Which factors affect the
acceptance of smart diaper
technology among nurses?
A qualitative research in residential dementia care
,Summary
Introduction: The amount of people with dementia in the Netherlands will redouble by 2040 which
puts residential long-term care facilities such as nursing homes under big pressure. People with
dementia suffer from urine incontinence even more than other elderly. Managing UI is currently
done by using diapers. However, due to inefficient diaper checks and wasted materials using diapers
is not efficient. Monitoring technologies such as the smart diaper have potential to make UI
management more efficient. However, the acceptance of monitoring technologies by nurses remains
a challenge and in-depth insight in which factors affect the technology acceptance are lacking. The
aim of this study is therefore to give an in-depth understanding about which factors affect the
acceptance of the smart diaper technology among nurses working in residential dementia care.
Methods: This study has an explorative and qualitative approach. The data was collected through in-
depth interviews among nurses (n=10) working in residential dementia care. For better interpretation
of the data, fieldnotes have been taken in practice. The process was iterative which means that data
analysis immodestly started during the data collection.
Results: The results showed insights in how the four key aspects of the UTAUT model affected the
technology acceptance of nurses. The most important finding is that the group of residents the
technology is used for determines the performance expectancy for nurses. Respondents roughly
distinguished two groups of residents: the vulnerable and dependent group and the more
independent group. For this first group the technology worked, however while using the technology
for the second group multiple challenges occurred. Within the effort expectancy we saw several
disadvantages within the ease of use and user friendliness such as the use of an external clip. The
most influential actors are nurses who inspire and motivate each other to use the technology. Lastly,
there are some aspects such as Wi-Fi, the separate phone and involvement of nurses that need to be
facilitated to properly use the technology and embed it in the daily practice of nurses.
Conclusion: The acceptance of smart diaper technology is mainly influenced by the performance and
effort expectancy. Benefits were experienced, however not among all residents the technology was
applicable. Moreover, the technology also lacked in certain features and user friendliness. There is a
lot of variation in how nurses deal with those disadvantages. The most influential actors in
technology acceptance are colleagues. By influencing each other more colleagues develop a positive
attitude towards the technology. However, this is not working for all colleagues right now and
negative attitudes remain. Therefore, we can conclude that smart diaper technology is not fully
accepted in practice to use among all incontinent residents, and work on the attitude of nurses and
the features of the technology is necessary.
,Table of contents
............................................................................................................................................................1
Summary............................................................................................................................................2
1. Introduction..................................................................................................................................6
1.1 Problem analysis...........................................................................................................................6
1.2 Objective and research question..................................................................................................8
1.3 Reading guide...............................................................................................................................8
2. Theoretical framework................................................................................................................10
2.1 Introduction of the UTAUT model..............................................................................................10
2.2 Performance Expectancy............................................................................................................11
2.3 Effort Expectancy........................................................................................................................13
2.4 Social influence...........................................................................................................................14
2.5 Facilitating conditions.................................................................................................................15
2.6 Insights current research............................................................................................................15
3. Research methods.......................................................................................................................16
3.1 Study design...............................................................................................................................16
Research methods........................................................................................................................16
Research population.....................................................................................................................16
Suppliers of the smart diaper technologies...................................................................................17
3.2 Data collection and analysis........................................................................................................18
3.3 Validity and reliability.................................................................................................................19
4. Results.........................................................................................................................................20
4.1 Performance expectancy differs per subgroup...........................................................................20
Experienced benefits for most vulnerable dementia residents......................................................20
Behavioural problems complicate the use of the smart diaper.....................................................20
Changes in working processes affect the attitude of nurses.........................................................22
4.2 Variation in dealing with user friendliness..................................................................................23
4.3 Social influences within teams are main reasons to still use technology....................................24
Positive colleagues inspire the more negative colleagues.............................................................24
4.4 Facilitating conditions affect the use of and attitude towards technology.................................25
4.5 Summary results.........................................................................................................................26
5. Discussion and conclusion...........................................................................................................28
5.1 Reflection on the results.............................................................................................................28
