A critical occupational perspective on user engagement of older adults in an assisted living facility in technology research over three years

Figures & data

Table 1. Steps, content and findings of user engagement, 2016–2019

Research-based occupation and date	Content	Findings
Information meeting June 2016	All residents in the assisted living and their next of kin were invited to an information meeting	Approximately 30 residents, a few next of kin and a few staff members met
Individual questionnaires (survey) June 2016 onwards	Socio-demographic data Opinions on technologies with instruments (ALP group in 2015) RAND 12 – Health questionnaire (RAND Corporation, USA) MCFSI – The Mail-In Cognitive Function Screening Instrument, Norwegian version (Michelet et al., 2018) HADS – Hospital Anxiety and Depression Scale (Zigmond & Snaith, 1983)	Currently under analysis
Dialogue cafés 26.10.16 14.12.16 06.04.17	Three café meetings with 15-20 residents The first café sought to identify users’ needs and challenges concerning daily living The second café discussed technological solutions following cartoon presentations of scenarios The residents’ opinions created a basis for making prototypes that were presented and appraised in the third café	The residents were concerned about falling, starting fires, and burglars, and wanted reminders that could help them to live safely and independently The residents were particularly interested in technology that could provide help if they had fallen or verbal reminders if they had left the stove on or forgotten to turn off the coffee machine or left the apartment with the windows or balcony door open
Recruitment for the trial intervention 06.04.17	After the three dialogue cafés, the residents were invited to take part in an intervention study that involved testing environmental sensors at home (Appendix 1: refer to online supplementary material)	8 participants (2 men, 6 women) consented to participate in the trial. One withdrew from the focus group discussion and one withdrew from the final individual interview
Individual interviews June 2016 onwards	The eight residents were interviewed with two standardised scales: the Canadian Occupational Performance Measure (COPM; Law et al., 2014), and the Everyday Technology Use Questionnaire (ETUQ; Nygård, Rosenberg, & Kottorp, 2015)	COPM results: Indicated that the three most meaningful activities were getting around outside the assisted living facility, going for walks in the neighborhood or grocery store to run errands or visit family, a hairdresser or a general practitioner; reading; and socializing with family and friends outside the assisted living facility ETUQ results indicated the participants had and used a wide range of devices; most frequently used were the TV, rated as the most significant technology by four, and the mobile phone, which six had and two wanted
Feasibility study 21.06.17	The first feasibility deployment of sensors took place in one of the apartments	The Medical Research Council’s (MRC) framework was used for the process evaluation Too few power outlets created problems with installation. Too many IP addresses competed, which caused lost connections with servers and created gateway errors. Some sensors tended to fall down due to their overly small frames on windowsills or uneven surfaces
Deployment of environmental sensors August 2017 onwards	The sensors were deployed in the seven other apartments following a contract with each participant regarding sensor installation (Appendix 2: refer to online supplementary material)	Difficulties in addition to the feasibility study were unreliable technology and poor wireless connections causing extreme delays in installing and configuring the sensors (i.e., server connection sometimes failed, components could not communicate with each other). After 2 months, all movement sensors were repositioned to cover the desired areas of the apartments. Loss of connection with the server and gateway errors required resetting the system and resulted in frequent visits by the researchers and engineers After 7-months the trial ended because the technology would not function as intended
Focus group discussion 14.03. 2018	The eight residents were invited to a final focus group discussion. The interview guide is presented in Appendix 3 (refer to online supplementary material)	Seven residents took part in an audio-recorded discussion led by a primary researcher and a doctoral student (TH and ET)
Individual follow-up interviews after 36 months 03.06.19 05.06.19 06.06.19	Eight residents took part in individual interviews (the RAND-12, MCFSI and HADS and open-ended questions)	Data from the COPM, HADS, RAND-12 and MSCFI were compared with 2016 and 2017 data (Table 1). Results indicated the sample was highly stable both physically and cognitively over the 3-years

Table 2. Overview of participants’ self-rated health status

Participant Age in years in 2017	RAND-12 (1–5) Self-rated health	Self-rated cognitive functioning (MCFSI)	HADS Anxiety	HADS Depression
A 85	Good	3.5	0	6
B 80s	Very good	4.5	2	3
C 92	Very good	4	1	0
D 82	Fairly good	2	1	0
E 86	Good	1	0	0
F 88	Poor	3.5	3	0
G 81	Good	3.5	1	6
H 88	Fairly good	6	3	0

RAND-12: 1 = excellent, 2 = very good, 3 = good, 4 = fairly good, 5 = poor

MCFSI: 1 = yes, 0.5 = maybe, 0 = no. According to a Norwegian validation study, the limit for recommending an assessment of cognitive functioning is 5 for self-scored responses and 7 for scores given by next of kin.

HADS: The instrument has scores for each item under Anxiety (A) and Depression (D) respectively. Number of scores: 0–7 = normal (no anxiety/depression), 8–10 = borderline abnormal (i.e., borderline case), 11–21 = abnormal (i.e., case).

Table 3. Example of inductive thematic meaning condensation

Quotation	Interpretation	Sub-theme	Overarching theme
“I think that this [project] is a nice initiative, that it takes what can be positive for older adults seriously. Because it focuses on older adults and what can benefit them, they won’t be forgotten so much”	Taking part in a project that can improve the lives of other older adults is important and meaningful, especially because older adults represent a marginalized group that may be overlooked	Older adults appreciate engaging in projects	Motivation for project engagement
“The one [sensor] under my bed was disturbing. It blinked when I got out of bed to go to the toilet. It came on all of the time”	The movement sensor interfered with normal habits, and the participant did not like the light blinking all of the time	Technology as an occasional burden	Mixed feelings towards environmental sensors at home

Table 4. Framework for the critical occupational perspective (Njelesani et al., 2013, p. 213)

What are the relevant sociocultural structures and processes that may mediate and constrain participants’ perspectives?*

Which occupations are seen as being preferable? How are they discussed or represented in the data?*

What appears to be understood as the preferred way to engage in occupations?

What assumptions underpin the ongoing valorisation of some occupations and the rejection of others?

What power relations are at play?*

Whose interests do the occupations serve?*

Who is privileged as participants in the occupations?

Michelet, M., Engedal, K., Selbaek, G., Lund, A., Bjorklof, G. H., Horndalsveen, P. O., & Bergh, S. (2018). The validity of the Norwegian version of the Cognitive Function Instrument. Dementia and Geriatric Cognitive Disorders, 46(3-4), 217–228. https://doi.org/https://doi.org/10.1159/000493463

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Zigmond, A. S., & Snaith, R. P. (1983). Hospital Anxiety and Depression Scale (HADS). https://www.svri.org/sites/default/files/attachments/2016-01-13/HADS.pdf

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Njelesani, J., Gibson, B. E., Nixon, S., Cameron, D., & Polatajko, H. J. (2013). Towards a critical occupational approach to research. International Journal of Qualitative Methods, 12(1), 207–220. https://doi.org/https://doi.org/10.1177/160940691301200109

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