Tensions between closure of the digital divide and acts of care in residential settings for persons with disabilities. A study of adopting customised information and communication technology

Abstract

Purpose

In contemporary society, being unable to take advantage of information and communication technology (ICT) can create barriers to maintaining social relations and, thus, can increase the risk of social exclusion and loneliness. Prior studies have revealed that, among persons with disabilities, customised ICT can contribute to the maintenance and improvement of personal social networks. Nevertheless, there is still a need for knowledge regarding the adaption of ICT of those involved when customized ICT are set up in the residents for persons with disabilities.

Methods

Through conducting interviews with four residents, as well as their relatives and members of staff this article explores how KOMP, a customised ICT product designed to enhance digital contact among people who are unable to use ICT independently, was applied in four different municipal residences in Norway. Collective qualitative analysis was utilised to perform this investigation.

Results

The analysis show that KOMP can help strengthen relationships, interferes with interactional practices, and underscores the institutionalised lives in the residences. These findings emphasise that applying customised ICT/KOMP in such settings highlights the underlying tensions regarding residents’ rights to self-determination and privacy.

Conclusions

This study provides insights into how formal and informal regulations developed by relatives and staff, with the purpose of both protecting residents and protecting oneself from digital exposure, impacts the residents’ ability to take advantage of customised ICT and overcome the digital disability divide.

IMPLICATION FOR REHABILITATION

• The present findings underscore the need for enhancing residential staff’s competence regarding the use of information and communication technology and their knowledge of the associated rights of persons with disabilities.

• These findings represent the need to improving residential staff’s awareness of their role in providing services that enable persons with disabilities to benefit from technological advancements offering distance communication.

Keywords:

• Collective qualitative analysis
• customised information and communication technology
• iCT
• digital disability divide
• KOMP
• residential living

Introduction

The growing role of information and communication technologies (ICT) in our daily lives has led to concerns of increasing inequality between those who can and those who cannot take advantage of such new technologies [1]. Accordingly, the digital divide, defined as the division between people who have access to and use digital media and those who do not, has been under academic study for many decades [2]. A key question, according to van Dijk (2020), is whether the digital divide intensifies old inequalities or causes new ones. The digital disability divide has been explicitly addressed in several studies (e.g., [3–6]). Individuals’ health and life situations have been determined to have the potential to represent central barriers to digital participation and risk factors for digital exclusion [7]. The aim of this article is to explore how KOMP, a customised ICT product designed to enhance digital contact among people who are unable to use ICT independently, is utilised by residents with varied disabilities, relatives and the staff in four different residences in Norway.

People with impairments are not a homogenous group and may utilise ICT in various ways and experience different obstacles to engaging in mainstream social media. As stated by Johansson, Gulliksen and Gustavsson [4] there are multiple digital disability divides, also related to life contexts. This study focuses on adults unable to use ICT independently and who live in residential settings such as nursing homes and shared housing associations. In the general Norwegian population, two out of every three adults (aged 16–79 years) use social media daily [8]. However, people living in residential settings are not included in this figure. International studies have found that people with disabilities who are living in residential settings have relatively low participation in electronic social networking [9].

Use of ICT can improve participation in daily life, social integration, and overall quality of life [10,11]. However, prior studies have demonstrated that people with disabilities face a range of technological and social barriers to successful adoption of ICT [12]. Resistance towards the adoption of ICT in residential care has been found to be related to staff members’ assumptions regarding the residents’ levels of functioning and moral judgements. The staff’s attitudes and assessments have generally overruled the residents’ wishes and interests [13]. During the implementation of ICT in such settings, the staff assume a variety of roles, including advocates, moral guardians, and enablers [14]. The positions they choose directly impact whether the service-users’ rights regarding self-determination and access to emerging technologies are realised.

