Perceptions and barriers of elderly adults and health professionals towards of information and communication technologies Summary: Background: The dramatic increase of ageing population around the world and has led that more individuals required the services provided by the age care settings which include hospitals, nursing homes and private residences. The transformation of the delivery of care require the adoption of emerging Information and Communication Technologies (ICT) which may assist older adults and health professionals. This has led to investigate the perceptions or attitudes that motivate older adults and health professionals in the adoption of ICT, as well as to identify their barriers that hinders the introduction of technologies in the aged care settings. Method: This document is a systematic review of the literature and includes English journal articles published from 2011 until now because technology advances rapidly and the perceptions or barriers of users may shift faster over the time. The review excluded publications from conferences, newspapers, and magazines. Results: The study shows that most of the older adults and health professionals have positive perceptions about using ICT, although there are also some individual and external factors such as lack of training and poor technical support that restrict its use. Likewise, the perceptions and barriers were categorised into themes and each of them summarise some of the common aspects found in the review and which may contribute to improve outcomes, efficiency and the management of technology. Conclusions: Most of the older adults and healthcare professionals have positive perceptions regarding to the implementation of ICT. However, there are some barriers that need to be addressed to ensure the complete acceptance of technologies and applications by both groups. Also, some authors suggest that further research and greater involvement of older adults and health professionals is indispensable because they identified some factors that need to be improved. Key terms: Perceptions, barriers, older adults, health professionals, ICT. Introduction: The rapid demographic change of ageing population is increasing in the world wide. This shift has become a trend specially in developed countries (Barbosa, & Amaro, 2012), although by 2050 the number of people over 65 years will reach to 22% of the global entire population (Chen, & Schulz, 2016). In Australia, older people has almost doubled from 8% in 1964 (948.100 people over 65 years old at that time) to 15% in 2014 (3.4 million over 65 years) and is expecting to continue increasing (Australian Institute of Health and Welfare (AIHW), 2017). Consequently, more individuals and families will need the services provided by the healthcare system especially in the age care settings which are addressed to the management of adults who have complex conditions or disabilities (McVey, McKenzie, & White, 2013). With the emerging field of ICT in the health sector, there is an innovation in the promotion of care which facilitates the decision making, allows the communication and exchanging of information, and integrates people’s preferences (Abaidoo, & Teye, 2014). These applications may assist older adults and healthcare professionals. The use of ICT in healthcare has become an essential factor in the quality and delivery of health services. Jones and Groom (2012) claim due to the increasing of ageing population it is necessary the adoption of technologies to minimise costs and to provide efficient and effective health services, allowing the improvement of medical outcomes, and enhancing the safety and experience of patients. Likewise, technological devices may be useful to minimise the feeling of social isolation, to maintain the cognitive skills, to improve health status and the proper use of leisure time through the activities offered by different apps (Czaja, 2016; Mosthagel, 2016; Heinz et al, 2013). ICT is useful to improve the efficiency and effective delivery of services and has some specific benefits for older adults. There are many source of technologies that may be used by elderly adults and healthcare providers. For instance, computers and mobile phones are the most popular technologies which connect people from anywhere, allowing the introduction of telehealth services and the management of chronic conditions (Free, Phillips, Watson, Galli, Felix, …& Haines, 2013). Wearable sensors are considered as other alternative to monitor physiological functions, to ongoing treatments and to prevent falls (Patel, Park, Bonato, Chan & Rodgers, 2012). Another example is the implementation of robots which is considered as an option for providing care assistance especially in the places where is a shortage of health workforce, to assist people to perform some basic activities, to improve the patients’ safety or to reduce the level of loneliness (Wu, Cristancho, Fassert, Faucounau, Rotrou, & Rigaud, 2014). However, there are positive and negative attitudes for using technologies in healthcare. This document will review the main perceptions of elderly adults and health care providers towards ICT in healthcare. The experience of elderly people to live in aged care facilities have had an important impact on their lives. For instance, Walker (2016) claim that one of the greatest changes that elderly adults have is losing contact with relatives and friends, leading to some degree of isolation and loss of purpose of life. However, the lack of social interaction may be associated to other factors such as death of friends or family members and the relocation of the place of living (McMurtrey, Downey, Zeltmann, & McGaughey, 2012). This aspect is fundamental because social interactions have been linked to a reduction of mortality rates and better health conditions (Thomas, O’Connell, & Gaskin, 2013). With the introduction of ICT social isolation can be minimised. Significance of the systematic literature review: The research of ICT has been addressed mainly to the spatial science, telecommunications, business, and humanities (Curtin University, 2016). Likewise, some studies developed in the health sector have mentioned the advantages of implementing ICT to improve the efficiency and effectiveness of services, to monitor patients and follow up ongoing treatments and to improve patients’ safety (Jones, & Groom, 2012, Patel, et al 2012). The adoption of ICT by older adults has also important benefits in different spheres of their lives such as social, physical, and for entertainment (Czaja, 2016; Mosthagel, 2016; Heinz et al, 2013; Thomas, O’Connell, & Gaskin, 2013). However, limited research has been done to explore the perceptions and barriers of older adults and health professionals towards the use of ICT (Vadillo, Rojo, Garces & Checton, 2016). This literature review will identify some common perceptions and barriers that may be useful to make improvements in the design of applications and devices to facilitates a greater acceptance of ICT by older adults and health professionals. Scope: This literature review is limited to identify the perceptions and barriers of older adults and healthcare professionals towards the implementation of ICT in the aged care settings which include hospitals, aged care facilities and private homes. The investigation does not include the perceptions or barriers identified by care givers or personnel from the administrative area of hospitals and aged care facilities. This research will contribute with valuable aspects that motivate or hinders the use of ICT and which may facilitate a greater acceptance for both parties. Also, the investigation will provide with useful information in order to make improvements of the current technologies and applications. Research Questions This literature review aims to address the following questions: ⦁ What are the main factors that restrict the adoption of technology by older adults and healthcare professionals in the aged care settings? ⦁ What considerations may influence the adoption of technologies by older adults and health professionals in the aged care settings? Objectives: ⦁ Determine the barriers that older adults and health professionals