Reflection on the use of UTAUT....................................................................................................28
The complex interaction between nurses and technology............................................................29
, The most influential actors are nurses themselves.......................................................................31
Technology evoked the debate about prioritizations in dementia care........................................31
The importance of facilitating conditions.....................................................................................32
Contribution of this study.............................................................................................................32
5.2 Strengths and weaknesses study................................................................................................33
5.3 Conclusion..................................................................................................................................33
5.4 Recommendations......................................................................................................................34
Further research...........................................................................................................................34
Practical recommendations care organisations............................................................................35
Practical recommendations suppliers...........................................................................................35
6. References...................................................................................................................................36
7. Appendix.....................................................................................................................................40
A. Topic list.......................................................................................................................................40
1. Introduction..................................................................................................................................3
1.1 Problem analysis...........................................................................................................................3
1.2 Objective and research question..................................................................................................5
1.3 Reading guide...............................................................................................................................5
2. Theoretical framework..................................................................................................................6
2.1 Introduction of the UTAUT model................................................................................................6
2.2 Performance Expectancy..............................................................................................................7
2.3 Effort Expectancy..........................................................................................................................9
2.4 Social influence...........................................................................................................................10
2.5 Facilitating conditions.................................................................................................................11
2.6 Insights current research............................................................................................................11
3. Research methods.......................................................................................................................12
3.1 Study design...............................................................................................................................12
3.2 Data collection and analysis.......................................................................................................14
3.3 Validity and reliability.................................................................................................................15
4. Results.........................................................................................................................................16
4.1 Performance expectancy differs per subgroup...........................................................................16
4.2 Variation in dealing with user friendliness.................................................................................19
4.3 Social influences within teams are main reasons to still use technology...................................20
4.4 Facilitating conditions affect the use of and attitude towards technology.................................21
4.5 Summary results.........................................................................................................................22
5. Discussion and conclusion...........................................................................................................24
5.1 Reflection on the results.............................................................................................................24
acceptance of smart diaper
technology among nurses?
A qualitative research in residential dementia care
,Summary
Introduction: The amount of people with dementia in the Netherlands will redouble by 2040 which
puts residential long-term care facilities such as nursing homes under big pressure. People with
dementia suffer from urine incontinence even more than other elderly. Managing UI is currently
done by using diapers. However, due to inefficient diaper checks and wasted materials using diapers
is not efficient. Monitoring technologies such as the smart diaper have potential to make UI
management more efficient. However, the acceptance of monitoring technologies by nurses remains
a challenge and in-depth insight in which factors affect the technology acceptance are lacking. The
aim of this study is therefore to give an in-depth understanding about which factors affect the
acceptance of the smart diaper technology among nurses working in residential dementia care.
Methods: This study has an explorative and qualitative approach. The data was collected through in-
depth interviews among nurses (n=10) working in residential dementia care. For better interpretation
of the data, fieldnotes have been taken in practice. The process was iterative which means that data
analysis immodestly started during the data collection.
Results: The results showed insights in how the four key aspects of the UTAUT model affected the
technology acceptance of nurses. The most important finding is that the group of residents the
technology is used for determines the performance expectancy for nurses. Respondents roughly
distinguished two groups of residents: the vulnerable and dependent group and the more
independent group. For this first group the technology worked, however while using the technology
for the second group multiple challenges occurred. Within the effort expectancy we saw several
disadvantages within the ease of use and user friendliness such as the use of an external clip. The
most influential actors are nurses who inspire and motivate each other to use the technology. Lastly,
there are some aspects such as Wi-Fi, the separate phone and involvement of nurses that need to be
facilitated to properly use the technology and embed it in the daily practice of nurses.