There are several examples of ICT solutions that have been purposefully designed for individuals who are unable to use mainstream ICT. These solutions have been developed to enable reciprocal communication, community connection, and societal engagement [15], and include customised hardware and software products, for example, robots, tablets, programs, and applications. KOMP is one such customised ICT product. It comprises a communication screen operated by a rotary switch (to turn the device on/off and adjust the sound level), and enables the user to receive photos, text messages, and videocalls from those connected to their KOMP.

KOMP is not an acronym, but can according to the developing company, No Isolation AS, be associated to terms as computer, compassion and companion. KOMP is described as a telepresence technology designed to combat loneliness by offering presence at distance [16]. People who are personally invited can join a user’s KOMP network through an application on their personal digital devices (e.g., their mobile phone or tablet). The KOMP features a screen that is the size of a small TV/medium computer screen and can be placed on a tabletop. However, the device is dependent on an external internet connection and permanent power supply.

Prior studies on the KOMP technology have focussed on user experiences, particularly those of older adults and their relatives [17,18]. Additionally, one study considered health-care personnel’s experiences and practice using KOMP to facilitate social connectedness among older residents in long-term care homes and their family members during the Coronavirus Disease 2019 (COVID-19) Pandemic [19]. These studies found that KOMP can contribute to the maintenance and improvement of social networks, and may foster new forms of interaction among residents, relatives, and health-care professionals. As the technology itself does not contain content, it is whether and how it is used that determines whether KOMP can reduce loneliness and improve social relationships.

Living with disabilities in residential settings frames everyday life in ways that hinder self-determination and societal participation. Further, contrary to political intentions of normalization, research shows that residential settings tend to have institutional traits [20–26]. As a concept, institutions are defined by Goffman [27] as places where like-situated individuals live enclosed and formally administered lives, cut off from rest of society. Such a setting entails a situation where system considerations are prioritised over the individual, workplace logic prevails, and staff hold great power. Thus, institutional living hinders both residents’ opportunities for autonomy and their contact with the outside world [27]. Hence, it would be interesting to explore the implementation of KOMP within residential settings.

Materials and methods

This study represents part of a project examining the experiences of users, relatives, and health-care staff regarding the implementation of customised ICT. This subsidary study is based on ten KOMP units that have been used in a Norwegian municipality for ten persons with disabilities. From those recruited for the project, six were living at home receiving home nursing care, while four were living in residential settings. The data for this paper is based on the experiences of adopting KOMP in these residential settings. Settings that have in common that they provide living contexts surrounded by professional care.

Recruitment

To identify and contact potential participants, individuals in the municipality who held the roles of welfare technology ambassadors were approached to assist recruitment. Meetings were held with the ambassadors, during which they were given an information sheet with inclusion criteria. The inclusion criteria were persons who: were receiving municipal health services, unable to independently use digital social media, had close family they were seldom able to meet due to geographical distance, and who were willing to share their experiences while beginning to use KOMP. The ambassadors then disseminated the project information at their workplaces. First the residents provided the names of the person they would like to administrate their KOMP, and when both agreed to participate these staff members were recruited. In practice the staff were often involved facilitating the process of getting started with KOMP before formally being asked to participate in the study. For this study, the intention was to have at least one relative of the resident and one staff member associated with each KOMP unit.

Participants

In this study, we examined the experiences of four residents, seven relatives, and five staff members, giving a total 16 persons. The participants’ usage of KOMP ranged from 10–16 weeks, and the residents had 3–9 contacts in their KOMP networks. One staff member had prior experience with KOMP from his personal network. Only the residents, three females and one male, were asked to give their ages; which ranged from 37–85 years. The group of relatives comprised four females and three males, and the staff group comprised three females and two males. An overview of the study participants involved is provided in Table 1. All residences had some common facilities and were staffed 24/7 to provide round-the-clock health services to the residents, if required.

Table 1. Study participants: Residents, relatives and staff.

