The integration of Artificial Intelligence (AI) in dental radiography not only presents an opportunity but also holds immense potential to enhance diagnostic accuracy and efficiency. This study addresses the exciting challenge of leveraging AI, specifically a generative pre-trained transformer model, to interpret dental panoramic X-rays, a task traditionally reliant on human expertise. The central purpose of the study is to evaluate the diagnostic capabilities of this AI model compared to professional dental evaluations, focusing on its accuracy and consistency, thereby paving the way for a promising future in dental diagnostics.

The research involved a sample of 35 dental panoramic X-rays obtained from Flexident AB, anonymized and annotated by a panel of dental professionals. The study was conducted in two stages: Stage One tested the AI model in three different methods: 1- without any annotations, 2- with numbered teeth, and 3- with colored circles highlighting areas of interest. Stage Two involved training a specialized GPT model with domain-specific knowledge.

Key findings indicate that the AI model, when provided with detailed visual annotations, achieved diagnostic accuracy comparable to that of dental professionals, as statistical analysis showed no significant differences between the golden standard (dentist group) and the visually annotated group (P>0.05). However, the model struggled with unannotated images, highlighting the importance of structured input. The research underscores the potential of language-based AI in medical imaging while emphasizing the need for detailed input to optimize performance. This study is pioneering in applying a generative pre-trained transformer model for dental diagnostics, opening new avenues for AI integration in healthcare.

The worldwide shortage of qualified care workers along with the increasing need for elderly care services has restrained the capacity of nursing homes to offer their residents high-quality care services. Along with digitalization, policymakers believe that technological advancements can improve the efficiency of care and streamline care work, thus helping to alleviate the challenge above. These investments include the creation of new care services by adopting innovations such as social robots, and the update of existing care services by replacing analogue technologies with digital versions, such as social alarm systems. While numerous studies have discussed the implementation of new digital technologies, the digitalization of existing care services has received less attention.This dissertation conducts empirical investigations on the digitalization of social alarm systems in four Swedish nursing homes. By applying theories of social shaping of technology with a focus on socio-technical transformations in care practices, it asks how implementation of the new social alarm systems is socially shaped in care practices. The social alarm system is an established technology that aims to enable users to call for help in emergencies. Based on a literature review of the central theme (Paper I), the dissertation examines discrepancies between planned and actual implementation outcomes (Paper II), differences within a team during project executing (Paper III), and the relationship between individuals’ actual use of technology and the assumptions inscribed in the system and the diverse care concepts in nursing homes (Paper IV). The methodological basis of the dissertation comprises analysis of implementation documents, observations of healthcare professionals’ daily work, interviews with employees of both technology companies and nursing homes, questionnaires completed by healthcare professionals, and a literature review.The results reveal that technology implementation is far from predictable outside the care context. During the implementation process, people from different groups have distinct goals, focus on different facets, and develop diverse approaches for integrating the system into daily work. Frontline professionals determine their ways of using the new social alarm system based on their personal and situational understanding of technology scripts and care concepts under given contexts. The results contribute to theoretical clarifications as well as practical possibilities and limitations to guide the implementation of social alarm systems in nursing homes. The findings indicate that the introduction of a digital social alarm system brings various changes. The digitalization of social alarm services in nursing homes can benefit from a clear positioning of the new system, a common ground for sufficient communication between actors involved, and an in-depth interpretation of local environments, as well as flexible and continuous implementation strategies.

Recent studies prove that when implementing new technology technology-driven and one-size-fits-all approaches are problematic. This study focuses on the process of implementing personal emergency response system (PERS) at nursing homes. The aim is to understand why the implementation of PERS has not met initial expectations. Multiple methods were used in two Swedish nursing homes, including document analysis, questionnaires (n = 42), participant observation (67 h), and individual interviews (n = 12). A logic model was used to ascertain the discrepancies that emerged between expected and actual implementation, and the domestication theory was used to discuss the underlying meanings of the discrepancies. The discrepancies primarily focused on staff competence, system readiness, work routines, and implementation duration. Corresponding reasons were largely relevant to management issues regarding training, the procurement systems, individual and collective responsibilities as well as invisible work. The uptake of technology in daily practice is far more nuanced than a technology implementation plan might imply. We point out the importance of preparing for implementation, adjusting to new practices, and leaving space and time for facilitating implementation. The findings will be of use to implementers, service providers, and organizational managers to evaluate various measures in the implementation process, enabling them to perform technology implementation faster and more efficiently.

Seeking effective approaches to integrate technology into formal healthcare professionals’ daily works has been acknowledged as challenging. The purpose of this article is to provide a comprehensive overview of the recent research concerning the implementation of personal emergency response systems (PERSs), with the focus on the routine use of PERS among formal healthcare professionals, as well as identify current gaps in this area. The scoping review followed the five-stage framework of Arksey and O’Malley and PRISMA-Extension for Scoping Reviews (PRISMA-ScR). Searches were performed in PubMed, CINAHL, EMBASE, and the Web of Science Core Collection for studies published from 2009 to 2019. Any peer-reviewed studies in English describing strategies, barriers, and facilitators, or assessing the impact of integrating PERS into healthcare professional practices fulfilled the inclusion eligibility. Two reviewers screened the manuscripts and extracted data independently, with a third reviewer resolving discrepancies. Due to a large heterogeneity of included studies, a narrative synthesis was conducted. In total, 25 studies were included out of 2,319 manuscripts. This study discusses supportive strategies, and enabling and inhibiting factors, as well as integration outcomes. Future studies can contribute to three gaps by examining: 1) how strategies such as training contribute to the effectiveness of technology integration separately and collectively; 2) how working environments affect the effectiveness of realizing operational works; and 3) how technology is shaped by social environments and relationships. 

