Older persons’ experience of eHealth services in home health care: A meta-ethnography eHealth services in home health care

Abstract

This study aimed to describe older persons’ experiences of eHealth services in home health care. A meta-ethnographic approach was applied, and a systematic literature search was conducted in three databases. In total, 11 articles were included and analysed, which resulted in two themes and six sub-themes. The results show that for older persons to use the eHealth services, they must provide some additional value compared to current contacts with healthcare professionals. Those with regular healthcare contact do not experience the eHealth service as adding anything to the care they already receive. The introduction of eHealth services involves learning how to use the new technology, and some older persons experience the technology as motivating and inspiring. The eHealth service makes some feel safer while some do not trust the technology. In order to make the best use of eHealth services, it is important that the services are adjusted not only to each person’s needs but also to their personal capabilities and resources, while the older person must feel valued as an active partner in the care process. Thus, when using eHealth services, the older person’s perspective needs to be given priority and decisions should not only be based on organizational considerations.

Keywords

eHealth experiences home health care older persons

Introduction

Global demographic trends such as the increasing number of persons 60 years and older ^1–4 are challenging health care due to growing requests for home-based health care.³ Even if many older persons enjoy relatively good health into their later years, they often live with one or more chronic conditions and are in need of help with various activities if their independence in their own homes is to be ensured.⁵ Home health care takes place in the older person’s home and depends on the collaboration of various people who can play active roles, such as family members and healthcare professionals.⁶ However, the current home healthcare system has its limitations. The consequences of these limitations and the chronic nature of cognitive impairment result in individual care needs for many older people.⁷ To improve the quality of care, more frequent care that targets individual needs seems to be what is needed.⁸ A possible solution to the need for improved home health care is the use of eHealth services.^9,10 eHealth services are defined as ‘health services and information delivered or enhanced through the internet and related technologies’.¹¹ They include the use of information and communication technologies (ICT) in supporting health.¹² In this study, we define eHealth as the use of ICT in home health care as used either by the older person him/herself or by the healthcare professional. There are a variety of eHealth services that can be used to enhance the quality of life of persons who have reduced health capacity. eHealth services can be central in providing support to family members through enhancing access to information and community resources and to connections with formal and informal support services.⁵ Research^14,15 indicates, for example, that the use of eHealth in home health care is successful in supporting older persons with cognitive impairment and their caregivers through the earlier detection of needs, increased self-monitoring and the encouragement of the resulting independence.^13,14 Despite promising results regarding the use of eHealth services in the elderly population, the implementation of eHealth can be difficult as older persons are often unfamiliar with this type of technology.

Various eHealth service frameworks show the importance of involving users early in the development process to get their perspective during continuous and systematic evaluations.¹⁵ Nearly 1.5 billion, or 22% of people worldwide, use the internet regularly.¹⁶ However, increased internet use has not yet resulted in the greater use of eHealth technologies in chronic disease populations.¹⁷ Sociodemographic factors, including age, gender, socioeconomic status^18,19 and a lack of user-friendly interfaces have been identified as key barriers to eHealth use among older persons,²⁰ and the challenge is to design systems that are acceptable and can be used effectively by older people.²¹ eHealth services can facilitate the management of complex comorbidities, and as older persons represent the most frequent users of home health care,³ an integrated and interpreted understanding is important. Therefore, this meta-ethnography aims to describe older persons’ experiences of eHealth services in home health care.

Methods

Meta-ethnography as described by Noblit and Hare²² was applied in this study. Meta-ethnography is used for reviewing and synthesizing the findings of published qualitative research. Noblit and Hare describe meta-ethnography as being primarily an interpretive and inductive process that aims to develop new conceptual understanding, that is, it ‘seeks to go beyond single accounts to reveal the analogies between the accounts’ (p.13). The method includes three phases that are conducted in sequential order: systematic literature search, quality appraisal and synthesis of findings.

Systematic literature search

The systematic literature search was conducted in the following three databases: (i) PubMed, (ii) Cumulative Index to Nursing and Allied Health Literature (CINAHL) and iii) Scopus. The search strategy was developed in collaboration with a health science librarian and conducted during August and September of the year 2019. The search terms were identified according to the aim of the study and finally lead to four search blocks: (i) aged, (ii) experiences, (iii) eHealth and (iv) home health care. In each search block, keywords were combined with the Boolean operator OR, and the final search combined the blocks with the Boolean operator AND. In CINAHL and PubMed, indexed search terms, MeSH and CINAHL headings, as well as non-indexed keywords were used. In Scopus, only keywords were used since Scopus does not have indexed search terms.

