Relational Digital Agency: An Everyday Life Study of Mobile Communication in Nursing Homes

Agency is a contentious concept with relation to nursing homes, both from an academic and a policy/practice perspective. The so-called “fourth age” has become so strongly associated with frailty and dependency (Gilleard & Higgs, 2017) that research agendas on ageing care contexts risk contributing to ageist narratives whether they employ or contest notions of agency. This reflects an ongoing dilemma within critical gerontology relating to how and whether the concept of “agency” can be ethically and meaningfully engaged with. While there has been interest in reclaiming speak of agency in ageing research as part of wider agendas to revalue older adults’ subjective experience (Wanka & Gallistl, 2021), there also has been longstanding hesitancy in critical gerontology to ascribe significance to “agency” for risk of contributing to narratives that exclude and devalue subjectivities that do not conform with mainstream conceptions of agency (Katz & Calasanti, 2015; Van Dyk et al., 2013). Furthermore, focusing on individual action and agency may shift attention away from the institutional contexts that produce vulnerabilities in later life, including heightened experiences of digital exclusion (Hebblethwaite et al., 2022).

While there is growing recognition that nursing home residents face digital inequalities (e.g., CSA Group, 2022), there is minimal research—whether quantitative or qualitative—that contributes to an evidence base on nursing home residents’ everyday uses of digital technologies (Schlomann et al., 2020; Seifert & Cotten, 2020). This research gap may in part reflect ageist assumptions about nursing home residents’ incapability to contribute to research—most studies have been about rather than with nursing home residents (Fernández-Ardèvol et al., 2017) and have employed models of technology adoption that fail to consider subjective experience (Neves et al., 2019). More generally, everyday life studies that consider older adults’ values for and experiences with technologies have been overshadowed by research questions framed around how technologies can improve ageing outcomes (Givskov & Deuze, 2018; Peine & Neven, 2019).

This research addresses what has been largely overlooked in mobile communication research: nursing home residents’ everyday, lived experiences with mobile communication devices, including tablets, smartphones, and smartspeakers. More specifically, the paper explores: How do care home residents experience agency with respect to mobile communication and what implications does this have for how we frame digital inequalities?

Drawing on qualitative research with 39 care home residents in Canada, the analysis considers the material and social factors that enable residents to experience a sense of control and ownership over their mobile communication practices. The findings show how meaningful communication environments in long-term care will provide opportunity for residents to deny and contest new technologies, bringing question to the inherent techno-optimism of digital divide discourses (see also Wagner, 2020, pp. 161–162). Whereas much research and policy attention on the digital inclusion of older adults has been concerned with the quantity and quality of technology use, this paper calls for a shift of attention to digital agency and the relational factors that support people to actively manage if, when, what, and how they engage with communication media. The paper develops an understanding of relational digital agency that provides conceptual space for addressing the intertwined nature of institutional and individual factors that shape experiences of digital inclusion/exclusion.

Mobile Communication and Residential Care

Paradigm shifts in social gerontology have incited interest in the cultural aspects of older adults “doings” with mobile media (Givskov & Deuze, 2018; Wanka & Gallistl, 2018). Research on older adults’ online communities (e.g., Nguyen et al., 2022), digital leisure practices (e.g., Chiribuca & Teodorescu, 2020), and mobile activism (e.g., Blanche-T & Fernández-Ardèvol, 2022) have revealed variegated everyday interactions with mobile devices, thereby diversifying and defying homogenized and stereotyped portrayals of older adults’ digital practices (Fernández-Ardèvol, 2020). However, a “deficit model” of technology use (Wanka & Gallistl, 2021) remains influential in mobile communication research in residential care settings. The host of Information and Communication Technology (ICT) research in nursing homes has been framed upon on an “interventionist logic” (Peine & Neven, 2019) with interest in how new devices and services can impact old age health and wellbeing (Neves et al., 2019; Wagner, 2022).