Background: Technologies such as social alarm systems contain expectations about how they should be integrated and used in practice. These expectations, also called technology scripts, usually fail to consider all the complexity in care practice. Shifting the focus from technology scripts to care practice, this paper examines how a social alarm system is used in assistant nurses’ care practices in nursing homes.

Methods: The paper draws on observations of assistant nurses’ daily tasks (32 hours) and semi-structured interviews with assistant nurses (n=12) in two Swedish nursing homes. The observation data were used to understand the care contexts and assistant nurses’ technology-mediated care practices, while interviews were used to deeply understand assistant nurses’ perceptions of the system, their care practices, and which aspects they considered during the provision of care.

Results: We show the complexities involved in integrating a social alarm system into care practices based on assistant nurses’ situational and personal interpretations of both technology scripts and quality of care. In technology-mediated care practices, consisting of receiving alarms from residents, checking alarms, responding to alarms and documenting finished alarms, the assistant nurses defined technology scripts according to their expected requirements and outcomes, and meanwhile considered the quality of care by evaluating the priority of practical, moral or relational care in the situations at hand. Through further negotiations with the defined scripts and the considered quality of care, the assistant nurses decided on the final way of using (or not using) the system in practice.

Conclusion: Results from our survey portray the complexity of technology in care practices. The findings contribute to increased understanding of technology-mediated care practices in nursing homes, and research on technology scripts in normative settings.

Background Technologies such as social alarm systems contain expectations about how they should be integrated and used in practice. These expectations, also called technology scripts, usually fail to consider all the complexity in care practice. Shifting the focus from technology scripts to care practice, this paper examines how a social alarm system is used in assistant nurses' care practices in nursing homes. Methods The paper draws on observations of assistant nurses' daily tasks (32 h) and semi-structured interviews with assistant nurses (n = 12) in two Swedish nursing homes. The observation data were used to understand the care contexts and assistant nurses' technology-mediated care practices, while interviews were used to deeply understand assistant nurses' perceptions of the system, their care practices, and which aspects they considered during the provision of care. Findings We show the complexities involved in integrating a social alarm system into care practices based on assistant nurses' situational and personal interpretations of both technology scripts and quality of care. The technology-mediated care practices consist of receiving alarms from residents, checking alarms via alarm phones, responding to alarms via alarm phones, checking specific residents' situations in person, documenting all finished alarms, and documenting some finished alarms. In these practices, the assistant nurses defined technology scripts according to their expected requirements and outcomes, and meanwhile considered the quality of care by evaluating the priority of practical, moral or relational care in the situations at hand. Through further negotiations with the defined scripts and the considered quality of care, the assistant nurses decided on the final way of following (or not following) specific scripts in practice. Conclusion Results from our study portray the complexity of technology in care practices. The findings contribute to increased understanding of technology-mediated care practices in nursing homes, and research on technology scripts in institutional settings.

Although health monitoring systems in smart homes have been revealed as a significant tool to help people ageing in place, the density of data poses a challenge on the information visualization. This review aims to make contributions to find gaps in the field of information visualization regarding smart home monitoring for older people. Three kinds of information needs of older adults and their informal caregivers regarding smart home monitoring are categorized, including physical needs, emotional needs and cognitive needs. The research studies reflect that these needs are mainly used to discuss ideas of, design approaches for, the information visualization from ten aspects in the visceral level, behavioral level and reflective level. Results show that there is still a big gap existing in enabling older people and their informal caregivers to better understand smart home monitoring information. Some existing design recommendations can be improved while at the same time, some needs have not been manifested through information visualization. A wider understanding of older adults, informal caregivers and home living environment in all aspects are necessary.

Background: New social alarm solutions are viewed as a promising approach to alleviating the global challenge of an aging population and a shortage of care staff. However, the implementation of social alarm systems in nursing homes has proven both complex and difficult. Current studies have recognized the benefits of involving actors such as assistant nurses and middle managers in advancing these implementations, however the differences in their perspectives during the implementation of these novel technologies have received less attention.Methods: Based in domestication theory, this paper aims to better understand the perspectives of middle managers and assistant nurses during four domestication phases. We interviewed middle managers (n = 5) and assistant nurses (n = 17) working in nursing homes to understand the two groups’ perceptions and practices during the implementation of social alarm systems.Results: During the four domestication phases, a total of four differences in perspectives emerged between the groups, including (a) system conceptualization; (b) spatial employment of social alarm devices; (c) treatment of unexpected implementation issues; and (d) evaluation of inconsistent competence in technology use. Our findings elaborate how individuals from the two groups have distinct goals, focus on different facets, and develop diverse coping strategies over time. Taking a closer look into middle managers’ and assistant nurses’ ways of overcoming these differences, we propose a tentative concept: “collective domestication“ to call for more studies about collective practices during technology domestication within organizations.Conclusion: Our findings reveal a divide between middle managers and assistant nurses in terms of domesticating social alarm systems and stress the potential of learning from each other to facilitate the whole process. Further studies could focus on the role of collective practices during different domestication phases to enhance the understanding of technology implementation in the contexts of complex interactions across groups.