Residents	Age	Residential setting	Relatives	Staff	Number of persons in the KOMP network
Anna	52	A small housing association with self-owned apartments	Sister	Two health professionals,(one milieu therapist and one middle manager)	9
Betty	85	A somatic long-term ward at a nursing home	Two daughters, a son-in-law, and a granddaughter	One health professional (who represented a primary contact)	9
Christina	37	A large housing association for younger adults with impairments	Father	One health professional(who represented a primary contact)	3
David	67	A (shielded) psychiatric ward at a nursing home	Sister	One health professional (who represented a primary contact)	3

Interviews

To explore the residents’, relatives’, and staff’s experiences regarding the adoption of KOMP, we chose to conduct face-to-face interviews. We developed customised, thematically organised semi-structured interview guides for the different groups. These guides comprised questions such as requirements regarding the usage of KOMP, the impact on everyday life, the pros and cons, and perceived benefits and concerns. The residents could, if they wanted, have a person of choice with them at the interview. Two residents, due to communicative challenges, choose to receive such help. A sister and a staff-member assisted by verbally interpreting and clarifying expressions during the interview process. All of the interviews were conducted jointly by the first and last author during the period between August 2019 and August 2020. The residents were interviewed first, and then the relatives and staff. Due to visiting and travel restrictions relating to the COVID-19 Pandemic, one interview with a relative was conducted by phone. The length of the interviews was 17–46 min. One of the authors wrote memos during the interviews, describing the interview context and key observations.

Data analysis

The interviews were transcribed verbatim by a professional transcriber. The analysis was based on collective qualitative analysis (CQA), applying the approach utilised by Eggesbø [30]. CQA exploits the benefits of a joint structured analytic process shifting between individual preparations, joint analysis workshops and individual draft revisions. Ahead of the analysis we enlisted a third researcher who was familiar with disability studies in residential settings. Including insider and outsider perspectives and researchers from different disciplines can benefit the rigor and quality of collaborative analysis [28,29]. CQA is based on qualitative thematic analysis and comprises four steps [30]. For the first step, all researchers involved in the present research read all transcripts in detail, individually making summaries and notes in preparation for a common workshop. Then, in the workshop we shared our initial summaries and notes based on the transcripts. As the study included four KOMPs in different residential settings, we co-wrote four cases, one per resident. This writing enabled us to obtain a common overview of the data. For step two, we created an open thematic description of emerging themes in the empirical material, focusing on identifying key aspects of the participants’ experiences regarding using KOMP in their everyday lives. For the third step, after mapping initial overarching themes we held several workshops involving writing joint working documents, to identify subthemes and adjust the previously identified themes. Before the workshops, all authors commented on the current draft in preparation for the joint revisions. In step four, we created a plan for writing the draft. We divided the writing of the different result sections between ourselves and made drafts for common discussion and feedback. After new discussions, the sections were revised by each team member until we had a text of unified results with unanimous approval. The thematic analyses resulted in three main themes with attached subthemes. Table 2 provides an overview of the themes and the subthemes.

Table 2. Themes and subthemes.

Theme	Subtheme
Provides an opportunity to strengthen relationships	Lowering the threshold for social contact
	Strengthening the social network
Creates a need to adjust interaction practices	Creating immediate transparency
	Interrupting established lines of privacy
Underscores the residents’ institutionalized lives	Highlighting the institutionalized logic of the care setting
	Triggering the staffs′ need for restrictions and regulations for use

Ethical considerations

Permission for this research was granted by the Norwegian Social Science Data Services (reference no. 520138/2019). All participants provided written consent to participate in the study. To ensure continued informed consent to participate, at each interview the information was repeated and consent was again obtained orally. Personally identifying information was removed from the empirical material. Thereby, all participants’ names used in this article are pseudonyms.

Results

The analysis revealed three themes. The first theme, “Provides an opportunity to strengthen relationships”, derives from appreciation of KOMP’s potential to strengthen relationships by lowering the threshold for social contact and buttressing social networks among people living in residential settings. The next theme, “Creates a need to adjust interaction practices”, reflects the use of KOMP in institutional contexts, and describes how KOMP creates instant transparency between those inside and outside the residences while also interrupting the established lines of privacy. The final theme, “Underscores the residents’ institutionalised lives”, provides an insight into how KOMP highlights the institutionalised logic of care and triggers the staffs need for regulations and restrictions for use.

