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Tailoring to support digital technology-mediated occupational engagement for older adults: a multiple case study
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Occupational Therapy. Department of Rehabilitation, School of Health and Welfare, Jönköping University, Jönköping, Sweden.ORCID iD: 0000-0002-5015-154x
Umeå University, Faculty of Science and Technology, Department of Computing Science. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Occupational Therapy. Association of Local Authorities in Västernorrland County, Härnösand, Sweden.ORCID iD: 0000-0003-1428-1950
Umeå University, Faculty of Science and Technology, Department of Computing Science.ORCID iD: 0000-0002-8430-4241
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Occupational Therapy.ORCID iD: 0000-0002-8265-5769
2020 (English)In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 27, no 8, p. 577-590Article in journal (Refereed) Published
Abstract [en]

Background: With the evolution of contemporary occupations mediated by digital technologies (DTs), there is a need for occupational therapists to develop and structure knowledge on how to support older adults’ engagement in occupations and social participation in a digitalised society.

Objective: The objective of this study is to explore how tailoring to support older adults’ engagement in DT-mediated occupations could be schematised.

Material and methods: The study employed a multiple case study methodology. There were nine cases, with each case involving an older adult undergoing a collaborative process to support engagement in DT-mediated occupations. The collaborative process was initiated through questionnaires, observations, and dialogues. Meetings and tailoring strategies were documented in fieldnotes and memos on tailoring, respectively. Semi-structured interviews concluded data collection. Cross-case synthesis was used in data analysis.

Results: The result is a proposed scheme for tailoring to support older adults’ engagement in digital technology-mediated occupations, wherein strategies undertaken in the collaborative processes were synthesised and described.

Conclusion and significance: The proposed scheme for tailoring could contribute to occupational therapists’ knowledge on how to support older adults’ engagement in contemporary occupations. Testing the model in various practice settings is recommended in order to enhance occupational therapy practice.

Place, publisher, year, edition, pages
Taylor & Francis, 2020. Vol. 27, no 8, p. 577-590
Keywords [en]
Approach, computer, digital competence, digital literacy, information and communication technology, internet, intervention, occupational therapy, occupational therapy informatics
National Category
Occupational Therapy
Identifiers
URN: urn:nbn:se:umu:diva-169581DOI: 10.1080/11038128.2020.1760347ISI: 000533735800001PubMedID: 32396419Scopus ID: 2-s2.0-85084824399OAI: oai:DiVA.org:umu-169581DiVA, id: diva2:1422419
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2013-2143
Note

Originally included in thesis in manuscript form. 

Available from: 2020-04-07 Created: 2020-04-07 Last updated: 2021-11-04Bibliographically approved
In thesis
1. Ageing in a digital society: an occupational perspective on social participation
Open this publication in new window or tab >>Ageing in a digital society: an occupational perspective on social participation
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Att åldras i ett digitalt samhälle : ett aktivitetsperspektiv på social delaktighet
Abstract [en]

Background: For older adults to continue being healthy and active participants in an evolving digitalized society, there is a need to support their social participation through engagement in occupations that they need, want, or are expected to do in accordance to the roles that they assume. Occupational therapists together with other professionals face emerging challenges to promote older adults’ engagement in occupations mediated by digital technology. It is therefore relevant to acquire an understanding about how older adults continue to participate in their daily lives and engage in the occupations within their particular contexts. It is also relevant to explore ways to tailor supports for engaging in contemporary occupations and to measure the outcomes of such supports. 

Aim: The overall aim of this thesis was to develop knowledge to support older adults’ social participation through engagement in occupations mediated by digital technology. Developing knowledge entailed an exploration of older adults’ engagement in occupations mediated by digital technology (Study I), their contexts surrounding social participation (Study II), and tailoring supports for engagement (Study III). Additionally, part of developing knowledge also entailed an investigation of how outcomes of tailoring – specifically ability to perform occupation mediated by digital technology and ability to manage technology – could be measured and related (Study IV).

