Telecare – where, when, why and for whom does it work? A realist evaluation of a Norwegian project

INTRODUCTION: Evaluations of telecare demonstrate disparate results, which are of little help for understanding what the users need from further policy and development. This study aims to provide a more nuanced approach to telecare evaluations. METHODS: Realist evaluation is used to scrutinize what it is about telecare that works for whom, why, how and in which circumstances. Sequential interviews were conducted with telecare users and relatives at pre- and post-implementation stages. RESULT: Some users experienced the intended effects from telecare, such as increased feeling of safety, whereas others did not. Various contextual elements influenced how people reasoned about the resources provided by telecare and affected the individual outcomes. DISCUSSION: The desire to remain in own home appeared to be a major driving force in accepting telecare. Users had surprisingly high tolerance to side effects of telecare, which might indicate that much was at stake. Some users disapproved of having telecare due to contextual reasons; however, readjustments proved successful to some. CONCLUSION: This study illuminates how and why telecare works differently in different situations, and thus leads to different outcomes. When telecare is correctly adjusted to match the user’s needs, abilities and contexts it enables them to feel safe and remain in their own homes.