An interview study was conducted with older people receiving aged care services at home from a single provider. The service provider offers a range of aged care services, including domestic support, personal care, social support, home modifications, nursing, allied health, and transport.

Study participants were in-home aged care clients who resided in metropolitan Victoria, Australia. Clients were approached by their aged care provider if they were considered to have poor emotional well-being, such as depression or low mood, based on their professional judgment, and were potentially interested in participating in a study on how technology can improve older people’s mood and emotional well-being. Participants were not required to have a diagnosis of a mental health disorder, and no mental health or well-being screening was conducted for this study. Eligibility criteria included age of 65 years or older and current receipt of a government-funded aged care service. Participants were not required to have any level of expertise in technology or digital literacy. Exclusion criteria included a diagnosis of dementia or presence of significant cognitive impairment, an acute health-related issue that could interfere with research participation, and difficulty engaging in an interview conducted in English.

After an initial conversation with the aged care provider, if the client indicated an interest in taking part in the research, a researcher called them on the telephone, confirmed their willingness to participate, and set up a time to visit their home for the interview. The participant information sheet and consent form were mailed or emailed to all participants prior to the interview. A researcher visited the client’s home, obtained written consent, and conducted the audio-recorded interview, using a semistructured interview format. Participants were given the opportunity to have a family carer present during the interview.

Demographic variables included client age, sex, living arrangement, and geographical location, which were obtained from the participant’s care record prior to the home visit. Additional data were collected during the visit: level of education, marital status, and a single item on the presence or absence of a health problem that prevents the participant from doing things people their age can normally do, which was answered “Yes,” “No,” “Don’t Know,” or “Prefer Not to Disclose.” A full list of demographic questions is available in Multimedia Appendix 1.

A semistructured interview was developed for the study, with interview questions exploring care recipients’ existing access to and use of technology, current access to support for their emotional well-being, and their views on the use of digital technologies to improve their mood or emotional well-being, such as web-based platforms, mobile apps, or videoconferences. Questions also explored their views of emotional support being offered by their aged care provider (refer to Multimedia Appendix 1 for interview schedule).

Demographic data were analyzed using descriptives (eg, mean, range, and frequency). Qualitative data were transcribed and coded using thematic analysis: a “method for identifying, analyzing and reporting patterns (themes) within data” to find “repeated patterns of meaning” [23]. The 6 phases of thematic analysis described by Braun and Clarke [23], namely, familiarization, generation of initial codes, searching for themes, reviewing themes, and naming themes, followed by report production, were used. No formal codebook was developed. Instead, an inductive strategy was used, which allowed the themes to arise from the data, and the phases of analysis were treated in a reciprocal manner, allowing movement back and forth between the phases. All transcripts were coded by 3 team members (DC, TDD, and HD) using Microsoft Excel. Any discrepancies were resolved through consensus during discussions. Regular discussions were held within the multidisciplinary research team to provide further insight into the themes arising from the analysis. Quotes were selected based on their ability to capture the theme accurately and articulately, ensuring that perspectives were drawn from across the participants.

Ethical approval was granted by the Swinburne University of Technology Human Research Ethics Committee, and data were collected between October and December 2023.

Fifteen clients were nominated for the study by the aged care provider. Two did not meet eligibility criteria (one due to dementia and one due to language issues), 1 could not be contacted, and 1 declined to participate. The final client sample included 11 aged care recipients (7 female participants and 4 male participants), who were all retired and ranged in age from 70 to 87 (mean 79, SD 5.2) years (Table 1). The sample size of 11 was determined to be sufficient as interviewers identified that saturation had been reached, with no new themes arising in the final interview, and data collection was ceased. Seven participants lived alone, while 4 lived with family members, and 7 were born in Australia. There was a range of formal education: most did not finish secondary school (n=7), but 1 participant had completed secondary schooling, 2 had completed technical or vocational training, and 1 had completed an undergraduate degree. Participants were either married (n=5), widowed (n=4), or divorced or separated (n=2). The majority were living with a health problem that prevented them from doing things people their age can normally do (n=7), but 2 answered “no” to this question, and 2 either were not sure or elected not to answer. Three clients were accompanied by a family carer in the interview, typically their spouse; however, in order to focus on the perspectives of clients themselves, only comments from the clients were included in this analysis.

Results are summarized in Multimedia Appendix 2, including illustrative participant quotes.

Results are summarized in Multimedia Appendix 2, including illustrative participant quotes.

Results are summarized in Multimedia Appendix 2, including illustrative participant quotes.

This study extends existing literature on the use of digital technologies in later life by focusing on a clinically complex population that has been largely overlooked by researchers but is growing rapidly. Aged in their 70s and 80s, this in-home aged care sample was considerably older than participants in much of the research previously published on this topic, with many researchers defining “older adults” as young as aged 50 or 55 years plus [19,24-26]. Participants in this study generally had limited postschool education, and most reported they were unable to do things others their age could do. Previous research has demonstrated that advanced older age [27-30], poorer health [29,30], and physical disability [28]—all of which are ubiquitous in the home care setting—have a negative impact on use of technology in daily life.

