The appropriation of assistive technologies by older people and stroke survivors: a domestication approach
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A presentation on my PhD that focuses on the use of three assistive technologies (telecare systems, robot-assisted stroke rehabilitation and ICT-supported stroke self management). This was delivered to a group of fellow students and so includes some personal reflections on my doctoral experiences.
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The appropriation of assistive technologies by older people and stroke survivors: a domestication approach
- 1. The appropriation of assistive technologies by older people and stroke survivors: a domestication approach @markhawker m.hawker@sheffield.ac.uk
- 2. About me • In my third year of a studentship supported by PIPIN (Promoting Independence through Personalised INteractive technologies) • Jointly-supervised by Dr. Bridgette Wessels (Sociological Studies) and Prof. Gail Mountain (ScHARR) • Background in computer science and informatics, and interested in humancomputer interaction. 11/12/2013 2
- 3. Presentation outline • • • • • • • Contextualisation Research questions Current research on assistive technologies A domestication approach Research design Progress to date Personal reflections. 11/12/2013 3
- 4. Contextualisation • Macro – We are living in an ageing population – Assistive technologies are seen as one way in which to address financial and human resource problems • Meso – Households are already the place where older people and stroke survivors would like to be – Households are becoming an important place for the delivery of health and social care interventions • Micro – Cognitive and physical challenges require older people and stroke survivors to adapt and change in all areas of their everyday lives. 11/12/2013 4
- 5. Research questions • How do older people and stroke survivors appropriate and engage with assistive technologies in their everyday lives? – In what ways is an existing technology to support independent living integrated into the everyday lives of older people? – To what extent can two different prototype assistive technologies designed to support the selfmanagement of stroke be integrated into the everyday lives of users? – How do the research findings support and extend the existing knowledge on assistive technologies? 11/12/2013 5
- 6. Current research on assistive technologies In Current Use Telecare systems Robot-assisted stroke rehabilitation For Future Use ICT-supported stroke self-management Passive 11/12/2013 Active 6
- 10. Opportunities for my thesis • Lack of theoretical reflection across all three assistive technologies • Gaps identified for future research • Availability of two research projects (SCRIPT and SMART2) that are currently deploying assistive technologies into stroke survivors’ households. 11/12/2013 10
- 11. “With one foot planted in theoretical sources and the other in the results obtained from empirical research into the practice of technology and [users], the area of [assistive] technology and [users] could in all likelihood contribute important and groundbreaking knowledge.” ÖSTLUND (2004: 59) 11/12/2013 11
- 12. A domestication approach • Technologies need to be transformed and embedded into the culture and routines of a person’s everyday life; technologies may shape cultures and routines, too • Concerned with the household but has been extended to other settings (e.g. work) • Highlights several processes involved in ‘bringing technologies home’: – – – – Appropriation Objectification Incorporation Conversion. 11/12/2013 12
- 13. Situating domestication • Other approaches to user-technology relations include: – Technological determinist – Semiotic – Social shaping • Domestication encapsulates both production and consumption, and adopts the perspective of users from the start • Technologies positioned as social products that have the potential to influence change but are also seen as political objects. 11/12/2013 13
- 14. Research design • Qualitative approach to understanding the use of assistive technologies and the meanings that are assigned to them • Telecare systems – Qualitative interviews (20 older people) • Prototype assistive technologies – Observing installations (~5 each) – Qualitative interviews approximately four weeks after each installation (~5 each) • Plus, literature from the local provider of telecare systems and documentation from research project websites. 11/12/2013 14
- 15. Progress to date • Completed 20 interviews with older people about the domestication of telecare systems • Conducted three observations and one interview with users of a robot-assisted stroke rehabilitation system • Awaiting ethical approval to begin researching the domestication of an ICTenabled stroke self-management system • In addition: analysing, reading, reflecting, writing … drinking, eating and sleeping (when possible). 11/12/2013 15
- 16. Going forward • Continue to observe and interview stroke survivors about their use of the robot-assisted stroke rehabilitation system • Start to observe and interview stroke survivors about their use of the ICT-enabled stroke self-management system as soon as ethical approval has been gained • Plan and write everything up into a thesis. 11/12/2013 16
