Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Dec 25, 2025
Date Accepted: Jul 6, 2026
Caregivers' Phase-Specific Roles in Integrating Digital Technologies in Chinese Nursing Homes: A Qualitative Ethnographic Study
ABSTRACT
Background:
The integration of digital technologies into nursing homes is widely promoted as a solution to address aging populations and caregiver shortages. However, their effectiveness is often constrained by rigid implementation paradigms that overlook the agency of frontline caregivers in reshaping these systems. While previous research critiques deterministic narratives of technology adoption, limited attention has been given to how caregivers actively modify and reconfigure these technologies in practice.
Objective:
This study aims to uncover the roles caregivers enact to reconfigure rigid technologies into flexible, relationally attuned tools.
Methods:
This study conducted a six-month ethnography and 30 interviews in two Chinese nursing homes which are implementing sensor-based detection systems. Drawing on the domestication theory, we trace how caregivers negotiate technology integration across four domestication phases: appropriation, objectification, incorporation, and conversion.
Results:
Our findings reveal caregivers embrace polyvalent roles in transforming rigid systems into flexible, relational tools. Key roles include ethical auditors, cultural weavers, temporal integrators, glitch navigators, and human-centric storytellers. Through these roles, caregivers tailor technologies, reorder workflows, negotiate tensions between institutional efficiency and resident dignity, and bridge individual scrutiny with collective norm-setting. The technologies are eventually transformed from fixed tools into flexible, relational resources that evolve with changing care needs.
Conclusions:
This study highlights adaptation, rather than adoption, as the defining feature of effective technology domestication. By expanding domestication theory to institutional care contexts, we demonstrate how caregivers’ phased labor mediates technology integration, advocating for technologies that prioritize caregiver-resident collaboration, and policies that formally recognize caregivers' tacit expertise.
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