Perspectives on assistive technology among older Norwegian adults receiving community health services

Abstract

Introduction

The western world is seeking increased implementation of assistive technology (AT) to meet the challenges of an ageing population. The objective of this study is to explore perspectives on AT use among home-dwelling older adults with or without cognitive impairment.

Methods

This study combines findings from a cross-sectional study with a questionnaire package (n = 83) and from qualitative individual interviews (n = 7) and is part of a larger study, the Assisted Living Project. Combining methods promotes complementary inquiries into a phenomenon.

Results

The participants already use ATs: TVs, social alarms, mobile phones, stove timers, electronic medical dispensers, PCs and tablet computers. They were both optimistic and skeptical of AT, and expressed different perspectives and expressed different perspectives on ATs in relation to usability, privacy and fear of losing personal face-to-face care.

Conclusions

This study reveals that older adults’ perspectives on AT are multifaceted and complex, and can partly be explained by the interacting factors in the HAAT model: person, technology, environment, and context. Further exploration in relation to older adults with health challenges, as well as ethical perspectives on AT implementation, is required for this group.

Trial registration number

The Norwegian Research Council, Number 47996, funds the Assisted Living Project (ALP).

IMPLICATIONS FOR REHABILITATION

• The study was useful in order to inform the health care services about older adults “perspectives on assistive technology”.

• This study reveals the complexity of understanding perspectives towards and the use of assistive technology among older adults with or without cognitive impairment.

• This study contributes to the understanding of the interactions between the four components: humans, activities, technology and the context.

Keywords:

• Assistive technology
• older adults
• dementia
• cognitive impairment
• home-dwellings
• health care services

Introduction

Assistive technologies (ATs) can enable people with disabilities to live active, safe, productive, independent and dignified lives [1]. There is a persistent demand, worldwide, for increased implementation of AT in community health services to meet the challenges posed by an ageing population and to facilitate active ageing and independent living [2]. The enabling aspects of ATs and viewing them as tools for overcoming barriers to full participation, is a common understanding [1,3]. ISO9999 defines assistive products as “any product (including devices, equipment, instruments, technology and software) especially produced or generally available” (p. 1) [3]. These assistive products refer to products that have been specifically designed for people with disabilities (e.g., wheelchairs, computer access technologies and environmental control systems) and or mainstream technology (e.g., simple devices such as nonslip mats and more complex devices such as smart home technologies). Norway has a common national policy for implementing general AT packages in community healthcare services. The Norwegian government, through the Norwegian Labour and Welfare Administration (NAV), also supports more individually tailored AT [4]. However, the municipalities employ different strategies to implement these AT packages. Local differences include how end users and frontline healthcare workers are involved, and the types of technological equipment they choose to implement in general. There is worldwide optimism that, supported by various types of AT, older adults with dementia and other disabilities will be able to age in place [5–8]. The picture of the use and non-use of technology is very complex and the terminology in this field is evolving, including terms such as use, acceptability, acceptance and adoption [9]. In the present study, the term “use” is applied unless the references use other terminology.

A meta-analysis conducted by Abrilahij and Boll [10] identified a large set of reasons supporting the use of ATs and even more for non-use. The predictors that affected the use of technology were connected to a person’s reasons along with “ease of use, perceived usefulness, perceived difficulty to use, perceived inefficiency, perceived low self-efficacy, perceived financial costs and perceived violation of privacy” (p. 89). The literature identifies a range of obstacles, which include technological properties and design [11,12]; furthermore, the insufficient ability of technology to adapt to potential physical and cognitive decline in later life [13], and inadequate user involvement during the needs assessment, development and implementation of AT [6,14,15]. Moreover, the literature shows that healthcare personnel working with older adults and the knowledge they possess are crucial determinants of whether AT is used or not [16,17]. Several studies refer to the residential environment, e.g., neighbours, family and friends, as contributing to perspectives on and adoption of AT, and are thus important factors that influence an older adult’s process of becoming a user of AT [18–20]. These barriers to using technology are linked to person (here: used interchangeably with human), environment, technology and context.