- 17. Personal reflections • Theory and practice are related but not equivalent: – Little appreciation of issues such as access and recruitment in text books – Data generated is messy and requires creative interpretation and reflection – Writing is hard and requires adequate planning • Need to remain flexible when things don’t quite go the way you planned; be opportunistic • Your supervisors are there to help and no matter how critical they are they do this to make you a better researcher (despite how bad you may feel). 11/12/2013 17
- 18. Conclusions • Assistive technologies are being designed and developed to ‘plug’ societal problems such as ageing populations, increasing health and social care costs and the lack of human resources • The household is becoming an important place for the delivery of health and social care interventions • Older people and stroke survivors are actively negotiating their use of assistive technologies, and therefore their perspective is important • Theoretical approaches that consider the interactions between users, technology and society can help identify current and future issues related to domestication. 11/12/2013 18
- 20. The appropriation of assistive technologies by older people and stroke survivors: a domestication approach @markhawker m.hawker@sheffield.ac.uk
Notas do Editor
- Hello, my name is Mark and I’d like to introduce you to my PhD thesis that is provisionally entitled ‘the appropriation of assistive technologies by older people and stroke survivors: a domestication approach’. I will be describing the outline of my thesis and offering personal reflections of my doctoral experiences so far. I hope this will provide you with an overview of my work and I would welcome any feedback via email or Twitter. (75 words)I have created a hand-out of these slides that can be used for note-taking and I will take questions at the end of the presentation. (25 words)Before we begin, I would like to explain a little about who I am. (15 words)
- I am in my third year of a three-year studentship called PIPIN. The aim of PIPIN is to bring together an interdisciplinary network of researchers with the goal of creating and evaluating technologies intended to support people’s independence. The network includes departments across Computer Science, Health Services Research and Sociology. There are three students in the network and I am one of them. My research focuses on the social aspects of technology production and consumption. (75 words)I have joint supervision across two departments: ‘Sociological Studies’ and the ‘School of Health and Related Research’. This means that I receive input both from a sociological but also a health and social care perspective. (35 words)My background is in computer science and informatics although I tended to focus more on human-computer interaction over algorithms, coding and software development. I was more interested in what people did with technology than the content of the technology itself. This focus was one of the main reasons why I applied for the PIPIN studentship. (55 words)Now that we have explored a bit about myself I would like to move to the contents of the presentation. (20 words)
- I would like to cover the following topics in this presentation. I will not be discussing my results or analysis at this stage as they are still in progress and ongoing. At the end of the presentation I’d like to offer a few reflections on my research journey so far, which some may find helpful for their own work. (60 words)
- I would like to begin this presentation by giving an overview of the context of my thesis. I have used the term ‘contextualisation’ as this overview aims to situate my thesis rather than provide a comprehensive description of every possible data item that could be covered. For example, it does not discuss ethical or legal aspects of assistive technology use. (60 words)The macro context suggests that we are living in an ageing population. This means that the number of older people, typically identified as those over the age of 65 (although this is changing due to increased longevity), is proportionally greater than in previous years. In Europe, for example, it is estimated that by 2025 approximately 18% of the population will be aged over 65 and by 2050 this will be approximately 25%. This is deemed problematic for two reasons: the biology of ageing suggests that as we age there is an increased risk of age-related conditions such as cancer, heart disease and stroke, which are expensive to sustain and treat; and, that statutory services will be unable to cope with the increased demand for health and social care services. While it has been suggested that a person’s social relations (such as friends and family) will be able to provide support, the number of these informal carers is decreasing. Assistive technologies are promoted as one way of addressing the so-called ‘burden’ of an ageing population. (175 words)The meso context highlights that the household is the place where older people would like to be in later life, which is described in the literature as ‘ageing in place’. For stroke survivors, the household is often the place where they return to after being discharged from a stay in hospital. Despite this, the household environment can present new challenges such as having stairs that are now difficult to climb, which may require adaptations to be made. For older people, they may also be living alone during later life and this can leave them socially isolated. Assistive technologies are suggested as a means of reducing the ‘risk’ of the household environment by offering support through telecare systems or through the provision of health and social care services at a distance. (130 words)The micro context suggests that cognitive and physical challenges that are associated with ageing and stroke require ongoing adaptation and change. Stroke, for example, affects a person’s brain and has the potential to reduce the functionality of a person’s upper and lower limbs. In many cases this functionality can be partially restored through intensive rehabilitation but, for many, their functionalities are seriously reduced. This can also have an effect on a person’s cognition and can lead to anxiety, depression and low self-esteem. It is hypothesised that these changes at a micro level may affect a person’s capacity to engage with assistive technologies or, at the very least, influence their decisions to appropriate and engage with them. (120 words)