Conclusion: The acceptance of smart diaper technology is mainly influenced by the performance and
effort expectancy. Benefits were experienced, however not among all residents the technology was
applicable. Moreover, the technology also lacked in certain features and user friendliness. There is a
lot of variation in how nurses deal with those disadvantages. The most influential actors in
technology acceptance are colleagues. By influencing each other more colleagues develop a positive
attitude towards the technology. However, this is not working for all colleagues right now and
negative attitudes remain. Therefore, we can conclude that smart diaper technology is not fully
accepted in practice to use among all incontinent residents, and work on the attitude of nurses and
the features of the technology is necessary.
,Table of contents
............................................................................................................................................................1
Summary............................................................................................................................................2
1. Introduction..................................................................................................................................6
1.1 Problem analysis...........................................................................................................................6
1.2 Objective and research question..................................................................................................8
1.3 Reading guide...............................................................................................................................8
2. Theoretical framework................................................................................................................10
2.1 Introduction of the UTAUT model..............................................................................................10
2.2 Performance Expectancy............................................................................................................11
2.3 Effort Expectancy........................................................................................................................13
2.4 Social influence...........................................................................................................................14
2.5 Facilitating conditions.................................................................................................................15
2.6 Insights current research............................................................................................................15
3. Research methods.......................................................................................................................16
3.1 Study design...............................................................................................................................16
Research methods........................................................................................................................16
Research population.....................................................................................................................16
Suppliers of the smart diaper technologies...................................................................................17
3.2 Data collection and analysis........................................................................................................18
3.3 Validity and reliability.................................................................................................................19
4. Results.........................................................................................................................................20
4.1 Performance expectancy differs per subgroup...........................................................................20
Experienced benefits for most vulnerable dementia residents......................................................20
Behavioural problems complicate the use of the smart diaper.....................................................20
Changes in working processes affect the attitude of nurses.........................................................22
4.2 Variation in dealing with user friendliness..................................................................................23
4.3 Social influences within teams are main reasons to still use technology....................................24
Positive colleagues inspire the more negative colleagues.............................................................24
4.4 Facilitating conditions affect the use of and attitude towards technology.................................25
4.5 Summary results.........................................................................................................................26
5. Discussion and conclusion...........................................................................................................28
5.1 Reflection on the results.............................................................................................................28
Reflection on the use of UTAUT....................................................................................................28
The complex interaction between nurses and technology............................................................29
, The most influential actors are nurses themselves.......................................................................31
Technology evoked the debate about prioritizations in dementia care........................................31
The importance of facilitating conditions.....................................................................................32
Contribution of this study.............................................................................................................32
5.2 Strengths and weaknesses study................................................................................................33
5.3 Conclusion..................................................................................................................................33
5.4 Recommendations......................................................................................................................34
Further research...........................................................................................................................34
Practical recommendations care organisations............................................................................35
Practical recommendations suppliers...........................................................................................35
6. References...................................................................................................................................36
7. Appendix.....................................................................................................................................40
A. Topic list.......................................................................................................................................40
1. Introduction..................................................................................................................................3
1.1 Problem analysis...........................................................................................................................3
1.2 Objective and research question..................................................................................................5
1.3 Reading guide...............................................................................................................................5
2. Theoretical framework..................................................................................................................6
2.1 Introduction of the UTAUT model................................................................................................6
2.2 Performance Expectancy..............................................................................................................7
2.3 Effort Expectancy..........................................................................................................................9
2.4 Social influence...........................................................................................................................10
2.5 Facilitating conditions.................................................................................................................11
2.6 Insights current research............................................................................................................11
3. Research methods.......................................................................................................................12
3.1 Study design...............................................................................................................................12
3.2 Data collection and analysis.......................................................................................................14
3.3 Validity and reliability.................................................................................................................15
4. Results.........................................................................................................................................16
4.1 Performance expectancy differs per subgroup...........................................................................16
4.2 Variation in dealing with user friendliness.................................................................................19
4.3 Social influences within teams are main reasons to still use technology...................................20
4.4 Facilitating conditions affect the use of and attitude towards technology.................................21
4.5 Summary results.........................................................................................................................22
5. Discussion and conclusion...........................................................................................................24
5.1 Reflection on the results.............................................................................................................24
