Philosophical position | Instrumental rationality | Phenomenology | Critical theory | Pragmatism |
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What is considered to be of value? | Efficiency, cost-effectiveness, rational solutions, technological progress, business success | Feelings, experiences, relationships, reciprocities | Emancipation, reduction in oppression/domination | Adoption, assimilation into business-as-usual, sustainability |
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Usual unit of analysis | Technology (product) | Person, technology-in-use | Interest group/conflict situation | Service model, organisational routine |
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Methodological approach | Experimental | Naturalistic | Historical | Naturalistic |
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Preferred research design | Randomised controlled trial (hypothesis-driven, deductive), emphasis on size and scale and production of generalisable truths | Ethnography, in-depth interview, focus group (qualitative, inductive), emphasis on understanding the individual's perspective | Case study (qualitative, inductive), emphasis on surfacing and challenging power struggles | Case study (qualitative or mixed-method, inductive), emphasis on explaining barriers to change |
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What is viewed as ‘research evidence’? | Effect size, metrics (eg, mortality rates, admission/readmission rates), ‘proof of concept’ | Authentic, plausible account of lived experience and the meaning of technology from users' perspective | Contextualised account of power struggles | Contextualised account of change (or lack of change) |
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Assumed characteristics of technologies | Automated, ‘smart’/‘intelligent’, sophisticated (eg, robotic), ubiquitous, seamlessly connected, failure-free, agentic (ie, does things) | Potentially stigmatising or constraining, prone to failure, needing human input to work effectively. May be low-tech for example, recycled everyday objects | Benefits inflated by marketing and commodification by an industry biased towards high-tech, ‘innovative’ products | Focus on technology-in-use. Hence, same technology will have different utility in different systems and contexts |
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Metaphor for technology development | Developing and implementing technological solutions | User-centred design or redesign | Manipulation of the market | Creating opportunities for system redesign |
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Metaphor for technology use | Deployment, choice, empowerment, compensation for human deficits | Being-in-the-world, technology ready-to-hand | Commodification | Acceptance, adoption |
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Assumption of what people will use telehealth/telecare technologies for | ‘Self-monitoring’—sending biometric data to health professionals | Communicating with friends/family, maintaining autonomy, leisure activity | Many people/services will buy these technologies but few will use them | Supporting routines (personal, family, healthcare provider) |
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Metaphor for how technologies are taken up | Business drivers, regulatory levers, innovation value chain, silver market | Creative, adaptive and perhaps heroic human effort | Market domination | Routinisation |
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Assumed consequences of (widespread) use of telehealth/telecare technologies | ‘Demographic time bomb’ will be contained; healthcare costs will fall; people will be healthier and happier; new markets for assistive products and services will boost the economy | Positive: can support independent living. Negative: may reduce/replace human contact, cause stress, medicalise the life-world, become the ‘patient’ when they break down | Public funds diverted into private business. Loss of service-sector jobs and traditional services (eg, district nurses). Institutionalised ageism inscribed in technology | Organisational tasks and processes made more efficient; staff time freed up to do other work; health outcomes improved |
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Non-use of telehealth/telecare technologies explained in terms of | Education gap, motivation gap, awareness gap, incentive gap | Uniqueness and complexity of individual circumstances; meaning of technology | Resistance to domination | Individual-, organisational- and sector-level barriers to change |
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