The implementation of smart continence care for people with disabilities: A qualitative study of key stakeholders’ first-hand experiences

Introduction:
Innovative technological applications like smart continence care (SCC) offer potential benefits in healthcare
delivery, particularly for individuals with profound intellectual and multiple disabilities (PIMD). SCC aims to prompt caregivers to change continence materials, potentially improving clients’ quality of life and reducing caregivers’ workload.
Although the use of SCC in PIMD care is promising, research is needed to improve its use in these complex settings. The
aim of this study was to reflect on the SCC implementation process in care organizations for people with PIMD.

Methods:
Fifteen semi-structured interviews were conducted with key stakeholders, caregivers, and SCC project leaders,
across four care organizations. Interviews utilized an integrated framework drawing from the centre for eHealth research
roadmap and the nonadoption, abandonment, scale-up, spread, and sustainability framework, both addressing eHealth
implementation. Thematic analysis and open coding were employed to identify key themes and sub-themes in the implementation process.

Results:
Four main themes emerged as crucial for successful SCC implementation: creating support, communication
between stakeholders, problem-solving, and willingness to adopt SCC. The first three themes were perceived as contributors
to the success of SCC implementation, whereas the last theme showed factors impacting willingness to adopt SCC. Early
involvement of key stakeholders and clear communication about expectations of their roles was perceived as crucial and
created clarity. Adequate problem-solving was identified as influential in SCC utilization and willingness to adopt person-centred continence care.

Conclusion:
Implementation of SCC requires changes in the work routines of those involved, and key stakeholders’ early
involvement appears to improve support for these changes. Fostering communication between key stakeholders and
adequate problem-solving contributes to positive experiences and the perceived success of sustainable implementation.
This study offered a rich understanding of day-to-day practices around implementing SCC in disability care organizations.
The findings may also be relevant for the implementation of technologies in other care settings