MacNeil, Margaret2019-12-182019-12-182019-12-182019-12-12http://hdl.handle.net/10012/15340Introduction Technologies can help older adults live independently in their homes, but innovators often struggle to get their technologies in the hands of older people, their families and the systems that help to care for them (Naylor et al., 2015). Governments and older adults agree that aging at home for as long as possible is the goal. Technologies exist to help health care institutions, older adults, and caregivers to manage health and wellbeing of older adults (Quinn, O’Brien & Springan, 2018), but the layers of jurisdiction combined with silos across types and levels of care settings are complex for innovators to negotiate. To ensure older adults and their caregivers see the benefits of innovative technologies as quickly as possible, innovators need to better understand the Canadian policy and regulatory landscape, and policy-makers need to better understand policy recommendations which could facilitate innovation and adoption of technologies. The objectives of this research are to i) document and understand facilitators and barriers to health technology adoption in Canada across all stages of innovation; ii) understand how these facilitators and barriers might impact technologies for older adults and caregivers; and iii) create an evidence-informed policy agenda for health technology innovation for older adults. Methods A scoping review guided by Arksey and O’Malley (2005) looked at the barriers and facilitators to health technology innovation and adoption in Canada in published and grey literature. A graphic depiction was developed to explain scoping review results which outlined the stages along the innovation pathway (development, assessment, implementation, sustainability) and how some facilitators and barriers to technology innovation and adoption exist within certain stages, and others are common across stages (Canadian policy context, resources, partnerships). Forty-six qualitative interviews with innovators, industry representatives, researchers and policymakers were analyzed using framework analysis (Ritchie & Spencer, 2003). Deductive coding guided by the graphic depiction developed in the scoping review as well as inductive coding to further explain phenomena within each theme guided data analysis. Through the scoping review and the qualitative interviews, an inventory of facilitators and barriers of health technology innovation was developed. Content analysis (Hsieh & Shannon, 2005) was used to code facilitators and barriers into policy actions. Group concept mapping was used as a systematic approach to integrate group brainstorming, sorting, and rating of policy action statements on their relevance and feasibility (Kane & Trochim, 2007). Results The scoping review generated a comprehensive summary of facilitators and barriers to technology development, assessment and implementation, and how those stages are crosscut by barriers and facilitators in the Canadian policy context, resources and partnerships. Qualitative interviews show resource constraints specific to innovation and adoption of the home and community care sector. Interviews revealed a complex home and community care sector where care delivery activities crowd out the possibility of considering or adopting a technology, exacerbated by the lack of funding for evaluation and implementation of technologies. Group concept mapping identifies which evidence-informed policy options are deemed the most relevant and the most feasible to be implemented, based on input from a diverse stakeholder group. Results reflect funding and system constraints in health care, and the value of diverse partnerships across all stages of technology innovation. Conclusions This work generated an understanding of facilitators and barriers to health technology innovation and adoption; how aging-related technologies might experience barriers and facilitators to health technology innovation and adoption; and expert stakeholders’ perceptions about the relevance and feasibility of potential policy options. These results can inform a policy agenda to facilitate innovation and safe adoption of health technologies for older adults.enpolicyregulationshealth technologiesmedical devicesolder adultsDoctoral Thesis