have about the adoption of ICT in aged care settings. ⦁ Identify the common perceptions that motivate older adults and healthcare professionals in the adoption of ICT in aged care settings. Methodology: This document is a systematic review of the literature. Liamputtong (2013) states that a systematic review involves the understanding and synthetising of the available information in a specific field. One of the greatest advantages of a systematic review is that it allows to researchers to quickly identify important information, summarising the findings and providing reliable data that is relevant in the clinical decision-making. The systematic review includes some specific criteria to minimise the biases in the selection of the information. Liamputtong (2013) provides the steps to guide the review: Set the questions for the review, select the strategy for evidence, define the inclusion and exclusion criteria, assess the quality, extract data and summarise the findings. Following the criteria mentioned, the purpose of this literature review was addressed to identify the positive perceptions and barriers that elderly people and health professionals have towards technologies. ⦁ Search strategy: The research was conducted only in English and the main data bases consulted were NCBI PubMed, Elsevier, ProQuest Central, Emerald and Google Cochrane. However, due to the costs of the articles was necessary the use of Griffith Library database because there is a free access to the articles published. The terms included for researching the articles were perceptions, attitudes, elderly adults, health professionals, and ICT. Also, the articles included were from 2010 until now because technology advances rapidly and the perceptions or barriers of users may shift faster over the time. Key terms: Perceptions, barriers, older adults, health professionals, ICT. To keep focus on the research was necessary to understand the meaning of the key terms included in the review. For instance, perception is defined as a belief or opinion and attitude is the feeling or opinion of someone about something (Oxford Dictionary, 2015). Barrier is considered as an obstacle that that prevents the achievement of something (Collins Dictionary, 2016). Moreover, elderly adults in most of the developed nations is defined as individuals with an age of 65 years or over and who are retired (World Health Organisation (WHO), 2017). Health professionals involves a varied workforce such as practitioners, nurses, allied professionals, etc. who provide essential health services, promote health and prevent illness for individuals and communities (WHO, 2017). Finally, ICT includes different devices such as computers, mobile phones, networks, communication satellites, as well as the gathering and storing of data which are used to improve the quality of care, enhance safety and reduce costs (Gagnon, et al 2012). ⦁ Inclusion and Exclusion Criteria: The research included journal peer review articles published only in English, while publications from conferences, newspapers, and magazines were excluded from the review of the literature. Also, articles that are addressed to asses only the perceptions of implementing electronic health records were also excluded because just evaluates one specific aspect and extended research have done to evaluate this area, reason for what this review is addressed to analyse the general use of ICT in healthcare and the perceptions of the users. ⦁ Assessment of the Quality: This is an important part of the literature review and helps to identify the strengths and limitations of the studies in order to reduce bias (Liamputtong, 2013). The evaluation of the quality of the information consulted includes the Mixed Method Appraisal Tool (MMAT) which is a checklist that assess qualitative, quantitative and mixed method studies (McGill, 2011). The checklist is divided in five parts and each one has specific questions with a yes/no answer, can’t tell and comments from the authors. The template has been attached to this document in Appendix 1. ⦁ Extraction of Data: A careful reading of the abstracts and the results was performed to ensure that the articles matched to the criteria describe above. Also, the review involved various types of studies such as qualitative, quantitative and mixed methods. The articles selected reported the perceptions and/or barriers that elderly people and health professionals have towards the introduction of technologies, aspects that were summarised in some tables provided to facilitates the analysis of both groups. Likewise, due to the increasing number of studies published in various databases is essential to establish a process of research. Hoogendam, Robbé and Overbeke (2012) claim that there is a high volume of resources available in the databases and therefore it is necessary key strategies to ensure the efficient searching of material. One approach that helps to search relevant information is the PICO framework which defines four components of the research: Population, Intervention, Comparison or control and Outcomes (Hoogendam et al, 2012). This is a recommended method to improve the research of evidence in the medical field. For this literature research the PICO framework will be structured by the following components: Population Older adults and health professionals Intervention The term used to filter the published studies in accordance to the scope of this systematic literature review is information and communication technologies. This term involves different sort of technologies used in health such as mobile phones, computers, tablets, telehealth and robots. Comparison or Control Aspects that influence and hinders the use of ICT by older adults and health professionals in the aged care setting. Outcomes Barriers and facilitators that enhance or hinders the adoption of ICT. This information might be useful for vendors and ICT designers to improve the accessibility to technologies Literature Review: Maintaining social interactions is an essential aspect of elderly adults who have a positive attitude in the adoption of ICT because of their remarkable advantages. Most of the authors consulted agree that the use of ICT help to keep the bond with relatives and friends and may alleviate the feeling of loneliness, improving motivation and self-esteem (Mostaghel, 2016; Czaja, 2016; Philip, Roberts, Currie, & Alasdair, 2014; Heart & Kalderon, 2013; McMurtrey et al, 2012; Walsh, 2011). The most common method of keeping in touch used by elderly people is the mobile phone (Walsh, 2011; McMurtrey, et al, 2012) although there are other alternatives of communication especially over long distances such as emails, social networks and text messages. This review shows the importance of social support to older adults. Likewise, elderly adults perceive the use of ICT as favourable for improving cognitive skills and health conditions, as well as a source of entertainment. The use of ICT may influence positively the health status through exercises that people may practice daily and can be followed using electronic devices such as tablets or television (Mostaghel, 2016). Conversely, the use of internet motivates seniors to maintain mental skills and improve self-esteem (Heart, & Kalderon, 2013). Moreover, a study reveals that participants recognised that cognitive games are useful to stimulate the mind, to improve memory, to compete with others or just as a source of entertainment (Heinz, Martin, Margrett, Yearns, & Franke, 2013). The entertainment options include playing games in computers or mobile phones individually or online with others (Heart, & Kalderon, 2013; McMurtrey et al, 2012) and seniors are aware of the alternatives and advantages for their welfare. Another advantage perceived by elderly adults is related to the safety and the management of diseases. A study developed in four European countries with a sample of 250 seniors who live in private homes reported that they are aware about the importance of using technological devices to monitor symptoms, to avoid falls or to locate people with dementia (Williams, McCrindle, & Victor, 2010). In addition, Czaja (2016) and Walsh (2010) agree that