Provides an opportunity to strengthen relationships

This experience was particularly striking for the residents and their families, but also the staff valued how KOMP enabled them to involve themselves in the residents’ lives.

Lowering the threshold for social contact

For Anna, KOMP enabled her and her family to communicate digitally without staff facilitation for the first time. Due to Annas impairments she had previously needed assistance to receive calls on her phone or iPad. As her sister stated: “We can communicate without them [the staff] as intermediaries […]. It is very nice, because now [with KOMP] we can talk to Anna without anyone else being present”. Another aspect of KOMP that was particularly valued by David and his sister was that KOMP allowed them to actually see each other digitally; this was because the KOMP had a better and larger screen than the technology they were previously using. They had previously been dependent on using the digital-communication software installed on the staff’s smartphones, which had small screens. As explained by David: “My sister lives somewhere else. If we’re talking to each other [on KOMP], I can see her on the screen. It’s very nice, and the image is sharp. And she [my sister] sees me”.

Overall, both David and his sister felt KOMP to be liberating because they were no longer dependent on the staff’s availability and intermediation in their digital communication, and because the size of the screen enabled them to actually see each other without preoccupying the staff’s devices.

Strengthening the social network

KOMP increased social interaction between the residents and their relatives. With KOMP, they could increase their level of contact without the expense of physically meeting. Using KOMP was perceived to be close to, but not a substitute for, physical meetings. As described by one of Betty’s daughters: “When I talk to her on KOMP, it’s almost like I am visiting her for real”. Through the video function, she could show her mother around in her home and take her on “visits” to the grandchildren, despite the fact that her mother was no longer able to travel. Betty herself described KOMP as “the best she could have gotten” because she constantly received photos from her children and grandchildren enabling her to keep up to date with family life and speak with them “face-to-face” in real time.

For the staff, KOMP facilitated conversations with the residents. They particularly found that photos the residents received functioned as starting points to talk about people and places well-known for the person they were to assist. By asking questions and commenting on the photos, their conversations became more meaningful, substantial, and longer, and their engagement in the residents’ lives increased. As stated by one staff member:

Now, you can see them [the relatives] […]. The photos [on the residents’ walls] may have been taken 10 years ago. But now you get to see how they look today. So, that’s a plus for us, too. We become a little more included in their everyday lives; their joy.

Another staff member in a housing association explained that KOMP helps the staff stay up-to-date:

It becomes very easy to find some topics to talk about when new photos arrive. Especially if you have had a few days off or been on a holiday […]; suddenly, there are some new photos and something new to talk about.

The potential for dialog also increased because the staff, through viewing the photos on KOMP, became able to familiarise themselves with the faces, names, and places that were important for the residents. Such information would have been difficult to otherwise obtain in cases when relatives live far away, or when the residents’ impairments make it difficult for them to initiate conversations.

A prominent finding for all of the study participants was that the quality of the social interaction between residents and relatives, among the family members using KOMP, and among residents, relatives, and staff improved. All of this improvement contributed to strengthening the residents’ social networks. Anne’s sister described how KOMP affected their relationship as siblings:

The contact is closer in a way. If we are not [physically] visiting, this [communicating through KOMP] is easier; speaking on the phone is not the same […]. She becomes, in a way, more a part of us [the siblings] when we know we can just call her. One night I called she was sitting in her chair, half asleep. She lit up and became so happy. That’s why it’s fun, because it becomes a bit like a glimmer of light in everyday life.

Calling on KOMP could also revitalise contact between generations. As stated by Betty’s daughter:

When you never see your grandparents, the contact becomes a bit anaemic. By using KOMP, we can keep in touch in a completely different way […]. Now, Mum is much more engaged when we talk about things that happen in our everyday lives. She knows what we’re talking about because she’s seen it […]. It makes a big difference to the quality of the relationships […], and for us who are connecting with her. It brings us closer to her and to each other.