Maximizing older adults’ potential for activity and ageing in place through the use of AT, requires an understanding and further exploration of the complex processes underlying the use of any given AT [10]. The International Classification of Functioning, Disability and Health (ICF) offers a tool [21] to enhance understanding of this complex process. ICF shows that a person’s overall activities are affected by personal factors (e.g., motivation and self-esteem) and environmental factors (e.g., technology) together with health condition, body function and participation. Furthermore, the technology acceptance model (TAM) offers a model that focuses more on the technological aspect [22]. TAM suggests that perceived usefulness and perceived ease of use have long been recognized as significant predictors of technology adoption in the general population. By broadening TAM’s applicability to older populations, the senior technology acceptance model (STAM) was developed to capture additional dimensions relevant to older adults, such as age-related cognitive and physical changes, and computer self-efficacy [23]. Another model by the Centre for Research and Education on Ageing and Technology Enhancement (CREATE) [24] has investigated the impact of several complex factors affecting older adults’ willingness to adopt technologies, such as attitudes to technology [25]. Moreover, the matching person and technology model addresses key assessments of a person, which include assessing functional needs, lifestyle and personal factors such as motivation, mood, readiness and predisposition [26]. Although these models address many key aspects of use relating to AT, our main interest is the human factor in theory development in nursing and healthcare informatics.

A model explains and predicts information and communication technology acceptance by healthcare consumers interaction with other relevant factors. The human activity assistive technology (HAAT) model offers a framework for understanding the interactions between the four factors: humans, activities, technology and context [27]. The HAAT model is viewed as an enabler for a human doing an activity in a context. This model is based on other interactive models such as the person–environment–occupation model and the person–environment–occupational performance model [27]. Physical, cognitive and emotional elements are included in the human factor; activity includes self-care, productivity and leisure in different environments; AT includes intrinsic and extrinsic enablers; while the context includes physical, social, cultural and institutional factors. A common conclusion that can be drawn from these models is that users have different interpretations and priorities, including how users think about AT [28], and that they use and talk about their technologies differently.

A literature review by Peek et al. [29] reports that an older person’s perspectives on and adoption of AT was dependent on characteristics shaped by personal, social and physical factors. Lee and Coughlin [30] identified the human factor as a determinant of older adults’ adoption of AT along with technological and environmental factors. The human factor was characterized by the older person’s social support, emotions, independence, experience and confidence. Larsen et al. [14] claimed that the “human” factor must be the main factor because failing to use a client-centred approach throughout the delivery process may prevent the use of the AT. A person’s age and level of education are also shown to influence people’s use of AT [31–33]. However, these associations are not always clear [34,35]. There are indications that reduced health status can be a barrier to AT use among older adults and especially among people with cognitive impairment or dementia [36].

In sum, AT use among older adults with dementia is connected to a person and his/her activity in a certain environment and context. However, little is known about the AT perspectives of home-dwelling older adults with health challenges; i.e., how they think about and use AT. The objective of this study is therefore to explore perspectives on AT among home-dwelling older adults with or without cognitive impairment who receive community health services. The following research questions will be explored:

• How do home-dwelling older adults express their perspectives on using AT as part of their everyday lives?

• What types of AT do they talk about AT?

• Do they express any concerns regarding the use of AT?

Methods

Design

This study combines findings from a cross-sectional study with a questionnaire and qualitative individual interviews, and is part of a larger study, the Assisted Living Project [37]. This combination of methods makes it possible to draw a range of inferences from a single study [38] and promotes complementary inquiries into the phenomenon of interest in our study, perspectives and use of AT among home-dwelling older adults receiving healthcare services. Tashakkori and Teddlie [39] consider this mixed design to be a pragmatic approach where research questions can be explored more effectively than by means of a single method study.