there are applications that facilitate the management of illnesses and the enhancement of safety to avoid injuries in limbs, hips, or head resulting of falls by using smartphones, interactive television, tablets and telehealth). These approaches benefit older adults from the social and safety view. The use of robots in healthcare may be perceived as a positive benefit for elderly adults. Wu et al (2014) identify in their investigation that some participants have positive perceptions about using robots in the stimulation of cognitive skills or to assist them to find lost objects. However, other adults consider that robots may not have a valuable use, they may be potentially dangerous and its use may reduce the human contact. This study also shows that some participants are willing to use robots in the future if they have any impairment, while very few people of the sample reported that they do not have any idea about this sort of technology. The results from this investigation shows certain ambiguity of the participants to implement robots in healthcare or to assist them in the performance of some activities. Another example of technology used by some elderly adults is telehealth services. This sort of healthcare can be provided to people with chronic conditions, individuals who live in rural areas or patients who want to be treated at home (Acharya & Rai, 2017; Bradford, Caffery & Smith, 2015; Cimperman, Brencic, Trkman, Stanonik, 2013). Most of the participants of these studies have good attitudes in the adoption of e-health services, and they are aware of the benefits provided. However, some participants prefer face to face consultations because they consider important the physical examination and telemedicine does not allow it (Bradford et al, 2015). Another aspect identify in the review is the issues using the applications and the technical support that adults may need (Acharya and Rai, 2017; Cimperman et al, 2013). This is an innovative that is changing the model and delivery of services. The literature review also points out various factors that influence negatively the perceptions of elderlies in adopting technology. Firstly, the age, educational level and health conditions may restrict the use of ICT. For instance, a study developed in United States and Israel shows that 68% of the participants associated the adoption of technology to the educational background (Heart & Kalderon, 2013), while another investigation in Scotland reveals that adults from rural areas have less computer skills compared with people from cities (Philip et al, 2014). Also, the decline of cognitive and motor abilities hinders the use of ICT because of the gradual loss of senses, as also the difficulties that some seniors may experiment in the execution of fine movements which are essential for manipulating the small buttons of mobile phones and tablets (Mostaghel, 2016; Gonzales, Ramirez & Viadel, 2015; Heart, & Kalderon, 2013; Philip et al, 2014; Williams et al, 2010). Another barrier identified by elderly adults is related to the privacy and confidentiality. This can be an important problem for older people who may use devices to access to telehealth or to send medical information to health professionals that may be not properly training (Williams et al, 2010). Other authors agree that privacy and confidentiality in the management of information still an issue for the elderlies despite of the improvements made to tackle this issue (Czaja, 2016; Heart & Kalderon, 2013). Therefore, it is indispensable that vendors explain the achievement done to handle these matters. Elderly adults identified as an obstacle for adopting ICT the lack of training and the lack of technical support. Some elderly people consider that poor knowledge and skills for using technologies may generate anxiety and frustration (Hearth & Kalderon, 2013; Walsh & Callan, 2011). However, they think that these perceptions can be minimised with training and technical support to enhance the use of different communication technologies such as internet, computers, mobile phones and telehealth services (Heinz et al, 2013; Walsh & Callan, 2011; Cimperman, Brencic, Trkman, & Stanonik, 2013), although participants in one study recognise that the learning process can be difficult for some elderly adults (Gonzales, Ramirez, & Viadel, 2015). The use of ICT by elderly people has increased dramatically in the recent years because of its benefits, but also health professionals are adopting new sorts of technology to perform daily tasks. ICT has various tools that are useful for gathering, storing and exchanging information, having an impact in the integration of services and in the improvement of productivity and patients’ care (Davis, Morgans, & Burgess, 2016; Mutula, 2015; Gagnon, Desmartis, Labrecque, Car, Pagliari, Pluye, … & Legare, 2012). However, and despite of the benefits of using technology in the workplace there are some factors that hinders its use by health professionals and both aspects will be discussed in this document. Healthcare providers perceive as positive the introduction of ICT in aged care. For instance, a literature review conducted in Sweden shows that ICT is useful to improve services (Mostaghel, 2016) and similarly another review derived from 31 journal articles state that emerging technologies have increased the used in different areas of the healthcare industry improving the accessibility and quality of services (Sezgin & Yildirim, 2014). These attitudes also are confirmed in a qualitative study that includes a survey and which results show that many registered nurses of various institutions in Netherlands claim that the use of different technologies have positive outcomes at different levels of the organisation (Veer, Fleuren, Bekkema, & Francke, 2011). Likewise, many participants from different countries agree that technology has become an essential tool to collect data, avoids repetitive tasks, saves time, facilitates the accreditation process and enhance the delivery of services (Vadillo, Rojo, Garces & Checton, 2016; Gund, Lindecrantz, Schaufelberger, & Sjöqvist, 2012; McDonalds, & Russell, 2012; Gagnon et al, 2012). However, few employees with low computer skills consider that technology has a negative impact in workloads (Mutula, 2015; McDonalds, & Russell, 2012), but the overall perception of health professionals towards technology is favourable. Likewise, health professionals recognise that training is crucial to facilitates the introduction of ICT and to improve the attitudes regarding technology. Participants in different studies state that the successful adoption of ICT by the workforce relies in the technical support and training provided by the organisations, aspects that facilitates the proper use of technology and may reduce negative attitudes towards its use (Vadillo, et al, 2016; Mutula, 2015; Vanneste, Vermeulen, & Declercq, 2013; McDonalds & Russell, 2012; Gagnon et al, 2012). On the other hand, some employees perceive the lack of training as a barrier to adopt technology in health organisations, causing frustration and delays during the implementation process (Vadillo et al, 2016; Mutual, 2015; Gagnon et al, 2012; Veer, 2011). Training and coaching are important to foster the acceptance of ICT and to reduce negative feelings among employees. Also, healthcare providers perceive that technology allows the exchange of information internally and between organisations. Some health professionals recognise the ICT allows gathering accurate data and the exchange of information between health professionals and institutions (Mutula, 2015; Vanneste et al, 2013; Gagnon et al, 2012). However, other healthcare providers perceive that the acquisition, integration and analysis of data cause frustration due to the incompatibility of the programs and the lack of standards (Vadillo et al, 2016). Moreover, some nurses claim that in particular cases the information gather is incomplete or inaccurate, especially when patients are transferred from hospitals to aged care facilities and the reason is related to the communication problems which hinders the continuity of care and may put at risk patients’ safety (Olsen, Ostnor, Enmarker, & Hellzen, 