In total, 921 articles were identified following the database searches and through manual searches (see Figure 1). At the title and abstract level, 869 articles were read, and were assessed as being duplicates or not relevant to the study’s aim. Finally, 52 articles were read at full-text level of which 41 articles were excluded, resulting in 11 articles for quality appraisal.

Figure 1.

Flow diagram.

Quality appraisal

The remaining 11 articles were quality appraised by using the Critical Appraisal Skills Programme (CASP).²³ CASP is widely used among researchers in nursing science to ensure that articles are of sufficiently high quality.²⁴ Quality appraisal is an increasingly common practice in the work of meta-synthesis. All the articles included in the study were assessed through CASP to be of sufficiently high quality (see Table 1), and a summary presenting the main features of each article has been compiled in Table 2.

Table 1.

Overview of quality appraisal using CASP for the included studies.

	CASP screening questions for qualitative studies
	1. Was there a clear statement of the aims of the research?			2. Is a qualitative methodology appropriate?			3. Was the research design appropriate to address the aim of the research?			4. Was the recruitment strategy appropriate to the aim of the research?			5. Was the data collected in a way that addressed the research issue?			6. Has the relationship between researcher and participants been adequately considered?			7. Have ethical issues been taken into consideration?			8. Was the data analysis sufficiently rigorous?			9. Is there a clear statement of findings?			10. How valuable is the research?
Answers *	Y	N	Ct	Y	N	Ct	Y	N	Ct	Y	N	Ct	Y	N	Ct	Y	N	Ct	Y	N	Ct	Y	N	Ct	Y	N	Ct	Y	N	Ct
Studies: Author (s)/year
Algilani et al. 2017	Y			Y			Y			Y			Y				N		Y			Y			Y			Y

Currie et al. 2015	Y			Y			Y			Y			Y					Ct	Y			Y			Y			Y

Ehn et al. 2018	Y			Y			Y			Y			Y			Y			Y			Y			Y			Y

Göransson et al. 2017	Y			Y			Y			Y			Y			Y			Y			Y			Y			Y

Holmströom et al. 2015	Y			Y			Y			Y			Y			Y			Y			Y			Y			Y

Jakobsson et al. 2019	Y			Y			Y			Y			Y			Y			Y			Y			Y			Y

Lindström vilstrup et al. 2017	Y			Y			Y			Y			Y			Y			Y			Y			Y			Y

Number et al. 2019	Y			Y			Y			Y			Y			Y			Y			Y			Y			Y

Shulver et al. 2016	Y			Y			Y			Y			Y			Y			Y			Y			Y			Y

van Middelaar et al. 2018	Y			Y			Y			Y			Y			Y			Y	—		Y			Y			Y

Waterworth et al. 2017	Y			Y			Y			Y			Y			Y			Y			Y			Y			Y
* Answers, Y=Yes, N=No, Ct=Can’t tell

Table 2.

Articles included.

