title: SCALS: a fourth-generation study of assisted living technologies in their organisational, social, political and policy context.
abstract: BACKGROUND
  Research to date into assisted living technologies broadly consists of 3 generations: technical design, experimental trials and qualitative studies of the patient experience. We describe a fourth-generation paradigm: studies of assisted living technologies in their organisational, social, political and policy context. Fourth-generation studies are necessarily organic and emergent; they view technology as part of a dynamic, networked and potentially unstable system. They use co-design methods to generate and stabilise local solutions, taking account of context.
  
  
  METHODS
  SCALS (Studies in Co-creating Assisted Living Solutions) consists (currently) of 5 organisational case studies, each an English health or social care organisation striving to introduce technology-supported services to support independent living in people with health and/or social care needs. Treating these cases as complex systems, we seek to explore interdependencies, emergence and conflict. We employ a co-design approach informed by the principles of action research to help participating organisations establish, refine and evaluate their service. To that end, we are conducting in-depth ethnographic studies of people's experience of assisted living technologies (micro level), embedded in evolving organisational case studies that use interviews, ethnography and document analysis (meso level), and exploring the wider national and international context for assisted living technologies and policy (macro level). Data will be analysed using a sociotechnical framework developed from structuration theory.
  
  
  BACKGROUND
  Research ethics approval for the first 4 case studies has been granted. An important outcome will be lessons learned from individual co-design case studies. We will document the studies' credibility and rigour, and assess the transferability of findings to other settings while also recognising unique aspects of the contexts in which they were generated. Academic outputs will include a cross-case analysis and progress in theory and method of fourth-generation assisted living technology research. We will produce practical guidance for organisations, policymakers, designers and service users.
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: Trisha
authors.initials: T
authors.lastname: Greenhalgh
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: Sara
authors.initials: S
authors.lastname: Shaw
authors.affiliation: Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK.
authors.forename: Joe
authors.initials: J
authors.lastname: Wherton
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: Gemma
authors.initials: G
authors.lastname: Hughes
authors.affiliation: Department of Politics and International Studies, University of Warwick, Warwick, UK.
authors.forename: Jenni
authors.initials: J
authors.lastname: Lynch
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: Christine
authors.initials: C
authors.lastname: A'Court
authors.affiliation: Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK.
authors.forename: Sue
authors.initials: S
authors.lastname: Hinder
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: Nick
authors.initials: N
authors.lastname: Fahy
authors.affiliation: Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Byrne
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: Alexander
authors.initials: A
authors.lastname: Finlayson
authors.affiliation: Department of Politics and International Studies, University of Warwick, Warwick, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Sorell
authors.affiliation: Department of Computer Science, University of Warwick, Warwick, UK.
authors.forename: Rob
authors.initials: R
authors.lastname: Procter
authors.affiliation: Sociology and Criminology Department, University of Western Sydney, Sydney, Australia.
authors.forename: Rob
authors.initials: R
authors.lastname: Stones
mesh_terms: D000884:Anthropology, Cultural; D006801:Humans; D057187:Independent Living; D007407:Interviews as Topic; D057766:Policy; D011057:Politics; D015397:Program Evaluation; D036301:Qualitative Research; D012944:Social Support; D013672:Technology / Q000379:methods* / Q000458:organization & administration; D006113:United Kingdom
keywords: co-design; new models of care; organisational case study; structuration; telecare; telehealth