Creates a need to adjust interaction practices

The introduction of KOMP altered the established communication practice for all participants in two ways: by creating instant transparency and by altering the established lines of privacy.

Creating immediate transparency

All KOMP functions generated a previously non-existent transparency. Videocalls could only be rejected by turning off KOMP within 10 s of the call’s initiation. This level of transparency was considered similar to entering the residents’ rooms/apartments without knocking on the door or being invited in. Christina’s father expressed this worry:

And I think there are many people who should not have insight into the home without first obtaining the occupant’s consent […]. It’s like walking into a room that’s currently empty. What are you doing there? You don’t go into people’s homes if they’re not home.

Some of the staff were also concerned about this issue, as the residents had no active choice regarding when they were called from outside the institution and who made the calls. The KOMP could also be used as a kind of surveillance tool, as the KOMP mobile phone application used by the relatives enabled them to check whether the residents’ KOMPs were switched on or off. This function was generally used to check if the residents were “at home”, and not as a means of surveillance per se. Rather, this behaviour represented an act of care.

The staff reported that some of their colleagues feared that someone might be “watching them” or would want to interact with them if they were in the rooms/apartments when the residents received calls. The participating staff felt comfortable with this, as they had good relations with the relatives, but reported that some colleagues had found interacting with relatives through KOMP discomforting and actively sought to avoid such situations. This “watching” could, as Christina’s father highlighted, also operate the other way around in video conversations:

They [the staff] could be in the bedroom where we can’t see them […]. So, what we are talking about and say has to be perceived as “normal”. […] that’s a lesson we have learned.

Not being present in person, the relatives could never be sure of whom they were talking to, as they could only observe the part of the room visible to the KOMP’s camera.

Interrupting the established lines of privacy

The relatives and staff, but not the residents, were concerned about the implications using the KOMP would have for the residents’ privacy. From the relatives’ perspectives, the photos they shared and their conversations needed to withstand “public scrutiny”. Christina’s father expressed this sentiment as follows:

The staff don’t need to see all the weird photos from the family […]. We, as parents, have talked about the fact that we have to be a bit careful of what we say. If she sits and complains and is in a bad mood […] we don’t yell at her. It’s not exactly home ground. There is a certain degree of public communication. We have to be aware that […] we could hear it back – “we [the staff] heard you yelling at her”.

Other privacy-related concerns were that photos shared could be misinterpreted out of context, and that the door to the resident’s room might be open and/or the speaker could be set at maximum level, consequently “broadcasting” private conversations into the hallways.

Underscores the residents’ institutionalised lives

In the interviews discussing concerns regarding KOMP and its practical use, it became evident that the residents’ institutionalised way of living also affected their adaption and use of KOMP. This theme illustrates how KOMP highlighted the institutionalised logic of care, and triggered a perception among the staff of a need for regulations and restrictions.

Highlighting the institutionalised logic of the care setting

Living in a residence implies that one is dependent on assistance in everyday life to such an extent that he/she is living in a setting where assistance is available on a 24/7 basis, and that their neighbours are in the same situation. It also implies that care staff are not far away and are there to assist the residents with the things they express a need for, as well as what the staff, based on their experience and competence, perceive the residents need.

The staff’s concerns and reactions to obtaining KOMP highlighted the institutionalised logic of the care setting. Some of the staff were concerned that the relatives were “invading” the residents’ privacy. A member of staff in Anna’s group-home stated: “She has no choice to guard herself against intrusions through KOMP”. Anna herself used her own way of rejecting videocalls; the same approach she used in every other situation she did not want to be part of: she turned her back to the KOMP.

