Welfare technology a paradoxical path forward for home care services

The overarching aim of this thesis is to generate insights into how welfare technology (WT) is experienced, perceived, and interpreted by users and other relevant stakeholders within a home care context. In this thesis, WT is defined as municipally provided digital technologies intended to support security, independence, activity, and participation in individuals with, or at risk of developing, a disability. Digital caregiver technologies are also included in this definition. WT is often framed as a category of technology expected to enhance efficiency and alleviate human and economic resource pressures within health and social care, particularly in the Nordic countries. Specific examples of WT are digital safety alarms, digital medication robots, digital locks, administrative care applications, and intelligent bidet toilets.
This thesis draws on empirical data from four separate studies conducted in municipalities across Sweden between the years 2022-2025. The four studies are embedded within a larger research project entitled “Welfare@home” and employ three methods: qualitative interviews, a quantitative cross-sectional survey, and qualitative research circles. Corresponding analyses comprise thematic analysis, binary logistic regression, and qualitative content analysis. Participants in studies I and II included older adults with WT and home care service staff (N = 52); study III included older adults with WT (N = 414); and study IV included older adults, municipal staff, technology researchers, and technology developers (N = 25).
Five categories make up the thesis findings: 1. Oscillating experiences of agency in WT use; 2. Similarities and differences in how stakeholder and user groups perceive WT; 3. Paradoxes in WT use; 4. Facilitating (digitally competent) human contact in the home care context; and 5. WT experiences and time. Each analytical dimension offers theoretical and practical insights into contemporary digital care contexts. The findings particularly resonate with paradox theory, which emphasizes the need to address both the enabling and constraining effects of WT through a both/and, rather than an either/or, orientation. The original contribution of this thesis lies in its mapping of user and stakeholder perspectives on WT into paradoxes, which suggest that a more reflexive, contradiction-embracing approach to WT design and implementation could enhance the overall advantages it provides to users.
One of the thesis’s main conclusions is that it may be necessary to reframe the questions underpinning the development and implementation of WT by shifting the focus not only toward how it can enhance efficiency in home care, but also toward what forms of care it ought to enable and sustain.