Positive outcomes associated with using tablets and smartphones in long-term care include reductions in depressive symptoms (Lin et al., 2020) and increases in social interaction and intergenerational communication (Akhtar, 2024; Jones et al., 2013). Likewise, there has been increasing policy attention to ICT use in care homes, particularly following the pandemic, and in Canada, numerous recommendations and initiatives have aimed to improve and promote ICT access and use in care homes (Wilson et al., 2022), alongside growing concern that care home residents have limited or inadequate access to the Internet (CSA Group, 2022, p. 28).

While research on everyday ICT use among nursing home residents is limited, studies have shown that Internet penetration rates in care homes are low (Seifert & Cotten, 2020), and a large-scale quantitative study in Germany with 80+-year-olds found that the living situation was the most important factor to explain probability of ICT use, where older people living in residential care were less likely to use ICT than their community-dwelling counterparts with comparable individual characteristics (Schlomann et al., 2020). This points to the need for further understanding of the contextual factors that contribute to care home residents’ disengagement with Internet communication. Research with ICT “non-users” has provided insights into the variegated factors that contribute to situational limitations on technology use and into the ways older people negotiate digital change (Fernández-Ardèvol et al., 2017; Gallistl et al., 2021).

Digital Inequalities, Ageing, and Agency

The term “digital divide” gained academic attention in the early 1990s to describe disparities in ICT access and use across countries, regions, and social strata (Hilbert, 2010). Insofar as the problem was initially conceived of as an access divide—the so-called “first level” divide (Scheerder et al., 2017)—the solution was increased technology diffusion. The term “digital inequalities” arose early on within digital divide debates to evade the inadequacy of a “divide” metaphor and account for inequalities of use among those with access (DiMaggio & Hargittai, 2001; Lythreatis et al., 2022). This marked the “second level” divide, which has drawn attention to a wide range of factors that influence quality and quantity of ICT use, with particular attention to digital skills (e.g., Deursen & Van Dijk, 2010). A “third-level” digital divide that concerns differential outcomes from digital technology use has been widely recognized (Scheerder et al., 2017; Van Deursen & Helsper, 2015), and discussions have arisen about a fourth-level divide relating to the wider context that enables technology use (Van De Werfhorst et al., 2022). This latter work has been explored with respect to childhood education studies, but parallel issues have been described in old age care settings where further attention to organizational support is needed for effective technology use (e.g., Wilson et al., 2022).

Age-related inequalities in respect to the first and second level digital divide have been well documented (Francis et al., 2019), and studies have drawn attention to the important role of family members in acquiring digital devices for older relatives (Selwyn, 2003) and providing support with device management and setup as “warm experts” (Martinez & Olsson, 2022). Along these lines, older adults’ digital repertoires have been characterized as interdependent with the digital skills of family members (Hänninen et al., 2023), which resonates with the concept of a “social envelope” outlined in childhood digital inequality studies (Talaee & Noroozi, 2019). While research on older adults’ and children's digital practices has highlighted the role of relational supports, the concept of “digital agency” has been most often used in research on youth and higher education contexts, with minimal attention to the social support networks that enable experiences of agency (see Siddiq et al., 2024).

Drawing largely on research with youth, Passey et al. (2018) have presented an initial definition of digital agency as “an individual's ability to control and adapt to a digital world” (p. 426). This resonates with longstanding approaches to digital inclusion that consider how individuals can obtain “a degree of control and choice over technology and content” (Selwyn, 2004, p. 349). However, whereas Passey and colleagues’ conceptualization concerns the individual, framed around confidence, competence, and accountability for one's own actions, Selwyn's analysis of meaningful use broadens the approach to the contexts that shape inclusion, including support networks.

The shared dimension of digital agency has been further developed to account for the experiences of rehabilitation professionals and their clients, where “agentic spaces” enable clients to accomplish digital tasks with the support of professionals (Silvennoinen & Rantanen, 2023). This characterization of digital agency builds on longstanding discussions around “agency” as fundamentally relational and as a product of social interactions (Burkitt, 2016).

