Negotiating Care and Control: Domestication of Smart Home Health Technologies in Chinese Multigenerational Households

Technical Summary: Negotiating Care and Control in Chinese Multigenerational Households

Problem Statement
Smart home health technologies (SHHTs) are increasingly promoted to support "ageing in place," risk detection, and home-based eldercare in China. While existing literature extensively covers individual acceptance, usability, and technical readiness, there is a significant gap in understanding how these monitoring technologies are negotiated within the complex relational dynamics of Chinese multigenerational households. In this context, eldercare is deeply shaped by intergenerational co-residence, adult children's caregiving obligations, and the moral expectation of filial responsibility. SHHTs do not enter a neutral domestic space; they become embedded in existing relationships of authority, privacy, and emotional dependence. A device interpreted by adult children as a tool for protection may be experienced by older parents as supervision or a loss of autonomy. This study addresses the lack of research on how families decide to use these devices and how older adults and caregivers negotiate the meanings of monitoring, safety, privacy, and dignity.

Methodology
This qualitative study employed a multi-sited household design to examine SHHT use in 30 Chinese households across urban, county-level, rural, and peri-urban areas. The sample included older adults (aged ≥65) and their primary caregivers (adult children, spouses, grandchildren, or family caregivers). Data collection involved:

• Semi-structured interviews: Conducted separately with older adults and primary caregivers (30–90 minutes each), focusing on daily routines, health conditions, device introduction, usage experiences, and family negotiations.
• Non-participant home observations: Documenting device placement, visibility, signs of use, and family-device interactions.
• Data Analysis: Thematic coding and cross-case comparison were performed using NVivo. The analysis was guided by an integrated theoretical framework combining Domestication Theory (appropriation, objectification, incorporation, conversion), Affordance Theory (perceived possibilities for action), and Care Ethics (moral and emotional meanings of care).

Key Contributions
The paper contributes to three primary theoretical domains:

1. Domestication Theory: It reinterprets the domestication of health technologies within Chinese family care, demonstrating that appropriation is often child-initiated rather than user-driven. It extends the concept of "objectification" to include moral classification of domestic spaces (safety zones vs. dignity-sensitive zones) and highlights that "incorporation" generates new forms of family labor (data interpretation, maintenance) rather than simply reducing burden.
2. Affordance Theory: It establishes that SHHT affordances are relationally distributed. The same technological feature (e.g., a camera or sensor) affords safety and reassurance to caregivers while simultaneously affording exposure, surveillance, and loss of autonomy to older adults.
3. Care Ethics: It analyzes filial responsibility as a "double-edged" moral force that motivates care but also legitimizes monitoring and unequal decision-making, creating moral pressure on older adults to accept devices to avoid causing children anxiety.

Results
Five key themes emerged from the analysis of the 30 household cases:

1. Child-Initiated Appropriation: SHHTs were rarely introduced by older adults themselves. Adoption was typically triggered by adult children's concerns regarding risk (falls, fire), chronic illness management, distance-care anxiety, or the inability to contact parents. Older adults often accepted devices reluctantly, viewing them as a necessary compromise to alleviate children's worry.
2. Domestic Placement as Boundary-Making: Families negotiated spatial boundaries to manage privacy. Public spaces (living rooms, kitchens, entrances) were generally accepted as "safety zones" for monitoring. In contrast, private spaces (bedrooms, bathrooms, beds) were treated as "dignity-sensitive zones." Even hidden sensors (e.g., under-mattress) were sometimes rejected if they intruded on intimate routines.
3. From Alerts to Routines: SHHTs transformed care from reactive verbal checking to proactive, data-driven routines. This included daily app checking, blood pressure recording, and responding to alerts. However, this incorporation created new maintenance burdens for families, including managing false alarms, battery life, and network connectivity.
4. Relational Affordances: The study found a dual character in technology-mediated care. For caregivers, devices provided "remote presence" and reduced uncertainty. For older adults, the same devices created a sense of being watched ("a pair of eyes") and led to self-discipline or behavioral modification in monitored spaces.
5. Filial Responsibility and Negotiated Control: Filial duty served as the primary moral justification for monitoring. While this facilitated the introduction of technology, it also created an imbalance in decision-making authority. Older adults often engaged in "negotiated control," accepting devices to preserve family harmony and dignity while resisting specific intrusions (e.g., refusing bedroom cameras).

Significance and Claims
The paper argues that SHHT adoption in Chinese multigenerational households is not merely a technical or individual acceptance issue but a culturally situated, emotionally negotiated, and intergenerationally contested process. The study claims that ethical smart ageing requires moving beyond individual technology acceptance models to recognize the family as the primary unit of care.

The authors assert that for SHHTs to ethically support ageing in place, they must be domesticated through:

• Meaningful older-adult participation in decision-making, rather than passive acceptance driven by filial pressure.
• Negotiable privacy boundaries that respect dignity-sensitive spaces.
• Designs that support both safety and autonomy, acknowledging that "less visible" technologies are not inherently less intrusive.

The study concludes that smart eldercare must address the tension between care and control, ensuring that technological solutions do not reduce older adults to objects of continuous family management but instead support a care arrangement where safety and dignity are jointly protected.