The uses and experiences of communication technology for home-dwelling older adults in a homecare services context: a qualitative systematic review (Preprint)

BACKGROUND European healthcare systems regard information and communication technology as a necessity in supporting future healthcare provision by community homecare services to home-dwelling older adults. Communication technology enabling synchronous communication between two or more human actors at a distance constitute a significant component in this ambition, but few reviews have synthesized research relating to this particular type of technology. As evaluations of communication technology in healthcare services favour measurements of effectiveness over the experiences and dynamics of taking these technologies into use, the nuances involved in technology implementation processes are often omitted. OBJECTIVE The present review aims to systematically identify and synthesize qualitative findings on the uses and experiences of communication technology for home-dwelling older adults in a homecare services context. METHODS Conducting a cross-disciplinary search in five databases for papers published between 2013 and 2023 yielded 4210 citations. Succeeding four screening phases and a subsequent appraisal of methodological quality guided by the CASP tool, a total of 13 studies were incorporated in a three-stage thematic synthesis producing four analytical themes. RESULTS The first theme presented the multiple trajectories that older users’ technology acceptance could take, namely straightforward, gradual, partial, and resistance-laden, notwithstanding outright rejection. It also emphasized both instrumental and emotional efforts by the older adults’ relatives in facilitating acceptance. Moving beyond acceptance, the second theme foregrounded the different types of work involved in attempts to integrate the technology by older users, their relatives, and healthcare providers. Theme three highlighted how the older users’ physical and cognitive conditions formed a contextual backdrop challenging this integration work, together with challenges related to spatial context. Lastly, consequences derived from taking the technology into use could be of both enabling and complicating nature as integration reconfigured the way users related to themselves and each other. CONCLUSIONS The acceptance and integration of communications technology for older adults enrols multiple user groups in work tending to the technology, oneself, and each other through inter-group negotiations. The review’s original contribution consists of its attentiveness to the dynamics across different users in deriving consequences from using the technology in question, in addition to its assertion that such consequences may be both intentional and unintentional. We argue that our findings may be used to nuance policies aimed at – and practices within – contexts involving constellations of users and technologies similar to the ones explored here.