Cross-sectional study, sample and procedure

The data for the current study were obtained from a broader study in Norway involving two sub-samples (home-dwelling older adults receiving homecare services and older adults in an assisted living facility). In this broader study, healthcare workers were contacted with the aim of recruiting home-dwelling older adults. A questionnaire package was administered in face-to-face interviews in the participants’ homes and took 45–60 min. Data collection was conducted by the first, second, third and last author of the study and by bachelor’s and master’s students (nursing and occupational therapy) from Oslo Metropolitan University. Data were assessed using pen and paper, and subsequently computed in the secure electronic database. The students’ training process started with students being recruited as unpaid research assistants by the researchers during their ordinary lectures as university professors. In the next step, the recruited students were offered a lecture about the current study, information about the questionnaire, how to run a structured interview, how to store the data, and to compute it in the electronic database. Third, a simulation of an interview was performed. Two researchers simulated an interview session in the classroom before two students simulated the same interview with one student as an observer. They also simulated computation of the data, after which all the students discussed their experiences together with the researchers. During the data collection in the participants’ homes, the students could, if they felt they were in need of supervision, contact the researchers by phone. However, the students mainly contacted the researchers about how to compute the data electronically.

The questionnaire package included study information, informed consent forms, sociodemographic questions, questions about perspectives on AT, the use of AT in their homes, and self-reported mental and physical health subscales (Rand 12) [40,41]. The cognitive function instrument (CFI) was used for self-reporting of cognitive and functional decline in the interviewees. This scale consists of 14 items involving memory function, orientation, social participation and functioning in instrumental activities of daily living. In line with the Norwegian recommendations, question number seven was omitted (assessing driving a car) [42]. The Hospital Anxiety and Depression Scale (HADS) [43] and Activities of Daily Living Scale (ADL) [44] were also used in the main study.

Statistical analysis

In this study, the questionnaire package served as background information. The descriptive statistics of the variables used were therefore analysed using SPSS 25 (SPSS Inc., Chicago, IL) [45].

Qualitative individual interviews

The consolidated criteria for reporting qualitative research (COREQ) were used to guide the qualitative part of the study [46]. A qualitative, exploratory approach, reflecting the interpretive framework [47], was considered to be the most appropriate design for developing an understanding of older adults’ perceptions of AT.

Participants for qualitative individual interviews

Participants were recruited among older adults receiving healthcare services at home (n = 3) and in an assisted living facility (n = 4) in Norway. The first and last author were responsible for recruiting the participants in collaboration with healthcare workers. All the participants had a social alarm. The participants in the assisted living accommodation had received tablet computers from the municipality, and had been offered a training course on how to use the tablet.

Data collection from qualitative individual interviews

The qualitative individual interviews were conducted in the participants’ homes. The authors developed a question guide for the interviews, based on the literature [6,48] and on the authors’ experiences. The guide was designed to cover key topics with reference to the aims of the study and the questions in the questionnaire. The following topics were included: (1) the challenges of everyday life and any solutions that make everyday life easier; (2) the participants’ use of AT in their everyday life; (3) self-reported health as one aspect of the participants’ characteristics.

All the interviews were voice-recorded and transcribed verbatim in Norwegian and then carefully translated into English, in collaboration with a professional native speaker of English. Two nurses and two occupational therapists conducted the interviews.

Data analysis of qualitative individual interviews

A thematic analysis was undertaken to identify key themes guided by Braun and Clarke’s [49] six-phase analysis. In the first step, the first and last author actively read the interviews, searching for meaning and patterns (phase 1: become familiar with the data). These authors then coded and organized the material into meaningful groups in line with the research questions (phase 2: generate initial codes). The codes were extracted from quotes that indicated perceptions of AT and the participants’ health (phase 3: search for themes). The codes were then reviewed by re-reading the interviews (phase 4: review themes). Next, the authors decided on which themes to use (phase 5: define and name themes). We can never be entirely free of preconceptions that may influence our interpretation of data. Therefore, to strengthen the validity, we addressed the criterion of trustworthiness, which includes credibility, dependability, confirmability, transferability and authenticity [50]. To meet these criteria, all the authors made explicit their pre-understanding and existing knowledge about the context before they carried out phase six of the analysis (writing the article) in line with Braun and Clarke [49]. All the authors met face-to-face and discussed interpretations of the material, and they critically revised the study design and the draft written by the first author.

