Changing the status quo: Evaluating service delivery models to enhance assistive technology provision

As a field, the majority of our research tends to focus on the design and application of assistive products to solve real world challenges for people with disabilities and functional limitations. In these cases, the focus of the work is typically on the product – how the product is designed, the technology required to make it work, and the experience of individuals who use the product. This is a vital area of research which has propelled the field forward significantly, paving the way for the development and application of both new and reimagined technologies, and understanding the best ways to solve challenges of everyday life. However, research suggests there is a relationship between satisfaction with assistive products, including their use and potential for abandonment, and the services provided to deliver that product (Larsson Ranada & Lidström, 2019).

It is striking then, research to understand and evaluate the processes used to deliver those assistive products to people is limited. The World Health Organization’s 2008 Guidelines on the Provision of Manual Wheelchairs in Less Resourced Settings was a landmark, internationally recognized document which laid out a series of eight steps in service delivery for an assistive product (World Health Organization, 2008). More recently, the WHO has published the Wheelchair Provision Guidelines, condensing those eight steps into four, and providing further guidance on what effective service provision entails (World Health Organization, 2023). However, we have yet to see an international guidance or standard on service delivery processes which apply to assistive technology more broadly. Ensuring people have access to the assistive products they need is one of the primary objectives of assistive technology policy and service delivery. Unfortunately, research into service delivery models, often defined by policies and funding schemes which govern access to assistive technology, is limited.

This is not to say there is no research in the area. For example, in the last number of years, we have witnessed a growth in research on training – investigating the various ways training can be provided to ensure the product meets individuals’ needs in the most efficient and effective way possible. There are also principles for service delivery which have been well established in the literature. For example, we can confidently say that user engagement in service delivery is associated with positive outcomes (Borg et al., 2012; Brandt et al., 2020; Pedersen et al., 2021). We also have research suggesting digital technologies can enhance service delivery processes, and reduce costs (Brandt et al., 2020). However, addressing these issues in isolation fails to address the full picture of service delivery, which is critical to understanding the models which are most effective for ensuring populations have access to the assistive products they need.

While standards for service delivery have been developed (Elsaesser & Bauer, 2011), and many authors have produced research guiding the development of service standards (Craddock & McCormack, 2002; de Witte et al., 2018; Federici et al., 2014; Visagie et al., 2020), evaluative research exploring outcomes and impacts associated with the use of those standards has been limited. This is in part, no doubt, to the fact that it can be difficult to evaluate outcomes related to service delivery, and even more challenging to compare service delivery models to establish which may be the most effective. Assistive technology provision is highly individualized, and consequently service delivery is complex (Ripat & Booth, 2005). However, the lack of robust evaluative research makes it significantly more difficult to advocate for changes to or the development of service delivery models in the policy sphere. In the absence of evidence to propel change, the status quo reigns.

There is an urgent need to conduct and publish research which evaluates the outcomes and impacts of service delivery models. The Assistive Technology Journal encourages authors to submit manuscripts describing existing service delivery models, with a particular interest in those with evaluative methods.