Digital Tools and Care Practices: Technology Utilisation Amon Caregivers in South African Old Age Homes

Technical Summary: Digital Tools and Care Practices Among Caregivers in South African Old Age Homes

Problem Statement
The study addresses the growing complexity of elderly care in the era of the Fourth Industrial Revolution, specifically within the context of South Africa's low- and middle-income setting. While digital health technologies (mHealth, telemedicine, electronic health records) offer potential for improved coordination and care delivery, their implementation in under-resourced rural and urban facilities remains problematic. The research identifies a critical gap: caregivers often lack sufficient training, infrastructure, and financial resources to utilize digital tools effectively. This digital divide is exacerbated by high data costs, poor network coverage, intermittent electricity, and low digital literacy. Consequently, despite the theoretical benefits of digital health, practical impact is limited, potentially leading to reduced care quality and increased isolation for both caregivers and the elderly. The study posits that without targeted intervention, the shift to digital care environments may deepen existing social and economic inequalities.

Methodology
The research employed a qualitative, exploratory, descriptive, and contextual design grounded in the Technology Acceptance Model (TAM) and the Ubuntu philosophical framework. The study utilized an Engaged Scholarship approach to co-create knowledge with participants.

• Setting: Two elderly care facilities were selected to represent contrasting demographics and infrastructures: one in an urban area and one in a rural area.
• Participants: Thirteen caregivers were selected via purposive sampling. The cohort included three males and ten females, aged between 38 and 51, with varying educational backgrounds ranging from home-based care certificates to nursing diplomas.
• Data Collection: Data were gathered over two months through individual, semi-structured, face-to-face interviews lasting 25–30 minutes. Interviews were audio-recorded, and field notes were taken.
• Analysis: Data were analyzed using Tesch's eight-step method for qualitative data analysis. Trustworthiness was ensured through peer review, member checking, an audit trail, and persistent engagement with participants.
• Ethical Considerations: Ethical clearance was obtained from the University of South Africa, with additional permissions from the Department of Social Development and facility management. Anonymity was maintained through coded identifiers.

Key Findings
Thematic analysis revealed six main themes and several sub-themes regarding caregivers' attitudes, knowledge, and experiences:

1. Acceptance and Reliance on Personal Devices: Caregivers demonstrated a positive attitude toward technology but relied almost exclusively on personal mobile phones for work-related tasks (communication, information search, medication verification). Facilities provided no institutional devices, airtime, or data support, forcing caregivers to bear these costs personally.
2. Perceived Usefulness:
   • Care Enhancement: Technology was viewed as critical for emergency response (calling ambulances), medication management (using Google to understand prescriptions), and family coordination.
   • Social and Emotional Support: Digital tools were used to reduce isolation among residents through music, videos, and video calls with family members.
   • Administrative Efficiency: Mobile phones facilitated faster communication, record-keeping, and resource procurement (e.g., accessing grocery specials via social media).
3. Perceived Ease of Use: Caregivers found mobile technologies intuitive and immediate, noting that they allowed for multitasking and faster information retrieval compared to traditional methods.
4. Infrastructure and Financial Barriers: Significant barriers included unstable electricity (particularly in rural kitchens), poor network coverage, and the high cost of data relative to income. In urban settings, the removal of landlines by employers further restricted communication options.
5. The Ubuntu Context: The study highlighted that while technology is useful, it must not replace the relational, human-centric nature of care. Caregivers emphasized that technology should support, not supplant, the emotional and spiritual bonds inherent in the Ubuntu philosophy ("I am because you are").
6. Training Gaps: Despite a willingness to use technology, participants highlighted a lack of formal training and digital literacy, particularly regarding specialized health tracking applications and online safety.

Key Contributions
The paper contributes to the field by:

• Providing empirical evidence of the specific barriers (infrastructural, financial, and educational) facing South African caregivers in both rural and urban old age homes.
• Demonstrating that despite low formal education and resource constraints, caregivers possess a strong intrinsic motivation to adopt technology to improve care quality.
• Integrating the Ubuntu framework with the Technology Acceptance Model (TAM) to propose a culturally grounded perspective on digital inclusion, arguing that digital systems must foster communal bonds rather than exacerbate isolation.
• Identifying the specific role of caregivers as the primary enablers of technology use for elderly residents, a role currently unsupported by institutional policy or funding.

Significance and Claims
The study claims that its primary significance lies in informing the development of a caregiver training programme. By mapping the current knowledge, attitudes, and experiences of caregivers, the research aims to create a curriculum that empowers caregivers to use technology efficiently. The authors assert that such a programme will not only enhance the quality of elderly care (through better communication, emergency response, and emotional support) but also offer opportunities for the professional growth of caregivers through digital competence.

The paper modestly concludes that while digital health holds transformative potential, its realization in South Africa requires addressing structural inequalities and centering the lived experiences of caregivers. It recommends future studies to explore the attitudes of the elderly themselves regarding the use of technology by their caregivers. The research does not propose new applications or experimental technologies but rather advocates for policy changes and training strategies that align with the existing realities of under-resourced care facilities.