Background: New social alarm solutions are viewed as a promising approach to alleviate the global challenge of an aging population and a shortage of care staff. However, the uptake of social alarm systems in nursing homes has proven both complex and difficult. Current studies have recognized the benefits of involving actors such as assistant nurses in advancing these implementations, but the dynamics by which implementations are created and shaped in their daily practices and relations have received less attention. Objective: Based on domestication theory, this paper aims to identify the differences in the perspectives of assistant nurses when integrating a social alarm system into daily practices. Methods: We interviewed assistant nurses (n=23) working in nursing homes to understand their perceptions and practices during the uptake of social alarm systems. Results: During the four domestication phases, assistant nurses were facing different challenges including (1) system conceptualization; (2) spatial employment of social alarm devices; (3) treatment of unexpected issues; and (4) evaluation of inconsistent competence in technology use. Our findings elaborate on how assistant nurses have distinct goals, focus on different facets, and developed diverse coping strategies to facilitate the system domestication in different phases. Conclusions: Our findings reveal a divide among assistant nurses in terms of domesticating social alarm systems and stress the potential of learning from each other to facilitate the whole process. Further studies could focus on the role of collective practices during different domestication phases to enhance the understanding of technology implementation in the contexts of complex interactions within a group.

Globalization has facilitated international communication and economic activities that motivate more international migration. Different cultures and values from the West and the East are interwoven in the same social context. Meanwhile, aging has become a notable phenomenon in most developed countries due to declining fertility and increased life expectancy. A digital transformation of society is taking place alongside the aging and international migration that will start to question the image of older adults and the patterns of providing elderly care. Chinese elderly care is characterized by familism providing family-based informal care to an older family member. Despite the influence of migration and modern lifestyles, filial piety is expected to continue to guide the care responsibilities and care providing among Chinese families. 

This thesis aims to understand the cultural provision of support and care for Chinese older adults living in Sweden and under the influence of the digital transformation of society. It starts by exploring the disparities, barriers, and facilitators for older immigrants in need of home care to utilize digital technology. After constructing knowledge about the influences of the foreign environment and continuous digitalization in home care, the thesis seeks to understand how filial piety continues to be enacted; what part of the tradition is preserved, and what is changed; how the internal and external factors influence the decision of elderly care; and the role of digitalization in this process. The thesis utilizes qualitative in-depth interviews to continue investigations among eight midlife and older Chinese immigrants living in Sweden. Thematic analysis was employed for data analysis. Berry’s acculturation framework and Yeh’s Dual Filial Piety Model provide the theoretical ground for the research. 

The results indicated that filial piety is in transition in terms of filial responsibilities, filial behaviors, and intergenerational relationships. Despite the differences in the acculturation level, the authoritarian element of filial piety lacked ground in the Swedish social context. Respondents showed their willingness to strengthen the reciprocity with their adult children by providing additional support, valuing affections rather than hands-on care, respecting adult children’s decisions. The uptake of digital technologies has enabled midlife and older Chinese immigrants to maintain more frequent contact with family members and friends in other countries. It also improves the autonomy and capabilities for respondents to plan more independent later lives. The conclusion is that traditional values such as filial piety was not as prominent in Sweden as they are in China. 

Better home care and home care technologies are no longer requested solely by nonimmigrant older adults but also by members of the fast-growing older adult immigrant population. However, limited attention has been given to this issue, or to the use of technology in meeting the needs of aging populations. The objective of this review is to map existing knowledge of older adult immigrants' use of information and communication technologies for home care service published in scientific literature from 2014 to 2020. Twelve studies met the established eligibility criteria in a systematic literature search. The results showed older adult immigrants faced similar barriers, which were independent of their ethnic backgrounds but related to their backgrounds as immigrants including lower socioeconomic status, low language proficiency, and comparatively lower levels of social inclusion. Technology use could be facilitated if older adult immigrants received culturally-tailored products and support from family members and from society. The results imply that the included studies do not address or integrate cultural preferences in the development of information and communication technology for home care services. Caregivers might provide an opportunity to bridge gaps between older immigrants' cultural preferences and technology design. This specific research field would also benefit from greater interest in the development of novel methodologies.

The discussion of the digital divide and digital inclusion has extended to older adults. Although knowledge on the digital divide and digital inclusion among native older adults has increased substantially, little is known about the situations of older immigrants in relation to the digital divide. This paper employed the scoping review approach to map the situations and research methods of the digital divide among older immigrants from recent empirical studies. The initial search identified 997 articles, of which 13 articles were selected for this review. The results showed that socioeconomic status, language proficiency, degree of acculturation, level of education, and digital literacy are the most common factors leading to the disparities between native older adults and older immigrants. Although the results showed a narrowing gap as concerns access to the Internet, interventions are needed to reduce the divide among individuals of different ethnicities due to disparities in digital skills and knowledge. The included studies applied quantitative, qualitative, and mixed-method approaches. The homogeneity of the findings of some included studies implied the need to develop more methods and models to study the digital divide among older immigrants. This review suggested that future research incorporate ethnic characteristics in the research design to provide in-depth knowledge about the ethnic group. This knowledge could potentially be utilized for future interventions aimed at narrowing the remaining gap of the digital divide.

Filial piety is a core cultural norm in East Asian countries that shapes eldercare obligations and responsibilities. Research on migration and science technology studies (STS) demonstrates the potential of digital technologies to influence the acculturation experiences of immigrants, but the primary focus has been on younger generations. This paper explores how the combination of digital technologies and acculturation influences expectations of filial piety and filial practices of midlife and older Chinese immigrants in Sweden. In-depth interviews of eight midlife and older Chinese immigrants provided qualitative data for thematic analysis, revealing that the in-formants expected to be more independent in later life but to maintain a close and reciprocally supportive relationship with their adult children. They considered their acculturation experiences to be both satisfying and challenging. The uptake of digital technology ensured frequent contact with Chinese communities and enhanced their experience of life in Sweden. The findings suggest a potential need for intervention through formal care supports for older Chinese immigrants, despite the stereotype of interdependence and family-based care. This study also provides insight into the need for social inclusion in Sweden by incorporating cultural preferences into digital communication and the design of care provision.

