**3. Results**

In this section, we present the results of the empirical study. Thirty-five online diaries were made available to the seven occupational therapists at the beginning of the data-collection process. Of these, 30 were completed by the 7 occupational therapists within the two-month data-collection period. The majority of the diaries related to real cases (80%, 24 cases), while 20% (6 cases) referred to examples the occupational therapists raised themselves. Of the 24 real cases, 8 concerned only a change in the household environment, while others were more complex, with some covering aids for the client (15 cases). In the latter cases, other investigations often had to be undertaken along with the HE assessment. In most cases, the visit was the occupational therapist's first visit in the home (17 cases). In five cases, the

occupational therapist had visited once before, while the occupational therapist had paid a visit at least four times before in three cases. In summary, the majority of cases were real cases with complex characters, and many of them were first visits.

As shown in **Table 1**, the duration of each assessment varied. The majority of investigations lasted between 21 and 50 minutes, but a few went beyond this timespan. In assessing time consumption, we must remember that the participants had little experience with HE at the time of data collection, as they had only just finished the introductory course. This point was raised by one of the participants: "The increased time use is more about the HE assessment, which is what causes it. It is not caused by the tablet" (i.e., the use of the online diary) (FG). The time consumption should thus be assessed in this light.

After each investigation, the occupational therapists were asked to rate different aspects of the app in terms of their agreement with various statements. The central tendencies of the ratings appear in **Table 2**. As can be seen in the table, the HE app earned higher ratings in terms of its usability. Thus, learnability, usability, and understandability all have ratings above the average (mean of 4.31, 3.66, and 4.31, respectively). Despite ratings below the average for enhancing the quality of the home visit (mean of 2.78), making the visit go faster (1.86), easing the dissemination of information to colleagues (2.50), and making the home visit better in general (2.38), the technology's usability may be what led to a rating above the average for the technology's flexibility in terms of the therapists' working situation (mean of 3.04). In the following sections, we use the focus-group interview to examine these differences in assessments.

## **3.1 The need for structure versus the need for situated data collection**

The HE application is designed to facilitate a structured workflow. It guides the user through the data-collection process on a step-by-step basis, and the structure ensures that the data is collected in a standardized manner. In some cases, the structure guides the user to focus on aspects of the dwelling that their clinical experience does not. One participant highlighted this point, stating "I think we are asked to focus on some areas that we usually would not have considered" (FG). In this case, the structure of the application is viewed as a positive aspect, as it guides the occupational therapist towards expanded data collection. Consistent data is one of the best-known strengths of structured data collection, and the HE app facilitates this aspect.

The structure also led occupational therapists to collect data at times when they would otherwise not do so. This happened in cases where the focus of the housing adaptation was predetermined, such as when the door or the bathroom needed to be adapted. In this regard, one user wrote: "Problem is limited to one room. The rest [of the HE app data] is not needed in this case of adaptation." In cases like this, the relevant data were so limited that the information collected through the HE app seemed superfluous: "If the question was whether to add a ramp or do something else, I would answer it by heart" (FG). This quote indicates that the occupational therapist felt he or she could save time by avoiding the structure of the HE app and instead relying on his or her clinical knowledge and understanding of the client's


**Table 1.** *Time consumption.* *Evaluating A Mobile App for Data Collection in Occupational Therapy Practice DOI: http://dx.doi.org/10.5772/intechopen.102084*


*As the ratings reflect the focal situation, the same OT rated the same statement several times, but each time with a point of departure in the focal investigation. 1 = "highly disagree" and 5 = "highly agree." N = 30.*

#### **Table 2.**

*Ratings from diaries.*

needs. This may be viewed as stepping away from the need for data consistency, but each client's particular case seemed to be more in focus: "Often, we have a specific reason for a home visit. (…) Something else may appear during the visit, but we focus on the initial reason for the visit" (FG1).

The app's structure also guides data collection in areas of the dwelling that occupational therapists rarely consider, such as parking spaces and access to outdoor areas. Even though focusing on other areas of the dwelling can be beneficial, collecting data on areas of the dwelling that the clients had not asked to be considered was often viewed as intimidating: "In reality, we would never do anything [in the dwelling] unless people have the need for it" (FG). The HE application's structure was sometimes experienced as conflicting with the client's interests. In this regard, one occupational therapist highlighted a question from a client: "I do not have any problems in the kitchen, so what are you doing in there?" (FG).

The structure of the HE application forces the user to gather data on areas of the dwelling that the occupational therapist may feel are unrelated to the specific case. As one participant pointed out, "there are many useless things to deal with [in the app]." Another stated, "many of the questions (…) are rarely needed." On the other hand, the occupational therapists often have a very specific focus in the dwelling but some areas of the dwelling are missing from the HE app. Notably, the structure of the HE app offered no options to add other information. The occupational therapists, therefore, suggested that an option be added to allow them to elaborate on selected areas that fit the client's case: "What I really need is the ability to enter the size of the bathroom, the sink, and so forth. (...) That would be extremely useful" (FG).

