When I imagine getting older, I imagine being in my own home
with a cat, maybe some plants, and I've been led to believe
that technology will help me to achieve this goal. But then I
had to wonder, how did I, and so many others get this as the
ideal for what it means to be getting older? In this talk,
Independence for Whom? A Critical Discourse Analysis of
Onboarding of a Home Health Monitoring System for Older
Adult Care. We will explore this and other questions like it.
Now, when we think about technology, particularly
technology for care as Storer and Branham have pointed out,
oftentimes this has been framed and created around this sort of
medical model. And then when we look at technologies
specifically for older adults, this then is where we see ageism
kind of come into play. And this then trickles down into how we
market technologies for older adults. So a lot of the language
that was used to describe the design is then used to describe
the system to potential participants. And this is
particularly true
hfor smart home technologies that are being used for home as
home health technologies. So these technologies are then
being used to help with monitoring health at a distance
and are said to provide companionship for older adults.
But then one has to wonder, does the discourse that we use to
market and onboard a home health monitoring system actually match
with the ousehold care practices as they are being performed? And
the system that we research was designed to record data from
multiple sensor points.
And then generate data insights through an AI system. Users
could then access these data insights through an application
or a web dashboard, their Voice Assistant or a wearable device
that they were given. Now this system was created without our
input. We were brought in sort of as independent researchers to
explore the positives and potential negatives of this
system. So by coming in as a sort of independent research
group, we wanted to establish
what was the dominant discourse that was being used to sort of
create the narrative around the system? And then what was the
subordinate discourse or that discourse that was being
affected by that dominant discourse? So first we looked at
how the research group talked about their products. So we
looked at their website content, the system overview that they
provided to participants, and then the how to guide to using
their voice assistance. This was then sort of
added to or supplemented by observing the onboarding process
done by a technician and then if participants had any questions,
looking at those other technician follow up sessions
and this is what created sort of what we determined was the
dominant discourse.
So to contrast this data, we had eight participants or five
households and we did three interviews with them each. So
there was first an entry interview which was done before
they got the system, the onboarding interview which was
done after they were onboarded by a technician and then finally
we did an initial use interview which was done after they got
the system and had used it for a bit.
This was then used to create the subordinate discourse that we
used to compare and see how it was affected by the dominant
discourse. We began our work by categorizing the dominant
discourse, and this was done by comparing the language that was
used by the research group to other commercially available
products that were marketed and advertised to older adults and
the public, and these were ones that had a similar nature to the
one that we were specifically looking at.
This then led to three categories. So this was the
three terms that were often used in marketing or advertising of
these systems. So Independence, Safety and Peace of Mind.
Next, we then had to understand, well how did the dominant
discourse affect the subordinate discourse in such a short span
of time. And to do this we can look at one term. So if we look
at the term Independence. So in the dominant discourse,
independence is thought of as this positive/negative continuum
where independence is versus dependence. And there's two ways
we can look at this so economic cost. So the more money you
have, the more independent you are, the less money you have,
the more government subsidies you might need, and the more
dependent
you are on others. The same can be said for labor. If you are
healthier, you might not need so much care assistance, but the
more your health deteriorates, the more care you might need and
the more labor cost is used.
So this is then reflected in the research group's website. So to
describe their system they say it empowers older people to keep
their independence at home. However, by using this sort of
terminology to keep, they are sort of framing it as without
this system you will not be able to be independent. So there is
sort of this necessity to technology that is then added to
sort of this continuum of independence versus dependence.
But then when we look at our participants, so particularly
Ben and his wife/carer Beth, the way that they sort of thought of
independence and their health independence was that they would
take a collective approach to care management. So when they
would talk about technology that they used for care, they would
use first person individuals. So I have a machine for this, but
then when they talked about actually the care management on
how they actually used the information or use the machines,
they would use first person collective.
So we go to the doctor, we check the vitals, that sort of
language. However, then when they got the system, we slowly
saw that their need to rely on Technical Support disrupted
their sort of collective care approach. As Ben said, typically
if there's anything I don't understand medically, I put it
over to Beth and she can read and she can interpret what we
have to do. But I felt it fell short on a lot of information
because if I'd had that information I wouldn't have
needed
the technician, but I did.
So oftentimes Ben who was a former engineer would take
control of sort of the the technical aspects of things and
that was his role in their sort of collective care approach.
However, with the system this was not possible and they became
more dependent on the technician to help them.
While through Ben and Beth's experience we can see sort of
more how over a short span of time this independence gets
deteriorated, we also saw this effect in our other households.
As we saw with Carl and his wife Carol, the system actually
caused Carl to become more dependent on Carol. As Carl
said, the only way I can get my data is to wait until Carol is
around so that she can have a look at the dashboard. So
because Carl was unable to use technology and use an
application or a smartphone.
He was not able to access his data. Now, we know that
discourse can affect how we describe design and how we
actually design systems. But what hasn't been explored yet,
and what we explored in our research was how that discourse
can affect our users. Besides creating expectations, discourse
can also influence how a system is used. So for instance, this
system that we researched innocently sort of suggested
that door sensors could be placed on a refrigerator to help
with monitoring
food intake. Now if this is used by someone who's potentially has
nefarious intentions, this could then be used in an abusive way
to prevent a person from accessing food.
Furthermore, if during the onboarding process a user is
told and demonstrated that the system is accurate and they
should rely on the system, they might then distrust someone,
another user on the system who says no, I didn't go to the
bathroom 20 times last night, there must be something wrong
with the system. So that can then disrupt and break down sort
of these interpersonal relationships.
One way to sort of remedy this is to think that the onboarding
and participant facing materials should then better reflect and
encourage this collaborative care approach.
We then also encourage other researchers to apply critical
discourse analysis as a methodology when they are trying
to look at and analyze the language that they're using to
describe or onboard a system to participants.
So I encourage you to think about what you write in text and
how you on board a system to participants because the
language that you use can affect how they will interpret that
system, they expectations they will create around that system
and then potentially how they will use that system. Thank you
so much for listening to my talk and thank you in advance for any
questions. I look forward to meeting some of you at Kai.