Community Health Care Workers’ Experiences on Enacting Policy on Technology with Citizens with Mild Cognitive Impairment and Dementia

Abstract

Purpose

Assistive technologies and digitalization of services are promoted through health policy as key means to manage community care obligations efficiently, and to enable older community care recipients with mild cognitive impairment (MCI) and dementia (D) to remain at home for longer. The overall aim of this paper is to explore how community health care workers enacted current policy on technology with home-dwelling citizens with MCI/D.

Participants and Methods

Twenty-four community health care workers participated in one of five focus group discussions that explored their experiences and current practices with technologies for citizens with MCI/D. Five researchers took part in the focus groups, while six researchers collaboratively conducted an inductive, thematic analysis according to Braun & Clarke.

Results

Two main themes with sub-themes were identified: 1) Current and future potentials of technology; i) frequently used technology, ii) cost-effectiveness and iii) “be there” for social contact and 2) Barriers to implement technologies; i) unsystematic approaches and contested responsibility, ii) knowledge and training and iii) technology in relation to user-friendliness and citizen capacities.

Conclusion

This study revealed the complexity of implementing policy aims regarding technology provision for citizens with MCI/D. By use of Lipsky’s theory on street-level bureaucracy, we shed light on how community health care workers were situated between policies and the everyday lives of citizens with MCI/D, and how their perceived lack of knowledge and practical experiences influenced their exercise of professional discretion in enacting policy on technology in community health care services. Overall, addressing systematic technology approaches was not part of routine care, which may contribute to inequities in provision of technologies to enhance occupational possibilities and meaningful activities in everyday lives of citizens with MCI/D.

Trial registration

NSD project number 47996.

Keywords:

• older adults
• community health care services
• discretion
• street-level bureaucracy

Ethics

The Assisted Living Project (2015-2019) is performed in accordance with the Declaration of Helsinki and approved by The Norwegian Centre for Research Data, NSD 16.03.2016, Application number 47996. The focus group participants received a written invitation to participate in the focus group discussions and were asked to sign an informed consent before the focus group discussions took place. Participation was voluntary. All personal data, except professional titles, were left out.

Acknowledgments

The Assisted Living Project: ‘Responsible innovations for dignified lives at home for persons with mild cognitive impairment or dementia,’ NSD project number 47996, is financed by the Norwegian Research Council under the SAMANSVAR strand (247620/O70). We are very grateful to all participants who dedicated their time to participate in the focus group discussions connected to the Assisted Living Project.

Disclosure

The authors report no conflicts of interest in this work.