To ensure trustworthiness and prevent potential threats to validity, we used the four “trustworthiness” criteria: credibility, transferability, dependability and confirmability [51]. Credibility was ensured through the qualitative interviews and detailed and descriptive analysis of the data, and quoting participants’ responses to substantiate the findings enhanced transferability. To increase dependability, the transcripts were reviewed several times, then coded and checked by the first and last author; interpretations were also based on consensus among all the authors. Confirmability was reached by substantiating each emergent theme with relevant quotes extracted from the participants’ statements.

Ethics

The privacy and data protection aspects of the project were assessed and approved by the Norwegian Centre for Research Data, NSD, on 16 March 2016, application number 47996. In addition, the participants were given information regarding privacy at the start of the interviews. Anonymity was assured as no names were used in any part of the data collection. Socio-demographic data were reported carefully because of the limited number of residents in the assisted living facility. An informed consent form was signed by those willing to participate in the interviews.

Results

First, the results of the cross-sectional study will be presented. Thereafter, the results from the qualitative individual interviews will be presented.

Results of the cross-sectional study

As shown in Table 1, the majority of the 83 participants who lived at home were women, lived alone, had a medium level of education, used medication, had a disease and had experienced a fall incident in the previous year. More than half of the participants regarded their health as good. Almost half of them reported a decline in cognitive function on the CFI. Missing responses to items appeared in 14% (n = 12) of the cases.

Table 1. Survey: demographic characteristics (n = 83).

Characteristics	n (%)
Gender
Female	57 (69)
Male	26 (31)
Education
Low	16 (19)
Middle	44 (53)
High	22 (28)
Partner
Living alone	75 (90)
Partner	8 (10)
Use of medication
Yes	79 (95)
No	4 (5)
Have diseases	62 (75)
Fell last year	44 (53)
Health (n = 79)
Good	43 (54)
Poor	36 (46)
	Mean (range)
Age, mean	85 (63–97)
Cognitive function (n = 71)	5.5 (0–13)
	n (%)
No cognitive decline (≤5)	39 (55)
Cognitive decline (>5)	32 (45)

Two-thirds of the participants who answered the questionnaire had a TV remote control (Table 2), but two did not know how to use it. This lack of knowledge about use was also reported in relation to the social alarm. Of the 67 (75%) who had a cell phone, three did not use it to make calls and two did not receive phone calls. Only 12 (15%, n = 78) reported having a smartphone. Few of the participants with cell phones reported receiving (32, 53%, n = 60) or sending (18, 27%, n = 68) text messages.

Table 2. Known assistive technology (AT) used by participants in the study (n = 83).

AT	n/%
TV remote control	79 (95)
Cell phone	62 (75)
Social alarm	67 (81)
Stove timer	34 (41)
PC/computer	20 (24)
Tablet	25 (39)
Digital calendar	3 (4)
Digital medicine dispenser	4 (5)

Six of those who had a PC (n = 20, 24%) did not use it. The others used their PC for paying bills, reading news, streaming films and music, searching the internet, and mail. Only a few of those who had a tablet computer reported a specific use such as calling (n = 3), social media (n = 3), mail (n = 3), shopping (n = 3) and searching for information (n = 8).

Table 3 describes the cross-sectional study participants’ answers to seven questions about their perspectives on AT. Two thirds of the participants considered “AT to be helpful in everyday life” (question (q) 3) and “did not worry about privacy regarding use of AT” (q 6). Half of the participants who “did use AT” (q 1), “considered themselves to be too old to use AT” (q 4), “considered AT useful for others” (q 5) and “did not fear less personal assistance due to new AT” (q 7). One third of the participants “enjoyed learning and using AT” (q 2).