Authors, year, country	Aim/eHealth services	Design/Data collection/Data analysis	Participants/Age setting	Results
Algilani S, langius-eklöf A, kihlgren A and blomberg K. (2017) Sweden	Develop and test feasibility and acceptability of an interactive ICT platform integrated in a tablet for collecting and managing patient reported concerns of older adults in home care. A platform operated by an interactive application for reporting and managing health‐related problems in real time	Mixed-method design combining interviews and logged quantitative data, analysed with content analysis	N = 8	The older adults experienced the application as meaningful with overall positive effects as well as potential benefits for the nurses involved. Acceptability of the application and management of concerns and self-care. Sub-categories of the first category were technical aspects, reporting and monitoring and content
			Five woman and three men
			Ages 67–90
			Home health care
Currie M, philip LJ and roberts A. (2015) scotland	Study older adults’ attitudes towards, current use of and acceptance of the use of technology in the management of their chronic pain	Qualitative design, semi-structured interviews, analysed with content analysis	N =7	eHealth technology use was most common amongst older adults who lived alone. There was broad acceptance of eHealth being used in future care of people with chronic pain, but older adults wanted eHealth to be delivered alongside existing in-person visits from health and social care professionals
			Ages 60–74
			Home health care
Ehn M, eriksson LC, åkerberg N and johansson AC. (2018) Sweden	Investigate how seniors experience using activity monitors (AMs) as support for physical activity (PA) in daily life. Two commercial AMs together with tablet-based apps were investigated for 9 days	Qualitative design.Activity diaries during usage and interviews after usage were exploited to gather user experience. Comments in diaries were summarized, and interviews were analysed by inductive content analysis	N = 8	By using the AMs, their awareness of their own PA increased. However, the AMs’ impact on the users’ motivation for PA and activity behaviours varied between participants. Additionally, participants reported different types of activities accomplished. To be meaningful, measurements need to provide the user with a reliable receipt of whether his or her current activity behaviour is sufficient for reaching an activity goal. Moreover, praise when reaching a goal was described as motivating feedback. To be useful, the devices must be easy to handle
			Ages 75 years or older
			Home health care
Göransson C, eriksson I, ziegert K, wengström Y, Langius‐Eklöf A, brovall M ... and blomberg K. (2018) Sweden	To explore the experiences of using an app among older people with home-based health care and their nurses. An interactive app, which included direct access to self-care advice, graphs and a risk assessment model that sends alerts to nurses for rapid management	Explorative qualitative designData were collected via interviews and analysed by thematic analysis	N = 17	The findings reveal that a process occurs. Using the app, the older people participated in their own care, and the app enabled learning and a new way of communication. The interaction gave a sense of security and increased self-confidence. The homecare nurses viewed the alerts as appropriate for the management of health concerns. However, all participants experienced challenges in using the new technology and had suggestions for improvement
			Ages 65 years or older
			Home health care
Holmström IK, nokkoudenm M-B, zukancic S and sundler AJ. (2016) Sweden	To explore older persons’ experiences of telephone advice nursing at primary healthcare centres. Telephone advice nursing provided by primary health care	A descriptive design with a qualitative inductive approachData were collected via interviews and analysed using qualitative content analysis	N = 10	The older persons’ experiences were described in two themes: The patient‐friendly aspects of telephone advice nursing and the patient‐unfriendly aspects of telephone advice nursing. The themes can be understood as two sides of the same coin; the differences point to both the advantages and disadvantages of the service and are further illuminated through seven sub-themes
			Ages 68–95
			Home health care
Jakobsson E., nygård L, kottorp A and malinowsky C. (2019) Sweden	To investigate experiences of using eHealth in contact with health care among older adults with cognitive impairment. Smartphone and phone calling computer – searching for information	A constructivist grounded theory approach was used. Individual, semi-structured interviews were conducted. Data collection and analysis were performed simultaneously using a constant comparative method	N = 9	Older adults with cognitive impairments seemed to prefer common and less complex eHealth when contacting health care. Therefore, it is necessary that health care providers offer different possibilities for patients to contact them, that is, both through the internet and by a personal telephone service
			Ages 65–84 years
			Home health care
Lindstrøm vilstrup D, elholm madsen E, fandt hansen C, wind G. (2017 Denmark	To explore the perspectives of older care recipients on the use of iPads by home care nurses for multiple purposes, such as documenting, taking pictures, and ordering and dealing with medicines	A qualitative approach based on semi-structured interviews. The organizing phase and interpretive process were conducted collaboratively by the research group using crabtree and Miller’s template method	N =7 three women and four men	Three themes emerged from the empirical data ¹: an unremarkable event, ² a symbol of professionalism, and ³ learning potential. Participants viewed nurses’ use of iPads as an everyday occurrence, reflecting societal growth in the use of technology, and some perceived it as a sign of professionalism with the potential to enhance care. Their perceptions varied somewhat according to their baseline knowledge and experience with the technology
			Ages 60–92 years
			Home health care
Number VM, bolmsjö BB, wolff M, calling S, gerward S and sandberg M. (2019)Sweden	Exploring elderly patients’ beliefs, attitudes, experiences and expectations of eHealth servicesExperiences of mobile phones as a digital tool with access to internet (smart-phones), seeking medical information online, contacting the health care system online or self-monitoring of chronic illnesses	A qualitative approach based on focus group interviews	N = 15	Elderly patients in Sweden described feelings of ambivalence towards eHealth, raising concerns about accessibility of health care, mistrust in poor IT systems or impaired ability to cope with technology. They also expressed the wish and need to move forward, albeit with reluctant curiosity
		Data were analysed with thematic content analysis	Ages 65–80 years
		Data were analysed with thematic content analysis	Home health care
Shulver W, killington M, morris C and crotty M. (2017) Australia	To examine patient experiences of home-based tele-rehabilitation. All had participated in individualized therapy programmes, using a combination of face-to-face and video consultations with therapists. The programme used ‘off-the-shelf’ technologies including iPads for video-conferencing and electronic FitBitR devices	A qualitative approach with 13 qualitative semi-structured interviews, analysed with content analysis	N = 17	Thematic analysis resulted in five emergent themes: (i) Tele-rehabilitation is convenient; (ii) tele-rehabilitation promotes motivation and self‐awareness; (iii) tele-rehabilitation fosters positive therapeutic relationships; (iv) mastering technologies used by younger relatives is a valued aspect of tele-rehabilitation; and (v) tele-rehabilitation does not replace traditional face‐to‐face rehabilitation therapies
			Ages 60–92
			Home health care
Waterworth S, raphael D, parsons J, Arroll B and gott M. (2018) new zeeland	To determine which aspects of primary nurse-patient telephone communication are viewed positively or negatively in terms of meeting the older person’s needs	Semi-structured interviews: Face-to-face and one telephone interview. Thematic analysis was informed by a constructivist grounded theory approach	N = 21Ages 66–90Home health care	The overarching theme was the difficulties older people face in making decisions about whether to contact a health professional by telephone and whether this should be the primary care nurse. Accounting for some of their symptoms as age-related added to the uncertainty of decision‐making. Importantly, some older people were not raising concerns, e.g. about their emotional state
Van middelaar T, beishuizen CRL, guillermont J, barbera M, richard E, moll van charante EP. (2017) Netherlands	To study older peoples’ experiences with an interactive internet platform for cardiovascular self-management; to assess which factors influence initial and sustained engagement; to assess their views on future use within primary care	Qualitative designData were collected with semi-structured interviews and analysed with thematic analysis	N = 20Ages 65 years and over home health care	In the initial phase, platform engagement was influenced by perceived computer literacy of the participants, user-friendliness, acceptability and appropriateness of the intervention and the initial interaction with the coach. Sustained platform use was mainly facilitated by a relationship of trust with the coach. Other facilitating factors were regular automatic and personal reminders, clear expectations of the platform, incorporation into daily routine, social support and a loyal and persistent attitude. Perceived lack of change in content of the platform could work as both stimulating and discouraging. Participants supported the idea of embedding the platform into the primary care setting