Research Design and Methods

Qualitative research was conducted at four long-term care sites on Vancouver Island, B.C., Canada, involving 39 residents, seven staff, and five family members. The methodology combined reflective and creative sessions—to co-produce understanding about lived experiences—with mapping activities to identify pathways to change. Methods included in-depth interviews, digital storytelling workshops, collaborative reflection meetings, and asset mapping workshops. Due to ongoing concerns with COVID-19 infection prevention during the fieldwork (03/2022–01/2023), all research activities were conducted remotely, by videocall or phone call. The study was limited to include residents who experience no or mild cognitive impairments following a scoping study showing that within policy and research about nursing homes this group is often overlooked (Wagner, 2022). Ethics approval was granted by the University of Victoria and Vancouver Island Health Authority, and all research participants provided informed, voluntary consent.

This paper focuses on findings from the in-depth interviews (with 34 residents) and asset mapping workshops (with nine residents) with relation to both using and not using mobile technologies. The interview procedure was conducted in two parts and combined narrative inquiry (Jovchelovitch & Bauer, 2007) on social and communication practices through the life course with the mapping of communication networks and resources, or “communicative ecologies” (Hearn et al., 2009). Interviews were on average 42 minutes in length and used visual aids shared on screen, including picture cards and mapping sheets developed in a preliminary study (Wagner, 2022). Participants ranged from 50 to 103 years of age, with an average age of 77 years. The asset mapping workshops involved a virtual tour of the care home's floor plan and invited participants to reflect on how different rooms and spaces enable/constrain social interaction and/or media engagement.

The analysis inductively moved from codes using the participants’ own phrasing to thematic categories and theoretical concepts. Following the initial emergence of a code hierarchy, the dataset from each participant was re-analyzed to explore contributing factors within individual participants’ standpoints. This profiled re-reading of data enabled connections to be drawn with wider contextual factors that shaped residents’ varied experiences with mobile communication. The analysis developed in this paper largely draws on the second phase of the analysis, with attention to participants’ narratives to develop depth of understanding on experiences of digital agency.

Findings and Analysis

While all four care homes had tablets for residents to use and offered support with scheduled videocall appointments, nine participants had never videocalled before the interview, including four participants who owned their own tablet or smartphone. Residents’ reasons for engaging and not engaging with Internet communication were not simply about affordability or capability but reflected wider relations of support as well as identities and preferences.

Figure 1 summarizes interview participants’ differential access to communication devices and resources in relation to how they generally felt about Internet communication. Participants expressed a range of emotions when speaking about digital technologies in respect to the immediate context, their longstanding communication habits, and the available supports. As can be seen in Figure 1, all participants who spoke predominantly positively about (either adopting or denying) Internet communication had regular contact with people outside the care home. In what follows, the analysis is developed in line with the classic levels of the digital divide (Scheerder et al., 2017)—(1) access, (2) use, and (3) outcomes—and in this way explores the mediating role of relational aspects (such as outside support) across all three levels.

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Figure 1.

Key Aspects of Interview Participants’ Communication Resources in Relation to the Predominant Sentiment They Associated With Internet Communication.

Discussion—Reframing Digital Inclusion and Agency

Participants’ everyday experiences with mobile communication were diverse in respect to the devices and platforms they engaged with, the uses they designated to different tools, and their associated emotions, which spanned frustration, nostalgia, humor, isolation, and competence. These findings support other studies that draw attention to the diverse ways that older adults engage with mobile media (Givskov & Deuze, 2018), countering homogenizing portrayals of older adults as technologically incapable or averse, which have particularly influenced ageing and technology research agendas in long-term care (Wagner, 2022). As also found by Gallistl et al. (2021), a wide range of contextual situations shaped the ways that individuals engaged and didn’t engage with mobile devices. For example, preferred videocalling platforms depended on who one was speaking with, and devices that caused frustration in one situation became valued in another when outside help was available.

Whereas other studies show how physical disabilities present challenges for the effective use of digital devices (Snyder, 2023), participants in this research more often described how new technologies and arrays of different tools provided avenues for them to adapt to their changing abilities, such as smartspeakers that could be used for literary games when one's eyesight worsened or the assemblage of a smartphone and laptop that allowed for photo-editing when one's hands became shaky. Feelings of failure were not directly associated with technology disengagement (cf. Gallistl et al., 2021) but rather arose when other communicative options and/or supports were not available. Moreover, participants often associated positive sentiments with digital disengagement: residents described pride when refusing new technologies or when choosing what they didn’t want to learn about a device.