This special issue contributes to the new academic field known as Socio-gerontechnology, which has emerged at the cross-section of STS and Age Studies. All contributions published in the following pages explore what happens when theories meet practice in the relation between ageing and technology, by pointing out the role of design(ers) in configuring and reconfiguring such a relation. In line with the so-called "engaged program" in STS, these articles address different topics of political importance and pragmatic relevance. Indeed, they share the critique of ageist images that underlie public and specialist discourses around ageing and technology. By combining the emancipatory thrive of critical studies of age and ageing and the nuanced STS approach to the study of the entanglements of ageing and technology, this special issue offers a collection of theoretical elaborations and methodological considerations developed along with empirical analyses. Overall, they explore the practical politics of technology, within the growing field of Socio-gerontechnology.

Digital practices in later life are not yet well understood. Therefore, this paper discusses the framework for a research design project that aims at tracing differences and similarities in how older adults use their smartphones in circumstances in and outside their homes in Spain, the Netherlands, Sweden, and Canada. The research questions of this international research project focus on the extent to which digital mobile practices relate to perceived social connectedness among older adults aged 55–79 years old. While studies have shown that the subjective experience of ‘being connected’ supports continued wellbeing in later life, there remains an insufficient understanding of the processes through which digital mediated social interaction is effective for social connectedness. The analytical framework of the project prioritizes the co-constituency of (digital) technology and ageing, and takes digital practices in everyday life as its entry point. The main data collection tool will be the tracking of smartphone activity of 600 older adults (150 per country) during four weeks. An online survey and qualitative interviews will gather data about the meanings of the quantified digital practices, and how they shape (if they do) the participants’ connection to the world. This approach will allow us not only to get insight into what older adults say how they used their smartphone but also to gain insight into their real-life daily use. The assessment of the challenges, strengths, and weaknesses of the methods contributes towards an accurate and appropriate interpretation of empirical results and their implications.

Population ageing and increased digitalization each constitute an ongoing and profound transformation within contemporary modes of living, as growing advances in technological development mix and intermingle with the lived realities of older people as the final recipients. It is against the backdrop of this interplay that user involvement has enjoyed ever-rising advocacy to an almost normative degree. Beyond articulating methodological principles, however, the literature has remained surprisingly vague as to the practical implementation of the approach. Less appears to be known, both empirically and conceptually, about how design and user involvement are done in practice and how they would matter to bring about intentional or unintentional effects. 

To engage with these developments, this thesis aims at taking the practices of user involvement and design to the centre of its inquiry by adopting a perspective from Science and Technology Studies (STS). Specifically, the thesis seeks to both build on and contribute to the established body of STS on the connection between technology design and older users and ask: What is there to learn about user involvement as a method, if we focus on the practices of doing user involvement? To answer this question, the thesis studies four different aspects of the practices of user involvement and design. In particular, the thesis reviews the literature on how user involvement mattered in previous empirical projects that include older people (Paper I), it examines how different configurations of participation matter in design workshops (Paper II), it scrutinizes the achievement of user involvement in corporate practices (Paper III) and it traces the circumstantial performances of such practices (Paper IV). The largest empirical piece comes from a two-year ethnographic study of a small- to medium-sized enterprise, the material from which informed Paper III and Paper IV.

The findings highlight how user involvement in practice is both contingent and transformative, as it selectively enrols different participants and performs multiple realities. In practice, user involvement appears to be dependent on a set of underlying premises and socio-material conditions and thus is always a dynamic and momentary achievement. Furthermore, the thesis shows how the practices of user involvement themselves may bring into existence different realities, articulating and materializing particular versions of objects and images of ageing. Accordingly, the thesis contributes theoretically by illuminating the underlying socio-material facets of user involvement, and by emphasizing ageing as a particular object/image of design. Specifically, the appended papers encompass a conceptual framework, as well as three new concepts: design multiple, shifting interstices and viscous image landscape, in order to theorize the underlying conditions for user involvement, its relationship with design and its entanglement with ageing. Practically, the thesis enunciates three main implications regarding questions of goodness, politics and ethics.

BACKGROUND AND OBJECTIVES: There is a lack of understanding of how older adults' involvement and participation matters in actual design practice. This systematic literature review investigates existing empirical studies involving older users during the design of technologies and explores the nature and consequences of involving older people.

RESEARCH DESIGN AND METHODS: Our literature review is informed by the guidelines of the PRISMA statement. We examined the included studies by means of thematic content analysis to identify the nature of older users' involvement and existing evidence on what consequences it has.

RESULTS: In total, 40 empirical studies published in the period 2014-2018 are included in the review. Most empirical studies involve older people from local networks, with underlying stereotypical images and at lower levels of participation. The results reveal three main consequences of involving older users: learning, adjusted design, and an increased sense of participation. Furthermore, we found that user involvement is a structured process whose outcomes are contingent on a range of premises.

DISCUSSION AND IMPLICATIONS: Synthesizing the results, we develop the concept of user involvement and present an analytical framework. Our results have implications for researchers and policy makers, since they throw into question the widely held assumption that involving older people inevitably yields beneficial outcomes.