2013; Vanneste et al, 2013). Another positive perception of using ICT identified by healthcare providers is related to the improvement of accessibility in the services especially in rural areas or with patients who can be treated at home. This is possible through the telehealth services which involve computing and mobile applications supporting medical decisions in places where there are not specialists or in the management of chronic conditions (Free, Phillips, Watson, Galli, Felix, …& Haines, 2013). The perceptions of most of the health professionals about using telehealth are positive, because they recognise the advantages of using this sort of technology to provide care, to reduce the expenses of transportation and to enhance the accessibility to health services of patients from rural areas (Guise, & Wiig, 2017; Acharya, & Rai, 2017; Ayatollahi, Sarabi, & Langarizad, 2015; Fortino, DiMartino, Entrikin, Muliner, Hanson, & Kath, 2012). However, few participants of a study report do not have knowledge in telemedicine and dentists do not consider as valuable the use of this sort of care compared with the opinions given by other health professionals (Ayatollahi et al, 2017). Also, health professionals concern about the privacy and confidentiality of patients’ data (Ayatollahi et al, 2015; Fortino et al, 2012). There are other specific opinions which differ among the studies. The use of technology by healthcare professionals is also perceived as a threat by some professionals. For instance, some nurses reported be concern about that technology may replace them impacting negatively the human resources of any organisation (Vanneste et al, 2013; McDonalds, & Russell, 2012). Other unfavourable feelings are increasing the workload and emotional reactions that may arise due to the difficulties to complete a task using ICT (Vanneste et al, 2013). However, these perceptions may be reduced with strong leadership, good managerial strategies, support and a change management plan addressed to enhance employees’ participation and the acceptance of introducing new technologies (Vanneste et al, 2013; McDonalds & Russell, 2012) Other barriers identify by professionals from the health field are associated to the age, gender, computer skills and training. Some authors consider that younger employees are more familiar with computers and they consider that the use of ICT is influenced by the educational background and age, recognising that older women have more difficulties to accept and use the introduction of new technologies (Vadillo et al, 2016; Adeleke, Lawal, Adio, & Abdullateef, 2014; Vanneste et al, 2013; Gagnon et al, 2012). Likewise, the lack of training and the lack of technical support may generate some discomfort in the adoption and use of ICT by health professionals (Mutula, 2015; Adeleke et al, 2014; Al-Harbi, 2011) reasons for what it is necessary to provide these essential aspects in the workplace to ensure that employees have the knowledge and skills needed to use new systems or equipment. Furthermore, some authors agree that low research has been conducted to determine perceptions and attitudes of health professionals towards the acceptation and use of ICT in the workplace (Vadillo et al, 2016; McDonalds & Russell, 2012). On the other hand the participation of healthcare providers in the design of technologies and applications is not sufficient and they suggest that vendors should obtain more contributions from them. Results: The dominant topics can be categorised in two areas: On the one hand, the perceptions and barriers of older adults towards ICT and on the other hand, the perceptions and barriers of health professionals about using ICT in the aged care setting. Initially, the literature review was addressed to identify the perceptions and barriers from healthcare providers and older adults in the field of age care. However, minimum research has been done in this industry on the use of ICT, reason for what was necessary to broad the research including hospitals, private homes, and nursing homes or aged care facilities. The articles selected in the initial research before applying the exclusion criteria were 47 and from this selection 9 of them were duplicated. Once it was applied the exclusion criteria, the number of articles removed were 14 and the remain documents selected for eligibility included 32 studies. However, the final documents that meet the quality criteria were 24 investigations that were analysed and included in this systematic literature review. This information has been summarised using the PRISMA flow chart that is a guideline introduced in 2009 and which provides important steps to reduce bias in the research, allowing a critical selection of information (Akhigbe, Zolnouriana, & Bultersb, 2017). The PRISMA flow chart for this literature review may be found in the figure 1. ⦁ Study Characteristics: The number of studies selected to identify the perceptions and barriers of older adults towards ICT were 10 and included 1 article from 2017, 2 articles from 2015, 2 articles from 2014, 3 articles from 2013, one article from 2011 and one more from 2010. The articles for this group were classified by continent and included 6 studies conducted in Europe, 2 investigations developed in Asia, 2 searches conducted in North America and 1 study from Oceania. To identify the perceptions and barriers that health professionals have about using ICT was necessary to consult 14 documents: 2 from 2017, 1 article from 2016, 3 studies from 2015, 1 investigation from 2014, 2 searches from 2013, 3 documents from 2012 and 2 studies from 2011. These investigations also were classified by continent and included 5 documents from Europe, 3 investigations developed in Asia, 3 articles from Africa, 2 investigations conducted in North America, and 1 from Oceania. ⦁ Research Design Characteristics: The type of research used to identify the perceptions and barriers of older adults towards ICT included 8 qualitative studies and 2 mixed methods, while for evaluating the same aspects in healthcare professionals involved 12 qualitative studies, 1 mixed method research and 1 quantitative research. ⦁ Participants Characteristics: The evaluation of the perceptions and barriers of older adults involved adults over 65 years old, while the age of healthcare professionals was not essential in the studies although full time and part-time employees who only work in the healthcare area and included clinicians, nurses, allied staff, psychiatrists, and social workers. The studies did not include dentists. The perceptions and barriers towards the adoption of ICT by older adults and health professionals were analysed separately and the information was categorised in hospitals, home care, aged care facilities and community care for each group. In the category of older adults, the number of studies developed in hospitals were 2; 5 investigations evaluated the use of technology by older people in their homes (home care) and 3 of these articles sought to compare the perceptions and barriers of the participants who lived in urban and rural areas; only 2 studies were addressed to evaluate these aspects in aged care facilities and 1 study was developed in a computer training program provided in an aged care community. On the other hand, the perceptions and barriers from health professionals were analysed in the same categories that for older adults, where 10 of the articles included participants who work in hospitals; 2 investigations were developed using telehealth in home care; 2 studies were conducted in an aged care facility and 1 article did not mention the area of healthcare where was developed. This information has been summarised in the Graph 1. The analysis of perceptions and barriers towards the use of technology was done using the same two categories: Older adults and health professionals. However, it is important to mention that most of the articles reviewed sought to identify some perceptions and barriers towards ICT from healthcare providers. The results show that healthcare professionals and older adults have positive attitudes towards the use of technology and most of them are aware about the