Our findings indicated that while participants generally had good access to digital devices and internet at home, access did not equate to independent or confident use. Technology use varied considerably: some participants used multiple devices for a broad range of activities and functions throughout their daily lives, while others used devices only for basic communication or were unable to use available devices or functions without support. Aged care providers should routinely assess not only device access, but also digital confidence, skills, support needs, and the availability of informal assistance, before introducing digital tools into care.

Most participants used their devices for communication, entertainment, social media, or to access information, while only a minority described using technology to manage their physical health, for example, to monitor their health or to seek health-related information. Participants did not use purpose-designed digital mental health or well-being tools and appeared largely unaware of them, despite their widespread availability in the general population [31]. However, many used technology for hobbies, social connection, music, reading, games, and religious content, which may indirectly support well-being [24]. This suggests that digital well-being tools may be more acceptable if embedded into familiar activities and existing care interactions, rather than presented as stand-alone programs. Aged care providers could address the gap in awareness by recommending apps aligned with their clients’ interests that have a strong evidence base, and by incorporating brief digital check-ins via telehealth.

Despite being identified by their aged care provider as likely experiencing poor emotional well-being, only 1 participant was receiving current professional support, although another had previously received counseling, and a further participant had attempted to access support. Most participants were open to receiving professional support, particularly when framed around having someone to talk to, rather than as mental health treatment. This aligns with previous research describing the reticence of in-home aged care recipients to seek mental health care [32] while also suggesting that many accept formal support at key points in their lives if presented in a nonstigmatizing and personally relevant way. Service providers should frame supportive services in terms of helping the person maintain their well-being, engage in valued activities and interests, or implement lifestyle changes.

Most participants expressed a preference for face-to-face or hybrid emotional support rather than fully online, consistent with previous research [19,32]. However, several were open to using telehealth to access mental health specialists, counselors, or people with lived experience, and identified convenience and anonymity, which are important enablers for digital mental health interventions [19]. Participants also recognized the potential for telehealth approaches to address barriers to accessing care, such as limited mobility. Their perceptions may have been shaped by strong current reliance on informal sources of emotional support. Ready access to family or community support may reduce perceived need for digital alternatives and reinforce preferences for personal, face-to-face interactions. This may help explain participants’ preference for in-person support, alongside their openness to digital tools when positioned as complementary to, rather than replacing, existing support networks.

Digital emotional well-being approaches must account for both general barriers to accessing mental health support, such as negative attitudes, low awareness, availability, and accessibility of services [21], as well as digital-specific barriers. In this study, participants identified challenges related to sensory impairments, reduced physical dexterity, low confidence, privacy and scam concerns, and the need for repeated practical instruction. These findings are consistent with previous research showing that older people may require accessible, reliable, and easy-to-use technologies, supported by clear instructions [11,19]. The current findings indicate that training for home care recipients should be ongoing, rather than one-off, with opportunities for repetition and practical demonstration. Approaches such as in-home coaching, simple step-by-step guides, and embedding support within routine care interactions may help to build confidence and sustain engagement over time.

Trusted health care providers may be well placed to introduce suitable digital well-being tools, either by sharing information about available options or embedding selected tools into service delivery [19,26]. Some participants were enthusiastic about the potential to receive emotional support from their aged care provider, while the majority indicated they might be willing to consider this approach, consistent with other recent research [32]. Future research should identify which types of digital supports are most acceptable and feasible in home-based aged care. While many digital mental health offerings focus on managing symptoms of depression and anxiety, in these interviews, care recipients described a broad range of activities that they saw as helpful for their emotional well-being, which offers the possibility of extending the types of interventions for greater engagement and uptake.

Implementation should address older people’s concerns about making a mistake or damaging technology, privacy, scams, and the credibility of digital tools, all of which may impact their willingness to engage [10,11,20,26]. Most participants in this study required at least some support in using digital technologies at home, typically provided by their adult children. While some only sought assistance after attempting to resolve technology problems independently, family members routinely completed digital tasks on behalf of other older people. Although family support may often be appropriate during implementation [11,33], reliance on family alone may reinforce dependence and limit autonomy. Encouragingly, even among care recipients who reported poor skills in using technology, many were willing to learn, consistent with previous research [33]. Proactive, no-cost support is likely important for successful implementation, given this sample’s poor uptake of existing technological support services available in the community and previous reports of limited use of technology helpdesks [34]. Roles such as digital navigators, technology mediation workers or facilitators within aged care services could support older people’s adoption and use of technology [25,26]. Policymakers should ensure that aged care funding enables older people to access not only apps, devices, and internet services where required, but also the practical support needed to use them. Greater coordination between aged care providers, health services, and community organizations (eg, community-based digital literacy programs) may also help ensure older adults can access consistent and trusted sources of assistance.

