Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, Whitechapel, London E1 2AB, UK.
Soc Sci Med. 2013 Sep;93:86-94. doi: 10.1016/j.socscimed.2013.05.036. Epub 2013 Jun 13.
Telehealth and telecare research has been dominated by efficacy trials. The field lacks a sophisticated theorisation of [a] what matters to older people with assisted living needs; [b] how illness affects people's capacity to use technologies; and [c] the materiality of assistive technologies. We sought to develop a phenomenologically and socio-materially informed theoretical model of assistive technology use. Forty people aged 60-98 (recruited via NHS, social care and third sector) were visited at home several times in 2011-13. Using ethnographic methods, we built a detailed picture of participants' lives, illness experiences and use (or non-use) of technologies. Data were analysed phenomenologically, drawing on the work of Heidegger, and contextualised using a structuration approach with reference to Bourdieu's notions of habitus and field. We found that participants' needs were diverse and unique. Each had multiple, mutually reinforcing impairments (e.g. tremor and visual loss and stiff hands) that were steadily worsening, culturally framed and bound up with the prospect of decline and death. They managed these conditions subjectively and experientially, appropriating or adapting technologies so as to enhance their capacity to sense and act on their world. Installed assistive technologies met few participants' needs; some devices had been abandoned and a few deliberately disabled. Successful technology arrangements were often characterised by 'bricolage' (pragmatic customisation, combining new with legacy devices) by the participant or someone who knew and cared about them. With few exceptions, the current generation of so-called 'assisted living technologies' does not assist people to live with illness. To overcome this irony, technology providers need to move beyond the goal of representing technology users informationally (e.g. as biometric data) to providing flexible components from which individuals and their carers can 'think with things' to improve the situated, lived experience of multi-morbidity. A radical revision of assistive technology design policy may be needed.
远程医疗和远程护理研究一直以疗效试验为主。该领域缺乏对以下三个方面的深入理论化研究：(a) 满足有辅助生活需求的老年人需求的因素；(b) 疾病如何影响人们使用技术的能力；以及 (c) 辅助技术的物质性。我们试图开发一种基于现象学和社会物质性的辅助技术使用理论模型。2011 年至 2013 年期间，我们通过 NHS、社会护理和第三部门招募了 40 名年龄在 60 至 98 岁的参与者，并多次到他们家中进行访问。我们使用民族志方法，详细了解了参与者的生活、疾病经历以及对技术的使用（或不使用）情况。我们通过对海德格尔的著作进行现象学分析，并参考布迪厄的惯习和场域概念进行结构化分析，对数据进行了分析。我们发现，参与者的需求是多样且独特的。每个人都有多种相互强化的损伤（例如震颤、视力丧失和手部僵硬），这些损伤在不断恶化，受到文化框架的影响，并与衰退和死亡的前景有关。他们从主观和经验的角度来管理这些情况，适当地使用或调整技术，以增强他们感知和应对世界的能力。已安装的辅助技术并不能满足大多数参与者的需求；一些设备已被废弃，还有一些则是被故意禁用。成功的技术安排通常具有“拼凑”的特点（即实用的定制化，将新设备与旧设备结合使用），由参与者或了解并关心他们的人来完成。除了少数例外，当前一代所谓的“辅助生活技术”并不能帮助人们带病生活。为了克服这种讽刺，技术提供商需要超越代表技术用户信息（例如生物识别数据）的目标，提供灵活的组件，使个人及其护理人员能够“用事物思考”，从而改善多病症的实际生活体验。可能需要对辅助技术设计政策进行彻底修订。