Table 3. The survey participants’ perspectives on assistive technology (AT).

Questions	Agree, N (%)	Neither agree/disagree, N (%)	Disagree, N (%)
1. I am accustomed to using computers, mobile phones and other technical equipment (N = 82)	40 (49)	8 (10)	34 (41)
2. I like to learn and use AT (N = 83)	32 (39)	9 (11)	42 (50)
3. AT is helpful in everyday life (N = 82)	63 (77)	11 (13)	8 (10)
4. I am too old to use AT (N = 82)	49 (60)	8 (10)	25 (30)
5. AT is useful for others, but not for me (N = 82)	45 (55)	8 (10)	29 (35)
6. When I am using AT, I am worried about others receiving information about me (N = 82)	14 (17)	11 (13)	57 (70)
7. AT might lead to less personal assistance (N = 82)	15 (18)	22 (27)	45 (55)

Results of the individual interviews

The attitudes to AT among home-dwelling older adults receiving healthcare services were further explored in individual interviews. An analysis of the interviews revealed three main themes: (1) our health is not excellent – we learn to use compensatory strategies; (2) AT use is sparse; (3) perspectives on AT are both optimistic and sceptical.

Our health is not excellent – we learn to use compensatory strategies

All the participants interviewed talked about their diseases, pain, physical decline or other health problems; however, they still assessed their health status as being more or less as anticipated. This was expressed as follows:

I can't say it [my health] is excellent when I have this [rollator] but I've learned to walk with it, because I can't sit in a wheelchair. It works well. (No 3)

As long as I try to realize that I can't manage as much as before, just realize this and align my body with my arms and legs, so to speak, this is what rescues me and the service I have. (No 4)

One participant expressed clearly that she was not healthy:

No [not healthy], I’m bothered a lot by back pain because I broke my back a few years ago. (No 6)

Assistive technology use is sparse

Most of the participants in the qualitative individual interviews reported having a TV and a social alarm. One participant was afraid of causing a false alarm and therefore did not use the social alarm during the night (No 4), while others expressed that just having an alarm made them feel safer (No 6). All, except one, had a cell phone. They all had a stove timer, however, knowledge about its use was not reported. Four of the participants had received a tablet computer with training support from the community. Two of these participants reported that they read the news, paid their bills and used other apps on their tablet (Nos 5 and 6). The other participants used neither a PC nor a tablet.

One participant spoke about the stairlift in her apartment, which enabled her to go out. She only used two channels on her TV, and no longer used her coffee machine or microwave. She said the following about the radio:

I don’t use the radio very much. Maybe I should use it? I have one in the living room and another small one. (No 1)

Perspectives on AT – optimism and scepticism

About half of the participants were sceptical about AT, thinking it might lead to loss of personal help. They were uncertain about who was going to pay for it (No 3) and concerned that ATs, such as an automatic door lock, might contribute to passivity (No 3). One person who had a digital medicine dispenser was disappointed and said:

They [healthcare workers] should have spent more time [when introducing the digital medicine dispenser] talking with us, but I haven't seen that happen yet. (No 3)

Digital meetings with the healthcare services were considered impersonal:

It will be impersonal. I want to talk properly with the doctors. The human aspect gets lost, and that's wrong. (No 3)

Some of the participants expressed concerns with respect to privacy, surveillance, leaking of information and a lack of necessary personal assistance once the AT was introduced. However, they requested, at the same time, that the AT should be “smart”. One participant was anxious about what might happen to her information if she searched on the internet or used social media. She was also worried about cyberbullying, which she had seen on the TV news (No 2). When asked about a camera being used in their apartments in order to alert people in the event of a fall, one participant referred to it as “surveillance”:

That is, yes, surveillance, it’s simply surveillance of other people. (No 2)

This participant considered personal assistance to be the safest type of care. This is in line with the argument made by another participant who did not want to use a digital medicine dispenser:

If something happens to me, it’s much safer if someone visits [personal assistance with medication]. If I fall and hit myself and lose consciousness or whatever, you never know. (No 3)

One assisted living participant did not consider the camera to be helpful in communication with the healthcare services:

No, I don't like it … as long as I can hear the phone and [have] this one [social alarm] on my arm, I'm safe. Because they arrive in 10 minutes. (No 5)

Another participant said:

As long as I have this [social alarm] … there is no need for a camera. (No 7)

Expectations that any AT should be smart were expressed as follows:

Intuitive AT, that it should be self-explanatory, so you see what to do, you don't need instructions. Yes, because when you learn this, you can transfer that knowledge to your TV… After I got a tablet, I think I’ve learned more. (No 4)

Addressing needs was generally considered to be more important than using different types of AT. Participants highlighted the need to go shopping (Nos 4 and 7), to get in and out of a taxi (No 7), to have access to their own balcony (No 7) and proper transportation when visiting family (No 7).

In sum, various ATs were used on a regular basis: TV remote, social alarm, cell phone, stove timer, digital medicine dispenser, PC and tablet computer. The participants were generally positive to ATs, with the exception of surveillance. Furthermore, they expected the AT to be intuitive to use and they did not want it to reduce the personal assistance they received from the healthcare services.

Discussion

In our study, the home-dwelling older adults receiving healthcare services on a regular basis expressed various perspectives on AT relating to its usability, the possible loss of privacy and the fear of losing personal face-to-face care. Similar findings are described in earlier research [10]. However, most studies have small samples and do not describe the living context [6,8,48]. The home-dwelling older adults in our study live in a context where the national policy encourages the implementation of AT by offering extra resources to the municipalities [7]. Furthermore, these Norwegian older adults also live in an environment where it is common to receive regular visits from the healthcare services and they also have AT installed in their homes. According to the HAAT model [27], the older adults (person) are in a position to interact with the technology, environment and the context. Nevertheless, in our study, ATs are sparsely used and different perspectives prevail on AT, which reflect both optimism and scepticism to AT. It is important to recognize perspectives regarded as a human factor in determining older adults’ use of AT [29,30] in the implementation of AT.

However, the picture of the use and non-use of technology is very complex [10]. A meta-analysis conducted by these authors identified a large set of reasons for the use of ATs and even more for non-use. Among the predictors that affected the use of technology were “ease of use, perceived usefulness, perceived difficulty to use, perceived inefficiency, perceived low self-efficacy, perceived financial costs and perceived violation of privacy” (p. 89). An additional 18 subjective reasons were listed that affected AT use although they were not considered to be predictors. These included: insecurity, perceiving AT use as painful, others’ negative views of oneself, perceiving oneself as a burden to others, and a desire for privacy.

The HAAT model offers an interpretation of the interaction between people, machines, activities and context [27]. This model describes how people perform within systems and that doing something connected to technology/AT is done within a context. In our study, the participants’ declining health might be the reason for the majority not using the internet or AT frequently and even scepticism. This is supported by Gell et al. [36], who state that health status plays a role in AT participation among older adults. Disabilities are one of the reasons for reduced digital participation among older adults. For example, cognitive impairment is shown to be a barrier to participation in regular online activities (shopping, paying bills and digital communication with friends and family) [52].

When considering participants’ positive perceptions of using and learning new ATs, the framework for their responses must be defined. The literature points out that healthy older adults are positive to using AT [35] as it helps them to feel safe and independent. This was important for all participants (aged between 79 and 91) in this Norwegian study. AT was understood to support them in staying in their homes for as long as possible which is in line with the Norwegian policy [7]. Interestingly, some of the participants in our study claimed to be too old to use AT, although they were younger than those in the Sanchez et al. study [35]. As Abrilahij and Boll [10] point out, a device may not cover what people actually need. Alternatively, as the HAAT model by Cook and Polgar [27] describes, the device or AT may be non-smart and thus not promote interaction with the field of AT. Our participants may have had experience of a device that neither fitted nor interacted with their need or declining health. For example, a common device like a TV remote control, which often served as a social AT, was frequently mentioned by our participants as being so complicated and challenging that the home-dwelling older adults need assistance to use it properly. This is supported by literature [17] and a smarter design is needed [53] to increase user-friendliness and support the interaction between people, machine (AT) and activity [27].

