Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Jul 11, 2018
Date Accepted: Jan 3, 2019
(closed for review but you can still tweet)
Remote monitoring and discordant values: A qualitative study of low-income immigrant elders in the U.S.
ABSTRACT
Background:
Remote monitoring technologies are positioned to mitigate the problem of a dwindling care workforce and disparities in access to care for the growing elder immigrant population in the United States. To achieve these ends, designers and providers need to understand how these supports can be best provided in the context of various socio-cultural environments that shape older adults’ expectations and care relationships, yet few studies have examined how the same remote monitoring technologies may produce difference effects and uses depending on what population is using them in a particular context.
Objective:
We examine the experiences of low-income and immigrant senior housing residents with a sensor-based passive monitoring system. We are interested in adoption and discontinuation decisions and use over time, rather than projected acceptance or preferences. The senior housing organization had been offering the QuietCare sensor system to its residents for six years at the time of study. Our research question is “Do cultural differences influence use of this remote monitoring technology, and how?” The study does not draw generalizable conclusions about how cultural groups interact with a given technology, but rather, it examines how values are made visible in elder care technology interactions.
Methods:
The sample population is 49 senior housing residents, family emergency contacts, and social work staff who are responsible for using the QuietCare sensor-based monitoring system in six large senior housing independent living apartment buildings. Interviews were conducted in English and Korean with these participants who collectively had immigrated to the U.S. from ten different countries.
Results:
The most significant differences in adoption and use of QuietCare were observed between Russian-speaking and Asian residents. None of the more than 200 Russian-speaking residents accepted the remote monitoring system, which social workers attributed to the desire for hands-on care and the expectation that care should be provided to them based on sociopolitical norms of publically provided services. Asian elders accepted the intervention social workers offered largely to appease them, but unlike their U.S.-born counterparts, they adopted reluctantly without hope that it would ameliorate their situation. Asian immigrants discontinued use at the highest rate of all residents and intergenerational family cultural conflict contributed to this termination.
Conclusions:
This research into the interactions of culturally diverse people with the same monitoring technology reveals the significant role that social values and context play in shaping how people and families interact with and experience elder care interventions. If technology-based care services are to reach their full potential, it will be important to identify the ways cultural values produce different uses and responses to technologies intended to help older adults live independently.
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