摘要：Purpose: Assistive technologies and digitalization of services are promoted through health
policy as key means to manage community care obligations efficiently, and to enable older
community care recipients with mild cognitive impairment (MCI) and dementia (D) to remain at
home for longer. The overall aim of this paper is to explore how community health care workers
enacted current policy on technology with home-dwelling citizens with MCI/D.
Participants and Methods: Twenty-four community health care workers participated in one of
five focus group discussions that explored their experiences and current practices with technologies
for citizens with MCI/D. Five researchers took part in the focus groups, while six researchers
collaboratively conducted an inductive, thematic analysis according to Braun & Clarke.
Results: Two main themes with sub-themes were identified: 1) Current and future potentials
of technology; i) frequently used technology, ii) cost-effectiveness and iii) “be there” for
social contact and 2) Barriers to implement technologies; i) unsystematic approaches and
contested responsibility, ii) knowledge and training and iii) technology in relation to userfriendliness and citizen capacities.
Conclusion: This study revealed the complexity of implementing policy aims regarding
technology provision for citizens with MCI/D. By use of Lipsky’s theory on street-level
bureaucracy, we shed light on how community health care workers were situated between
policies and the everyday lives of citizens with MCI/D, and how their perceived lack of
knowledge and practical experiences influenced their exercise of professional discretion in
enacting policy on technology in community health care services. Overall, addressing
systematic technology approaches was not part of routine care, which may contribute to
inequities in provision of technologies to enhance occupational possibilities and meaningful
activities in everyday lives of citizens with MCI/D.
关键词：older adults; community health care services; discretion; street-level bureaucracy
