JMIR Publications

ABSTRACT

Background:

Digital technologies are increasingly implemented in geriatric long-term care (LTC). However, their sustained use depends on acceptance among nursing staff. A preceding systematic review identified individual, organizational, and technological determinants of digital technology acceptance in this setting but could not establish their relative importance across heterogeneous technologies.

Objective:

This study aimed to validate and prioritize cross-technology, evidence-based determinants of digital technology acceptance among nursing staff in geriatric LTC through a two-round modified Delphi consensus process.

Methods:

A preregistered, two-round modified Delphi study was conducted online using QuestionPro between February and March 2026. It was done with a purposively sampled panel of German experts from LTC practice, management, consulting, and research. In round 1, 25 experts rated 15 statements derived from a previous systematic review on a 6-point Likert scale (0-5, no neutral midpoint). Consensus was defined a priori as median ≥4, interquartile range (IQR) ≤1, and ≥75% agreement (ratings 4-5). Items not reaching consensus, together with 10 additional items derived from inductive qualitative analysis of open-ended responses, were rated by 22 experts in round 2.

Results:

Overall, 29 of 58 invited experts (50.0%) completed at least one round. Among the 25 who completed round 1, 18 also completed round 2 (72.0% retention). The panel was predominantly female (72.0%), with a mean age of 48.6 (SD 12.71) years in round 1 and substantial LTC experience (more than 20 years for over 40% of participants). Of the 25 items evaluated across both rounds, 12 met all predefined consensus criteria, with the strongest agreement for technological reliability, supportive leadership, staff involvement in implementation, active managerial support, and perceived usefulness (all ≥88% agreement). Consensus was also reached for the original item on documentation burden, as well as for newly generated items addressing stable technical infrastructure, timely technical support, structured testing phases, and basic digital knowledge.

Conclusions:

Acceptance of digital technologies in geriatric LTC is best understood as a socio-technical phenomenon. Experts prioritized organizational and technological conditions, such as leadership support, staff participation, reliability, and technical support, at least as strongly as individual-level factors, including perceived usefulness and digital competence. This consensus-based, technology-independent factor set provides a foundation for developing standardized acceptance-measurement instruments and targeted implementation strategies in geriatric LTC.