Ethical challenges with welfare technology: a review of the literature

Employees' attitudes towards welfare technology in substance abuse treatment in Finland

Aim:

The significance of welfare and health technology has been highlighted in recent years. However, employees’ attitudes towards welfare technology in substance abuse treatment have received little attention. This article examines employees’ readiness to introduce welfare technology in substance abuse treatment and their attitudes towards its use.

Design:

The theoretical framework of this study is based on Ajzen’s (1991, 2001) theory of planned behaviour, and the ongoing discussion about the adoption of new technology in healthcare. The research data (N = 129) were collected in the form of an electronic questionnaire in Finland in 2015.

Results:

The results are consistent with the theory of planned behaviour and previous studies on the acceptance of information systems in healthcare. Employees’ readiness to introduce new welfare technology applications and devices in substance abuse treatment is influenced by their personal appreciation of welfare technology, the expectations of their colleagues and supervisors, as well as their own perceptions of their capacity to learn to use the applications.

Conclusions:

The study found some links between demographic factors and cognitions related to welfare technology. In particular, employees with a healthcare background are more inclined to adopt the technology than other employees in substance abuse treatment. In addition, a person’s age has a negative relationship with their perceived technology management. However, age has no significant connection with attitudes and no direct independent effect on the readiness to introduce a new welfare technology. Lastly, the results show that previous positive experiences of welfare technology make it easier to introduce new technologies.

Exploring resistance to implementation of welfare technology in municipal healthcare services - a longitudinal case study

Background

Industrialized and welfare societies are faced with vast challenges in the field of healthcare in the years to come. New technological opportunities and implementation of welfare technology through co-creation are considered part of the solution to this challenge. Resistance to new technology and resistance to change is, however, assumed to rise from employees, care receivers and next of kin. The purpose of this article is to identify and describe forms of resistance that emerged in five municipalities during a technology implementation project as part of the care for older people.

Methods

This is a longitudinal, single-embedded case study with elements of action research, following an implementation of welfare technology in the municipal healthcare services. Participants included staff from the municipalities, a network of technology developers and a group of researchers. Data from interviews, focus groups and participatory observation were analysed.

Results

Resistance to co-creation and implementation was found in all groups of stakeholders, mirroring the complexity of the municipal context. Four main forms of resistance were identified: 1) organizational resistance, 2) cultural resistance, 3) technological resistance and 4) ethical resistance, each including several subforms. The resistance emerges from a variety of perceived threats, partly parallel to, partly across the four main forms of resistance, such as a) threats to stability and predictability (fear of change), b) threats to role and group identity (fear of losing power or control) and c) threats to basic healthcare values (fear of losing moral or professional integrity).

Conclusion

The study refines the categorization of resistance to the implementation of welfare technology in healthcare settings. It identifies resistance categories, how resistance changes over time and suggests that resistance may play a productive role when the implementation is organized as a co-creation process. This indicates that the importance of organizational translation between professional cultures should not be underestimated, and supports research indicating that focus on co-initiation in the initial phase of implementation projects may help prevent different forms of resistance in complex co-creation processes.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-016-1913-5) contains supplementary material, which is available to authorized users.

Patients’ moral views on coercion in mental healthcare

Background:

Coercion in mental healthcare has led to ethical debate on its nature and use. However, few studies have explicitly explored patients’ moral evaluations of coercion.

Aim:

The purpose of this study is to increase understanding of patients’ moral views and considerations regarding coercion.

Research design:

Semi-structured focus-group and individual interviews were conducted and data were analysed through a thematic content analysis.

Participants and research context:

A total of 24 adult participants with various mental health problems and experiences with coercion were interviewed in 2012–2013 in three regions of Norway.

Ethical considerations:

Ethical approval and permissions were obtained according to required procedures. Informed consent and confidentiality were also secured.

Findings:

Ethical considerations regarding coercion included seven main themes: the need for alternative perspectives and solutions, the existence of a danger or harm to oneself or others, the problem of paternalism, the problem of discrimination and stigma, the need for proportionality, the importance of the content and consequences of coercion and concerns about way that coercion is carried out in practice.

Discussion:

The participants’ views and considerations are in line with previous research and reflect the range of normative arguments commonly encountered in ethical and legal debates. The study accentuates the significance of institutional factors and alternative voluntary treatment opportunities, as well as the legal and ethical principles of proportionality and purposefulness, in moral evaluations of coercion.

Conclusion:

Broader perspectives on coercion are required to comprehend its ethical challenges and derive possible solutions to these from a patient perspective.

Ethical analysis in HTA of complex health interventions

BACKGROUND

In the field of health technology assessment (HTA), there are several approaches that can be used for ethical analysis. However, there is a scarcity of literature that critically evaluates and compares the strength and weaknesses of these approaches when they are applied in practice. In this paper, we analyse the applicability of some selected approaches for addressing ethical issues in HTA in the field of complex health interventions. Complex health interventions have been the focus of methodological attention in HTA. However, the potential methodological challenges for ethical analysis are as yet unknown.

