Technology Utilisation Among Caregivers in South African Old Age Homes

Technical Summary: Technology Utilisation Among Caregivers in South African Old Age Homes

Problem Statement
The integration of digital health technologies into elderly care is increasingly vital, particularly in low- and middle-income countries (LMICs) like South Africa. However, the rapid shift to digital platforms, accelerated by the COVID-19 pandemic, has exposed significant gaps in infrastructure, training, and resource allocation. Caregivers in both rural and urban settings often lack sufficient digital literacy, access to reliable internet, and institutional support (such as devices or data allowances). Furthermore, existing technologies are frequently designed without consideration for low-resource environments, leading to a digital divide that exacerbates social isolation and limits the quality of care. The study addresses the specific gap in understanding caregivers' knowledge, attitudes, and practical experiences with technology to inform the development of targeted training programs.

Methodology
The study employed a qualitative, exploratory, descriptive, and contextual design.

• Participants: Thirteen caregivers were selected via purposive sampling from two facilities: one in an urban area and one in a rural area. The cohort included three males and ten females, aged between 38 and 51, with 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 conducted in private settings, audio-recorded with consent, and supported by interpreters where necessary.
• Analysis: Data were analyzed using Tesch's eight-step method for qualitative data analysis. Trustworthiness was ensured through peer review, audit trails, member checks, and persistent engagement with participants.
• Theoretical Framework: The study utilized the Technology Acceptance Model (TAM) to assess perceived usefulness and ease of use, alongside the Ubuntu philosophical framework to contextualize care within South African communal values.

Key Findings
Thematic analysis revealed six main themes, with the following critical insights:

1. Acceptance and Reliance on Personal Devices: Caregivers demonstrated a positive attitude toward technology but relied almost exclusively on their personal mobile phones for work-related tasks (communication, information search, coordination). Facilities provided no institutional devices, data, or airtime, forcing caregivers to bear these costs personally.
2. Perceived Usefulness:
   • Caregiving Enhancement: Technology was viewed as essential for emergency responses (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, video calls with family, and entertainment.
   • Administrative Efficiency: Tools facilitated faster communication, record-keeping, and resource procurement (e.g., accessing grocery specials via social media).
3. Perceived Ease of Use: Caregivers found mobile communication intuitive and effective for reassuring families and streamlining tasks. However, the "ease" was often compromised by external factors.
4. Infrastructure and Financial Barriers:
   • Rural Settings: Faced challenges with unstable electricity (impacting cooking and device charging), poor network coverage, and intermittent availability of basic office equipment (printers, desktops).
   • Urban Settings: Faced a lack of organizational support, with no landlines or institutional printing, requiring reliance on external clinics or personal funds.
   • Universal Constraint: High data costs relative to income were a significant barrier in both settings.
5. Ubuntu and Care Ethics: Participants emphasized that technology should support, not replace, the relational, human-centric nature of care. The "Ubuntu" ethos ("I am because you are") highlighted the need for technology to foster communal bonds rather than deepen isolation.
6. Training Gaps: Despite a willingness to learn, participants noted a lack of formal training in digital tools, limiting their ability to utilize advanced features beyond basic communication.

Key Contributions

• Contextual Insight: The study provides a nuanced comparison of technology utilization between rural and urban South African old age homes, highlighting that while rural facilities may have slightly more diverse hardware (e.g., desktops, landlines), they suffer more from infrastructural instability (power, network).
• Caregiver-Centric Perspective: It documents the reality that caregivers are currently self-funding their digital integration into professional duties, a critical finding for policy and management.
• Framework Integration: It successfully applies the Technology Acceptance Model (TAM) and Ubuntu philosophy to the South African caregiving context, demonstrating that cultural values and perceived utility are central to technology adoption.
• Training Programme Foundation: The primary contribution is the empirical basis for developing a caregiver training programme. This program aims to equip caregivers with digital skills, enhance their professional growth, and improve the overall quality of elderly care.

Significance and Claims
The paper claims that equipping caregivers with relevant technological skills is essential for effective elderly care in the era of the Fourth Industrial Revolution. By addressing the identified gaps in training and infrastructure, the study argues that digital health can transition from a tool of exclusion to one of empowerment.

The authors modestly state that the study's findings will directly contribute to the development of a training programme designed to:

1. Empower caregivers to use technology efficiently.
2. Enhance the quality of care for the elderly.
3. Create opportunities for professional growth for caregivers through technology use.

The study concludes that while caregivers are motivated and recognize the value of technology, structural barriers (cost, infrastructure) and skill deficits must be addressed to realize the full potential of digital health in South African elderly care. Future work suggested includes exploring the attitudes of the elderly residents themselves regarding the technology used by their caregivers.