- My thesis consists of one primary research question and three subsidiary questions. The focus is on the meanings and understandings as described by the users of the assistive technologies rather than those who design and develop them. I will also relate my findings to current research on assistive technology use, which will now be explored. (55 words)
- The term ‘assistive technology’ describes “any product or service designed to enable independence for disabled and older people” (FAST, 2001). This definition can be expanded to include products or services that support self-rehabilitation. For my thesis, I am focusing on three assistive technologies. I have categorised them in the following grid that represents their novelty (as either in current use or intended for future use) and their requirements for passive or active engagement of users. (75 words)Telecare systems are designed to be worn around a person’s neck, waist or wrist and connect to a ‘base station’ that is plugged into an electrical socket and telephone line. If required, users can press a button on their pendant alarm or wristwatch to be connected to a call monitoring centre who will respond to their need. I have described telecare systems as passive as the buttons are not activated automatically. However, newer telecare systems are able to detect events such as a person falling and are even able to ‘know’ when they are being worn. The rationale for this is that research suggests that telecare systems are often not worn and so technology is being used to promote use. Some providers of telecare systems, such as the one that I have studied, send out a response team to calls that are assessed as requiring assistance. Telecare systems are mostly provided by Local Authorities although there are commercial telecare systems available such as from Age UK, Sage and Welbeing. (170 words)Robotic systems have been used in stroke rehabilitation for almost two decades. There are a number of different ‘types’ of robotic systems that range from levers and pulleys that connect to an orthotic attached to a person’s limbs through to exoskeletons that encapsulate a person’s limb like a glove. There are numerous reasons why robot-assisted stroke rehabilitation is considered appropriate including that it can support multiple, repetitive movements that are objectively measured and can be personalised to users. In addition, current advances in robotic systems have begun to exploit their ability to host applications such as games and virtual environment that can facilitate household-based rehabilitation. These will enable user to use the robotic systems without the need for health professionals to be present. (120 words)Finally, stroke self-management is a relatively new concept that focuses on motivating and supporting a person to exercise and keep healthy following a stroke. The difference between this and robotic systems is that ‘everyday’ technologies such as mobile telephones and touchscreen monitors are used. The rationale for this is that these technologies are cheaper and more familiar to users. This should improve their uptake and use, which, in turn, will provide clinical benefits as increased activity is associated with improved motor function. The provision of feedback is seen as critical to the use of self-management systems, which needs to be accurate, measurable, personalisable and rewarding. Unlike telecare systems, both robotic systems and self-management systems require the active engagement of users in order to be effective. (125 words)
- Current research on telecare systems has lacked theoretical reflection on their acceptance and use. Early reviews focused on ‘acceptability’, ‘intrusiveness’ and ‘functionality’ but did not problematise the interactions between users and technology. More recent research has begun to consider the active role of users in telecare systems use and the influence that the technologies have on the everyday lives of older people. There has been a lack of primary research in this area although ‘ethnographic’ methods such as interviews and observations are gaining in popularity. Three findings of current research are helpful, however, and suggest that: users must negotiate the intrusiveness of telecare systems in order for them to become acceptable to them and not only worn but pressed if required in emergencies; users are required to negotiate the symbolic properties of telecare systems in terms of their identity and what goals the technology helps them achieve; and, telecare systems are not just material and symbolic, they require (negotiations between older people and their social relations from initial appropriation to sustained use. For example, social relations may ‘force’ an older person to accept a telecare system or, conversely, may prevent them accepting a telecare system because they consider it to be inadequate method of supporting health and social care needs. Future research on telecare systems could focus on their design and development through ‘co-production’ or on improving our understanding on current use and what works for whom, in what way and in what circumstances. (245 words)