This article introduces a new method to design with older people: unfettered design. We discuss three points of concern with existing methods of involving older users: unspecific design outcomes, prejudiced views on older users, and underlying power asymmetries, which can diminish the innovative capacities of the older adults involved. To overcome these issues, we argue for the benefits of adopting unfettered design. Through unfettered design, the users involved are given the space to explore design ideas on their own terms, and unusual and unsolicited responses are explicitly desired and listened to. This, in turn, may help designers to elicit novel design ideas and identify potentials for innovative technologies. Thereby, designers may learn about the concerns and potentials for which older adults would find technologies particularly helpful - a crucial aspect considering rather low levels of technology uptake in this population segment. We illustrate our approach by means of examples from our own design experiences, and we formulate four core principles of unfettered design: ongoing reflection, retained impartiality, a distinct focus on the participants’ view and remaining flexible throughout the procedure. Having undergone several waves of both technological and social change, older adults possess unique experiences and tacit knowledge that can serve as valuable inspirations for designers. Unfettered design can be particularly helpful to benefit from these competences during design projects. 

Involving older people through co-design has become increasingly attractive as an approach to develop technologies for them. However, less attention has been paid to the internal dynamics and localized socio-material arrangements that enact this method in practice. In this paper, we show how the outcomes that can be achieved with user involvement often pertain to learning, but their content can differ significantly based on how the approach is implemented in practice. Combining explorative, qualitative findings from co-design conducted in four countries (Canada, the Netherlands, Spain, and Sweden), we illustrate how different types of learning occurred as design workshops engaged the experiences and skills of older people in different ways. Our findings make visible how learning can be a core outcome of co-design activities with older adults, while raising awareness of the role of the power relations and socio-material arrangements that structure these design practices in particular ways. To benefit from the full wealth of insights that can be learned by involving older people, deeper knowledge is needed of the implicit features of design, the materials, meanings, and power aspects involved.

In this paper, we explore the seeming stability of aging. More precisely, we offer an empirical account of how aging – images of aging, embodiments of aging, feelings about aging – is enacted in company practice, both in place and across time. Drawing on ethnographic fieldwork conducted at SMCare, a small-to-medium sized company active in the care technology sector, we show how aging achieves its stability not through practices that are characterized by affection, or purposefully targeted at maintaining or caring for aging, but due to ongoing re-enactments in the shadows of other care practices. In so doing, we mobilize STS care literature that foregrounds the often-invisible relationships among objects that are otherwise neglected, marginalized and excluded. In particular, we interrogate the interlinkages between aging and caring practices as emerging in the shadows of care. In these blind spots, we find, certain unloved and disliked objects such as aging may aggregate and grow, becoming stable and durable as they are incidentally brought into existence, drawing energy from, and feeding off, other care practices.

This article critically interrogates how participation is practiced during the design process. We present the findings of three different configurations of participatory design workshops, each involving a different stakeholder group (age researchers, care experts and older adults). Building on insights from Science and Technology Studies (STS), we reveal how, in design practice, different configurations of participation enact and materialize multiple versions of ageing. To refer to this ontological layer of design processes, we introduce the concept "design multiple". Our study adds to current debates on the practices of participatory design and STS, as it shows how different configurations multiply enact objects into several material realities. We raise awareness on the practices of configuring participatory design, and their ontological consequences

In this study, we explore the constitution of user representations of robots in design practice. Using the results of ethnographic research in two robot laboratories, we show how user representations emerge in and are entangled with design activities. Our study speaks to the growing popularity of and investment in robotics, robots and other forms of artificial intelligence. Scholars in Science and Technology Studies (STS) have shown that it is often difficult for designers and engineers to develop accurate ideas about potential users of such technologies. However, the social context of robots and design settings themselves have received significantly less attention. Based on our laboratory ethnographies, we argue that the practices in which engineers are engaged are important as they can shape the kind of user images designers create. To capture these dynamics, we propose two new concepts: 'image-evoking activities' as well as 'user image landscape'. Our findings provide pertinent input for researchers, designers and policy-makers, as they raise questions with regards to contemporary fears of robots replacing humans, for the effectiveness of user involvement and participatory design, and for user studies in STS. If design activities co-constitute the user images that engineers develop, a greater awareness is needed specifically of the locales in which the design of robots and other types of technologies takes place.

Care robots are often portrayed as an exciting new technology for improving care practices. Whether these robots will be accepted and integrated into care work or not, is likely to be affected by the assumptions, expectations and understandings held by potential end users, such as frontline staff and the people that are cared for. This paper describes how the conceptual framework of technological frames was used to identify the nature of care robots, care robots in use and care robot strategy as shared group level assumptions, expectations and understandings of care robots among care staff and potential care receivers. Focus groups were conducted with 94 participants. These groups consisted of line managers, frontline care staff, older people and students training to become carers. The technological frame of the nature of care robots revealed two complementary components: care robots as a threat to the quality of care, and care robots as substitute for humans and human care, held together by imaginaries of care robots. The technological frame of care robots in use revealed aspects of prospective end-users’ uncertainty of their ability to handle care robots, and their own perceived lack of competence and knowledge about care robots. In addition, the following potential criteria for successful use of care robots were identified: adequate training, incentives for usage (needs and motives), usability, accessibility and finances. The technological frame of care robot strategy was revealed as believed cost savings and staff reduction. The novelty of the results, and their relevance for science and practice, is derived from the theoretical framework which indicates that adoption of care robots will be dependent on how well societies succeed in collectively shaping congruent technological frames among different stakeholders and aligning technological development accordingly. 