This safeguarding was also evident in relation to the placement of the KOMP. For residents living in small studio apartments, the staff rearranged the room the KOMP was placed in in such a manner as to shield the resident from exposure; for example, to reduce the risk of the residents being undressed in areas visible to the KOMP. A staff member in a long-term psychiatric ward stated the following:

[Privacy concerns] relate to the [KOMP’s] placement and how KOMP works. […] if someone calls up on the video screen, you [as a staff member] don’t know what’s going on in the room. [The resident] may not be prepared for that video call. Maybe he is lying naked in bed with nothing on him […]. It becomes a little difficult to follow up, not being there.

Also evident was the staff’s concern regarding whether using KOMP was actually good for the resident. To reassure themselves, some of the staff surreptitiously “checked” what was going on regarding the KOMP. A staff member at Anna’s residence stated the following:

Sometimes, when it rings, I just sneak in […] to see if she’s paying attention. If she discovers me, she will keep staring at me, so I go in and say: “Hey, I’m the one at work”. Then I go, because I know […] she’s agreeing to the conversation. I’m not going to involve myself in it. It wasn’t me they wanted to speak to, otherwise they would have called me on the work phone instead.

As illustrated, the staff were torn between protecting privacy and making sure KOMP was good for the resident; aspects of care that can be difficult to concurrently fulfil. Another concern the staff had was safeguarding the other residents. This was especially evident in Anna’s case, where the staff discovered that Anna’s family had taken photos of other residents at a social event outside the group-home, and that these photos had been posted to Anna’s KOMP network. The staff assumed that this was illegal, as none of those photographed were asked for their consent regarding sharing the photos. This triggered both a sense of awkwardness and ambivalence regarding the problem: “It doesn’t matter really, but it’s not allowed. […] However, they [the photos] will eventually disappear”.

Triggering the staffs′ need for restrictions and regulations for use

KOMP triggered among the staff a sense that restrictions and regulations on use of the KOMP were necessary to protect the residents, both regarding their privacy and their health. More specifically, such regulations and restrictions were implemented to both safeguard the residents and protect the staff’s own privacy.

One such regulation involved the staff practically facilitating the residents’ ability to use KOMP. In Anna’s case, the staff created a customised technical solution using a Velcro system and specialised buttons so that Anna could operate KOMP herself without asking for help. This included being able to shut off the KOMP herself. Further, Anna and Christina were given additional training on how to turn the KOMP on and off, and the staff described regularly taking measures to ensure that when they used KOMP they did so of their own choice.

Concurrently, it emerged that staff regulated the use of KOMP by creating restrictions intended to shield residents; these restrictions appeared as rules (e.g., how many images and participants the residents could have on their KOMP at once). In David’s residence, his primary contact among the staff added himself to the KOMP network. He established rules for the relatives by demanding to be contacted first in order to assess whether David’s health status was compatible with receiving a call via KOMP, and to ensure David’s consented to the calls:

…I’ve had access to KOMP and monitored how things have gone. I've also made a framework for its use […]. Our framework is that he [David] is the one who has to take the initiative to talk through KOMP, and they [the relatives] are not to call until he has spoken to them first on the cell phone.

Such frameworks, understood by the relatives as acts of care, were also perceived as rules to be followed. Despite the fact that both David and his sister mentioned that they were very fond of photos and would like to have more of them, the framework was not challenged due to the number of photos they were allowed to add.

Regarding regulations to protect the staff’s privacy, these regulations were implemented by stipulating the placement of the KOMP. One of the staff helping Anna stated the following:

She’s never sat like she does now. She’s always sat with her back to the doorway into the living room. But we found out that was very stupid with that video call thing, because then […] if we went into her bathroom we became visible on the screen, right?

Despite the staff stressing that the KOMP was the residents’ property, it also emerged that the staff reserved the right to confiscate the KOMP itself if they considered that its use did not accord with what, in their professional assessment, was in the best interests of the users. Such confiscation could be triggered, for example, if the KOMP was infrequently used, or if its use was considered to have negative consequences for the resident. Possible scenarios in this regard included the sharing of nude photos or harassment, or if the presence of KOMP contributed to creating unrest:

If there had been any nudes or anything like that, I can tell you we would have taken it right away, yes […]. If there had been harassment or any threats or anything like that through it, I would have taken it away immediately. That’s not going to happen. That’s not what it’s supposed to be used for. I wouldn’t have been gracious.

