Social Technologies
Author: Dr Richard Vance, Post-Doctoral Researcher, Department of Psychology and Assisting Living & Learning (ALL) Institute, Maynooth University
“I fear the day when technology overlaps our humanity” goes a quote, which is dubiously attributed to Albert Einstein on the internet—sometimes you can trust technology, sometimes you can’t.
Last week was Social Justice Week in Maynooth, and it’s as good a time as any to reflect on whether we’re making a positive difference to the lives of others and the world around us. I want to look at how we’re approaching the design and provision of digital health technologies for older adults to promote health and well-being and reduce inequality.
The Challenge
Humans have a range of health and care needs as they progress through life. In addition to acute health problems, older adults are more likely than younger adults to experience chronic illness and multimorbidity requiring physical, psychological, or social care. Loneliness, social exclusion, declining quality-of-life, and loss of independence are major challenges. How do we support people to remain independent, healthy, and socially connected as they age? Global populations are growing and ageing, meaning that demand for health and social care (H&SC) is rising. We need to think carefully about how we ensure care needs are met, while also promoting inclusion and ensuring independence. These are complex challenges, with many moving parts, including complex health issues, diverse care needs ensuring person-centredness, research advances, governance, legal aspects, and costs, to name just a few.
To meet complex challenges, we must see them holistically. SHAPES (Smart & Healthy Ageing through People Engaging in Supportive Systems) is a pan-European research project led by Maynooth University, and it is designed to do exactly that. SHAPES is developing a technological platform and ecosystem to integrate different care technologies to facilitate healthy and active ageing and the maintenance of high quality of life. SHAPES, however, is even more extensive than that. SHAPES is assembling a broad range of scientific, technological, organisational, clinical, ethical, legal, educational, and social perspectives, all founded upon a comprehensive understanding of older adults’ lifeworld.
Researching and Developing Health and Care Technology: Who Is Involved?
Older adults are a diverse demographic, varying in age from 65 (younger, in some definitions) to supercentenarian. Older adults may or may not at some point experience substantial declines in physical, cognitive, or mental health. Others may have completely different experiences. Some will have numerous social connections; others may experience isolation. Intersectional inequalities, wealth inequality, disability, rural dwelling, varying digital literacy, and more all need to be considered. It remains unclear, however, just how representative the participants in many research and development endeavours are, which has implications for genuinely meeting need.
A central question is: who is involved in development and research? To change environments or develop technologies, we must consider who we change them for, or more appropriately, who we change them with; ‘Nothing about us, without us’. Relatively recently, we have seen progress on inclusion, participatory co-design, and patient and public involvement (PPI) in research. Co-design is designing assistive or health technologies together with all stakeholders. PPI might be described as “research being carried out ‘with’ or ‘by’ members of the public rather than ‘to’, ‘about’ or ‘for’ them”. PPI and similar initiatives, like co-design, tend to result in higher quality research, research and technologies that are more responsive to users’ needs and views, and have fewer negative or unintended consequences. They also promote citizenship and equity. That may help prevent the non-adoption and abandonment endemic to health and assistive technology development.
Accordingly, research and researchers should be self-reflexive; are we making that positive difference, and could we do more? Are researchers accounting for diversity, and how do projects involve older adults? With colleagues in Maynooth University, I am examining publicly available materials from the OpenDEI Healthcare Cluster of European research projects, including SHAPES, to establish how representative and inclusive cluster projects are.
Evaluating Health Technologies: Measuring Meaningful Outcomes
SHAPES is piloting technologies with older adults in scenarios that allow us to understand how specific technologies and the SHAPES ecosystem work in real-world settings. Health technologies are often experienced as capable, useful, and convenient, but they are often also abandoned and experienced as intrusive, inconvenient, and expensive. When we design, pilot, and research digital health technologies—like mobile apps or social robots—it’s essential that we measure outcomes that are meaningful and important to older adults.
SHAPES pilots will administer a set of psychometrically robust questionnaires at the beginning and at the end of the pilot programmes, and at subsequent follow-up. The questionnaires assess psychosocial outcomes that are particularly meaningful to older adults, including quality-of-life, community participation, social support, self-efficacy, and health literacy, as well as sociotechnical outcomes like usability and technology acceptance. To facilitate holistic evaluation, outcome measurement has been harmonised across the pan-European consortium. We can evaluate SHAPES and its technologies not merely in terms of technical efficacy, but in terms of helping people to maintain quality-of-life as they age, for example. In the coming months, we will also use the NASSS framework to evaluate potential barriers to adoption, use, and sustainability of SHAPES and its technologies.
One of the outcomes above, technology acceptance, is a measure of whether people adopt, use, approve of, reject, or are satisfied with technology. I am currently undertaking an umbrella review to better understand the landscape of technology acceptance for digital H&SC technologies among older adults. The review is designed to directly answer how technology acceptance has been conceptualised and measured, and what features of technology acceptance are associated with different technologies or sub-groups of older adults.
The review will lay the groundwork for a deeper understanding of why technology acceptance is measured, and whether it is most usefully considered as an intrinsic endpoint or as a mediator of outcomes most meaningful to older adults, like health, quality-of-life, social participation, and independence. Technologies offer vast possibilities, but there are many routes to achieving what is most important to older adults.
By applying our humanity to technology—centring diversity, making processes inclusive, and considering meaningful outcomes—we have a real chance of improving health, reducing inequality, and promoting the social connection, independence, and empowerment that is important to older adults. Surely Einstein—or anybody—could support that.
The SHAPES project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No. 857159.