benefits that ICT provide, but at the same time some of the participants have reported a few barriers that hinders the adoption of different technologies in the healthcare setting. This information has been summarised in each group in the following tables. Theme Number of studies Article Perception Reduction of social isolation 4 articles 2,4,8,9 ⦁ + to keep in contact with family and friends even over long distances. ⦁ + to reduce depression. Enjoyment of free time 3 articles 4,7,8, ⦁ + to remind exercises. ⦁ + to gaming and playing videogames. Unnecessary transportation 3 articles 1,3,6 ⦁ + to reduce costs. ⦁ + to schedule appointments. ⦁ + to improve accessibility to healthcare services. Improvement of mental skills 3 articles 5,7, 8 ⦁ + to stimulate mind with puzzles. Monitoring physiological systems 2 articles 4,10 ⦁ + to check blood pressure, glucose levels, oxygen saturation and temperature. Table 1: Perceptions of older adults towards the use of ICT in aged care settings Theme Number of studies Article Perception Accessibility and delivery of care 8 studies 11, 12, 13, 14, 15, 16, 17, 21, 22 ⦁ + impact in the delivery of services and in the diagnose of illnesses. ⦁ + effects in patients’ outcomes. ⦁ Technology has become an essential tool in health. ⦁ + to provide services in remote areas. Reduction of repetitive tasks 6 studies 16, 18, 20, 21, 23, 24 ⦁ + perception of ICT to save time. ⦁ + to follow patients. ⦁ + to improve productivity and performance. ⦁ + perception in the improvement of job satisfaction. ⦁ + attitude in the decision making and workload. Communication 2 studies 17, 18 ⦁ + to improve the communication among professionals. ⦁ + to allow the exchanging of information between institutions. Unnecessary transportation 2 studies 11, 14 ⦁ Reduction of costs and unnecessary transportation. Gathering data 1 study 20 ⦁ + outcomes to collect patients’ data. Table 2: Perceptions of health professionals towards the use of ICT in aged care settings Table 3: Barriers of older adults towards the use of ICT in aged care settings Theme Number of studies Article Barrier Distance 5 studies 1, 2, 3, 5, 7 ⦁ - due to the lack of physical examination. ⦁ - for few adults, due to the poor satisfaction with the treatment provided. ⦁ - for some people who may loss the physical contact with family and friends. Ergonomic challenges 2 studies 4, 10 ⦁ - for some older adults, due to the difficulties to type, using a mouse or a touch screen. ⦁ - for patients with vision or hearing issues. Lack of training 2 studies 8, 9 ⦁ - for some adults who may experiment anxiety. ⦁ - for some adults who consider that poor knowledge affect the use of ICT. Table 4: Barriers of health professionals towards the use of ICT in aged care settings Theme Number of studies Article Barrier Lack of training and technical issues 6 studies 11, 12, 14, 16, 20, 24 ⦁ Some professionals in Africa have poor computer skills. ⦁ Poor computer abilities lead to discomfort and anxiety. Age 4 studies 11, 13, 17, 18 ⦁ Some professionals associate the age and educational background to the use of technology. ⦁ One study report that older professionals are more frustrated than men in using technology. ⦁ Negative feelings such as anxiety and frustration may arise using ICT. Privacy 4 studies 14, 16, 18, 22 ⦁ Some professionals are concern about the patients’ data resulting in some resistance to accept ICT. ⦁ Few professionals consider that ICT will reduce the issues about patients’ privacy. Costs 15, 16 ⦁ Costs for maintenance may restrict the use of technology ⦁ Some technologies are not available for professionals in Africa. ⦁ Lack of technology’s infrastructure will increase costs (Africa). Communication barriers 19 ⦁ Communications problems between hospitals and aged care facilities. Discussion: The aim of this literature review was to identify the main perceptions and barriers of older people and health professionals towards ICT in the aged care settings which include hospitals, nursing homes and private residences and which results show that the evaluation of these characteristics have very low research. Most of the studies reviewed are from 2015, 2013 and 2014. This may reflect the lack of research conducted in the last two years to explore the perceptions and barriers of older adults and healthcare providers in the aged care settings, as well as the lack of involvement of these people in the improvement and design of technologies addressed to the health field. This review also points out that most of the investigations were developed in Europe and Asia for both groups. However, Africa shows some research to identify the perceptions and barriers of health professionals about using ICT, although there are some issues to determine their level of acceptance of technology and drawbacks related to its use due to the lack of infrastructure and the costs associated to its implementation and maintenance. Also, there are some popular technologies such as fax, scans, or computers that are available for many health professionals in other countries, but in Africa still being unaffordable due to the limited health budget and the prioritisation that government gives to other issues. This literature review shows that most of the older adults and health professionals have positive perceptions of introducing ICT in the aged care settings, although many investigations have been addressed only to the clinical field involving different health professionals. It is important to mention that ageing population is increasing dramatically especially in developed countries and it is probably that more older adults will need the use of technology to support their independence, maintain their social life, preserve their cognitive skills, etc. However, the use of technology for some older adults has become difficult due to the decline of the sensory-motor abilities. Likewise, most of the studies were addressed to evaluate the perceptions and barriers that hinders the introduction of ICT by professionals who work especially in hospitals, leaving out other areas of the aged care setting that have equal importance. Also, the results show a very important issue in the communication between aged care facilities and transfers which affect the continuity of the care and may affect patients’ safety. Further investigations may provide other perceptions and barriers in using technology to make improvements in the current issues and to ensure that the technologies implemented meet the expectations and needs of healthcare providers and older adults. The literature review also highlights that most of the healthcare providers and older adults have a positive view about using telehealth or telemedicine because it improves the accessibility to healthcare services and reduces travel expenses or unnecessary transportation especially for people with chronic conditions or who have mobility problems. However, there are important barriers that make difficult the adoption of this service because the results show that people from rural areas have less technology skills compared with individuals who live in cities. This aspect can be unfavourable to manage because the use of technology for the population who live in remote areas may be not necessary in their daily lives. Also, there is a wrong misconception of health professionals who belief that telemedicine may lead in increasing wrong practices. Conclusion: The increase of ageing people in Australia and around the world has required the modification of the model and delivery of care, where the adoption of ICT has become an essential tool for health institutions to improve the performance, to facilitate the decision-making process, to strength the communication among different services and users and to assist staff members in the execution of some tasks. Also, ICT plays and important role for the ageing community because it increases independence, reduces social isolation, and improves their safety not only in aged care facilities but also its implementation has many advantages for elderly adults’ private homes. Consequently, ICT has impacted positively in the quality and delivery of care, as well in the independent living of the ageing