Introduction: This article contributes to the discussion on digital transformation and welfare technology in municipal eldercare. The aim of welfare technology solutions is to exceed the current welfare system and to meet the challenges of an ageing population through technological innovations and applications that help people to better cope with health issues and strengthen their participation, activity and independence regarding their own healthcare. Methods: First, this article outlines a number of different perspectives on technological and social change. Against this backdrop, this article portrays the challenges faced by Swedish municipal eldercare organizations due to the moving targets of digital transformation and the development of welfare technologies. Conclusion: In this context, eldercare organizations are at risk of becoming victims of the fast pace at which technology develops and the rhetoric of technological determinism; they may try to pursue the latest technological innovation at the expense of their stakeholders’ needs. The implementation and deployment of welfare technology become a real-world social experiment. Without proper tools for evaluation, welfare technology might be implemented and deployed as an end in itself, instead of as means for better ageing or improved eldercare. This article concludes by framing a set of questions to help increase the understanding of welfare technology implementation and deployment in order to mitigate risks and improve outcomes.IMPLICATIONS FOR REHABILITATION Analysis of different perspectives regarding technological and social change. Identification of the challenges faced by municipal eldercare organizations due to digital transformation. Presentation of evaluation questions to increase the understanding of welfare technology implementation and deployment in order to mitigate risks and improve outcomes.

Introduction: Swedish municipalities face a number of daunting challenges; an aging population, the public's increased demands and expectations on municipality services, and a strained economy to mention some. Welfare technology, a Scandinavian concept launched to promote digitalization, is seen as one solution to meet these challenges. Objective: Despite these promises, few welfare technology applications are offered by local Swedish municipalities and care organizations. Numerous studies have shown that Swedish municipalities have a great interest in welfare technologies. Methods: In this article, we draw on empirical research in one Swedish municipality. Through two case studies it is illustrated how technological change and municipality employment of welfare technologies are employed. Results: These case studies show how core values of care are being lost in the quest for digitalization due to the lack of organizational skills and knowledge in transforming the relationship of caregiving and care-receiving through the use of digital technology. Conclusions: Digitalization and welfare technologies deployed ought to represent and support the core values of caregiving and to receive care. Thus, digital transformation most likely will transform conditions for care receivers and working conditions for care workers. New work processes will evolve, which in turn produce new meanings of home help service work and caregiving.

This paper introduces a conceptual framework: the CPS triangle, which has evolved over four years of research on ‘older people meet robots’. It is a synthesis of domestication theory, modern social practice theory and empirical data. Case studies on the domestication of one current technology, the robotic vacuum cleaner, and two emergent technologies, the eHealth system and the service robot, provide empirical evidence. Considering ‘older people meet robots’ within the framework of the proposed CPS triangle can help us to understand older people’s domestication or rejection of robots. In the CPS triangle, C represents the cognitive dimension; P, the practical dimension; and S, the symbolic dimension. The CPS triangle is meant to serve as a tool rather than a rule. It is recommended that the CPS triangle be tested more widely in a range of contexts. It will require adaptation and customisation for the context of use.

Purpose: An ageing population presents a challenge for municipal eldercare in Sweden due to difficulties recruiting staff and there being a strained economy. A strategy involving welfare technology is presented as one such solution. An important group to carry out this strategy involves those who work with welfare technology in municipal eldercare. In this paper we describe their perception of welfare technology, and the challenges and opportunities they perceive in utilizing it. Methods: A self-administered online questionnaire was distributed to all Swedish municipalities and answered by 393 respondents. Analyses show that the respondents were representative of the different professions who work with welfare technology within municipal eldercare. Results: Welfare technology was perceived as being more reliable and safer than humans with regards to supervisions and reminders. The respondents acknowledged factors that slowed down the implementation of welfare technology in municipal eldercare organizations, such as resistance to change, lack of finances, lack of supporting evidence, lack of infrastructure, high staff turnover, difficulties with procurement and uncertainties about responsibility and laws. Conclusions: We found that the people who work with and make decisions about welfare technology in municipal eldercare organizations were generally very positive about the deployment and use of such technology, but there appear to be problems within municipal eldercare organizations to realize this vision. The lack of structured implementation processes and coherent evaluation models indicates inequality of the access to welfare technology and, as a result, even though Swedish eldercare is publicly funded, the availability of welfare technologies and their usage differ between municipalities.

This extended abstract is a report on older people’s perception of interactive robots in health- and elderly care. A series of focus groups was conducted. In total 31 older people participated. The majority of the participants viewed interactive robots in health- and elderly care as an asset but they also voiced concerns regarding reliability, practical handling, costs and fear of mechanical care.

The maintenance of older workers and determining the appropriate age for retirement are growing issues related to the fact that fewer people, still active in working life, have to provide for more non-working people due to increased life expectancy. As a result, retirement age has started to rise in many countries, and employers need to find ways to maintain an older and healthy work force, not least to avoid the loss of important experience. The aim of the current study was to increase the knowledge of factors influencing the retirement decisions among blue-collar workers in different national settings. A survey and semi-structured interviews were conducted with a sample of 100 blue-collar workers in Sweden, the Netherlands, and France, aged 55 years and older, within a global manufacturing company. Based on the results, implications for companies' age management strategies were discussed from a system perspective. Factors contributing to both retirement and to a prolonged work life were found on individual, organisational, and societal levels. This indicates the importance of a system perspective when planning for age management interventions.

