We are very grateful to all of the participants in this study and to our contacts at each case study site who helped to coordinate our interactions with interviewees. We are also very grateful to everyone who gave their time to participate in the study. We would also like to thank our peer-reviewers of the report, Dr Jo Ellins (BRACE Deputy Director, University of Birmingham) and Prof Iestyn Williams (Head of Research within the School of Social Policy, University of Birmingham).
Patient and public involvement
The impetus for this study was an NIHR-instigated/funded national prioritisation exercise held in October 2019, which included people who draw on care and support and their carers. In the scoping stage of this study, we also worked with people who draw on care and support and carers to confirm the relevance of our research questions and to design the detail of our approach. This engagement occurred through online project design groups, including members of the BRACE Health and Care Panel and the University of Birmingham Social Work Service User and Carer Contributor group.
The initial protocol for this study included further patient and public involvement in the form of interviews and/or focus groups with individuals who draw on care and support and their carers. To facilitate this, a member of the study team with experience in involving people with dementia and their carers (DT) was available to provide support. However, due to challenges in recruitment and engagement, this engagement was not possible.
Ethics
Ethical approval from the University of Birmingham Research Ethics Committee (ERN_13-1085AP41, approved 31 May 2021; ERN_21-0541, approved 5 July 2021; and ERN_21-0541A, approved 8 October 2021).
Funding
This project was funded by the NIHR Health Services and Delivery Research (HS&DR) Programme (HSDR16/138/31). Further information is available at: https://www.birmingham.ac.uk/research/brace/projects/new-and-emerging-technology-for-adult-social-care.aspx
Contributions of authors
Jon Glasby (https://orcid.org/0000-0003-3960-7988) (Professor of Health and Social Care, University of Birmingham) was the Principal Investigator for the study. He contributed to the conception and design of the study, the theoretical framework, and overall data analysis and interpretation, and is a co-author of the final report.
Ian Litchfield (https://orcid.org/0000-0002-1169-5392) (Senior Research Fellow, University of Birmingham) contributed to the theoretical framework, data collection and overall data analysis and interpretation, and is a co-author of the final report.
Sarah Parkinson (https://orcid.org/0000-0002-2858-1842) (Senior Analyst, RAND Europe) was the Project Manager for this study and contributed to the theoretical framework, data collection, and overall data analysis and interpretation, and is a co-author of the final report.
Lucy Hocking (https://orcid.org/0000-0002-8319-962X) (Senior Analyst, RAND Europe) contributed to the theoretical framework, data collection, and overall data analysis and interpretation, and is a co-author of the final report.
Denise Tanner (https://orcid.org/0000-0002-6944-7367) (Associate Professor of Social Work, University of Birmingham) contributed to the conception and design of the study, the theoretical framework, and overall data analysis and interpretation, and is a co-author of the final report. She brought particular expertise in terms of the involvement of people with dementia and their carers.
Bridget Roe (https://orcid.org/0000-0002-2625-9315) (Research Fellow, University of Birmingham) contributed to the theoretical framework, data collection and overall data analysis and interpretation.
Jennifer Bousfield (https://orcid.org/0000-0002-5671-2336) (Analyst, RAND Europe) contributed to the conception and design of the study, and data analysis and interpretation of the scoping exercise.
All authors contributed to integrating the findings of the study. JG made additional critical revisions to the final report and approved the final manuscript. All authors agree to be accountable for all aspects of the work in ensuring that any questions related to the accuracy or integrity of any part of the article are appropriately investigated and resolved.
Data-sharing statement
All data requests should be sent to the corresponding author in the first instance. Due to the consent process for data collection at case study sites within this evaluation, not all data can be shared.
Equality, diversity and inclusion
The study has endeavoured to incorporate the views, perspectives and contributions of people from diverse backgrounds and with protected characteristics at different points during the study. At some stages this has been limited by more general difficulties in recruitment (see Chapter 2).
Identification of topic: Prioritisation workshop
The research topic itself – new and emerging technology – was identified as being among a number of priorities for rapid evaluation during an NIHR-instigated/funded national prioritisation exercise held in October 2019. The 23 members of this workshop included people who draw on care and support and their carers, care staff, academics/researchers, commissioners and policy-makers. Care was taken to ensure that membership of the workshop reflected diversity in terms of protected characteristics of ethnicity, age and gender.