people. Likewise, introducing various wearables and technologies addressed to elderly adults and healthcare providers is influenced by individual and organisational factors that have been identified in different studies. This review shows that both groups are aware about the benefits that ICT has in different contexts and situations. Firstly, the common technology used by elderly adults is mobile phones, although the literature mentions other sort of technologies that have a number of benefits for improving different spheres of their lives in the social, leisure and cognitive areas, aspects that are fundamental for maintaining the wellbeing of people in the physical and psychological level, improving self-esteem, motivation and longevity. Also, some elderly people are not prepared for the complete adoption of ICT due to the lack of training and technical support, poor computer skills and / or difficulties to execute fine movements as a result of the age or an illness, aspects that can be considered as barriers. These factors may be related to the educational background, although some authors agree that elderly adults who lived in rural areas have more negative perceptions to use ICT. Few studies mention that elderly adults suggest more involvement in the design of applications and technologies addressed to them to ensure that these wearables and devices meet their expectations and needs according to their sensor-motor skills and cognitive abilities. On the other hand, most of the health professionals have positive attitudes and perceptions to use ICT because of the outcomes achieved at different levels of the organisation, excepting dentists who do not perceive the use of technology as favourable for treating patients. Also, the use of ICT has helped to avoid repetitive tasks and has facilitated the accessibility of people to health services especially in rural areas through the use of telehealth, improving productivity and the efficiency of health services. However, there are few health professionals who are not informed about the advantages of telehealth and others consider that ICT increase workload. Moreover, some professionals have mentioned difficulties to receive data from patients transferred from hospitals to nursing homes, because in some cases the information is incomplete and may be associated to the lack of compatibility between programs. Health professionals and elderly people agree that some of the main factors that hinders the adoption of ICT are related to the age and training. Both groups perceive that young generations have more interaction and are more familiarise with technology compared with the older adults and professionals. Also, they consider that these aspects are crucial in the use of different wearables technologies and applications. Likewise, few healthcare providers and elderlies perceive that privacy and confidentiality of the information still an issue despite of the improvements made in this matter to maintain patients’ data safely stored. It is recommended further research to obtain a better understanding about the perceptions and attitudes of the elderly population and health professionals towards the implementation of ICT because it has been ignored by researchers and vendors. The results may be useful to make improvements in the technologies and applications implemented, as well as to determine factors that hinders the adoption of ICT by those groups in order to deploy strategies that allow an easier access and management of them. Also, it is necessary a greater involvement of older adults and health professionals in the development of technologies because there are some factors that were identified and need to be improved. Author(s) Country(s) Type of Study Sample Technology Positive Perceptions Barriers ⦁ Acharya & Rai (2016) India Qualitative Study (Cross sectional study) 71 people who are registered in Apollo Hospital Telemedicine ⦁ Telemedicine ⦁ Computers ⦁ Mobile phones ⦁ 63 of the participants report that they are satisfied with the services provided by telehealth and with the schedule of the appointments. ⦁ They state that the treatments provide suit their needs. ⦁ 38 patients claim that they do not have issues with the use of telemedicine. ⦁ 17 people report technical problems using telehealth. ⦁ 6 older adults said that they do not feel comfortable with the consultation because of the lack of physical contact with the doctor. ⦁ Gonzales, Ramirez, & Viadel (2015) Spain Qualitative (Exploratory Study) 191 older adults. Training program ⦁ Computers ⦁ Internet ⦁ 177 participants express positive attitudes towards the use of computers for socialising and online surfer. ⦁ The confidence and negative attitudes from some participants to use computers increase with the training provided. ⦁ 74 people have some level of difficulty to use the computer. ⦁ The experience and skills influence the use of computers. ⦁ The learning process to use new technologies can be complicated for some adults. ⦁ Bradford, Caffery, & Smith (2015) Australia Qualitative Study (Phenomenological study with Semi-structured interviews) 47 patients in rural areas of Darling Downs. ⦁ Telemedicine ⦁ 28 of the participants identify the benefits of telehealth services because it reduces the travel expenses and improve the accessibility to healthcare, reducing inequity. ⦁ 19 participants are not aware about the benefits of using telehealth. ⦁ 3 participants consider that they will not use telehealth services because they prefer face to face consultations. ⦁ 2 participants see as a disadvantage the use of this service because of the lack of physical examination. ⦁ 4 participants believe that older generations may be difficult to engage with this sort of service. Author(s) Country(s) Type of Study Sample Technology Positive Perceptions Barriers ⦁ Philip, Roberts, Currie, & Alasdair, (2014) Scotland Mixed Study 168 participants who live in urban and rural areas. Private homes of elderly adults ⦁ Mobile phones ⦁ Computers ⦁ Blood pressure monitor ⦁ Glucose monitor ⦁ Sensors for falls ⦁ Telehealth ⦁ 151 adults think that telehealth is an option to receive health services and it is perceived as positive. ⦁ 132 participants use mobile phones for keeping in contact with professionals and family. They perceive the use of technology beneficial to reduce loneliness and depression. ⦁ The most used technologies are mobile phones and computers. ⦁ Also, technology is used for pain management and adults believe that this option is good to remind the exercises. ⦁ 17 people from rural areas are less likely to use telehealth because of the lack of equipment or knowledge. ⦁ who live in urban areas have more computer skills than people from rural areas. ⦁ 67 older adults express difficulties to use internet. ⦁ Patients from rural areas expressed no experience with eHealth. ⦁ Older people face ergonomic challenges in using ICT devices (typing, using a mouse, or touch the screen of mobile or tablet). ⦁ Impairing vision or hearing difficult the use of devices. ⦁ Wu, Cristancho, Fassert, Faucounau, Rotrou, & Rigaud (2014) France Qualitative Study (Focus group and semi-structured interview) 20 adults from Broca Hospital in Paris. ⦁ Robots ⦁ Some participants have good perceptions about using robots to assist them to cognitive stimulation and to obtain help to find objects. ⦁ 7 people think that they consider the use of a robot if they have some impairment. ⦁ Few people did not have any idea about robots. ⦁ Some adults perceive robots as potentially dangerous and their use is not valuable. ⦁ Some participants reported the need of human contact and the relationships that are not provided by the robots. ⦁ Most of the participants perceived that robots are suitable for providing care. ⦁ Cimperman, Brencic, Trkman, Stanonik (2013) Slovenia Qualitative Study (Focus Group) 87 participants living in their homes in rural and urban areas between 55 and 75 years old. ⦁ Telemedicine ⦁ Monitors ⦁ Most of participants believe that telehealth services are useful and they are willing to pay for additional services are home. ⦁ Elderly adults consider that family members are the primary source to obtain help in the access to