Technology-enhanced Speech and Language Relearning for Stroke Patients- Understanding the users and their needs for technology acceptance

Abstract: Stroke is a rapidly increasing disease worldwide, and speech and language impairments are common in stroke patients. A patient’s ability to speak, listen, read and write is reduced after stroke which affects the patient's independently living and quality of life. After an initial evaluation at the hospital, the stroke survivors are referred to the stroke rehabilitation centre where the speech therapists assist them in their challenging and long journey towards speech and language relearning. To enhance the patient's quality of life and to facilitate the speech therapists, technology-enhanced systems can play an important role. However, the currently used software applications such as online speech and language relearning applications are not specifically designed after the user’s need, and the user’s participation and empowerment are compromised. Medical caregivers and stroke patients are the main stakeholders and potential users of these software applications. Therefore, this study is aimed to understand the medical caregivers and the stroke patients’ needs for technology-enhanced speech and language relearning from medical caregivers’ viewpoint.  Design science research strategy was adopted to create, implement and evaluate the artefact. Some important stakeholders such as speech therapists, a stroke specialist doctor, information and technology professionals and one stroke survivor participated in this study. Following the speech therapist’s expert opinion, an application for speech and language assessment was developed as an artefact. The application was then evaluated for technology acceptance with the speech therapists. The Unified Theory of Acceptance and Use of Technology (UTAUT) was used as the theoretical foundation for making the interview questions and data analysis.  The user's requirements for software application differ from one patient to another depending upon the patient's overall health after stroke, their age, social life, the level of speech and language loss, and previous experience with technology use. Stroke is common in adults and adults like to participate in designing their relearning process; therefore, adults should be involved in deciding the learning objectives, and adult learning principles are helpful to understate their needs for speech and language relearning. Due to impaired physical and cognitive conditions, the patients need a bigger interface with larger fonts and pictures and more constructive colours than usual. Tablets with touch pens are preferred hardware. The speech therapist should have the possibility to change the exercises runtime according to the patient's abilities and stamina to do the exercises.  The technology acceptance evaluation showed that the developed application was easy to use and efficient for speech therapists. The study participants also highlighted some critical issues for better usability and technology acceptance. The application should be synchronized with speech therapists’ existing workflow and routines, and it should directly be connected to the hospital records system so that the patients’ data can easily be transferred to their journals.  The role of facilitating conditions such as proper education and training about the system, and personalised support is also important in technology acceptance. The user’s trust in the system’s security and privacy and their personal integrity were also highlighted as main determinants for technology adoption and use. To achieve better coherence between the users and technology, all the tasks/exercises and sub-tasks in the application should be designed in close collaboration with speech therapists and stroke patients. Due to the Covid-19 pandemic, only one stroke survivor was interviewed in this study. However, the patients’ perspective is of utmost importance, and in future research, they will be involved in the design and development of such technology-enhanced systems.