This made it clear that the app's structure had both positive and negative effects. App's are structured by nature, which goes hand in hand with the nature of structured data-collection tools. This is often highlighted as the best way to collect valid and reliable data. At the same time, the structure of the HE app seems to make it difficult to adapt when different situations call for expanding or decreasing certain areas of data. In developing apps for data collection in the field, attention must be paid to the nature of the occupational therapists' data-collection context, which is dynamic and situated. Options for changing the structure when using the HE app could be considered. Such options may include alternative focus areas, and the extension or removal of areas for data collection. Therefore, along with developing the app itself, there is potential for developing the ways in which it is used. Clearly,

knowledge of the field is essential for the development of data-collection apps if they are intended to be employed in the field.

### **3.2 The need to collect multiple types of data**

As the HE app is based on the Housing Enabler assessment, it has specific focus areas for data collection. It is meant to be an assessment representing "only a part of the arsenal of methods that should be used in connection with housing adaptations" ([6], p. 22). Therefore, the data collected through the app only covers one aspect of the data the occupational therapist needs (i.e., data on necessary housing adaptions).

This is a challenge, as occupational therapists find it hard to utilize only one method. They often use a variety of methods during the same home visit. Naturally, housing-adaption cases often call for different assessments. Some may require measures aimed at securing the caregiver's work environment, while others may need measures based on the client's occupational needs and functional level. As one occupational therapist explained, "our starting point is the client's activity problems and the work environment" (FG).

When using the HE app the occupational therapists felt restricted, as they generally utilized several methods simultaneously. Despite the fact that the HE app was never intended to replace other necessary assessments, it was found to be too restrictive, as it was bound to one assessment. One participant highlighted this issue, stating that "I simply cannot do without my notes on activity analysis" (FG). The occupational therapists explained that they were accustomed to taking notes on various issues, drawing floor plans, and taking extra measurements in the room using pen and paper. The HE app does not gather multiple types of data. Instead, it only covers data focused on dwelling accessibility. The HE app created a feeling of complexity among the occupational therapists, who usually used several assessments and tacit knowledge in parallel during their home visits. Therefore, the HE app was rejected as a time-consuming "add-on" to the existing arsenal of methods and tacit knowledge. In place of the HE app, the occupational therapists envisioned a tool that would cover several aspects simultaneously: "the activity, the dwelling, and the work environment" (FG). In other words, the occupational therapists called for an app that would cover multiple aspects of their data-collection process. In theory, such a tool may be hard to develop and it may actually increase the complexity of data collection.

In general, the clinical practice calls for an app that embraces several of the assessments or methods used in the field. Although the development of such an app may not be theoretically or technically possible, it is important to learn about the many methods used in the field in order to define the relationship between those methods and the app itself. Consideration of the ways in which the HE app is expected to correspond with and supplement other methods of data collection seems essential for this aspect of clinical practice.

#### **3.3 The HE app's influence on the interaction between the occupational therapist and the client**

Occupational therapy is a client-centered field [20]. The use of an app to collect data concerning the client might influence the interaction between the occupational therapist and the client, as well as the approach to and extent of the client-centered practice. The client's situation, personality, and needs differ every time the occupational therapist visits, which also has an impact on the occupational therapists' experiences with using the HE app in the dwelling: "There has been a big difference

#### *Evaluating A Mobile App for Data Collection in Occupational Therapy Practice DOI: http://dx.doi.org/10.5772/intechopen.102084*

in how much tranquility the clients have given me to do [the assessment]" (FG). In accordance with the client-centered perspective, the occupational therapists find it necessary to respond to client's current needs and adjust their work processes accordingly: "Then the client comes around and you have to chat a little. And she also wanted to discuss something about the garden" (FG5).

Consequently, most of the occupational therapists felt that measuring the dwelling with the HE app took extra time, as the app requires the user to follow certain steps and to go through a precise number of items. It is not possible to skip items in order to make time for chatting with the client. One occupational therapist said, "I felt as though I used more time because of the Housing Enabler, which was a waste for both the client and I" (OD). Another suggested that "it can be difficult to stay focused on all of the items in the app when you are visiting a very chatty client" (FG). Another issue concerning the occupational therapist's contact with the client was that the app might be perceived as a physical obstacle in the relationship, as it made it difficult for the occupational therapist to maintain eye contact with the client: "I think I use too much time on reading the questions and that I have too little eye contact with the client" (FG).

Importantly, the extra time used on measuring the dwelling was not always regarded as wasted time by the occupational therapists: "The visit took 30–45 minutes longer than it would have without the HE app. However, it is a nice structured tool that ensures that you get all of the details on your first examination of the dwelling" (OD). Another occupational therapist added: "The app gives me peace to work, as the client can understand the necessity of me going around and typing in all of the information into the system. It gives you more peace than going around with a pen, paper, and a tape measure" (OD).

The HE assessment method ensures thorough data collection, and the app makes the assessment appear even more thorough and professional. One participant highlighted this benefit, stating "I think the client felt I was being thorough in terms of the problems he faces with being in a wheelchair. Therefore, from the client's perspective, I think my visit was better than if I had only been concentrating on the accessibility of the dwelling" (OD).

In sum, on one hand, the HE app signals professionalism and can reassure clients that the occupational therapist is doing the job well. Moreover, the app provides the occupational therapist with the peace needed to focus on systematic data collection without interruptions from the client. On the other hand, the tablet can be a physical obstacle in the occupational therapist's contact with the client, as it can hinder eye contact and take time away from social interaction with the client.