En växande äldre befolkning i kombination med ett minskande födelsetal kan orsaka obalans på arbetsmarknaden, med en mindre grupp arbetande befolkning som försörjer en större grupp pensionärer, likaväl som förlust av viktig kompetens och resurser. Som ett resultat av detta har pensionsåldern börjat höjas i flera länder, och arbetsgivare behöver finna sätt att behålla en äldre arbetskraft med god hälsa. Tidigare forskning kring åldrande arbetskraft har i stor utsträckning fokuserat på enskilda faktorer (t ex arbetsförhållanden och upplevd hälsa) som påverkar tiden för pensionsavgång. Orsakerna till pension ligger ofta på flera olika nivåer och det behövs mer kunskap om hur interventioner, med syfte att möjliggöra för fler att arbeta längre, kan utformas utifrån ett systemperspektiv. 

Syftet med studien var att öka kunskapen om faktorer som påverkar tiden för pension bland verkstadsanställda i ett globalt industriföretag. Baserat på resultaten föreslogs en strategisk plan för age management interventioner utifrån ett systemperspektiv.  

Urvalet bestod av 116 verkstadsanställda som arbetade med olika former av verkstadsarbete (t ex montering och logistik) eller som nyligen gått i pension. Studien genomfördes vid sex olika produktionsanläggningar i fyra olika europeiska länder. Individuella semistrukturerade intervjuer genomfördes. Intervjuerna innefattade bland annat ämnena arbetsmiljöfaktorer, attityder till pension, samt förutsättningar för att vara en äldre arbetare. 

Bland riskfaktorerna för tidig pensionsavgång fanns obalans mellan krav och kontroll i arbetet, arbetsrelaterad stress, brist på stöd från chefer samt arbetsskiftens utformning. Motiverande faktorer för ett förlängt arbetsliv var bland annat socialt stöd och ett positivt socialt arbetsklimat, liksom att kunna använda sin kompetens. Nattskift uppgavs vara särskilt slitsamt, och även om skiftarbete nämndes som en källa till positiv variation, efterfrågades dagarbete, kortare arbetstid och minskad mängd fysisk belastning. Det fanns även önskemål om utveckling och lärande i form av stöd inför kommande livsförändringar, att fungera som mentor till nyanställda, samt att cheferna skulle visa mer respekt för de utmaningar äldre arbetare utsätts för.  

Företaget agerar på en global marknad, med produktionsanläggningar i flera länder med olika kulturer och strukturer (t ex olika lokala och nationella pensionssystem) och resultaten visar att både orsaker till tidig pensionsavgång, och faktorer som möjliggör ett förlängt arbetsliv, ligger på flera olika nivåer. En systemmodell som inkluderar både individ-, arbetsplats-, och organisationsnivå samt ett makroperspektiv hjälper till att fånga relevanta aspekter. Det kan bli ett verktyg för att ytterligare förstå och förbättra arbetssituationen för äldre verkstadsanställda när man planerar för, och genomför, age management interventioner.  

Background Welfare technology has been launched as a concept to accelerate digital transformation in care services, but the deployment of these technologies is still hindered by organisational resistance, lack of infrastructure, and juridical and ethical issues. This paper investigates decision-making among municipal actors in the application and deployment of welfare technology from a procurement process perspective. The study explores the perceptions and negotiations involved in purchasing welfare technology at each stage of the procurement model, revealing the impact of technical, economic, juridical and ethical competence on the mapping, planning, procurement, implementation and management of welfare technology. Methods The study presents empirical findings from qualitative interviews conducted among municipal actors in Sweden. Semi-structured interviews were gathered in 2020 among procurement managers, IT managers, and managers in social administration in three different municipalities (n = 8). Content analysis and systematic categorisation were applied resulting in the division of procurement practices into sub-categories, generic categories and main categories. Results Challenges in the application and deployment of welfare technology occur at all stages of the procurement model. In mapping and planning, barriers are identified in the need analysis, requirement specification and market analysis. In the procurement stage, economic resources, standardisation and interoperability hinder the procurement process. Implementation and management are complicated by supplier assessment, legislation, cross-organisational collaboration and political strategy. Building on these findings, this study defines 'procurement competence' as consisting of technical, economic, juridical and ethical expertise in order to assess and evaluate welfare technology. Technical and ethical competence is needed in early stages of procurement, whereas juridical and economic competence relates to later stages of the model. Conclusions Procurement competence is associated with the application and deployment of welfare technology in (1) assessment of the end-user's needs, (2) estimation of the costs and benefits of welfare technology and (3) management of juridical and legislative issues in data management. Economic and juridical decisions to purchase welfare technology are not value-neutral, but rather associated with socially shared understandings of technological possibilities in care provision. Optimisation of procurement processes requires a combination of capabilities to introduce, apply and deploy welfare technology that meets the demands and needs of end-users.

Assistive technologies can significantly increase older adults' independent living if these technologies are designed to meet their needs and abilities. This study investigates conditions and present possibilities for assistive technology to provide physical and cognitive support to older adults in a specific domestic task, which is cooking a meal at home. The empirical material consists of six video recordings of adults aged 65 and over preparing a meal in their kitchen. The study unpacks the complexity of kitchen tasks, from the physical interactions involved to the temporal and spatial alignment of objects and goals in the kitchen. We focus on a) Physical manipulation, such as chopping, opening packages, and moving objects around the kitchen, b) Organisation and coordination, including switching, synchronising and monitoring cooking tasks, and c) Reorchestration and reorganisation in the form of inserting additional tasks, and rearranging tools and ingredients when adjustments need to be made in the cooking process. The study outlines design principles for operational and organisational interventions to support cooking a meal for independent living. The study concludes with discussing design implications for conversational user interfaces in the kitchen, and the significance of assistive kitchen technologies for ageing in place. 

