Powered Mobility Devices in a Nordic Context: Service Delivery, Effectiveness and Methodological Development

This thesis has contributed to the methodological development in the field of assistive technology and has generated new knowledge about the effectiveness and the service delivery process when powered mobility devices are provided to adult first time users in a Nordic context. Some of the results have been used to investigate the relationship between the three key elements of Donabedian’s conceptual model when scooters are provided to users from two Nordic countries, Denmark and Norway. As most of the results from the psychometric testing of the SATS and NOMO 1.0 were above the recommended levels, both instruments can be reliably administered in studies among adult users of powered mobility devices in Nordic context. The factor analysis of the need for assistance and frequency scales of the NOMO 1.0 identified unidimensionality for the first scale and multi-dimensionality for the other. However, further psychometric testing is required for the NOMO 1.0 regarding the validity. As for the SATS, the instrument needs to go through a basic investigation of its validity. There is a need to consider the wording of the items in order to avoid, for example, double-barrel questions. A factor analysis should be carried out in order to establish the dimensionality and to see if there is a need for item reduction. In other words, a revision of the instrument is needed. Concerning the NOMO 1.0, (further validity studies) a confirmatory factor analysis is needed. Reliability and validity studies are needed for the study-specific questionnaires used in the SATS study. All three instruments need to be psychometrically tested in other user groups of assistive devices than powered mobility devices and in other cultures than the Nordic countries. Supporting previous research, this thesis showed that the powered mobility device interventions increase mobility-related participation in daily life among adult users in a Nordic context. Mobility became easier for several aspects, and buying groceries and go for a walk/ride were carried out more frequently. Men, scooter users, and users with poor self-reported health seem to benefit the most from the interventions. Assessments and administrative work were accomplished in almost all the cases, while the other steps of the service delivery process were carried out to a various degree when scooters were provided to users in Denmark and Norway. More time was spent on assessments, administration and total time in the Danish sample. The user satisfaction with different aspects of the service delivery process was high. However, there was no association between time spent in the service delivery process and use satisfaction and effectiveness. The finding that there were differences in time spent on the service delivery process between samples from two countries with structural differences confirm the assumption that structure of the services predicts the time spent in the service delivery process. Different rules regulating the area seem to be an important explanation for the time differences. The expected association between the structure, the time spent in the service delivery process and the outcomes in terms of user satisfaction with the service delivery process and effectiveness was not found.