- Current research on robotic systems for stroke rehabilitation has focused predominantly on clinical outcome measures. While this is necessary for determining their effectiveness it has made the users of robotic systems invisible and ‘objectified’ their experiences. Where users are consulted their acceptance of robot-assisted stroke rehabilitation has been reduced to single-value scores. There has been a move towards using gaming and virtual reality content to support the use of robotic systems in the household. The picture shows an example of one such robotic system, part of the SCRIPT project, that features an exoskeleton that attaches over a user’s hand and sends signals to a desktop computer to control a game. It is envisaged that this will reduce the need for the physical presence of a health professional as progress can be monitored remotely. However, little is known as to how users will react to such a technology being placed in their household and whether it will become integrated into their everyday activities and routines. (165 words)
- My review of current research on ICT-supportedstroke self-management is currently underway and so is not included in this presentation. However, a general comment can be made that, as with robot-assisted stroke rehabilitation technologies, there has been a shift towards delivering health and social care services in the community. Feedback is an important factor in motivating stroke survivors to use technologies to promote their self-management, which can be supported through utilising familiar technologies such as mobile telephones and touchscreen monitors. (80 words)
- To summarise my reading of the current literature on assistive technologies, I have identified a lack of theoretical reflection that can be addressed through an approach that illuminates the perspectives of actual users of the technologies. Research on telecare systems, in particular, has begun to appreciate the user’s perspective and identified areas where further research is required. There is a need to support current research that has focused on the involvement of users in the design of assistive technologies but has not considered how the assistive technologies are engaged with and used in practice once they have been developed. (100 words)
- The essence of my thesis is embodied by this quote by Britt Östlund from Lund University who is reflecting on the existence of social science research on technology and older people, specifically. It is to the theoretical sources that she mentions that we now turn. (45 words)
- The theoretical approach that I am taking in my thesis is based on domestication. Domestication approaches emerged in cultural and media studies approximately two decades ago to explore technologies such as personal computers and televisions. Domestication describes the processes of how technologies are appropriated and need to find a physical space in people’s households. Technologies then need to be incorporated into a household’s existing routines and structures, while also creating new routines and structures to support their use. Some technologies also enable a household to connect with the world outside, which is known as conversion. The approach has not been applied to assistive technologies, which is part of the contribution of my thesis. (115 words)
- It is recognised that there are a number of approaches that could have been used to help understand user-technology relations. Some of these approaches include: (25 words)Technological determinist approaches would not consider the role of users at all but would look to quantify the ‘effects’ of the assistive technologies. This has been the dominant approach within policy that professes that assistive technologies will create independence. Here, the effect of assistive technologies is assumed rather than positioned as something that is negotiable. (55 words)Semiotic approaches wouldemphasise the role of designers and developers in ‘configuring’ users who are said to ‘read’ assistive technologies and interpret them based on their readings. Technologies are described as being ‘scripted’ in that they are designed to enable or constrain actions. In short, semiotic approaches are mostly concerned with how designers and developers inscribe their views of users and use in technological objects. (65 words)Social shaping approaches would emphasise the production of assistive technologies (from either a micro or macro perspective) but may not say much about their use by older people or stroke survivors. For example, emphasising the social groups involved in their design and development, and the ‘interpretative flexibility’ of assistive technologies. (50 words)Domestication approaches, however, consider both the role of designers, developers and users of technologies. Domestication approaches also emphasise how technologies can influence change but also how users can shape technologies to fit their everyday lives. (35 words)
