Management of Everyday Technology Assessment, META
What is META?
Management of Everyday Technology Assessment, META, is an observation based assessment aiming at identification of performance skills, and skill deficits in use of everyday technology in older adults with Mild Cognitive Impairment (MCI) or dementia, but also in older adults in general, and people with cognitive impairments due to for example brain injury.
The assessment starts with an interview, where the interviewer and the client reaches an agreement on technological objects and services that are relevant to the client but also somewhat challenging. This interview is based on a hierarchy covering everyday technologies of different challenge, from easy to hard. Thereafter the assessment takes place through an observation of the client’s use of 3-4 of these somewhat challenging technologies, then followed by an interview to capture the person’s own view on his/her performance skills. The assessment hence is a combination of observation and interview.
The META assessment covers 4 different areas: A/assessment of observable performance skills during technology use (10 items), B/assessment of how environmental characteristics influence when a piece of technology is being used (2 items), C/ assessment of intrapersonal capacities that may contribute to problems when technology is used, including safety (3 items), and D/ the client’s appreciation of how important the technology is.
META has so far been most used in research concerning older adults with mild cognitive impairment or dementia, and also adults with acquired brain injury, in comparison to those with no known cognitive impairments. Education days have also been arranged for clinical occupational therapists in Sweden. In the future, our goal is that META could be used in clinical occupational therapy when there is reason to pay attention to clients' ability to use technology, as a base for interventions for individual clients and as a base for general adaptations of technology or when design and testing new technology.
The work to create META was initiated in 2006 by Louise Nygård (länk) in collaboration with clinical occupational therapists and research colleagues, and with particular support from Swedish Brainpower (länk). The point of departure was the emerging new insights about specific difficulties related to technology use available at that time through our research. This new knowledge indicated that particular skills related to technology use are important when performing activities that require the use of technology. Hence, having methods for investigation of this particular aspect seemed important, and to enable this, an instrument was needed. META was consequently built on two earlier studies: in one study, we had investigated the use of 86 common everyday technologies (objects and services) in samples of older adults with dementia or MCI compared to older adults with no known cognitive impairment. These 86 technologies could thereby be arranged in a hierarchy from easiest to most difficult to use (Rosenberg, Nygård & Kottorp, 2009). In the other study, we had qualitatively explored difficulties and obstacles to everyday technology use in a sample of older adults with mild to moderate dementia who lived alone, and this resulted in a taxonomy of types of difficulties related to technology use (Nygård & Starkhammar, 2007). In the META, the hierarchy describing level of difficulty of technologies is used as a point of departure in the initial interview aiming at identification of 3-4 technological objects or services that are relevant but somewhat challenging to the individual. The taxonomy covering types of difficulties when using technology was converted into a set of items in META, to be assessed in specific situations when a person is using his/her technologies. The first version of META was evaluated by Camilla Malinowsky (länk) in her PhD-thesis (2011). Anders Kottorp (länk) had, and still has, a particularly important role in this work as the expert in instrument development.
What can META contribute with in clinical work?
- META offers a systematic method for investigation of individuals’ as well as groups’ observed ability to use everyday technology, in the homes as well as in society. META can be a complement to assessments within the field of activity (ADL/IADL/social activities) but it does not replace these.
- META also provides added information about how the requirements of the context and the person’s prerequisites influence his/her ability to use everyday technology
- META can also provide information regarding the person’s perception of his/her skills when handling everyday technology
- META is a standardized method that provides detailed information about performance skills and skill deficits in daily life among clients who often are independent and where subtle changes in daily life activities are difficult to detect
- META can contribute by identifying target areas for interventions; occupational therapy interventions as well as others.
How can I get access to META?
As many clinically active occupational therapists in Sweden have shown interest in the META, we have offered education days a couple of times per years since 2010. These education days are free of charge, but in exchange each participating OT commit to submitting a minimum of 5 persons, each assessed with the META in 3 or more assessment situations, to our database within 6 months after the education. This is important as it allows us to continue developing the instrument and make sure that it works as intended in different populations. When somebody wishes to use the META in research, an agreement is made between the researchers and KI/Louise Nygård in each particular case. This agreement also outlines how META data will be shared.
Planned education days: None yet planned. Date and time will be announced later.
