BV is currently working on many of these facilitators. One of the most cost-efficient facilitators estimated by the researcher is to raise awareness for the application. This is something that can be improved for Reducept. Therefore, the researcher is designing a website for Reducept to raise awareness for the application. They will integrate and address as many facilitators as they can on this platform, of which the process is described in Chapter 6. 


Evolving of

Technology Eligibility of Patients, Realism, Standardised Platforms, Reliability of Hardware, Incompatibility

By evolving the technology, technological issues can be avoided. However, this is a costly facilitator.

Independence of

Patients Patient’s Unwillingness to Try, Time, Organisational Issues, (Costs, Liability) Since the patient can train more at home, this is advantageous to both practitioner and patient. Depending on the organisation of this, costs for practitioners can decrease and liability issues could be avoided. This is mostly possible when a mobile version is created. This is high in costs.

Stronger Evidence

Base Negative Pre-Misconceptions, Unaware of VR Advances, Eligibility of Patients, Patient’s Unwillingness to Try, Lack of Clinical Evidence Base, Overabundant Offer, Critical Staff, Not Solving Problem

A stronger evidence base diminishes a lot of barriers. However, generating this takes a lot of time and a lot of money due to research needing to be performed. These barriers could also be tackled with other facilitators. However, it has a lot of added value and should be seriously considered.

Gather Data Eligibility of Patients, Patients Unwillingness to Try, Lack of Clinical Evidence Base, Practitioner-Patient Relationship

If applicable to the application, gathering data could be very beneficial and

attractive for practitioners. However, it does require high implementation costs. For this particular application, the costs could outweigh the actual added value. Affordable

Hardware Costs

Making the hardware more affordable, could diminish the barrier of cost. Even though this barrier is crucial, the costs for the company are also high. Eliminating other barriers and focussing on the application could make the costs less relevant since the return for the healthcare institution is very high.

Affected Barriers Facilitators

6. Realisation of Website

As described in Section 5.4., raising awareness for Reducept is a highly cost-efficient facilitator. Since there is not much awareness-raising marketing available for Reducept yet, the researcher designs a website with the goal of raising awareness for Reducept, providing information on the application and addressing as many facilitators as possible that are identified in Chapter 5. This website is developed through a user-centred design process, visually depicted in Figure 7.

As described in Section 3.5., a project consists of different phases in which different stakeholders are involved. The stakeholders are identified in Chapter 4. In order to keep an overview, the ‘Practitioners’, ‘Potential Buyers’ and ‘Potential Promoters’ are merged as ‘Healthcare Professionals’. The ‘Developers’ are split up into separate categories, namely ‘Graphic Designers’ and ‘Website Developers’, since these specific parties are involved in different stages of the project. The division of stakeholder involvement is shown in Table 5.

Currently, many practitioners get lost in the abundant offer of information provided on websites and, due to previous negative experiences, they are not motivated to investigate every VR E-health application they come across. Therefore, by conforming the website to the needs of the practitioner and addressing the facilitators for implementation, this helps provide useful information to healthcare professionals. Moreover, this could result in creating more awareness and enthusiasm for the product amongst healthcare professionals. In turn, this could facilitate the implementation of Reducept in healthcare institutions, meaning Reducept would actually reach the patient. Of course, this is the ultimate goal of both the company as well as the practitioner.

Figure 7: Visual presentation of methodology, where the purple color indicates which blocks are relevant for Chapter 6.