These preparations for potential scenarios appear to have been based on professional judgements, with the staff being torn between performing acts of care, protecting privacy and self-determination, and shielding the residents from potential risks when entering the social-media realm.

Discussion

This study explored experiences of residents, relatives, and staff in residential settings regarding the initial introduction of customised ICT. This enabled us to identify these stakeholders’ perceptions regarding the pros and cons of the technology, and how, in their opinion, this technology strengthens and disrupts established lines of communication and interaction.

The initial reactions were positive, as KOMP enabled a direct communication line between the residents and their relatives. This strengthened their relations by lowering the threshold for social interaction and allowing the sharing of photos and video conversations. This finding supports previous findings regarding general ICT [31] and the KOMP technology [17,18]. The staff also experienced the same benefits, as they were able to get closer to the residents and their family members, and consequently obtain access to significant information that could help them have more meaningful conversations based on updated information provided by the relatives. Such functionality may be particularly valuable for those who are assisting persons with impairments that affect their communication and/or cognition, as well as in residences with high staff turnover. For the latter case, KOMP allows the relatives to contact the residents independently of the staff’s mediation, and the residents can have conversations without staff presence. Additionally, KOMP seemed to enable more person-centered care by prompting substantial conversation with the residents, and thereby strengthening the resident–staff relationships. In sum, use of KOMP may enhance residents’ social networks, both with the staff within the residence and with relatives who are distantly located. Nevertheless, due to the residents’ living conditions and the fact that they can only receive calls and content through KOMP, they remain dependent on others’ will and initiative to utilise social digital technology, even if it is customised. Such dependency is a typical attribute of institutionalisation [27].

According to Goffman [27], institutional life is characterised by being cut off from the outside world. This was highlighted in the present study by another key discovery, that KOMP “made the residences’ walls transparent”, establishing a potential peephole. This represented the creation of immediate transparency, with KOMP interrupting the established lines of privacy for all stakeholders. However, the residents already had limited control of their privacy as a result of their living conditions and health-care needs.

Järvinen and Mik-Meyer [32] stated that institutional living implies being treated based on a problem definition. This consists of staffs’ collective understanding of the background to your placement in the institution, and forms the real basis for the help you receive within such systems [33]. In this case, the help was provided on the basis of the residents’ need for assistance in order to negotiate everyday life; something that has been shown in previous studies to evoke gatekeeper attitudes among staff [22,34] and staff overruling the residents interest as guardians in studies of ICT [13,14]. This finding also accords with Goffman’s [27] presentation of institutional practice, from being clearly paternalistic while the act of overriding is situated in arguments based on medical conditions, as taking the position of safeguarding the residents’ life and health.

Nevertheless, there appears to have been uncertainty among the staff regarding the potential dangers they were actually protecting the residents from. As Norwegian health personnel they are torn between their duties to ensure health [35] and dignity [36], as well as protecting the residents rights to privacy and self-determination according to the Constitution of Norway [37] and Human rights [38]. Both the restrictions and the perceived dangers mostly existed on the conceptual level. For example, the staff envisaged being able to seize the KOMP if there was an exchange of nude photos; however, this represents an unlikely scenario, and one that is not necessarily illegal when the communication is voluntarily and between adults. Regarding this in the context of the staff’s uncertainty concerning the problems associated with sharing images of an outdoor barbecue indicates that the staff’s regulation of the use of KOMP was conducted on an undefined professional basis. This finding concurs with those of previous studies of ICT, such as Ramstein and Blomberg [14], where the staff based their positions on moral judgements, the study of Ali, Alam, and Taylor [12], who underscored staff as a social barrier to the adoption of ICT among people with disabilities and studies highlighting the need to enhance staff competencies on ICT [39,40].