The findings can be understood through the lens of the Unified Theory of Acceptance and Use of Technology (UTAUT) [35], which proposes that uptake is shaped by performance expectancy (perceived usefulness), effort expectancy (perceived ease of use), social influence, and facilitating conditions. Participants’ emphasis on technologies needing a clear and meaningful purpose aligns with performance expectancy, with care recipients being more open to using digital tools when they could see how these would support their daily lives or well-being, or help them engage in valued activities. However, low confidence, fear of making mistakes, and the need for repeated instruction reflect low effort expectancy, highlighting perceived complexity as a key barrier.

Social influence played a central role in shaping technology use, with family members, particularly adult children, playing a central role in introducing and supporting technology use, although in some cases they completed digital tasks on behalf of participants. Technology adoption in this population is not solely an individual process but is strongly embedded within social relationships, which may both facilitate and inadvertently limit independent use. Facilitating conditions were often limited, with most participants relying primarily on informal support networks and reporting limited engagement with structured sources of technological assistance for training and ongoing assistance.

Collectively, applying UTAUT highlights that limited uptake of digital technologies to support emotional well-being in home-based aged care is not primarily driven by lack of interest, but by a combination of modifiable factors related to usability, support, and perceived value, as well as lack of awareness of relevant tools. Technology adoption in this population is strongly shaped by reliance on informal carers and the need for ongoing, hands-on support, rather than access alone. Even when interest is high, low effort expectancy and limited support can constrain engagement. Together, this suggests that improving uptake of digital well-being interventions in this population will require not only demonstrating value but also reducing complexity and embedding sustained support within service models. This study extends existing literature on UTAUT by demonstrating how these constructs operate in a clinically complex, home-based aged care population, where reliance on informal carers and physical limitations may amplify effort expectations and limited access to resources.

While this is the first in-depth exploration of the views of in-home aged care recipients in using technology to support their emotional well-being, there are several limitations of this study, most notably the small size of the sample and the potential for sampling bias; those with very low interest in using technology and those uncomfortable discussing emotional well-being may have chosen not to participate in the study. In addition, the study recruited participants considered by their care workers to have poor emotional well-being, given the broad focus of the research. Some of the participants may have experienced symptoms of depression, anxiety, or other mental health conditions, but their mental health status was not formally assessed, and different results may have been obtained with a sample with confirmed mental health conditions. It is also possible, given the absence of formal criteria provided to referring staff, that some participants did not experience poor emotional well-being at the time of the interview; however, all participants referred to either current or previous periods where they struggled with low mood or aspects of poor well-being during interviews. Aged care recipients from regional or rural areas, those who were non–English-speaking, and those with significant cognitive impairment were not included in this study; additional research is required to understand the perspectives of these populations. Similarly, the research was conducted with recipients of a single aged care provider, and the results may not generalize to the broader population of older people who receive aged care at home. Three participants had a family carer present during their interview, which may have influenced how they responded to interview questions. Finally, the interviews were conducted from October to December 2023 and explored technologies readily available at that time. Novel AI-based tools to support emotional well-being, such as chatbots, were not discussed in interviews. With technology evolving rapidly, research findings should be updated regularly.

Despite the limitations, this study highlights an openness to both formal and informal support for well-being among in-home aged care recipients. Digital technologies could play an important role in supporting a population facing increasing mental health rates [36] and poor access to professional mental health services [7]. As well as increasing access to support, digital technologies have the potential to allow older people to self-manage their well-being. However, our findings suggest that access to everyday digital devices does not necessarily translate into awareness or use of purpose-designed digital well-being tools among frail and clinically complex older people living at home. Aged care providers could play a valuable role in introducing suitable programs to older people, leveraging established trusting relationships and should consider integrating digital tools into existing service delivery to support their clients’ well-being [11].

When considering digital initiatives, aged care providers should prioritize those that can be delivered using the devices older people already access in their homes, particularly smartphones, tablets, and smart TVs. Importantly, many care recipients will require significant and ongoing technology training and support in using new technologies, even those accessed via their existing devices, which requires appropriate resourcing [11]. This study identified several barriers that should be addressed throughout implementation and highlighted the need for a highly tailored implementation approach, given the heterogeneity in care recipients’ digital literacy and experience using technology—one size will not fit all. The routine use of brief assessments of care recipients’ technological readiness has been proposed previously for the aged setting [10]. It may also be beneficial to provide education to aged care workers [10], some of whom may hold negative perceptions about the use of technology in aged care [11,25] and may themselves have low digital readiness [10,11,37], which could impact their willingness to offer these solutions.