Methods: Study participants were selected from rural and urban municipalities in Northern Sweden. In Study I, data was gathered through concurrent think aloud protocol and observations of ten older adults, aged 66-79 years, while they engaged in occupations that involved digital technology. Narrative inquiry was used to illuminate features in their occupational engagement and participation in daily life. In Study II, focus group interviews of eighteen older adults, aged 66-81 years, were conducted and analyzed using qualitative content analysis.  Study III used a multiple case study methodology that included nine cases. Each case involved one adult who participated in a collaborative process to tailor supports for engagement in occupations mediated by digital technology. Data was gathered through questionnaires, observations, fieldnotes, memos for tailoring, and interviews, and then analyzed through cross-case synthesis. Nine older adults, aged 74-95 years, participated. In Study IV, twenty-five older adults, aged 71-93 years, were observed in their performances of digital technology-mediated occupations and scored on the Assessment of Computer-Related Skills and the Management of Everyday Technology Assessment. Data was analyzed using Rasch analysis and Spearman correlation test. 

Results: Findings in Study I were presented as three stories reflecting facets of participation – Being alone, Belonging together, and Being alone together. The stories illuminated older adults’ participation involving digital technology as a negotiation of needs and values, refinement of identities, and experience of meaning during interactions with technological and social environments. Findings in Study II were sorted in three categories – Experiencing conditions for social participation in a state of flux, Perceiving drawbacks of urbanization on social participation, and Welcoming digital technology that facilitates daily and community living – and encapsulated in the theme The juxtaposition of narrowing offline social networks and expanding digital opportunities for social participation. The findings suggested that facilitating satisfactory use of digital technologies and co-creating usable digitalized services could support older adults’ social participation through occupations that they find relevant in their lives, and subsequently, might enable them to live longer at home. Study III resulted in a proposed scheme for tailoring to support older adults’ engagement in digital technology-mediated occupations. The scheme included various intervention strategies tailored to persons in their contexts, such as adapting visual settings on the device and forming instructional materials based on the older adults' needs and preferences. Tailoring interventions require collaboration with other professionals. Results in Study IV indicated preliminary evidence of internal validity and reliability in two aforementioned instruments on a small sample of older adults. Results also showed that there is a significant and strong positive correlation between the ability to engage in digital technology-mediated occupations and the ability to manage digital technology. It implies that an older person who is more able to engage in digital technology-mediated occupations will likely have more ability to manage digital technology and vice versa. In the same manner, an older person who is less able to engage in digital technology-mediated occupations will likely have less ability to manage digital technology and vice versa.

Conclusions: In the contexts of ageing, narrowing social networks, and expanding digital possibilities, participation through satisfactory digital technology use can provide older adults opportunities to continue being active members of society. A scheme has been proposed to tailor supports for older adults’ occupational engagement, which needs further testing in various practice settings. Instruments for measuring outcomes of tailored supports have also been identified but need further validation in studies with older people.

Abstract [sv]

Bakgrund: För att äldre personer ska kunna fortsätta att vara hälsosamma och aktiva medborgare i ett digitaliserat samhälle behöver det finnas stöd för social delaktighet genom engagemang i aktiviteter som de behöver, vill eller förväntas göra i enlighet med de roller de har. Arbetsterapeuter tillsammans med andra yrkespersoner står inför nya utmaningar för att främja äldre personers engagemang i aktiviteter som utförs med hjälp av digital teknik. Det är därför relevant att få en förståelse för hur äldre personer deltar i sitt dagliga liv och engagerar sig i aktiviteter i sin kontext. Det är också relevant att utforska metoder för att skräddarsy stöd så att de ska kunna engagera sig i aktiviteter och för att mäta resultaten av dessa stöd.

Syfte: Det övergripande syftet med denna avhandling var att utveckla kunskap som kan användas för att stödja äldre personers sociala delaktighet genom engagemang i aktiviteter som utförs med hjälp av digital teknik. Detta har gjorts genom att utforska äldre personers engagemang i aktiviteter som utförs med hjälp av digital teknik (Studie I), deras kontext i samband med social delaktighet (Studie II) och skräddarsydda stöd för engagemang (Studie III). En studie syftade också till att undersöka hur förmågor kan mätas och relateras, särskilt förmågan att utföra aktiviteter med hjälp av digital teknik och förmågan att hantera teknik när skräddarsytt stöd har givits (Studie IV). 

