The participants had varied backgrounds as regards their health, social and economic status, and they had different needs and experiences. Most of them lived alone, and there were significant variations in housing standards. While some lived relatively isolated, far from their nearest neighbour and in simple living conditions, others had moved to modern, practical apartments or to an independent living facility with services in the city centre area. Some of the participants had problems remembering or expressing themselves orally, for example after having had a stroke. In contrast, others had no problem at all and eagerly kept up with the news and were socially engaged. Some participants expressed that they were active users of Skype, Facebook and other types of social media, while others were not on the internet and had neither a mobile phone nor a computer.
Figure 1 shows the four main themes that emerged during the analysis. There were challenges related to involvement in the decision-making process because of the different preferences among the participants as regards user involvement. Moreover, individual differences in information, knowledge and training affected the participants’ ability to ask for welfare technology and become involved in the decision-making process. A third theme concerned how the experience of safety affected attitudes to and the use of welfare technology. Participants’ experience of welfare technology as a tool that could enable them to stay as long as possible in the home was the final main theme.
Diverse preferences for user involvement
The results showed differences between the participants as regards to what extent and in what way they wanted to participate and be involved when welfare technology was implemented
and used. Some participants’ attitude was that health professionals knew best and made the correct choices on their behalf when the municipality acquired welfare technology. Other participants said that they did not want to decide because they lacked energy or knowledge. They expressed gratitude for the help they received and said that other service users should also be grateful and not complain or argue when health professionals came up with ideas for new technology. It was a challenge that some of the participants did not remember whether they had been asked if they wished to use welfare technology.
Oh, no, I don’t want to decide. I don’t have enough energy, so the health professionals must choose (the type of welfare technology).
Some of the participants felt that they coped well with everyday life themselves, but reported that their family or health professionals argued that they needed to use welfare technology. In some situations, participants felt that others decided for them. For some, this was okay, while, for others, it was not because they wished to make their own decisions. Nonetheless, most of the participants said that they accepted what the health professionals and next of kin thought they needed because they did not have enough knowledge or did not want any conflicts.
No, that’s... it’s the family. They want me to have such a safety alarm, but I do not think I need it.
On several other occasions, participants stated that they wanted to be involved when health professionals suggested or brought welfare technology with them. They wanted to discuss the available opportunities with the health professionals and be given a chance to accept or reject the new technology. To be able to make individual choices and having the feeling of being in charge of their own lives were perceived as important.
..they just came with it (medication dispenser). They are a bit.. what can I say ... they are a bit controlling. It would have been nice if they had asked.
In procurement processes for welfare technology, the municipalities frequently bought or
rented just one model to cover the services in their municipality, and the service users were not invited to participate in the process. The result indicates that the technology was not tailored to the individual service users’ health challenges. In some cases, the result was that some participants could not use the model offered by the municipality, at least not in the expected way. An example from this study was a new type of safety alarm. Several of the participants found it too heavy to wear around their necks. For that reason, they put the safety alarm in their handbag, laid it on the table or hung it on their walking frame. The participants did not reflect on the risk of being unable to access the alarm if they were in need of help. This example also indicates that not all development is necessarily positive.
... it doesn’t work with me. I never wear it on me. I can’t wear anything heavy around my neck. I am very sore in all my muscles and body ... in my skin.
Individual preconditions for knowledge, information and training
Participants’ prior knowledge of welfare technology varied from not knowing what the term meant to having a good overview of what it is, what kind of welfare technology exists and what the municipality can offer. For most of the participants, it was important to be given information about welfare technology in general, and what the municipality could offer in particular.
We need more information because there is a lot that I do not know. What you can apply for, what you are entitled to, such important things.
Other participants said that they did not need such information now, but that, if they got worse and some technology could help them in their everyday lives, they would like to be given such information. Based on the results, it also seems that what is known and what is unknown about welfare technology influenced whether service users themselves take the initiative to apply for it. For example, most of the participants stated that they or their next of kin had applied for safety alarms. As regards medication dispensers and digital door locks these were aids that health professionals suggested when they thought it would help service users to cope with everyday life and continue to live at home.
