Technology for disabled adults in care: a realist review and evaluation

Abstract

Introduction: Technology is increasingly used as a tool to close the gap in unmet support needs for disabled adults in residential care settings (RCS). While previously used to streamline and empower the workforce, more precise information was needed for technology to be a successful tool for disabled people to use themselves. Disabled technology users identified independence, autonomy, social inclusion, and wellbeing and satisfaction as key outcomes to describe in detail. Methods: This research employed a critical realist disability studies methodology to understand how disabled people were experiencing technology while living in RCSs. In a realist review and evaluation, evidence from 193 academic and grey papers was synthesised with data from five focus groups and 22 interviews for a total of 75 participants to generate four causal context-mechanism-outcome configurations (CMOCs), statements describing the precise context elements that generate positive technology outcomes. Results: Critical foundations in physical infrastructure, financial pathways, leadership, and technology knowledge and skills underpinned all positive technology outcomes studied. Independence was enhanced through compatible assistive technology and access methods, alongside a shared understanding of independence. Technology enabled autonomy by empowering people with independent control combined with support that incorporated opportunities for using technology rather than relying on person-delivered support. The inclusion of leisure activities in support plans facilitated social inclusion by enabling people to pursue interests and control their engagement. Effective utilisation of well-suited assistive technology fostered increased fluency, resulting in the accomplishment of complex goals and enhanced overall wellbeing and satisfaction. Conclusion: This research underscored the transformative potential of technology as a tool to fill unmet support needs when used by disabled people. It described the conditions for success which should be considered and invested in in policymaking, organisational technology delivery and integration planning, and in the practice of providing professional support services for disabled people.