Table 4 Barriers and suggested next steps

(1) Staff turnover

High staff turnover meant lack of sustained use of SoW. There is a need to engage more staff at each site.

(2) Risk averseness

Perceptions of the device being unsafe and risky to use in a care environment were noted. There is a need to conduct a risk assessment on site to demonstrate the safety of the device before use. In addition staff training to reduce perceptions of risk that override implementation.

(3) Intervention design

The SoW device did not appear user-friendly to some residents, therefore staff suggested there is a need to redesign it. Staff wanted to provide video-calls on a larger screen such as a TV because residents are more familiar with it, compared to an iPad.

(4) Family commitment

Staff reported that some relatives stopped video-calling because they may have been unsure of what to talk about, therefore a conversation aid is needed. C1, C4, C6 felt there should be additional social contacts other than family to video-call with to increase their social networks and reduce loneliness.

(5) Staff attitudes towards intervention implementation

Not all staff members committed to the project. Some staff felt they needed more training in how to use the intervention. Staff leading the project felt there is a need to target those who are not confident in using technology without causing embarrassment. Also, adherence to completing the feedback sheet by staff was low because it was not made a priority.