Furthermore, half of our participants considered AT to be of greater importance for other older adults than for themselves. Wu et al. [54] identified a clear need for support in everyday life among older adults. However, these older adults did not accept AT assistance, but they anticipated that using AT would be appropriate for others. Our participants’ self-reported declining health might be one explanation for being less positive to AT in relation to themselves. Our study also revealed that there were few technological devices in the participants’ homes and that some were not used properly. There may be a lack of reliable and relevant AT needs’ assessment, as has been pointed out in several recent reviews [6,8,14,48].

Some of our participants were concerned about the two very relevant issues of privacy and loss of face-to-face contact. These issues indicate the importance of ethical reflection, which is an area of ongoing debate in relation to advances in AT [55,56]. For example, privacy is a challenging issue in relation to GPS location for users with cognitive impairment, though the majority of users carrying a GPS do not feel that they are under surveillance [57]. However, it is important to address ethical aspects when introducing AT to human beings. Hofmann [58,59] deduces from a literature review that while each AT has an expedient purpose, it also needs to be individually assessed, and he suggests that the following aspects should be assessed: autonomy, integrity, dignity, privacy, time for human contact, actors involved (relatives, technological companies, etc.), changes in responsibility and conflicts of interest. On the other hand, society's continuous development and use of AT may exclude vulnerable groups because privacy and dignity may be ignored if there is insufficient in-depth discussion in each case.

Another factor when investigating the relevance of AT is the possible influence of ageism in a society that expects older adults to be AT illiterate. The social environment around the user is likely to be an important determinant of AT attitude and acceptance [11,29,60]. As the HAAT model emphasizes, both the environment and the context are important to understand the interactions in the field between users and AT [27]. The attitudes of the public and healthcare providers to AT among older adults need to be considered as an important component in implementing AT.

Strengths and limitations

The findings derived from combining a cross-sectional study with qualitative individual interviews strengthen our study, demonstrating older adults’ perspectives on AT. However, we did not interview the same older adults who answered the questionnaire, which might have given us an opportunity to investigate their perspectives on AT in greater depth. Using a validated scale for perspectives on technology [61] is another possibility that would have strengthened our study. A cross-country comparison might also have strengthened our study. However, our study is performed in the Norwegian context using a tax-funded healthcare model that provides free healthcare services at home and AT. As far as we know, this model is used in few countries. All the authors were involved in the larger study on AT, the Assisted Living Project and this might have influenced our interpretation of the data either positively or negatively. The authors have multi-professional backgrounds, and the results might have been positively influenced by the deep inter-professional discussions and dialogue.

Conclusions

This Norwegian study supports earlier studies showing differences in perspectives on AT among home-dwelling older adults with health challenges who receive healthcare services on a regular basis. These perspectives on AT were related to usability, the possible loss of privacy and the fear of losing personal face-to-face care. Moreover, this study reveals that older adults’ perspectives on AT are multifaceted and complex, and can only partly be explained by the interacting factors in the HAAT model: person, technology, environment and context. This study emphasizes the complexity of understanding perspectives on and the use of AT among older adults with health challenges resulting in disabilities. Further research should explore how suitable and individually tailored AT solutions can be offered in the general implementation of AT in the municipalities. Participants’ perspectives on AT, as well as ethical perspectives, should continue to be discussed when implementing AT for older adults.

Acknowledgements

We acknowledge the support received from the City of Oslo and thank the participants who took part in the Assisted Living Project. Furthermore, we acknowledge the assistance received from the Research Council of Norway and OsloMet - Oslo Metropolitan University.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The interview guide and the questionnaire are available in Norwegian by contacting the first author.