In certain parts of the world, medical waste is often stolen and sold during transportation, resulting in disease transmission and environmental pollution, which seriously affect people's health. Consequently, guaranteeing a safe and correct delivery of medical waste has a significant meaning. This article analyzes the problems of medical waste transportation management in Beijing Haidian Hospital. To assess the impact of deploying RFID technology, we established a transportation model, which includes three business modules: temporary storage and distribution, loading and transportation, uploading and disposal. At the same time, the role of such transportation model in solving problems was evaluated. On the basis of this, the social and economic benefits of the technical model are discussed and the shortcomings of the research are analyzed. We found that the RFID technology model could solve the problems existing in the transportation process of medical waste to a certain extent, and implement safe transportation management of medical waste. It provides some guidance on the practical application of the technical model.

Background: In the last decade, research has highlighted the importance of interprofessional approaches to education and practice. Collaboration between medical practice and engineering has been identified as particularly relevant to developing accountable models for sustainable healthcare and overcoming increased specialization leading to professional barriers. This study aims to analyze insights and understanding expressed by nursing students and biomedical engineering students following a joint learning activity regarding a medical device used in the hospital setting.

Method: A qualitative approach deriving from a phenomenological view examined an interprofessional learning activity where the focus was on active integration and knowledge exchange.

Conclusion: The activity was expressed as a positive opportunity for getting insights into perspectives from other professional groups as well as insights into the importance of a system perspective in patient safety. The learning and insights listed in the evaluations included ideas about how the two professional groups could collaborate in the future.

Background Home care is beset with work environment issues and high staff turnover, while research concerned with interventions to improve the work environment is sparse. Few of the existing interventions apply a participative approach, despite this being associated with more positive outcomes and sustainable change. This paper presents a framework, rooted in action research and action learning, for participatory work environment interventions in home care, and demonstrates how this framework has been implemented in four Swedish home care organizations. Methods The framework has three phases (pre-intervention, intervention planning and intervention implementation) and consists of cycles of action and reflection in three constellations: a group of researchers, a reference group with labour market organization representatives and home care managers, and intervention work groups in the home care organizations. The work was documented and analysed with focus on the realization of the framework and challenges that were met on the way. The interventions were evaluated using a pre-/post-test questionnaire design. Results Parts of the framework were successfully implemented. The pre-intervention phase and the intervention planning phase, with intervention work groups, worked well. All four groups identified one intervention relevant to their own context. However, only two of the proposed interventions were fully implemented and evaluated. The high staff and management turnover, and the high rate of organizational changes made it impossible to evaluate the interventions statistically. Yet, data from open-ended questions in the post questionnaire showed that the two implemented interventions were perceived as successful. Conclusions The participatory framework, presented in this paper, seems promising for work environment interventions in home care. The framework was designed to reduce the risk of known disturbances affecting the process in unstable organizations. Despite this, it proved challenging to execute the framework, and especially the interventions, due to changes happening at high speed. In the two cases where organizational changes were not dominating, the interventions were implemented successfully. While the prerequisites for participation and successful implementation could be improved somewhat, the main issue, the instability of the organizational context, is hard for researchers or the individual home care units to tackle alone.

Home care for elderly people is an important part of the social welfare system. The sector employs many people, especially women, and work environment issues are common. This review explores the scientific literature on organizational interventions that target the home care work environment. Altogether, 16 studies of varying quality met the inclusion criteria. The interventions identified involved organizational change, education and training, digitalization and scheduling. Many interventions were concerned with changing specific behaviors or with introducing new technology rather than tackling complex issues such as sick leave, stress or gender inequality. Employee participation increased the likelihood of success.

The Corona pandemic has accelerated the digitalization of Swedish society showing that most new Internet users turn out to be 76 years and older. At the same time, digitalization of elderly care is progressing more slowly than expected. Why is this? In this paper, robots and personal emergency response systems are examples of digitalization of elderly care, discussed using result from Swedish and European research on social uptake of new technology and work conditions in the care sector. The result points out the contradiction between the high expectations and the large investments made in digital cutting-edge technology for the care sector and the fact that this issue is under-theorized. Also, what works is what is well organized and well integrated in the work and in daily habits and routines. Robots and PERS represent two opposites where the alarms are well integrated but robots based on expectations only. 

Robots are entering care work but the development remains slow. One key issue is how to educate healthcare professionals in the use of robots. This paper explores robots in relation to the education of assistant nurses working in care for the elderly. How can we make robots part of the curriculum and what is it that future care workers really need to know? A collaboration between the Royal Institute of Technology, KTH, and 49 teachers at the College of Care and Welfare, VO-COLLEGE, in Sweden that includes teachers, two seminars, two course development meetings and one design workshop aims to explore teachers’ experiences of technology in care for the elderly work and in teaching technological matters. The results show that design workshops seem to be a more useful method to generate suggestions on how robots can be better adapted to care work, compared to seminars that brought up broader, though important, questions about care work and the role of assistant nurses and care receivers. The conclusion is that a greater awareness of technology used in care for the elderly is important to contribute to a relevant adaptation of robots and to be able to meet the challenges of an increased demand for care and care professionals. Increased responsibility for this development conveyed in education can help to broaden the view of technology, from being passive recipients of technology to being active co-creators.