Synthesis

The synthesis process was based on the approach described by Noblit and Hare.²² The findings sections of the articles were read through repeatedly by three of the researchers in order to get an understanding both of the whole and of the specific details of each article. The researchers noted the interpretative metaphors, that is, the terms, concepts, phrases and expressive quotations. In the next phase, the researchers juxtaposed the findings to make their initial assumption of the relationships between these findings. In this phase, a data extraction template was conducted and the findings of each article were summarized independently. The researchers found that the content was analogous. In the next phase, the extracted findings were related to one another, involving a systematic search for similarities and differences. The last phase, synthesizing translations, was an iterative and inductive process in which the researchers worked together in an ongoing process of moving forwards and backwards between the whole and the parts of the texts. Several possible interpretations were discussed, while pre-existing concepts were re-created into new ones. Finally, after several critical reflections, consensus was achieved between the authors and resulted in six sub-themes that were further synthesized into two themes.

Results

This meta-ethnography aimed to uncover knowledge about older persons’ experiences of eHealth services in home health care. The results are presented under two themes, each with its own underpinning sub-themes.

Overview and context of included articles

The summaries and context of the articles included are presented in Table 2. 11 studies published in scientific journals between 2016 and 2019 were included in this meta-ethnography. Six were conducted in Sweden with one each from Australia, Denmark, Netherlands, New Zeeland and Scotland. A total of 137 older persons were included (75 women and 58 men). The gender of the three participants in the study from Scotland was not reported. The samples varied between 7 and 21 participants with a gender distribution of 33–75% women and 25–67% of men. All participants were between 60 and 101 years old.

Theme 1: eHealth services as a complement to personal visits

This theme and its sub-themes relate to older persons’ responses to being offered the use of eHealth services. For older persons to want to use the eHealth service, it had to provide some added value to their current contacts with healthcare professionals. In regular healthcare contacts, the eHealth service was not experienced as adding anything beyond the care they already received.

