This study explored the everyday use of technology by patients with various medical conditions and their family carers, and how they integrated the technology into their daily routines, including key factors which influenced this. The vast majority of the patients, as well as their carers, expressed a positive experience of the assistive device. In line with many other research findings in the area, some of the common reasons for using the device were: ease of use, assistance with planning various tasks and accessing information [4, 25,26,27].. Additionally, the device provided a sense of reassurance, companionship, comfort, security and autonomy [4, 25,26,27].
Some of the results defied the common perception that older individuals are apprehensive about technology [15]. Previous research in this area has shown that the ageing population feared technology and were less likely to use them [15, 28]. Generally, the acceptance of new digital solutions and innovative technology by patients and carers relies on their anxieties and feelings of insecurity concerning the device/technology. Our findings suggest that most of the users (geriatric population functioning in different levels of independence) recruited through senior care providers, a diabetes network and GPs were eager to adopt new technology and willing to learn to use them, which accords with previous research in a similar area [29]. However, some patients did voice concerns in terms of difficulty in using the device. This was mainly due to their self-perceived technological incompetency and initial feelings that they were not “tech-savvy”. Consistent with the literature [26, 29], although the patients found the device complex and voiced apprehension about a lack of clarity, instructions and support initially, over time they learnt to use it. Eventually, upon achieving successful integration of the assistive device into their daily lives, they harnessed its potential. This is reflected in their responses, which shows that the device made their life a bit easier. Additionally, the carers expressed that they were surprised about the use of the device for providing support by answering key questions that they had, helping them with reminders, and organising their daily life as it is not advertised directly for this purpose. The carers recognised the fact and suggested that it was important to tap the potential. These findings show that assistive technology can enable people to have more control over their lives, health, social and mental well-being. Furthermore, it can assist the carers with their roles and responsibilities.
The present study raises the possibility that assistive technology besides offering general support, may benefit patients with chronic medical conditions such as diabetes and dementia. For instance, effective diabetes care is largely dependent on patient self-management and patient empowerment. Patients with diabetes may have to seek knowledge and need to sift through many sources to find information to make essential lifestyle choices concerning diet and exercise [7]. Moreover, they need assistance with monitoring blood glucose levels, strictly adhering to medications, and determine their insulin dose and timing [30]. The findings generated from this study showed that the assistive device played an effective role in providing this support. Patients were self-motivated and driven towards their goals to manage their health with that extra personal support. As suggested in previous research, this shows that digital health and assistive technologies may help improve patient outcomes [30, 31]. On the other hand, certain medical conditions like dementia require a lot of carer support. Carers feel the need to be informed with the latest knowledge through a variety of sources to find out about the support available for the person with the medical condition and to enhance their care levels. They also have constant concerns about the safety and well-being of those whom they care for. The findings from this study showed that the assistive device supported the carers in this regard. These results seem to be consistent with existing research, which found that assistive technology can provide reassurance and support for carers of persons with dementia [4].
Whilst the use of assistive technology is being well-realised, there are a few barriers to adoption in the mainstream of health care. First of all, individuals accept change at different rates and the process of adapting to technology in their lives takes time. As discussed earlier, self-perceived technical skills and also the real ability to learn and develop skills to use the device remains a key challenge. This can be overcome by understanding the users’ perceptions of technology while introducing digital solutions to this population. This will lead to the preparation of an extensive user community to successfully implement digital solutions at a community level and maximise the potential of technology to facilitate independent living. Internet availability, especially wi-fi speed may be an additional factor that may be a challenge to access and use assistive technologies unhindered. Currently, there is increased concern about ethical issues whilst adopting health technologies [32]. Alongside healthcare provision, protection of privacy of patient data has always been a priority with healthcare providers and technology developers. Through careful consideration and well-devised regulatory safeguards and boundaries patients’ data can be protected, which in turn would facilitate the adoption of technology for various beneficial purposes [32]. Also, educating users on data protection and providing useful instructions to protect their privacy can have mutual benefits for both providers and users. Another most common barrier to adoption is cost [32]. The costs of the device and maintenance can be an issue with implementation for both the individuals and organisations. It may be true that investing in good assistive technologies can incur substantial costs, especially for health care providers. However, the potential benefits may outweigh the onetime set-up and maintenance costs. The costs of adoption to assistive technology for improving health and social well-being may be lesser in comparison to paying the price owing to increasing health and socioeconomic burden leading to unmet needs. Constantly, there is an increasing demand on local services and a significant burden is imposed on health care workers. This results in unmet needs due to the national shortage in health care workers and carers [26, 33,34,35]. However, such situations can be better managed by embracing assistive technologies as an adjunct for care provision and remote monitoring that can ease some of the workloads of health care workers/carers [7]. This, in turn, may have a positive impact on their health and well-being as well as improve productivity. Thus, there may be some direct and indirect cost-effectiveness with the adoption of assistive technology. There is some evidence in the existing literature that institutional and certain in-home personnel costs reduced through strategic implementation of assistive technology for care [36, 37]. However, continued research in the area to assess the cost-effectiveness of assistive technologies for health and social care is required specific to devices and settings.
Another widely debated concern is whether technology promotes or demotes social interactions. Current literature highlights both positive and negative impact of technology on social interactions. Whilst few studies highlight that new technologies can have a dehumanizing effect of distance and create insensitivity, some suggest that it facilitates social interactions [38,39,40]. In general, evidence suggests that technology may have negative impact on children and young adults [38, 41]. However, for adults who enter into older adulthood, use of social media through various technologies may play a more active role in keeping this geriatric population socially connected [42]. This is because maintaining social connectedness may become cumbersome or increasingly difficult due to mobility limitations, chronic diseases and other age-related issues, thus decreasing physical connectedness with friends, family, and community [40, 42]. Similarly, many of our participants found that their digital assistants facilitated social contact (for the socially isolated, patient’s carers, distant family and friends) rather than substituting it. Since the device also had a screen, making video calls was easier through voice-commands which were found to be helpful for many. As highlighted earlier, the assistive device facilitated a bonding experience across generations for some of our participants. Moreover, in the recent times, during various national lockdown restrictions in the UK owing to the COVID-19 pandemic, the assistive device was found to be timely. Exploring the benefits of technology for social interactions, especially in geriatric population may be an interesting avenue of future research projects.
Strengths and limitations of this study
This study recruited participants (patients and carers) from a select region in the UK through a convenience sampling strategy to identify people with a range of medical conditions to capture data relevant to the use of a particular type of assistive device and to explore user experience post the integration of the device in their routine lives. The findings from the study provided rich insights from real-world data to understand patients’ and carers’ perspectives on using assistive technology. Many valuable insights were generated on how assistive devices integrated into the routine lives of individuals and played the role of a personal assistant. Furthermore, the study helped to identify some enablers and barriers to integration of assistive devices in routine care, which can support with health care decision-making on future implementation of assistive technologies in homes, effectively facilitated by formal health and social care services. A limitation of the study could be the small sample size limited to one geographical area of England, so our findings may have limited generalisability to other locations. The participants were recruited using convenience sampling method, which involves using respondents who are accessible to the researchers. Therefore, there may be some degree of selection bias. Future research in larger sample using probability sampling techniques may help to overcome such bias.