Digital Enabling Assistive Technology Through the Provision Lens - A Global Perspective in a Nordic Context.

The Nordic healthcare system is well-established, taxation-based, and locally administered, featuring person-centered care as a social welfare pillar. Public provision of assistive technology and welfare technology within healthcare systems means every citizen has equal access to services. But how well are policies and procedures keeping pace with demographic changes and technology developments?. This study critically analyses qualitative data from 24 stakeholders involved in municipal-level procurement and allocation of assistive and welfare technology in Sweden with a specific focus on emerging digital technology. An extant analysis framework was used: the World Health Organization-GATE 5P framework for strengthening access to AT. Recommendations are made for agile procurement and an outcome-based decision frame. The voice of the AT user may be a valuable addition to inform policy.

I Know My Rights! A Longitudinal Study of Discrimination due to Physical Inaccessibility from the Perspective of Wheelchair Users.

It is a fundamental right to be able to access society and the services in it. From the perspective of disability rights, people with mobility-related disabilities who use wheelchairs must have equal opportunities to participate in and contribute to society - whether it is school, work, or (activity) leisure. This ongoing study is a longitudinal document study with qualitative content analysis. The document study is based on incoming complaints of discrimination due to inaccessibility received by the DO in Sweden, 2015-2023. The study explores how the users of wheelchairs and scooters experience discrimination due to their inaccessibility, using the ICF framework, among reported complaints to the DO from 2015-2023. The preliminary results show an increase in the number of complaints about discrimination across the entire period of 2015-2023. Responding to peoples' lived perspectives has often been cited as crucial to understanding how inclusion and exclusion play out in real life. A more accessible world depends on the extent of our knowledge and the politics of knowing-making, according to recently published research. Analyzing complaints about lack of accessibility over time generates essential knowledge for how discrimination against people who use wheelchairs can be prevented. This project also contributes to essential knowledge for social sustainability, economic sustainability, and a sustainable, accessible environment for people who use wheelchairs.

The struggle for access - a qualitative document study of how people using wheeled mobility devices experience exclusion and discrimination.

PURPOSE: The overall aim of this study was to describe experiences of discrimination due to inaccessibility among people using mobility devices. MATERIAL AND METHODS: We conducted a thematic qualitative analysis of 88 complaints about wheeled mobility device use, inaccessibility, and discrimination submitted to the Swedish Equality Ombudsman (DO) during 2015 and 2016. RESULTS: The analysis resulted in three themes: instigating change by invoking laws and regulations and highlighting lack of compliance; demanding to be recognised, understood, and listened to; and struggling for equal access and social participation. Regulations and treaties were invoked as the basis for complaints by people using mobility devices regarding their lack of access to physical environments and impediments to their enjoyment of their full right to participate in and contribute to society. The complaints described feelings of discrimination, the disadvantages and exclusion due to physical inaccessibility, and experiences of being prevented from living one's life as others do. CONCLUSIONS: Complaints filed by people using mobility devices showed that they were denied access to a wide range of contexts, including offices, theatres, restaurants, schools, and public transportation, though they desired to live an active and social life outside their homes. Filing a complaint was a way to take action, highlight present inaccessibility, and express a hope for change.IMPLICATIONS FOR REHABILITATIONDifficulties experienced by people using wheeled mobility devices can reveal knowledge important for revising existing design and renovation standards for housing and public buildings.Documenting facilitators and barriers in different environments is important for giving voice to the needs of wheeled mobility device users and revealing standards that need to be strongly enforced or revised.People using wheeled mobility devices should be supported in finding solutions in inaccessible environments, both to fulfil their wishes and to enable their participation in society.

Decision-Making Is in the Making! Aspects of Decision-Making in the Area of Assistive and Welfare Technology-A Qualitative Study.

Assistive and welfare technology (AT/WT) has been introduced as a way of facing an ageing population and providing support for older adults in their daily lives. There is much research concerning the assessment and recommendation of AT/WT to individual end-users. However, few studies have explored AT/WT decision-making from a managerial perspective. This study explores what aspects influence decision-making in assistive technology organizations concerning new technology procurements. The study is based on interviews with 24 managers engaged in assistive technology organizations, representing 13 of 21 regions in Sweden. The interview data consisted of the participants' experiences deciding on AT/WT procurement. A reflexive inductive thematic analysis was used to identify aspects that influenced decision-making. The main findings show that decision-making is in the making, meaning that decision-making is a constant on-going managerial process. Furthermore, the findings show that managers experience uncertainty in the decision-making, sometimes make ad hoc decisions and request an evidence-based, person-centred approach to improve decision-making. The study concludes that supportive, technology, patient, and knowledge aspects influence managers' decisions.

The concept of welfare technology in Swedish municipal eldercare.

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.IMPLICATIONS FOR REHABILITATIONThe research findings show that implementing welfare technologies in municipal eldercare must include transformed working processes and long-term strategies or they may lead to conflicts of priorities or unstructured implementation processes.Structured implementation processes and coherent evaluation models are needed for equality of access and availability of welfare technologies in municipal eldercare.High staff turnover negatively affects the deployment of welfare technology and the root cause of high staff turnover needs to be addressed.

Views of Swedish Elder Care Personnel on Ongoing Digital Transformation: Cross-Sectional Study.

BACKGROUND: Swedish municipalities are facing demographic challenges due to the growing number of older people and the resulting increased need for health care services. Welfare technologies are being launched as possible solutions for meeting some of these challenges. OBJECTIVE: The aim of this study was to explore the perception, experimentation, evaluation, and procurement of welfare technology practices among professionals working in municipal elder care in relation to their gender, age, and profession. METHODS: Data for this explorative cross-sectional study were collected from 393 responses to a web-based survey on municipal elder care in Sweden. Chi square tests were performed to determine the associations. RESULTS: The results revealed gender, age, and professional differences in perspectives of municipal elder care workers. Differences were particularly evident in attitudes toward technology, both the use of technology in general and in the workplace, and involvement and participation in decision making regarding the procurement of new welfare technologies. Men (37/53, 70%) expressed a more positive attitude toward and curiosity regarding new technologies than women (157/336, 46.7%) (P=.03). Regarding age, the younger respondents (18-24 years old) perceived the digital transformation in the workplace as "too slow" (4/4, 100%), whereas the majority of older respondents (65-74 years old) perceived it as happening at the "right pace" (4/7, 57%). The elder care personnel felt encouraged by management to explore and experiment with new welfare technologies, but never did so either for management or with patients. Even though the majority of the respondents were women, more men (4/7, 57%) were involved in the procurement process for welfare technology devices and solutions than women (98/336, 29.2%) (P<.001). CONCLUSIONS: Personnel working within municipal elder care were generally very positive toward new technologies. However, both gender and age differences may influence these perspectives such as the personnel's resistance to welfare technology and patients' participation in welfare technology usage and deployment. Different levels of participation in the decision-making process regarding new technology deployment may negatively affect the overall digital transformation within municipal elder care.