Variations in need for eHealth services

The results show that older persons’ experiences of eHealth services varied in relation to their needs. Persons who perceived a limited need also made limited use of the eHealth service.^25,26 They tended to follow their usual routines and did not change their habits in order to adapt to the eHealth service. Being monitored by a system had no impact on their performance. There were other things that did motivate them, such as incipient health problems.²⁵

To those who were aware of their risk status and were motivated to achieve lifestyle changes, the eHealth service was experienced as relevant. Furthermore, self-care advice, self-management and self-measuring of cardiovascular risk factors were considered to be useful and interesting.^26,27

Older persons who regarded their existing contact with their healthcare provider as being sufficient²⁶ experienced no need for the eHealth services,^25,28 and to them, the eHealth service offered no additional benefit. Some were interested in digital solutions, but others preferred to receive an ordinary letter rather than an electronic message.²⁹ If they had a question or wanted to speak to a specific professional, leaving a voice message did not appeal.³⁰

The need to be in charge

Any use of the eHealth service provided had to be on the older person’s own terms. They did not want to feel controlled, monitored or pushed into something that they did not choose themselves,²⁵ nor should the required activities be too time-consuming.²⁶ Waiting for a call back or not being able to call a specific professional on a direct number made some older people feel that they lacked control, and they viewed the eHealth service as an inconvenience.^30,31 Older persons were more inclined to engage in the eHealth services when they could incorporate them into their daily routines and complete them at their own pace.^26,27

A controversial complement

The convenience of some eHealth services was appreciated by older persons. Videoconferences and tele-rehabilitation were accepted as supplementary to face-to-face contacts to save time and having to travel.³² Especially for those with disabilities, the eHealth services could serve as a complement to personal visits. On the downside, access to eHealth services could mean fewer or no face-to-face contacts. If the older person knew the healthcare professional initially, before they started using the eHealth services, and if they knew who was receiving their call or measurements, this facilitated their use.^26,28,30 Some older persons stated that they did not experience any major difference between meeting in a videoconference versus face-to-face. On the contrary, they felt that they were given more time, that it was easier to ask questions and that the eHealth service did not negatively affect the therapeutic relationship. Others experienced talking to a screen as inconvenient and preferred to meet the professional in-person.^28,32 Some older persons even felt resistant to calling healthcare providers on the phone, and this meant that certain concerns were not discussed over the phone.^30,31

Theme 2: The use of eHealth services as a challenge

For many of the older persons, the introduction of an eHealth service meant that they had to learn how to use new technology. While some of the older persons experienced this as a major trial, others experienced the new technology as both motivating and inspiring, and the use of the eHealth services had a ripple effect. For many older persons, the eHealth service made them feel safer, but some did not trust the technology to work when needed.

Technological endeavour

EHealth service systems were sometimes experienced as complicated, and technical problems, to a varying extent, could affect the older person’s use of the service. Their lack of experience with new technologies and with the internet could also complicate their use.²⁵ Some of the older persons described how they were anxious about crashing the tablet or the application,²⁷ while others found the telephonic nursing advice difficult to follow, and they had negative experiences of the communication.³¹ Furthermore, using internet platforms was experienced as time-consuming.²⁶ Technical challenges made older persons feel daunted, uncertain, discouraged and incompetent, and this could hamper their continued use of the eHealth service.^25,26,31,32

Motivational and inspiring

For some older persons, the use of technology and the eHealth services was experienced as motivating and inspiring.^26,27,32,33 Many older persons found the eHealth services easy to handle²⁵ and that only very basic ICT skills were needed.³⁴ The eHealth service was regarded as technically free from problems even though the older persons experienced some minor problems, such as entering the wrong pin code or forgetting to charge the device.²⁷ Older persons who used eHealth services to measure their physical activity experienced that, when used in combination with goalsetting,²⁵ the activity monitors and scheduled video consultations influenced their motivation in a positive way.³² A clear, simple and attractive website increased the motivation of older persons to use an interactive internet platform for cardiovascular self-management.²⁶ In some cases, the use of the service also inspired the older person to use the technology for fun, such as surfing the internet.³³

