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Implementing eHealth solutions in informal care

By Nikita Sharma Published 10.11.2020

Informal caregiving is a process of providing care to loved ones who are unable to care for themselves. This process, at times, takes a toll on the physical, emotional, and social well-being of caregivers. The burden on informal caregivers will increase as the elderly population is rising at an alarming rate. To ease this burden, external help or assistance that can help in the care process is required. In response to this requirement, various eHealth solutions have been explored and suggested for elderly care. These solutions include mobile applications for behavior changes like medication reminders, wearable sensing solutions like wrist bands, and use of wireless sensing environments like smart homes. The use of these solutions can potentially reduce in-person monitoring time while ensuring quality care by alerting caregivers in an emergency. For example, the Gator Tech smart house project aimed to create a sensing environment by using a combination of sensors (like pressure sensor in floors for determining user position and orientation, RFID in power plugs for monitoring use of electrical devices in the house, etc.) to support the independent living of elderlies [1]. This smart house is capable of providing real-time information about people living in the house to their caregivers. Such systems can help in determining the early onset of diseases by communicating the recorded physical and physiological data of elderlies to healthcare practitioners. These advantages show the potential of eHealth solutions in in-home care provided their effective implementation.

Here implementation means the process of putting these early-stage (prototypes) solutions into real-life uses. It depends on a lot of factors like the reliability of the intended system and the ease with which it can fit into the user’s life. These factors might differ from person to person but for sure they will lie in two big bubbles of user perspective (in this case elderlies and caregivers) and technology maturity (growth attainted by technologies). With these two bubbles, one more aspect that plays an important role in effective implementation is industrial commitment (the willingness of the industries to develop these products). Industries act as a bridge between new technology and the target user group. Thus, for successful implementation, these three major factors can be considered.  

User Perspective:

Recently, more weightage is given to the perspective of the user while researching and developing new technology. In a focus group study by Steele et. al., it was shown that elderlies are concerned about the influence of technology on their independence and quality of life [2]. Other than these factors, concerns like cost, social implication, confidentiality, support available after purchasing the device also add to the acceptability of any new technology. So, if the user’s perspective is considered from the beginning the chances of successful implementation will enhance. For accounting user’s views frameworks like the technology acceptance model (TAM), Centre for eHealth, and Wellbeing Research (CeHRes) roadmap were created and are also actively adopted by new projects [3,4]. These frameworks help in ensuring human-centered development and implementation of eHealth solutions.

Technology maturity:

This measures the growth attained by technology by accounting a multitude of technical factors. For example, healthcare continuously leverages the advantages of sensing technology for in-hospital care in form of medical investigations (like ECG), life-sustaining implants (like intelligent prosthesis) but it is still considered as a novice and less reliable when it comes to in-home preventive measures (like the use of sensors for avoiding or helping in fall situation). This indicates that the sensing technology in in-home care has not attained the technical maturity hence more research work in attaining reliance on technology is required. For example, rigorous testing in a real-life setting can be done to establish the reliability of the systems. Apart from this, we need solutions that are adaptable and scalable. For determining these crucial factors, assessment of systems by using existing implementation frameworks (like NASSS) that can indicate the technical maturity of the system beforehand is advised. The NASSS (non-adoption, abandonment, scale-up, spread, sustainability) framework can identify the adoption rate of identified technological solutions and suggest a plan to implement, scale-up, or discard the technology [5]. 

Industrial commitment:

Industries are an integral part of the whole implementation process. Their interest partially decides the fate of new technology. After the research process, industries should take a step ahead for providing opportunities to emerging technologies. Startups like No isolation, Nectarine Health, birdie, are working to provide smart solutions for elderly care. For example, no isolation’s KOMP is a technology-friendly one-button screen that enables frequent communication with family members. With startup, the growing aging population demands the participation of multi-national technology companies for designing and developing products. With their participation, the implementation process can be made much more effective and faster. 


While we are continuously thriving to update our care system by introducing new technical interventions, parallel work is needed to build the faith of stakeholders (elderlies, informal caregivers, formal caregivers, and industries) to give an unbiased chance to these emerging eHealth solutions. This can be done by taking a step-by-step approach, starting from obtaining the user’s perspective followed by improving technical aspects to involving industries.

Recommended Readings:

1. Helal, S., Mann, W., El-Zabadani, H., King, J., Kaddoura, Y., & Jansen, E. (2005). The gator tech smart house: A programmable pervasive space. Computer, 38(3), 50-60.
2. Steele, R., Lo, A., Secombe, C., & Wong, Y. K. (2009). Elderly persons’ perception and acceptance of using wireless sensor networks to assist healthcare. International journal of medical informatics, 78(12), 788-801.
3. Davis, F. D. (1989), "Perceived usefulness, perceived ease of use, and user acceptance of information technology", MIS Quarterly, 13 (3): 319–340, doi:10.2307/249008, JSTOR 249008
4. Van Gemert-Pijnen, J. E., Nijland, N., van Limburg, M., Ossebaard, H. C., Kelders, S. M., Eysenbach, G., & Seydel, E. R. (2011). A holistic framework to improve the uptake and impact of eHealth technologies. Journal of Medical Internet Research, 13(4): e111. 
5. Greenhalgh, T., Wherton, J., Papoutsi, C., Lynch, J., Hughes, G., Hinder, S., ... & Shaw, S. (2017). Beyond adoption: a new framework for theorizing and evaluating

About the author: Nikita Sharma, is an early-stage researcher and a Ph.D. candidate at NEDAP and University of Twente. Her Ph.D. project is to facilitate Implementation of unobtrusive sensing for elderly care.