- In order to understand the domestication of the three assistive technologies a qualitative approach is adopted. The reason for this is that I am interested in hearing the perspectives of users themselves and so this requires a methodology that is sensitive to generating data that reflects this commitment to knowledge. (50 words)In terms of research design, the fieldwork has been split into two parts. For the first part, which has been completed, twenty older people who had a telecare system were interviewed about their perceptions on use. For the second part of the fieldwork, which is ongoing, I am observing installations of each of the prototype assistive technologies and then interviewing research participants approximately four weeks after installations. This, it is hoped, will give them enough to to have built up a working knowledge of the technologies. In addition, I have been using extant documents to begin to understand how each of the assistive technologies has constructed their users. This will then be contrasted with actual use to identify any differences. (120 words)
- As mentioned in the previous slide, in terms of progress to dateI have completed my fieldwork on telecare systems and am in progress with the other two assistive technologies. (30 words)While I had hoped to be further along in my journey I have been using the time between fieldwork activities to analyse, read, reflect and write. This is not an ideal strategy although it has helped me refine the questions that I ask in interviews, for example. I have also had time to refine and think about the concepts that I am using to analyse my data that only comes with their application to the ‘real-world’ data. I feel like there are lots of activities to balance and juggle, which, I imagine, should be how a PhD student should feel! (100 words)
- Going forward with my research, I hope to continue with observations and interviews. This will also include analysing the data that is being generated and incorporating it into my thesis. (30 words)I am developing a plan for writing over the next year and have just started to produce drafts of a Literature Review chapter that will support both the approach I am taking as well as helping me contextualise my findings. (40 words)
- Before we move to the conclusions of this presentation I would like to offer some personal reflections on my doctoral experience. I hope that you find them interesting and perhaps some will even identify with them. It is my hope that they will be helpful no matter what stage of your studies you are at. (55 words)Firstly, I spent a lot of time reading about research rather than engaging in research. As an example, while textbooks can give an overview of issues such as access and recruitment of research participants this is not a replacement for getting out there are doing it. Initially, I had envisaged approaching one organisation to help me recruit research participants. After nearly six months I think I had contacted over fifty. Another area of research that is different in practice is data generation and analysis. Being a researcher is about working with research participants and enabling them to tell you a story that is helpful to answer your research questions. Some research participants will talk a lot while others will say very little at all. Use this to improve next time. Finally, writing your thesis is hard work. I have yet to fully ‘get’ what my thesis will look like and this can be a frightening prospect. Think, plan and write. (160 words)Secondly, I have learned that plans change and part of the experience is being able to adapt to changing circumstances. In my case, this has included needing to engage with existing research projects to enable me to conduct fieldwork. There is a need to take opportunities when they are on offer while still trying to get what you want out of your research. Working in an interdisciplinary environment has helped me with this although I have far from mastered it. (80 words)Finally, research is a process and there are highs and lows at every stage. I am learning to take criticisms about my work although I do find it difficult at times. Remember that your supervisors are there to help you but that you also need to respect their input (despite how bad you may feel at the time). Take time to reflect on what they are telling you even if it means going for a walk to clear the air. (80 words)I’m sure there is a lot more I could have said here but we are running close to time. (20 words)
- In this presentation I wanted to introduce you to my research and the approach that I am taking to conduct a social study of assistive technology use by two distinct, but related, groups of people. (35 words)I indicated that assistive technologies are being designed and developed to address societal problems but that there is a need to understand the perspective of users who may be affected by them. For example, do assistive technologies really support their independence in a straightforward way? I also identified the household as an important place for the delivery of health and social care interventions. The household can be a place of comfort for many but it may also present new challenges to people dealing with cognitive, physical or social change. The introduction of assistive technologies into the household may contribute to feelings of comfort or disdain. Finally, a lack of theoretical reflection was also identified in the current literature on all three assistive technologies, of which my thesis is one response. (130 words)That’s all we have time for. I would like to thank you all very much for listening. (20 words)
- Before we finish, are there any questions about this presentation or my thesis in general? (15 words)