In many ways, the introduction of KOMP helped highlight the pre-existing practices in residences, which are clearly institutional. As observed in previous studies of KOMP as a content-less device enabling social interaction [17,18], this technology can only enhance what already exists in established social relationships. However, KOMP can contribute to strengthening social relationships among residents, staff, and relatives if it is actually used for that purpose and with respect for the residents’ rights to privacy and self-determination.

Conclusion

This study underscores the potential of utilising customised ICT to strengthen social relationships among persons with disabilities living in residential settings. Nevertheless, the findings suggest that the institutional logics of care settings and stakeholders’ perceptions of privacy and potential health risks limit how customised ICT can be used by persons with disabilities living in residential settings. This study provides insights into how formal and informal regulations developed by relatives and staff with the purpose of protecting the residents, as well as protecting themselves from digital exposure, frames the residents’ ability to take advantage of customised ICT. The findings indicate that it is the relatives’ and staff’s attitudes and acts of care, not the technological solutions per se, that are the biggest obstacles to overcoming the digital disability divide in residential contexts.

Methodological considerations

To our knowledge, this is the first study to include all stakeholders’ perspectives regarding the use of KOMP in different residential settings. However, as this study suggests that the residence setting and the staff’s attitudes impact stakeholders’ experiences with KOMP, there is a need for additional studies that include long-term experiences from an extended number of participants.

This study does not provide extensive information regarding the residents and residences; collecting such information might have strengthened our findings. Nevertheless, our residents represent a wide range of ages and living conditions. Recruiting the participants through gatekeepers in the municipal health-care system may have led us to recruit individuals who had pre-existing positive attitudes towards ICT and to omit individuals with less-positive attitudes. As in previous studies the residents had positive experiences with KOMP. When it comes to presenting new aspects of adopting KOMP from the residents perspective this paper supports previous research rather than promoting new perspectives.

Conducting interviews with residents within their residences placed us in situations where other relatives or staff who were pre-informed about the intention of our visit were present. This meant that this study featured a varied number of participants from the different stakeholder groups. The presence of a person of choice might have affected the content of the interviews with the residents; however, it is likely this interview structure provided us with more experiences than we would have otherwise obtained. Offering the residents a person of choice to be with them in the interview, may lower the threshold for persons with disability to participate in research in general, rather than including or excluding them on the basis of specific impairments.

Acknowledgements

The authors thank the participants for sharing their experiences, the municipality for their facilitation of the study, and the research group, Equitable Community Participation and Marginalised Groups, at Nord university for constructive feedback on article drafts.

Disclosure statement of interests

The authors report there are no competing interests to declare.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Anita Berg

Anita Berg Ph.D. in Sociology at Nord university, Faculty of Nursing av Social Sciences, Norway. Professional background: Social Educator/Disability Nurse. Currently assistant division leader for Social Education and Mental Health, study program advisor at the bachelor program in social education, and head for the research group “Equitable community participation and marginalised groups”. Research interest: Disability studies, E-Health, Public Health Work in municipal setting, Science of Professions and Social inequality in health.

Hilde Guddingsmo

Hilde Guddingsmo Ph.D in Social work at Nord university, Faculty of Nursing and Social Sciences, Norway. Currently lecturer and researcher at the Disability Nurse programme. Research interest: Disability studies, Residential Living, Human Rights, Inclusive Research, Art-based Research and Creative methods.

Gunn Eva Solum Myren

Gunn Eva Solum Myren Ph.D. in Health Sciences at Nord university, Faculty of Nursing and Health Sciences, Norway. Professional background: Social Educator/Disability Nurse. Lecturing in social education bachelor/master. Currently head for the Norwegian national network “Inclusive research together with people who have intellectual disabilities”. Further,- 20% in Centre for Care Research, as supervisor to municipal health care. Interests: Dementia Care, Inclusive Research, Intellectual Disabilities and Welfare Technology.