Only to a limited extent did health professionals ask the participants about how they experienced using the technology and what knowledge they felt was lacking. Most participants were satisfied with the use of welfare technology and felt that it was easy to use, even though several of them had only been given limited training. Our results indicate, however, that, in some situations, participants had a limited understanding of how to use the equipment, which may have led to incorrect use.
Because I didn’t know how to ... Because I thought it was just a case of pressing the button, but it was not. You have to touch it and hold it for a few seconds or so. Then you have contact with the home care (safety alarm).
Feeling safe and getting help
The participants expressed that the use of several welfare technologies gave them an experience of safety, and that this was essential if they were to have a positive attitude to using such technology. For example, using safety alarms made the participants feel safer, and this feeling was further enhanced for those who had safety alarms with GPS tracking. None of the participants experienced GPS tracking as intrusive monitoring, only as providing increased safety. This indicates that participants were more concerned about getting help than about the possibility of being monitored. Another positive aspect emphasised by the participants was that if they forgot to charge for example the safety alarm, the health care professionals were notified digitally about the low battery. In such case, the health professionals contacted the participants and asked them to charge it. The home care service was also notified if the service user forgot to take the medication from the medication dispenser, or if there was something wrong with the dispenser, for example, if the medication inside the dispenser had jammed.
It is the safety that makes it okay to have one (safety alarm), so you can get hold of someone if you should fall.
The results indicated that, for some participants, the conditions for involvement and understanding information were challenging. It emerged from our findings that some participants’ insight into their own cognitive capacity was limited. For example, some of them
stated that they did not understand why the medication dispenser repeated that they had to take their medicine. They said they sometimes became irritated and thought that the dispenser was being ‘fussy’. Experiences also differed as regards whether health professionals observed that they mastered the use of welfare technology. Most of the participants said that it was reassuring that the health professionals checked how they used it, while, for others, it was perceived as rather controlling and indicated a lack of confidence in them.
Now, they do not check. In the beginning, they did, but then they realised that I could remember how to do it myself.
Some of the participants had experienced some start-up problems with the technology, for example related to an unstable network or software issues. When the welfare technology had faults or did not work, this could represent a safety risk for the service users, for example if the health professionals could not open the digital door lock when service users were in need of help. The participants did not emphasise such challenges. Instead, they found pragmatic approaches until the problem was solved. For example, participant 18 stated: ‘It still happens a few times that the door lock does not work, but I keep the balcony door open and the health professionals can enter by it, so it is not a problem.’ The participants did not perceive an unlocked balcony door as a security problem and seemed to be less afraid of uninvited guests than of not getting help when needed.
A wish to stay at home as long as possible
Several of the participants stated that welfare technology was a prerequisite for continuing to stay at home. They were positive about making more use of welfare technology if that would enable them to cope with their everyday. When they experienced, for example, that technology helped them to remember to take their medicine, this gave them a feeling of mastery.
I think you can say that everyone should try a medication dispenser. They will become so fond of them. In the morning when I get up, the dispenser says, “it’s time for medicine” and then I manage to take it myself.
None of the participants had been asked whether they would prefer a visit from a health professional to administer their medication instead of using the medication dispenser. However, most participants said that they preferred the medication dispenser. One argument that was mentioned several times in the interviews was the importance of taking medication at the right time, instead of waiting for the health professionals to come, which had previously been a problem. Managing the administration of medication gave the participants a feeling of independence and increased freedom, which illustrates that, for some service users, technology can be experienced as better than the services provided by health professionals.
The home care service came up with this idea, and I thought it was a gift package (medication dispenser). It is a lot easier because, if people come here every day, then I have to ... then I am very tied up.
However, some participants preferred physical visits for the administration of medication but were not given this option. For them, health professionals represented social contact in a situation where they struggled with loneliness.
If I had the choice, I would have chosen someone to come. I am alone a lot. I think it is nice when someone comes here and talks to me.