Lack of trust in eHealth services

Being able to contact a nurse through a secure eHealth service was considered important by the older persons and was seen as having the potential to improve care. However, the use of some of the eHealth services created uncertainty and concern lest the wrong information was registered. Older persons expressed concerns about the safety of video consultations³² and described difficulties in trusting the telephonic nursing advice. Furthermore, there were uncertainties about whether the technology was reliable and functioning correctly. Waiting for a response often created uncertainty and caused the older person to wonder if the information they had entered into the system had really gone through.³¹ Some of the older people became worried that they might have pressed the wrong number or buttons and therefore would not be called back. Not knowing if or when they would be called back together with the waiting time were seen as inconveniences that impacted their everyday lives and routines. Increased availability in the form of direct numbers would improve their experience.^30,31 The importance of having reliable eHealth services in place for contacting a nurse was described.³⁰ The nurse’s use of an iPad in the older person’s home was experienced as both reassuring and professional.³⁵

Discussion

The results show that personal contact was a prerequisite for using the eHealth services. For an older person to be prepared to use the eHealth service, it has to provide some added value to their current contacts with healthcare professionals. Many older persons did not experience that the eHealth service added anything to the care they already received. The Health Authority³⁶ states that those persons who have access and knowledge of the eHealth area have greater influence and participation in their care, and the most important factors in the development of internet services for older people to utilize are support, needs, positivity, interest and ease of access.³⁷ This highlights the importance of support in the implementation of eHealth services in home-based care. Findings show that older persons experience eHealth services as both challenging and motivating. While some experience them as providing safety, others do not dare to trust the technology. The participants also want eHealth service use to be based on their own terms and not be something imposed on them that they cannot control. If the eHealth service is already included in their daily life, it is easier for them to become engaged. These findings are confirmed in a scoping review³⁸ from the fields of gerontechnology and home-based care, and show both advantages and disadvantages in relation to the experience of safety when using technology. This suggests that ethical considerations need to be taken into account when implementing eHealth services in home-based care. One possible approach that could be used in nursing care is to systematically apply the principles of person-centred care.³⁹ In order to make the best use of the eHealth services, it may be important to adjust the services not only to each person’s needs but also to their personal capabilities and resources while valuing the older person as an active partner in their own care. Thus, when using the eHealth services, the older person’s perspective needs to be given priority, and decisions must not only be based on organizational considerations. This is especially important as research^40,41 has pointed out that older persons have limited possibilities for influencing and making decisions about the content of their home-based care. This is in contrast with the Swedish Patient Act,⁴² which claims that the patient has freedom of choice regarding care and the right to influence their own care. This act was introduced with the purpose of strengthening the patient’s rights and position in health care. Therefore, an ethical approach must be observed when designing, testing and implementing eHealth services in home-based care.

Methodological considerations

One strength of this study is the comprehensive literature search strategy employed. Three databases were searched, based on the different focus of each as relevant to this study’s aim. The databases included cover the areas of nursing, medicine and technology, and all were deemed to be appropriate to the study. Another strength is that the search strategy included both indexed and non-indexed search terms, as well as manual searches of the reference lists of the included articles. Despite the comprehensive search strategy, some relevant articles may have been missed due to the different indexing systems of the databases. All the included studies were checked by the CASP screening questions for qualitative studies. Only articles published in the English language were included, which possibly narrowed the search results. Since there seem to be relatively few articles describing older people’s experience of eHealth services in home health care, there is value in compiling existing articles to get insight into this knowledge area.

Opinions differ regarding whether it is necessary to conduct quality appraisal of articles to be included in meta-ethnography.⁴³ Polit and Beck²⁴ suggest that articles included in meta-ethnography must, at the least, have utilized appropriate methods, and the findings must be supported by the participants’ experiences in the form of quotations. We contend that a certain level of quality appraisal is needed, and we chose a frequently-used instrument for our quality appraisal. Hence, CASP²³ was used to for the quality appraisal of all articles included, and our results confirm the satisfactory quality of the articles.

Another strength is that three researchers with different research expertise conducted the analytical process. Regular reflections and discussions on the analysis were held by all researchers. These discussions brought multiple perspectives on the study’s phenomena into the interpretations, enhancing the trustworthiness of the findings. Furthermore, the analytical process has been described in detail, which makes it possible for the reader to follow its trail, clarifying its transparency.

Conclusion

In order to make the best use of eHealth services, it is important that the services are adjusted not only to each person’s needs but also to their personal capabilities and resources, while the older person must feel valued as an active partner in the care process. Thus, when using eHealth services, the older person’s perspective needs to be given priority and decisions should not only be based on organizational considerations.

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Terese Lindberg

Ewa K Andersson

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