Situations where residents attached positive sentiments, including pride and humor, to their non-use of mobile devices were intertwined with access to outside support. Support networks included other tools and modes for communicating—bus routes, private landline connections, powered wheelchairs, and family visits—that enabled feelings of competence and confidence about everyday communication practices, and thus the space to say “no” to new devices. For example, Philip, who regularly used public transport to meet with family, felt positive about his decision not to use Internet communication as he had effective access to other communication resources.

Other studies have also found that older adults who identify as “offliners,” like Philip in this research, do not always perceive their non-use of the Internet negatively or as a form of exclusion (Seifert et al., 2018). This research contributes further understanding on how relational factors, including effective access to analogue media, enable positive experiences of ICT non-use, and moreover, that the capacity to deny ICT can be an important part of feeling socially and digitally included. That is, residents’ narratives in this research show that having outside support networks and effective access to other forms of media, including transport and face-to-face encounters, can provide the grounding upon which meaningful engagements and disengagements with digital technologies can transpire.

These findings point to two key implications for how we understand digital inequalities. First, digital inequalities are not simply about differing levels of technology access or use, but more fundamentally about differing levels of agency over communication and information practices. Accessing mobile devices can increase frustration when no support is available, whereas denying unwanted forms of mobile communication can be an important part of a meaningful communicative ecology. A more comprehensive understanding of digital inclusion is needed that can account for the important role of technology disengagement when communication devices and services are unwanted. While the third-level digital divide shifts attention to inequalities in the outcomes of communication technology use (Scheerder et al., 2017; Van Deursen & Helsper, 2015), there remains an underlying assumption that all people should use and obtain successful outcomes from digital technologies.

Second, the findings show how experiences of digital agency result from material and social interactions. When participants had a wider range of communication resources and options—including access to transport, landline phones, multiple devices, and regular in-person visits—they had more agency over how they engaged with mobile communication, choosing when, where, and what forms of communication they wanted to use or deny. This builds on existing work on “agentic spaces” (Silvennoinen & Rantanen, 2023) and “social envelopes” (Talaee & Noroozi, 2019) that describe how support networks enable meaningful engagements with digital technologies. This study contributes new understanding on how these supportive “spaces” involve wider contexts of media use, including analogue forms of communication, which can play a fundamental role in shaping emotional responses to digital technology use. Having “warm” digital support from family or friends and/or the ability to access outside social worlds enabled participants to have a wider range of communication resources.

Residents who did not have these supports described feelings of isolation and disconnection, and the prospect of relying on staff for support increased frustrations with communication devices, as described by Wayne when trying to be “patient” and Alexander who did not want to feel like a daily burden when setting up video calls. Overcoming such barriers at care homes would not simply be about digital skills development or further access to devices. Participants’ experiences suggest that digital support at care homes needs to be more holistic and better grounded on personal relationships, with further attention to how staff can provide “warm” support with identifying and setting up relevant communication resources—including analogue media and in-person engagements, sourcing new devices, and providing ongoing, caring support with maintaining and using devices.

Conclusion

Whereas prior work on digital agency has largely concerned youth (Siddiq et al., 2024), this paper has developed an understanding of relational digital agency to account for long-term care residents’ experiences negotiating and adapting to digital change. The narrative and mapping approaches employed in this research respond to a gap in understanding on mobile communication in long-term care, as much prior research has overlooked residents’ subjective experiences. The everyday life focus of this research developed insights into residents’ experiences of digital agency, which have implications for digital practices in care homes and for digital inclusion research more broadly.

Findings showed how a greater array of analogue communicative resources and supports contribute to a more positive relationship with Internet media. More holistic and caring approaches to digital support—ones that encompass all stages of identifying and using a wide range of communication resources, including analogue forms of communication—will be important to address digital inequalities in care homes.

The research also contributes to digital divide debates by showing how meaningful communication environments afford space for people to deny and contest digital technologies. This finding brings into question existing measures of digital inclusion that focus on the quantity and quality of technology use and calls for further research attention to how people across institutional settings are afforded the capacity to deny unwanted forms of digital communication and how this capacity may underpin or contribute to experiences of digital inclusion.