**Abstract**

This study investigates the use of a mobile app for data collection in occupational therapy practice. Seven occupational therapists used a mobile app to collect data on housing-adaptation home visits for a period of two months. The occupational therapists documented five home visits on an online diary to document their use of the mobile app. Subsequently, a follow-up focus-group interview was conducted to discuss the diary results and elaborate on the use of the app in occupational therapy practice. The benefits of using the mobile app include the app's systematic approach, ease of navigation, and the automation of data collection steps. Limitations include the inability to capture the complexity of the practice. Thus, the occupational therapists to some extent experienced that the need to use the mobile app is an added task in therapists' daily work that did not reflect their current practice. Future transformations of paper-based tools must be conducted in a way that closely reflects the work processes in clinical practice. This study suggests that a digitized tool holds significant potential for developing clinical practice, but digitization does not change the issues or the complexity associated with the tool itself or the existing practice.

**Keywords:** mobile application, health information technology, workplace information, occupational therapy, practice studies

## **1. Introduction**

The practice of occupational therapy naturally includes client-centered investigations of the clients' abilities and disabilities, as well as problems related to occupational performance. Occupational therapy involves the examination of external factors, such as the physical and social environment, along with personal factors, such as body function. A wide range of standardized and non-standardized assessment tools has been developed over the years as an important part of occupational therapists' work in this regard. To our knowledge, most of these assessments, including the ADL taxonomy [1], OSA [2], COPM [3], Mohost [4], and IPPA [5], only exist in paper form.

Health information technology (HIT) refers to the information technology used in the health domain and it is commonly associated with two lines of research: adoption and impact. Adoption studies focus on the level of adoption and barriers to the adoption of existing solutions, while impact studies center on the effect of the technology on the quality of the service, efficiency, or financial performance [6]. This study can be characterized as an adoption study.

M-health is a concept that is closely related to HIT. It denotes the use of mobile technology in the healthcare field [7] by patients, clinicians, and health professionals [8]. Applications have been developed for mobile phones and tablets to support information and time management, health-record maintenance and access, communication and consulting, referencing and information gathering, clinical decision making, patient monitoring, and medical education and training. A number of benefits have been identified in conjunction with m-health, including convenience, better clinical decision making, improved accuracy, increased efficiency, and enhanced productivity [9].

Occupational therapists are employed by all Danish municipalities. Notably, occupational therapists are the primary professionals involved in investigating the physical home environment of people with functional limitations. In this regard, they are responsible for identifying factors that hinder daily activities and for finding solutions to identified problems. In identifying these factors, the Housing Enabler tool is one of only a few assessment instruments that offer a valid, reliable, and systematic way to identify accessibility barriers in the dwellings of adults with functional limitations [10]. In occupational therapy practice, the demand to use information and communication technology (ICT) to document observations and share data creates a need to replace paper-based rating forms and assessments with digital solutions. In order to comply with this demand, we developed a mobile version of Iwarsson and Slaug's Housing Enabler assessment tool [10], which we hereafter refer to as the HE app. The purpose of developing this app was to transform the paper-based rating forms into a digital solution that could communicate with other ICT tools and documentation systems [11]. The development of the HE app was based on interactions with users and several usability tests [12].

The use of mobile technology in occupational therapy has only been covered to a minor extent in research [11]. In the present chapter, we investigate the use of the HE app for data collection in an occupational therapy clinical setting. Two recent studies have analyzed the acceptance and use of technology in occupational therapy interventions. Liu et al. [13] used a questionnaire to investigate the adoption of new technologies among occupational and physical therapists at a Canadian rehabilitation hospital. The study, which had 91 participants, showed that therapists see the potential for technology to help them reach their work goals and assist clients, but they have trouble finding the time to use it and they need more training in its use. Furthermore, Liu et al. [13] found that positive expectations about technology and its use increase intentions to use it in the future. Another study investigated the adoption of a web-based obesity prevention intervention program at commercial health centers in the Netherlands [14]. Clients were offered tailored feedback based on their own reports of their weight over time. Eight adopters and 12 non-adopters took part in semi-structured interviews. The study found that the main reasons for adoption were accessibility and correspondence with related activities. Similar findings emerged in a review study on general m-health by Sezgin and Yildinm [15], in which usability and ease of use were found to improve adoption. Notably, in the Dutch study, non-adoption was attributed to issues regarding time consumption, competitiveness with own interventions, and fear of falling profits [14]. Lastly, a study from 2007 investigated the use of the Housing Enabler tool in a Swedish municipality [16]. Twenty-five occupational therapists participated in the study and carried out 422 assessments using the tool. The purpose of the study was to analyze the implementation of the tool on PalmPilots in the municipality. Various methods were used to document the process, including diaries, e-mail correspondence, and meeting minutes, all of which were subjected

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

to qualitative analysis. The study found that the utilization of technology in occupational therapy practice was demanding in terms of the amount of technical support needed and in other ways. The occupational therapists' initial expectations that the use of technology would reduce the time needed for the assessments were not met. At the same time, the potential to digitize professional communication was appreciated by the participants [16].

This chapter aims to examine the adoption of the HE app in Danish occupational therapy clinical practice. While this study is somewhat similar to the study by Fänge et al. [16], we assume that occupational therapists have become more accepting of the technology. Furthermore, tablets are now more widely used by the general public than was the case with the PalmPilot a decade ago. Our focus is on the practical benefits and challenges of using the HE application from the perspective of work processes. We use the findings to identify the ways in which the HE app example can inform the development of data-collection apps and add to best practices in this respect.

#### **1.1 The HE app**

After the publication of the paper describing the transformation of the HE assessment to a mobile app [11], further programming and development were carried out to improve the app. When the revised version was ready for testing in the field of occupational therapy, our aims were not only to create a final report but also to gain deeper insight into the use of the app in occupational therapy practice.

The HE app, which is in Danish, is available for Android from Google Play in Denmark. In order to ensure data security, users must have a personal login. The dwelling and client function profiles are registered by address. All data concerning environmental barriers are collected and divided into the categories of A, B, and C, which refers to the outdoor environment, the entrance, and the indoor environment, respectively. All items are listed and the user can choose the ratings of "yes," "no," and "not rated." More exact items offer the option to add notes or photos. The dwelling's accessibility score is automatically calculated, and data is automatically saved on the unit and can be exported.