Ehealth. ⦁ Elderly adults think that only their own doctor should access to their medical information. ⦁ They concern about the technical support to use systems if they have problems in using them. Author(s) Country(s) Type of Study Sample Technology Positive Perceptions Barriers ⦁ Heinz, Martin, Margrett, Yearns, & Franke (2013) United States (Group Focus) Qualitative research (Focus Group) 30 Participants: Living in private homes in urban and community areas. ⦁ Computers ⦁ All participants included in the study were aware about using different technologies. ⦁ People enjoy gaming and puzzles because they stimulate their mind and is a good source for entertainment. ⦁ The study focus in the needs and challenges of adopting technology. ⦁ Sometimes older adults are not aware about the benefits of using technology. ⦁ Concerns about privacy. ⦁ Lack of training and support in the use of applications. ⦁ The use of technology improve communication but also hinders the physical contact with family and friends. ⦁ Hearth & Kalderon (2013) United States and Israel Qualitative Study (Survey) 123 respondents: 63 from United States and 60 from Israel. Private homes and aged care facilities. ⦁ Mobile phones. ⦁ Computers ⦁ 98 participants use different sort of technologies and recognise the benefits that they provide. ⦁ Minimising social isolation by using different technologies. ⦁ Different applications are useful to maintain cognitive skills, foster mental stimulation and improve memory. ⦁ Improving self-esteem. ⦁ Most of the activities done by elderly people are sending and receiving emails followed by videogames. ⦁ 26 older believe that the use of computer is too difficult. ⦁ Declining of sensory and cognitive skills, makes more difficult the use of technology. ⦁ Difficulties in obtaining technical support. ⦁ Many older adults have a negative attitude for using technology due to the lack of knowledge or the anxiety that may arise. ⦁ The adoption of technology is associated to the education. Author(s) Country(s) Type of Study Sample Technology Positive Perceptions Barriers ⦁ Walsh & Callan (2011) Ireland Mix method 60 participants. Rural and urban community-care sites. ⦁ Mobile phones. ⦁ Computers. ⦁ Telehealth. ⦁ 53 older adults recognise that technology has many benefits especially for social connection. ⦁ Mobile phone is the more used device to keep in touch with family and friends. ⦁ The use of technology addressed to prevent falls has remarkable benefits to avoid potential risks to people. ⦁ Another benefit of technology is that devices are useful to reduce social isolation. ⦁ Few people (3) have negative attitudes towards the use of devices due to the limited knowledge for their use. ⦁ Lack of resources, limited budget to invest in ICT and prioritisation of other activities hinders the adoption of technology in long term facilities. ⦁ Training and education are crucial factors to enhance the use of technology. ⦁ The wrong implementation of technology could be a problem to integrate systems with the current model of care, affecting the quality and delivery of the services. ⦁ Williams, McCrindle, & Victor (2010) United Kingdom, Greece, Czech Republic, and Belgium. Qualitative Study (Exploratory) 158 participants from private homes. ⦁ Mobile phones. ⦁ Computers. ⦁ Internet. ⦁ 146 older adults use technological devices in their homes. ⦁ Some technologies are used to monitoring blood pressure, pulse, temperature and oxygen saturation. ⦁ Detects falls and help staff to locate people specially with dementia. ⦁ 38 people report difficulties to manipulate small buttons and buttons from mobile phones. ⦁ Concerns about privacy and confidentiality. ⦁ The use of internet is associated to the educational level and the geographical location. Author(s) Country(s) Type of Study Sample Technology Positive Perceptions Barriers ⦁ Guise & Wiig (2017) Norway Qualitative Study (Focus group) 26 participants working in home care services. ⦁ Telemedicine ⦁ They recognised that telehealth have many advantages for delivery health and to reduce transport expenses, but the use video technology will improve the results. ⦁ Most of the participants consider that training is needed to conduct proper virtual home visits. ⦁ Several participants report poor training experiences. ⦁ Participants identify that older professionals have difficulties to cope with this sort of technology. ⦁ Acharya & Rai (2016) India Qualitative Study (Cross sectional study) 116 professionals who are working in Apollo Hospital ⦁ Telemedicine ⦁ All professionals have used telehealth services and perceive that this sort of technology is useful to improve the accessibility to services. ⦁ 109 health professionals are satisfied with the diagnose and results obtained. ⦁ 66 of the professionals recommend the use of telehealth services. ⦁ 4 specialists report technical issues with the hardware. ⦁ 17 professionals encounter problems with the speed of the service. ⦁ 14 professionals mention constraints in the delay of information scheduling appoinments. ⦁ Vadillo, Rojo, Garces & Checton (2016) United States Mix Method 85 full time and part time employees who work in a small hospital. ⦁ Computer ⦁ Electronic health records ⦁ 72 employees agree that using computers is beneficial to improve patient care. Also, they perceive that technology is becoming an essential tool. ⦁ The investigation highlights the importance of training in the use of computers or new systems. ⦁ 2 participants report the need for training in the use of computers. ⦁ 4 participants state that other barriers are related to reasons such as workforce generation, age, anxiety to use technologies. ⦁ The professionals in health consider that “acquiring, integrating and analysing patient data” (p. 354) cause frustration because of the programs’ incompatibility and the lack of standards. ⦁ Limited research has been conducted to determine the perceptions of technology. Author(s) Country(s) Type of Study Sample Technology Positive Perceptions Barriers ⦁ Ayatollahi, Sarabi, & Langarizadeh (2015) Iran Qualitative Study (Semi-structured survey) 206 clinicians. Three public and private hospitals located in northern of Iran. ⦁ Telemedicine ⦁ 198 clinicians perceive that the use of telemedicine has many advantages. One is addressed to the reduction of unnecessary transportation and its costs. ⦁ 154 clinicians agree that the use of telemedicine will be beneficial to provide services in remote areas. ⦁ 96.1% of clinicians report low knowledge in telemedicine. ⦁ It is essential to provide training to improve the knowledge of telemedicine. ⦁ 65 participants believe that the use of telemedicine may lead to the increase of wrong practices. ⦁ Dentists perceive that the use of telemedicine has less benefits compared with the opinions given by physicians, nurses, and specialists. ⦁ Most of the participants report concerns about the privacy and confidentiality of patients’ data. ⦁ Olok, Yagos, Ovuga (2015) Uganda Qualitative Study (Cross sectional Study) 68 doctors. Three public hospitals and four private hospitals. ⦁ Mobile phones ⦁ Internet ⦁ Computers ⦁ E-health ⦁ 40 participants have moderate attitudes towards ICT and they perceive an improvement of the medical practices. ⦁ The technologies more used by doctors in Uganda are computers and mobile phones. ⦁ The level of skills influence the used of ICT and is a predictor of their use in the workplace. ⦁ Doctors believe that the use of E-health positively impact in the delivery of services. ⦁ Doctors over 50 years old have more access to computer and internet facilities that professionals between 41 and 50 years old. ⦁ 24 participants report that in some hospitals is limited due to the high cost for its maintenance and problems with the electricity. The improvements of these aspects may impact positively the delivery of services. ⦁ Some technologies may not be available to all health professionals such as fax machines, scans or computerised sensors. Author(s) Country(s) Type of Study Sample Technology Positive Perceptions Barriers ⦁ Mutula (2015) South Africa Qualitative Study (Cross sectional descriptive study) 226 registered nurses, nurse assistants and enrolled nurses. 