Case study 2 - GPS tracking
Co-producing GPS tracking technology for people with dementia (Adult Social Care, assistive technology and telecare service)
Issues of ‘wandering’ or becoming lost outside are among the most frequent problems faced by people living with dementia. Technologies based on Global Positioning Systems (GPS) can constantly give a person’s position online, thus enabling carers to track and locate the person with dementia outside their home. These technologies can be configured to raise alerts if the wearer exits predefined ‘safe zone’ or leaves the home at certain times.
At this case site, we are working with Adult Social Care teams to support effective implementation and use of GPS solutions. There are a number of challenges to the successful use of such technology. For example, users must remember to wear the device, it must be charged daily, and a ‘responder’ must be available and able to find the wearer in the event of an alert. In addition, it requires a greater degree of configuration, such as geographical and temporal parameters that enable sufficient freedom, while providing safety and reassurance.
This project seeks to understand the challenges of using GPS tracking solutions and establish how the care service can provide and support workable GPS solutions through co-production. Co-production is a participatory design approach that focuses on user-centred ‘design-in-use’ of both the technology and ways of working with it, through continually feeding back users’ experiences and practices into ongoing design and development process.
STUDY DESIGN AND METHODS
This organisational case study has involved ethnography and action research with service staff (and their collaborators), service users with dementia and their carers. The ethnography explored the work practices in the provision of GPS tracking, and challenges faced by professional staff (e.g. occupational therapists, technicians, call centre monitors, technology suppliers), users and carers during implementation and use.
The action research component involved JW being directly involved in supporting users and addressing problems with the technology provided. Five cases were enrolled in this phase of the study, in which the researcher worked alongside service staff to help resolve issues and improve the solution in place for the client, while also generating generic insights to feed into organisational learning. Each case provided a context to understand organisational processes and work practices involved, highlighting broader organisational challenges that would need to be addressed.
The research has highlighted a number of areas, in which greater attention needs to be paid for the development and provision of GPS tracking solutions.
Wandering as a meaningful and fulfilling practice: In all cases, it became evident over time that engagement in wandering was a meaningful and worthwhile activity for that person (and that different individuals found different kinds of meaning and fulfilment from wandering). ‘What mattered’ to the individual powerfully shaped the ways in which the GPS technology was used, This perspective contrasts with the biomedical perspective of wandering, which seeks to establish underlying cognitive deficits (e.g. ‘disoreinttion’, ‘disinhibition’, ‘agitation’) and attempts to control such behaviour, with an emphasis on risk management. Knowledge of the person’s social and cultural histories is an important part of understanding the meaningful and purposeful aspects of their wandering behaviour, and how application and configuration of the device can support this.
Coordination and collaboration: The case studies highlighted that ‘articulation work’ (the ability to co-ordinate resources, actions and people to deal with local contingencies and unanticipated situations) across different people and organisations is needed for maintaining the technology in ‘working order’”. This articulation work does not merely supplement formal procedures, but also involves informal or ‘invisible’ work that is largely unrecognized at service level. It is therefore important to facilitate new ways for health and social care professionals and lay carers to communicate and share information, monitor use, and collaboratively manage the customization and configuration of devices.
Human relationships and situated knowledge: The technology solutions relied heavily on human relationships and situated knowledge of the person and their wider care network. Various uses and configurations of the GPS technology were shaped by the differing interpretations of the risks associated with wandering, which were socially situated and influenced by different (and often changing) knowledge, values and beliefs among carers. The formation of personal relationships was also important in dealing with the complex social and ethical issues related to use of GPS tracking devices. This included ways to talk about and represent the technology so as to not disrupt the person’s dignity, but also address issues of acceptability and continued use.