Implementation of exoskeletons in care work : a study of acceptance, domestication, impacts and orientation needs

Abstract

Health and care services face increasing pressure from workforce shortages and physically demanding tasks in ageing societies. Health and welfare technology (HWT) has the potential to assist care workers in various ways, yet its implementation in complex care work environments is underexplored. Successful technology implementation requires a comprehensive approach, including attention to usability, effectiveness and ethical considerations. Physically demanding postures are common in care work, even with ergonomic considerations. One of the most physically taxing tasks is transferring clients in poor physical condition within round-the-clock housing services for older adults. To address this issue, a type of wearable HWT, exoskeletons, have been introduced to support care workers by reducing their physical exertion. In Finland, musculoskeletal strain is a central challenge for care workers, and exoskeletons have the potential to reduce physical load.

This dissertation examines the key elements behind the successful implementation of HWT, especially exoskeletons in care work. Specifically, it focuses on four perspectives that are connected to implementation in practice: technology acceptance, domestication (i.e. the gradual process through which technology becomes embedded in everyday routines and social practices), social and health impacts, and orientation needs regarding exoskeleton use in care work. The theoretical foundation is built around central implementation aspects and connected to the four perspectives of the sub-studies. The dissertation examines the implementation of passive exoskeletons in Finnish health and care services. In addition to exoskeletons, other selected HWT solutions are examined. An abductive mixed-methods research approach is applied in this dissertation across four sub-studies. The participants include care workers in round-the-clock housing services for older adults as the main focus group.

The findings show that acceptance is influenced by perceived usefulness, ergonomics and enjoyment of use, alongside the reactions from colleagues and clients. While exoskeletons are generally well-experienced and accepted among care workers, there may be issues related to task planning, for example. Domestication requires attention to work tasks and practices, thorough learning and knowledge building via orientation, as well as support and motivation from colleagues and managers. Everyday constraints include remembering activation and deactivation, hygiene requirements and time pressures, while perceived benefits concentrate on support for forward leaning tasks. Social and health impacts are both positive and negative. Physical impacts, experienced mental impacts, impacts on care work practices and processes, and impacts on learning needs are associated with exoskeleton use by care workers. The research shows the intertwined and multidirectional character of the impacts. Orientation emerges as a critical enabler when it is needs-driven, continuous, tailored and supported by a clear, accessible information design.

The research contributes to implementation science by consolidating findings on acceptance, domestication, impact assessment and orientation in the care work context, emphasising the multifaceted nature of implementation. In addition, a practical implementation guide is introduced to support care organisations in planning, starting and embedding exoskeleton use. The in-depth analysis into exoskeletons produces new knowledge that is likely to be applicable more generally in HWT implementation in care work, as there are often fundamental commonalities regardless of technology. The research emphasises that successful implementation considering acceptance, domestication, impact assessment and orientation likely empowers users and contributes to their knowledge building through communication. Impacts should be considered prior to implementation, and multi-method and multi-perspective impact assessments should be conducted. HWT implementation is emphasised as a highly social activity where it is necessary to understand social environment issues and social interactions.