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People working in the home health care sector are seldom consulted when development and implementation of ICT is involved and which effects their work practices. This is surprising given the assumptions of participatory design principles that have in¬fluenced Scandinavian re¬search and design work. To address this shortcoming, this thesis takes the perspective of the homecare personnel. A central purpose of the thesis is to explore care staff's participation in, experiences and knowl¬edge of the design and use of ICT in home health care services, with a special focus on care assistants. The methodological approach for this exploration is based on qualita¬tive methods and interpretive and hermeneutic perspectives applied in four different research and development projects. The empirical ma¬terial was conducted with focused interviews, undertaken work with focus groups, facilitated workshops, engaged in systematic observations and used the storyboard technique with personnel working in the home health care services. Thus a variety of participatory design meth¬ods and techniques have been used. The gathered data has been ana¬lysed using different methods: discourse analysis, the cyborg figure, thematic analysis, and reflective analysis. The findings from each analy¬sis complement each other and bring forward different perspectives. Common assumptions about participatory approaches are that partici¬pation improves workplace democracy and increases user acceptance. Nonetheless, it is not that straight forward. This research has revealed that participation involves conscious reflections on when, where, and how the users should participate in the design process. The degree of participation is an issue where the ultimate level is shared collaborative decision-making for reaching effective and high quality systems that supports the work processes. An additional issue in the design process is the quest for official power. The conducted research confirms that participatory design is difficult and takes time, participation and participatory design techniques that have been used demonstrate the complexity in the work practice and that it is not only to "get the work done". Further, if the point of de¬parture is taken in (participatory) action research and participatory de¬sign it is possible to intervene in the process and change the direction of a research and development project in order to engage all stake¬holders that are involved in the care of the client. Finally, when applying an appreciative approach, care staff were en¬abled to value their situated knowledge and how it contributes to the services delivered i.e., they were enabled to reflect on their work, learn, and share together. Findings indicate that by integrating the principles of participatory action research (PAR) in the participatory design (PD) process, the users participate during the full development process, make decisions and take part in the design work. With this degree of participation, the care staff are able to follow the whole process, reach a realistic expectation of what to expect from the de¬signed technology and additionally develop their situated knowledge about the relations between technology and work practices. ; Godkänd; 2007; Bibliografisk uppgift: Härtill 5 uppsatser; 20080211 (evan)

To meet the demands and to maintain an acceptable level of services in health and homecare, implementation and use of ICT as support for caring work, are increasing. The assumption is that technology will give rise to a large number of improvements, such as effectiveness and ability to follow up and evaluate the performance of the services provided. Representatives from government and municipalities also assume that use of technology will attract young people, raise the status and improve the whole work situation within homecare. However, people working in this area are seldom consulted when development and implementation of ICT into their work practices take place. Given the assumptions of participatory design principles that have in¬fluenced Scandinavian research and design work, this is surprising. To address this shortcoming, this thesis takes the perspective of the care assistants. The purpose of this thesis is to explore the expectations, needs, dreams, and no¬tions, care assistants have on/about ICT and homecare work. I pose five re¬search questions which will help me to understand and bring insight into those issues. To bring forward care assistants' expectations and needs, I have conducted focus group interviews with personnel working at a care resource centre in the north of Sweden. Additionally, I have studied legislations, strategies and official authority reports regarding social service in health care and homecare. My research is based on the qualitative, interpretivistic and hermeneutic ap¬proaches. The gathered data has been analysed using three different methods: content analysis, Critical Systems Heuristics and the cyborg approach. The findings from each analysis complement each other and support different re¬search questions. The conclusions point to contradictions and ambivalence and are as follows: Care assistants experienced that they have no influence over the purchase, development or implementation of ICT into their work. At the same time, care assistants were not able to express their needs when it comes to ICT, and responded with silence. However, when they discussed their concrete work and work tasks they could very well express their needs in relation to tech¬nologies. They wished for improved functions in existing technologies and improvement in organisational issues surrounding technology. I also found that care assistants' dreams and expectations on/about ICT were always ex¬pressed from the clients' perspective. This is the prevailing discourse of care and their own dreams and expectations came second. Care assistants do not believe that implementation of new technology will raise the status of their work. They emphasised increased salaries and better working conditions as a way to raise the status. They also believed that the profession needs more men in order to raise the status. On the other hand, they do not think that implementation of new technologies will attract young people, not least men, to work in care and nursing areas. Care assistants do not share the positive assumptions that representatives from government and municipalities express in regard to technology. Still, they will accept the technology when it arrives and their strategy is to deal with the problems as they occur. Assumptions and solutions of public representa¬tives are created in the discourse of technology, while the assumptions and solutions of care assistants are created in and through the discourse of care. In the "fight" of representations of realities between a dominating and a com¬peting discourse, we are perhaps witnessing what is, in effect, a revival of old and new dreams - old dreams of offering citizens welfare in terms of care and services; and new dreams, of developing and implementing new technologies in order to recruit personnel ; Godkänd; 2005; 20060928 (evan)