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SCALS: a fourth-generation study of assisted living technologies in their organisational, social, political and policy context
  1. Trisha Greenhalgh1,
  2. Sara Shaw1,
  3. Joe Wherton2,
  4. Gemma Hughes1,
  5. Jenni Lynch3,
  6. Christine A'Court1,
  7. Sue Hinder2,
  8. Nick Fahy1,
  9. Emma Byrne2,
  10. Alexander Finlayson1,
  11. Tom Sorell3,
  12. Rob Procter4,
  13. Rob Stones5
  1. 1Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  2. 2Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK
  3. 3Department of Politics and International Studies, University of Warwick, Warwick, UK
  4. 4Department of Computer Science, University of Warwick, Warwick, UK
  5. 5Sociology and Criminology Department, University of Western Sydney, Sydney, Australia
  1. Correspondence to Professor Trisha Greenhalgh; trish.greenhalgh{at}


Introduction Research to date into assisted living technologies broadly consists of 3 generations: technical design, experimental trials and qualitative studies of the patient experience. We describe a fourth-generation paradigm: studies of assisted living technologies in their organisational, social, political and policy context. Fourth-generation studies are necessarily organic and emergent; they view technology as part of a dynamic, networked and potentially unstable system. They use co-design methods to generate and stabilise local solutions, taking account of context.

Methods and analysis SCALS (Studies in Co-creating Assisted Living Solutions) consists (currently) of 5 organisational case studies, each an English health or social care organisation striving to introduce technology-supported services to support independent living in people with health and/or social care needs. Treating these cases as complex systems, we seek to explore interdependencies, emergence and conflict. We employ a co-design approach informed by the principles of action research to help participating organisations establish, refine and evaluate their service. To that end, we are conducting in-depth ethnographic studies of people's experience of assisted living technologies (micro level), embedded in evolving organisational case studies that use interviews, ethnography and document analysis (meso level), and exploring the wider national and international context for assisted living technologies and policy (macro level). Data will be analysed using a sociotechnical framework developed from structuration theory.

Ethics and dissemination Research ethics approval for the first 4 case studies has been granted. An important outcome will be lessons learned from individual co-design case studies. We will document the studies’ credibility and rigour, and assess the transferability of findings to other settings while also recognising unique aspects of the contexts in which they were generated. Academic outputs will include a cross-case analysis and progress in theory and method of fourth-generation assisted living technology research. We will produce practical guidance for organisations, policymakers, designers and service users.

  • telehealth
  • telecare
  • new models of care
  • co-design
  • organisational case study
  • structuration

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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