Scoping study
The research team undertook scoping work to inform our research design. This comprised key informant interviews and project design groups with stakeholders to explore: the questions we should ask stakeholders; the themes to consider; and methods for collecting data from care providers and commissioners, people who draw on care and support, carers and care staff.
In total, nine key informant interviews were conducted with research experts in the field and with decision-makers and operational leads from local authorities and care providers over several months in 2020. Our approach aimed to be inclusive by offering a choice of phone or online interviews.
The research team also held three online project design groups with stakeholders in October 2020. Design group 1 involved four local authority commissioners and care providers who were decision-makers and operational leads with experience of using IndependencePlus. Design group 2 involved four people who draw on care and support, and carers. Design group 3 involved three people who draw on care and support, and carers. Attendees of the second and third group were from the BRACE Health and Care Panel and from the University of Birmingham Social Work Service User and Carer Contributor group. To avoid exclusion based on an individual’s access to, and proficiency or confidence with technology, individuals were asked if they would prefer to speak over the phone with a member of the research team, rather than attend the design meeting. Furthermore, one carer who was interested in contributing but was unable to attend the dates of the online project design groups was offered an individual interview. For both the key informant interviews and project design groups, it was not possible to extend involvement to face-to-face participation because of the COVID-19 restrictions in place at the time.
Research design
Given that people with cognitive impairment may be among those most likely to benefit from the use of technology to promote independence, we felt it was important that their experiences were included in the study. We aimed to include people who lacked the capacity to consent to participate via the involvement of consultees who could advise about their likely willingness to take part and be interviewed on their behalf if appropriate
Our research design aimed to facilitate and encourage the participation of other people who might face barriers to involvement, such as people with learning difficulties and people with dementia. Researchers were recruited to the study who had specific training, experience and skills in interviewing people with different communication needs. We produced accessible information sheets and a choice of different methods of interview engagement, including face-to-face or online meetings or telephone interviews. Our intention was to seek advice from care providers, carers and, where possible, the individuals using the technology themselves, to agree the most suitable methods of communication for them, including the use of visual communication aids if appropriate. Prior to the interview commencing, our aim was to make sure that interviewees were comfortable and in a suitable private location, and we planned to spend time on building a rapport to put people at ease. In line with ethical considerations, the research team agreed a process of: active listening; attending and responding to participants’ body language and facial expressions; and a continual ‘checking in’ with participants to monitor and assure their well-being.
As mentioned earlier, online project design groups helped us to develop topic guides that were clear, relevant and mindful of accessibility and inclusion.
Research participant characteristics
Decision-makers and operational leads within the case study sites were asked to nominate potentially suitable staff, people drawing on care and support and carers for interviews. As discussed in the Methodology section (see Chapter 2), a number of significant challenges were faced in the recruitment of participants, especially people who draw on care and support and carers. This left little scope for us to be proactive in seeking out and selecting participants with a view to ensuring the inclusion of people from diverse backgrounds and more marginalised communities.
Research findings
Our findings consider the impact of different dimensions of inequality in terms of access to and use of home sensors with AI. For example, our research has highlighted: barriers to technology faced by people with poor internet access (e.g. those living in remote rural locations); and issues of ethics and consent relating to people with cognitive impairments. These are important equality, diversity and inclusion issues for commissioners and providers to consider when planning the use of technology in adult social care.
Outputs and dissemination
Project findings will be shared and discussed at a meeting of the full BRACE Health and Care Panel, which includes eight people drawing on care and support and public members. We will also seek the advice of these panel members in terms of the best ways to communicate findings to people who draw on care and support and public audiences, helping to ensure that dissemination activities have a wide reach and impact.
Research team
The research team consisted of researchers from BRACE rapid evaluation teams and the University of Birmingham, incorporating disciplines such as applied health research, social policy and social work, and with research interests in topics such as use of technology in care settings, commissioning, prevention, dementia and user/carer involvement. The research team had a mix of backgrounds in relation to gender, age and research experience, though not ethnicity to the same extent.
The team held weekly project meetings and weekly data collection and analysis meetings throughout the project to ensure that all members of the team were well supported. All researchers were supported by the Principal Investigator, Project Manager and senior members of the team.
Disclaimers
This report presents independent research funded by the National Institute for Health and Care Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, the HSDR programme or the Department of Health and Social Care. If there are verbatim quotations included in this publication the views and opinions expressed by the interviewees are those of the interviewees and do not necessarily reflect those of the authors, those of the NHS, the NIHR, the HSDR programme or the Department of Health and Social Care.