METHODS

Six of the most frequently described and applied ethical approaches in HTA were critically assessed against a set of five characteristics of complex health interventions: multiple and changing perspectives, indeterminate phenomena, uncertain causality, unpredictable outcomes, and ethical complexity. The assessments are based on literature and the authors' experiences of developing, applying and assessing the approaches.

RESULTS

The Interactive, participatory HTA approach is by its nature and flexibility, applicable across most complexity characteristics. Wide Reflective Equilibrium is also flexible and its openness to different perspectives makes it better suited for complex health interventions than more rigid conventional approaches, such as Principlism and Casuistry. Approaches developed for HTA purposes are fairly applicable for complex health interventions, which one could expect because they include various ethical perspectives, such as the HTA Core Model® and the Socratic approach.

CONCLUSION

This study shows how the applicability for addressing ethical issues in HTA of complex health interventions differs between the selected ethical approaches. Knowledge about these differences may be helpful when choosing and applying an approach for ethical analyses in HTA. We believe that the study contributes to increasing awareness and interest of the ethical aspects of complex health interventions in general.

Technologies in older people’s care

Background:

The tension between care-based and technology-based rationalities motivates studies concerning how technology can be used in the care sector to support the relational foundation of care.

Objectives:

This study interprets values related to care and technologies connected to the practice of good care.

Research design:

This research study was part of a development project aimed at developing innovative work practices through information and communication technology.

Participants and research context:

All staff (n = 18) working at two wards in a care facility for older people were asked to participate in interviews, and 12 accepted. We analysed the data using latent content analysis in combination with normative analysis.

Ethical considerations:

The caregivers were informed that participation was voluntary and that they could drop out at any time without providing any explanation.

Findings:

Four values were identified: ‘presence’, ‘appreciation’, ‘competence’ and ‘trust’. Caregivers wanted to focus on care receivers as unique persons, a view that they thought was compromised by time-consuming and beeping electronic devices. Appraising from next-of-kin and been seen as someone who can contribute together with knowledge to handle different situations were other desires. The caregivers also desired positive feedback from next-of-kin, as they wanted to be seen as professionals who have the knowledge and skills to handle difficult situations. In addition, the caregivers wanted their employer to trust them, and they wanted to work in a calm environment.

Discussion:

Caregivers’ desire for disturbance-free interactions, being valued for their skills and working in a trustful working environment were interpreted as their base for providing good care. The caregivers’ arguments are based on caring rationality, and sometimes they felt the technological rationality interfered with their main mission, providing quality care.

Conclusion:

Introducing new technology in caring should support the caring relationship. Although society’s overall technology-based approach may have gained popularity as a problem solver, technology-based rationality may compromise a care-based rationality. A shift in attitudes towards care as a concept on all societal levels is needed.

INTEGRATING ETHICS IN HEALTH TECHNOLOGY ASSESSMENT: MANY WAYS TO ROME

Objectives: The aim of this study was to identify and discuss appropriate approaches to integrate ethical inquiry in health technology assessment (HTA).

Methods: The key question is how ethics can be integrated in HTA. This is addressed in two steps: by investigating what it means to integrate ethics in HTA, and by assessing how suitable the various methods in ethics are to be integrated in HTA according to these meanings of integration.

Results: In the first step, we found that integrating ethics can mean that ethics is (a) subsumed under or (b) combined with other parts of the HTA process; that it can be (c) coordinated with other parts; or that (d) ethics actively interacts and changes other parts of the HTA process. For the second step, we found that the various methods in ethics have different merits with respect to the four conceptions of integration in HTA.

Conclusions: Traditional approaches in moral philosophy tend to be most suited to be subsumed or combined, while processual approaches being close to the HTA or implementation process appear to be most suited to coordinated and interactive types of integration. The article provides a guide for choosing the ethics approach that appears most appropriate for the goals and process of a particular HTA.

A passive positioning alarm used by persons with dementia and their spouses--a qualitative intervention study

Background

Increasingly, information and communication technology is being used to support persons with dementia living at home and their relatives. The aim of the present intervention study was to describe and explore the use and experiences of using a passive positioning alarm, over time, in daily life among persons with dementia and their spouses.

Methods

Using an ethnographically inspired approach, five couples, each including a person with Alzheimer´ s disease and his/her spouse living in their own home, were repeatedly observed and interviewed regarding their experiences of using a passive positioning alarm. Interview text transcripts and field notes were analyzed using qualitative content analysis.

Results

The main findings show changes over time, where testing and checking the passive positioning alarm successively led to trust in the alarm and in one own´s ability to use it. These components were a prerequisite for the couples to perceive the value of the alarm.

Conclusions

A passive positioning alarm for persons with dementia and their spouses needs to be packaged as a “service” with flexibility for each user and based on user needs, abilities, knowledge and skills. Using a passive positioning alarm can be a valuable support that allows persons with dementia to be alone outdoors and can increase safety and security for them and their spouses. The present study contributes to our understanding of what prerequisites need to be in place and what barriers need to be dealt with before successful implementation can occur.