Metoder: Studiernas deltagare kommer från olika kommuner i norra Sverige. I Studie I samlades data in med hjälp av tänka-högt metoden och observationer av tio äldre personer, i åldern 66–79 år, när de genomförde aktiviteter som involverade digital teknik. Narrativ metod användes för att belysa aspekter av deras engagemang i aktiviteter och delaktighet i det dagliga livet. I Studie II genomfördes och analyserades fokusgruppsintervjuer med arton äldre personer, mellan 66–81 år, genom kvalitativ innehållsanalys. I Studie III användes flerfallstudier som inkluderade nio fall, där varje fall bestod av en person som deltog i en samarbetsprocess för att skräddarsy stöd för engagemang i aktiviteter som utförs med hjälp av digital teknik. Data samlades in genom frågeformulär, observationer, fältnoteringar, memos om skräddarsydda stöd och intervjuer. Materialet analyserades sedan genom korsfallssyntes. Nio äldre personer, i åldern 74–95 år, deltog. I Studie IV observerades 25 äldre personer, i åldrarna 71–93 år, när de utförde aktiviteter medierade via digital teknik och bedömning genomfördes med hjälp av instrumenten Assessment of Computer-Related Skills och Management of Everyday Technology Assessment. Data analyserades med hjälp av Rasch analys och Spearman korrelation. 

Resultat: Resultatet i Studie I presenterades som tre berättelser som återspeglar aspekter av delaktighet – att vara ensamatt tillhöra varandraoch att vara ensam tillsammans. Berättelserna belyste äldre personers delaktighet med hjälp av digital teknik som en förhandling av deras behov och värderingar, förfining av identiteter samt upplevelser av mening vid interaktioner med tekniska och sociala miljöer. Resultaten i Studie II sorterades i tre kategorier – att uppleva förändrade förutsättningar för social delaktighetatt uppfatta nackdelarna med urbanisering för social delaktighetoch att välkomna digital teknik som underlättar dagligt och samhälleligt liv. Det övergripande temat blev Ettkrympande socialt nätverk och en utvidgning av digitala möjligheter för social delaktighet står sida vid sida. Resultaten antydde att underlättande av tillfredsställande användning av digital teknik och samskapande av användbara digitala tjänster skulle kunna stödja äldres sociala delaktighet genom aktiviteter som de finner relevanta i sina liv, vilket kan göra det möjligt för dem att bo kvar hemma längre. Studie III resulterade i ett strukturerat tillvägagångsätt för att skräddarsy interventioner som stödjer äldres engagemang i aktiviteter medierade av digital teknik. Det strukturerade tillvägagångsättet inkluderade olika individualiserade interventionsstrategier, såsom att anpassa visuella inställningar på den digitala enheten och skapa instruktionsmaterial baserat på äldres behov och preferenser. Skräddarsydda interventioner kräver samarbete med andra professioner. Resultat i Studie IV indikerade intern validitet och reliabilitet i de två ovannämnda instrument i den deltagande gruppen äldre personer. Resultaten visade också att förmågan att utföra digital teknikmedierade aktiviteter är positivt korrelerad med förmågan att hantera digital teknik. Det innebär att en äldre person som har mer förmåga att utföra aktiviteter som utförs med hjälp av digital teknik sannolikt kommer att ha mer förmåga hantera digital teknik och vice versa. Det innebär också att en äldre person som har mindre förmåga att utföra aktiviteter som utförs med hjälp av digital teknik sannolikt kommer att ha mindre förmåga hantera digital teknik och vice versa.

Slutsatser: I samband med krympande sociala nätverk och växande digitala möjligheter kan delaktighet genom tillfredsställande användande av digital teknik ge äldre möjligheter att fortsätta vara aktiva medlemmar i samhället. Ett strukturerat tillvägagångssätt har föreslagits i syfte att skräddarsy stöd för äldre personers aktivitetsengagemang, detta behöver ytterligare testas i fler sammanhang. Instrument för att mäta resultat av skräddarsydda stöd har också identifierats men behöver ytterligare validering i studier med äldre personer.

Place, publisher, year, edition, pages
Umeå: Umeå University, 2020. p. 89
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2080
Keywords
computer, digital competence, digitalization, digital literacy, digital technology, information and communication technology, internet, intervention, occupation, occupational therapy, occupational therapy informatics, older adult, older people, social activities
National Category
Occupational Therapy
Research subject
Occupational therapy
Identifiers
urn:nbn:se:umu:diva-169583 (URN)978-91-7855-249-8 (ISBN)978-91-7855-250-4 (ISBN)
Public defence
2020-05-08, Triple Helix, Samverkanshuset, Umeå universitet, Umeå University, Umeå, 09:00 (English)
Opponent
Supervisors
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2013-2143European Regional Development Fund (ERDF)
Available from: 2020-04-17 Created: 2020-04-07 Last updated: 2020-10-20Bibliographically approved

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