Independence for Whom? Critical Discourse Analysis of the Onboarding of a Home Health Monitoring System for Older Adult Care

Title of the Paper

Independence for Whom? A Critical Discourse Analysis of Onboarding a Home Health Monitoring System for Older Adult Care

Bibliographic Information

• Subject Area: Human-Computer Interaction (HCI), Health Monitoring Systems, Elderly Care
• Keywords: Elderly care, health monitoring systems, assistive technology, critical discourse analysis, social impact of care, user experience design, home monitoring, health technology, technology adoption, medical model

Research Background and Issues

• Issues and Challenges:

  • Home Health Monitoring Systems (HHMS) are often marketed as tools to enhance older adults' independence, provide safety, and offer psychological comfort, but in practice, they may undermine users' autonomy.
  • There is insufficient social discourse analysis on how monitoring technologies affect the collaborative relationships between care recipients and caregivers.
  • The language and discourse used in the design and marketing of these systems may obscure technological limitations and exacerbate power imbalances.

• Significance:

  • The aging population has accelerated the development of digital health and assistive technologies, making it crucial to understand their potential impacts on elderly care to guide future designs.
  • These technologies may contribute to a phenomenon of "institutionalization at home," contradicting the ideal of "aging in place."

• Motivation and Related Work:

  • Designs based on the medical model may lead to power imbalances between caregivers and care recipients, which is associated with older adults' reluctance to adopt or their abandonment of technology.
  • Marketing discourse about older adults often contains ageist elements and fails to accurately reflect the complexity of caregiving networks.
  • This study aims to use critical discourse analysis to examine how narratives during the promotion, onboarding, and initial use of HHMS influence users.

Solution

• Methodology:

  • Critical Discourse Analysis (CDA) was employed to analyze the contextual discourse used during the promotion and onboarding of HHMS.
  • Research methods included textual analysis (websites, brochures), participant interviews and observations, as well as feedback from actual deployment of the system in users' homes.

• Innovative Aspects:

  • Applying CDA to user interviews and studies of home health monitoring devices to identify potential ageism and power imbalances in device design and marketing.
  • Focusing on the transformation of core terms (independence, safety, psychological comfort) in promotional materials and during initial use.

• Implementation Steps:

  1. Analyze promotional texts from HHMS research teams to explore embedded medical models and ageist discourse.
  2. Conduct three rounds of interviews with participants before onboarding, during onboarding, and after system installation to summarize changes in language use.
  3. Observe interactions between users and technicians to assess whether promotional messages align with user expectations.
  4. Investigate promotional discourse of similar commercial health monitoring systems to identify mainstream narratives and opportunities for improvement.

Research Findings

Specific Outcomes

• Independence:

  • The system failed to meet users' expectations for independence. Older users became more reliant on caregivers and technical support, particularly for system setup and data access.
  • For example, manuals and setup guides were designed with caregivers, rather than care recipients, as the primary audience.

• Safety:

  • While the system's promotion emphasized "data security" and "proactive prevention," the lack of transparency regarding data access and storage left users confused about how their data was being handled.
  • Example: One older user believed her data was being continuously monitored in real-time by external observers, which heightened her anxiety.

• Psychological Comfort:

  • The technology failed to alleviate participants' psychological burdens, and certain designs even caused additional stress. For instance, malfunctions and mismatched functionalities (e.g., voice assistants only effective in fixed locations) undermined users' trust in the system's ability to provide safety.
  • Some participants felt the technology negatively interfered with existing caregiving dynamics, even straining family relationships.

Comparison with Existing Solutions and Advantages

• Compared to the optimistic promises in standard marketing language (e.g., "making life smoother"), this study reveals the complex realities of power imbalances and technological limitations in real-world usage environments.
• Extends existing research on how home health technologies may replicate "pseudo-institutionalization."

Experimental and Evaluation Results

• Data analysis showed that the introduction of HHMS disrupted participants' established collaborative caregiving models. For example, care recipients became passive dependents on the system rather than active participants in health management.
• Users frequently expressed misunderstandings, distrust, or psychological and emotional stress caused by the system during interactions.

Limitations and Future Directions

• Limitations:

  • The sample lacked cultural diversity (all participants were White), making it difficult to analyze the influence of race, culture, or other social factors on technology adoption.
  • Participants had limited access to technical support during the study (only a few instances of technical communication were provided).

• Future Directions:

  • Further exploration of cultural differences in technology adoption and the institutionalization effects of such systems.
  • Incorporating greater transparency and user collaboration elements in the design of promotional materials.
  • Adding multimodal user interfaces (e.g., screens, printer connections) to address the diverse needs of older users.
  • Drawing on the theory of "interdependence" to prioritize collaboration and information sharing in technology design and marketing.

The above content systematically summarizes the key findings of the paper, providing important guidance for the future development and research of related technologies.