Navigating through technological landscapes : Views of people with dementia or MCI and their significant others

Abstract: The general aim of this thesis was to increase knowledge about people with MCI or dementia and their significant others, particularly as users of everyday technology and assistive technology (AT). The overall aim included increasing knowledge about the interactions between people with MCI or dementia and their significant others, and technology. In Study I the psychometric properties of the Everyday Technology Use Questionnaire (ETUQ), when used with older adults with and without cognitive deficits, were investigated using the Rasch rating scale model. Study II compared the perceived relevance of and difficulty in using everyday technology, measured with the ETUQ, in people with mild-stage dementia, people with MCI, and older adults without known cognitive impairment, using one-way ANOVA analyses. In Study III, actions and driving forces of the agents involved in the process of introducing AT to people with dementia were explored, using a case study methodology combined with grounded theory. Study IV explored and described how significant others of people with dementia related to technology, and their readiness to use AT together with the person with dementia, using a grounded theory approach with focus groups and individual interviews. The findings of Study I suggested that the ETUQ demonstrates acceptable validity in terms of internal scale validity and person response validity, when used in this population. The ETUQ showed sensitivity in detecting differences between three subgroups in perceived difficulties in everyday technology use. Study II showed significant differences in perceived difficulty in everyday technology use between all three groups. Here everyday technology was perceived most difficult by people with dementia, followed by people with MCI, and older adults without known cognitive impairment. It also suggested that older adults with MCI or dementia experienced fewer technology artifacts and services as relevant to their daily lives, as compared to older adults without knowncognitive impairment. In Study III, Doing the right thing was the main driving force among actors in this AT intervention process. However, as conflicting views appeared of what the right thing to do was, findings suggest that it is important to be attentive to who has decision power, as this person is likely to influence the process profoundly. Study IV s findings showed that the significant others took a utilitarian perspective on technology, as they refused technology for technology s sake but showed an overall readiness toward using technology if they considered it to benefit them and their relatives with dementia. Technology was found to be important for keeping an active lifestyle and for creating and maintaining self-images among people with dementia and their significant others. The thesis contributed new knowledge about the perceived relevance of and difficulty in everyday technology use in older adults, particularly in those with MCI or dementia. Findings also indicate that the ETUQ is a tool that generates valid, sensitive measures of perceived difficulty in everyday technology use, and valuable information about its perceived relevance that may support researchers and clinicians. The thesis contributed new knowledge about the complex situation of a person with dementia and his/her significant others when AT is introduced in the home, suggesting the need of a more flexible and process-oriented procedure with ends-in-view instead of clearly set goals. Significant others of people with dementia were found to be generally ready to adopt technology, although they took a utilitarian perspective. Technology was perceived by them as important for keeping an active lifestyle and for creating and maintaining self-images, which suggests that such conceptions should be considered. Finally, the thesis contributes knowledge of design-related principles and conditions that may be decisive in transactions between people with dementia andtechnology. It is suggested that what is communicated through the interface of the technology isparticularly crucial, as this is likely to guide the person through suitable use, whereas instructions are likely to be forgotten.