Understanding information on, access to, and provision of continence and toilet-use assistive products: a needs assessment for intervention development

Research question: Can a systems approach be used to map policy and practice regarding information on, access to, and provision of continence and toilet-use assistive products (C&TU APs) for community-dwelling adults in three place-based areas and gain stakeholder perspectives on improving provision? Background: Millions of adults in England live with continence and/or toilet-use problems causing harms including infections, skin damage, depression, employment loss, isolation, and unwanted residential care admission. C&TU APs (such as continence pads, commodes and toilet frames) can support independence. However, there are over 160 product types, choosing products is complex and needs are often unmet. Responsibility for provision is often unclear (GPs, NHS Trusts, local councils, charities, or self-purchase) and unequal. Our end goal is to develop a Choose & Find tool helping users and professionals identify and source the right products. First, we need to better understand the current system and potential improvement. Objectives: Gain a comprehensive whole system understanding of C&TU AP care journeys (product information, access and provision) by: Developing a comprehensive network of stakeholders. Identifying and mapping cross-sector policy and services. Exploring user, carer and professional perspectives/experiences of services. Eliciting perspectives on how an intervention could improve services, and implementation barriers/facilitators. Outlining the Choose & Find intervention and gathering stakeholder feedback. Methods and timelines: Using complex intervention guidance, a systems approach and 5Ps Assistive Technology Framework, in four work packages in three diverse Wessex localities we will: WP1 Map C&TU AP policy and services (Months 1-17): engage with stakeholders (including NHS trusts, GPs, local authorities, and third-sector providers) to map the current routes of C&TU AP provision in each locality. use data visualisation tools to present findings for refinement during WP 2-4. WP2 Gain end-user perspectives of C&TU AP provision (Months 3-18): purposively (by socio-economic statuses, ethnicity, disability, age and sex) recruit (via NHS Trusts, local authorities, www.joindementiaresearch.org.uk, local carer charities and homecare agencies) C&TU AP users and/or carers (n=24) to ascertain experiences of accessing C&TU APs and how services could be improved. Framework analysis approach will be used. WP3 Gain practitioner and other stakeholder perspectives on C&TU AP provision (Months 3-18): purposively (profession/sector, location, experience) recruit and interview (n=30) health and social care professionals, service commissioners, third-sector staff and other key stakeholders across three localities seeking diverse views on the current C&TU APs provision and potential service improvements. Framework analysis approach will be used. WP4 Ongoing stakeholder engagement (Months 1-19): form a stakeholder group including AP end-users/carers, NHS Trusts, local authorities, Health Innovation Wessex, and organisations such as Home Care UK to feedback on findings via three online meetings and one in-person half-day workshop. Impact and dissemination: This work will inform a follow-on project to develop the Choose & Find tool, but will additionally provide key outputs: Cross-sector map of C&TU AP access in 3 localities. Analysis of perspectives on the current provision of C&TU APs. Outline Choose & Find intervention. We will disseminate via our stakeholders plus relevant academic and professional journals and conferences.