16 hospitals of KwaZulu-Natal ⦁ Computers ⦁ Internet ⦁ 151 professionals consider that the use of computers will improve the storage of medical data and the delivery of care, facilitating the performance of tasks, increasing productivity and saving time. ⦁ Some professionals consider that introducing technology will increase the cost of car and workload, as well as will affect the attention to patients. ⦁ They concern about the confidentiality and privacy of patients’ data. ⦁ Some challenges that nurses concern is the lack of enough computers, poor computer skills and training and lack of technical support. ⦁ Internet and intranet is not available in some hospitals due to the lack of infrastructure. ⦁ Some professionals express the frustration of using computers ⦁ Adeleke, Lawal, Adio, & Abdullateef (2014) Nigeria Qualitative (Cross sectional study) 374 health information management professionals ⦁ Computers ⦁ Electronic health records ⦁ Integration systems ⦁ 364 participants acknowledge the importance of ICT in healthcare, especially in the delivery of services and in the management of patients’ records. ⦁ 366 health professionals perceive that ICT improve the communication between health professionals. ⦁ 258 participants report need for training especially in statistical analysis of patient data. ⦁ The age and educational background is associated to the use of ICT. Author(s) Country(s) Type of Study Sample Technology Positive Perceptions Barriers ⦁ Vanneste, Vermeulen& Declercq (2013) Belgium Qualitative Study (Structured Questionnaire) 282 qualified professionals including: nurses, allied professionals, dieticians, social workers, physicians, etc. Home care, nursing care and acute hospital care. ⦁ Information and Communication Technologies ⦁ The results highlight the need of training, computer skills and a good software. The training should be long enough to obtain familiarisation with the new software or equipment. ⦁ The use of technology improves job performance. ⦁ The acceptance of technology by nurses is influenced by facilitators such as leadership, good managerial strategies, support and collaboration. ⦁ Information technologies allows the exchanging of accurate information between institutions. ⦁ The use of technology cause concerns on human resources, confidentiality and an increase of workload. ⦁ The experience towards technology is influenced by the age and gender. Older women may be frustrated using technology. ⦁ Some employees may experiment anxiety or emotional reactions because of the difficulties to complete a task. ⦁ The lack of communication may lead to clinical errors or adverse events. ⦁ Olsen, Ostnor, Enmarker, & Hellzen (2013) Norway Qualitative (Descriptive exploratory study) 14 registered nurses with minimum 5 years of experience from an aged care facility. ⦁ Computers ⦁ Email ⦁ The study does not report any positive aspect towards the use of technology. Just focus on the issues. ⦁ 12 nurses report that around one-third of the patients (34/102 patients) transferred from hospital to the geriatric home do not send the documentation immediately or is incomplete. ⦁ Other barriers are the lack of a standard method to gather data and the lack of knowledge to send information outside the institution in both parties. Author(s) Country(s) Type of Study Sample Technology Positive Perceptions Barriers ⦁ McDonalds & Russell (2012) Australia Qualitative Study (Semi-structured survey) 250 health professionals including registered nurses, assistant nurses and allied staff. Only 112 professionals answered the survey. Aged care facility. ⦁ Computers ⦁ Electronic health records ⦁ 90 participants report that they feel comfortable using computers and 155 respondents have confidence and knowledge using their programs. ⦁ Managers and health professionals have positive perceptions about ICT because it avoids repetitive tasks and saves time. ⦁ New technologies in aged care involved “training and individual coaching” (p. 88) to improve employees’ attitudes. ⦁ The introduction of technologies requires change management and leadership to obtain the acceptance. ⦁ Participants consider that technology has positive outcomes in gathering data and in the accreditation. ⦁ Only 30 participants do not feel comfortable using computers. ⦁ Low research has been conducted to determine the professionals’ view of using technologies in the daily work. ⦁ Some nurses are concern that technology may replace them. ⦁ Employees with low computer skills have some discomfort in using it at the workplace. ⦁ Gund, Lindecrantz Schaufelberger & Sjöqvist (2012) Sweden Qualitative (Survey) 139 healthcare professionals working chronic heart failure (CHF) of 85 hospital departments. ⦁ Computers ⦁ ICT ⦁ 93 participants recognise the importance of using computers at work and they state that they use this tool for largest part of the day. ⦁ 89 participants report that ICT save time. ⦁ 97 respondents believe that technology is useful to monitor patients and follow up patients from home. ⦁ Just 3 participants consider that technology does not have any benefit to monitor patients in long distances. This can be related to the lack of experience to monitor patients at home. ⦁ Fortino, DiMartino, Entrikin, Muliner, Hanson & Kahn (2012) United States Qualitative Study (Cross sectional study) 179 nurses who work in three hospitals ⦁ Telemedicine ⦁ Despite that the sample was 179, only 93 professionals decided the participation in the study. ⦁ 50 nurses belief that telehealth has positive effects on patients’ outcomes who live in remote areas or have mobility issues. ⦁ 84 nurses consider that telehealth services will not reduce medical errors. ⦁ 25 nurses consider that this service may affect patients’ privacy. Author(s) Country(s) Type of Study Sample Technology Positive Perceptions Barriers ⦁ Veer, Fleuren, Bekkema, & Francke (2011) Netherlands Qualitative Study (Survey) 685 registered nurses and assistants who work in hospitals, psychiatry, care for disable people, home care, nursing homes for elderly people. ⦁ Sensors ⦁ Electronic monitoring ⦁ Telecare ⦁ Electronic health records ⦁ The study took a sample of 685 registered nurses and only 459 responded a survey to evaluate the aspects that influence or failure the implementation of technologies introduced the past three years. ⦁ 280 health professionals claim that the use of technology has positive outcomes in the professional and financial level, as well as job satisfaction and saving time. ⦁ 203 employees recognised that the most well-known technology in healthcare is electronic health records. These participants usually work at hospitals or aged care facilities. ⦁ 110 nurses believe that they do not have sufficient involvement in the development of new sorts of technology and they recommend to vendors more participation of health professionals. ⦁ Some employees perceive as disadvantages the lack of technical support and training. ⦁ The study stress in the need of developing clinical guidelines before adopting and implementing technologies. ⦁ If employees consider the use of a new technology difficult to use it is perceived as a barrier. ⦁ Al-Harbi (2011) South Arabia Hospital Quantitative Research 623 healthcare providers including physicians, nurses and other clinical personnel in a hospital. ⦁ Health records ⦁ Computerised physician order entry ⦁ All respondents perceive that technologies have valuable benefits ⦁ 311 respondents have participated in the introduction of a new technology. ⦁ Only 112 participants think that some technologies are easy to use. ⦁ 87 participants perceived a significant relationship between training and good use of technologies. ⦁ There are not differences in the perceptions of technologies between males and females. ⦁ Nurses have higher positive perceptions in the use of technology especially for preparing reports, decision making and workload. ⦁ Some barriers perceived by 220 participants are related to the lack of training, lack of technical support and lack of management support. ⦁ There are important differences between employees who attend to training and those one who did not attend it. 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