META in research
META has its origin and home in the research group Cognitive ACcessibility and Technology Use when ageing in home and Society, CACTUS (länk), at the Division of Occupational Therapy, NVS, Karolinska Institutet (länk). The research is part of a research programme financially supported by FORTE and others. Below you will find a short summary of the programme.
Living and ageing with cognitive impairments in the technological landscapes of homes and public places
In recent years there has been an increased emphasis on participation in society for people with different kinds of functional impairments. This requires an accessible society. Much focus has been placed on physical accessibility, while little is known of the cognitive aspects of accessibility. Technology use is very important in today’s society, and peoples’ participation in everyday life are increasingly influenced by the development and use of technology; both Everyday Technology, ET (e.g. cell phones, electronic household equipment, cash machines) and Assistive Technology, AT (e.g. electronic calendars and reminders). This on-going research programme’s departure point is in the identified gap between the technologically developed society and the possibility for people living and ageing with cognitive impairments to manage technology, and to access and use public spaces, part of the accessibility problem being related to technology.
The first track investigates the match between technology users with cognitive impairment and the requirements of technologies, with the aim to critically investigate the conditions for use, adaptation and development of technology to meet these users’ needs and desires, to identify mismatches and consequences of these, as well as to identify and try out improvements. The second track; access to and usability of places and activities in public space, particularly outside the home: promoting engagement and participation, aims at providing new knowledge of the conditions for participation in public space and society outside the home for people with cognitive impairment, and to identify possible avenues to increase accessibility and provide relevant support. In both tracks, the research is undertaken in collaboration with different disciplines nationally and internationally, and in close collaboration with the health care practice field, aiming at continuous development through knowledge translation and implementation of new knowledge.
Kottorp A, Nygård L, Hedman A, Öhman A, Malinowsky C, Rosenberg L, Lindqvist E, & Ryd C (Published online before print March 16, 2016). Everyday technology use of older adults: An occupational justice issue for some? Journal of Occupational Science.
Malinowsky, C., Larsson-Lund, M. & Kottorp, A. 2016) Return work in people with acquired brain injury; Association with observed ability to use technology. Under revision, Scandinavian Journal of Occupational Therapy e-pub ahead of print doi.org/10.1080/11038128.2016.1194466
Kassberg, A. C., Prellwitz, M, Malinowsky, C. & Larsson-Lund, M. (2015) Interventions aimed at improving the ability to use everyday technology in work after brain injury. Scandinavian Journal of Occupational Therapy. doi: 10.3109/11038128.2015.1122835
Malinowsky, C., Kassberg, A. – C., Larsson-Lund, M. & Kottorp, A. (2014). The stability of the test-retest reliability of the measures in the Management of Everyday Technology Assessment (META) among persons with acquired brain injury.Disability & Rehabilitation, Assistive Technology, e-pub ahead of print doi:10.3109/17483107.2014.968812
Malinowsky, C. & Larsson Lund, M. (2014). The association between perceived and observed ability to use everyday technology in working age people with ABI. Scandinavian Journal of Occupational Therapy, e-pub ahead of print. doi:10.3109/11038128.2014.919020
Kassberg, A. C., Malinowsky, C., Jacobsson, L. & Larsson-Lund, M (2013). Ability to manage everyday technology after acquired brain injury. Brain Injury, 27 (13-14), 1583-38. doi: 10.3109/ 02699052.2013.837196
Malinowsky, C., Kottorp, A. & Nygård, L (2013). Everyday technologies' levels of difficulty when used by older adults with and without cognitive impairment –Comparison of self-perceived versus observed difficulty estimates. Technology and Disability, 25 (3), 167-176.doi: 10.3233/TAD-130380
Malinowsky, C., Almkvist, O., Nygård, L. & Kottorp, A. (2012). Individual variability and environmental characteristics influence older adults’ abilities to manage everyday technology. International Psychogeriatrics, 24, 484-495. DOI: 10.1017/S1041610211002092.
Patomella, A-H., Kottorp, A., Malinowsky, C. & Nygård, L. (2011). Factors that impact the level of difficulty of everyday technology in a sample of older adults with and without cognitive impairment. Technology and Disability, 23, 243-250.
Malinowsky, C. (2011). Managing technology in everyday activities: A study of older adults with dementia, MCI, and no cognitive impairment. Doctoral dissertation. Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy.
Malinowsky, C., Almkvist, O., Kottorp, A. & Nygård, L. (2010). Ability to manage everyday technology: A comparison of persons with dementia or mild cognitive impairment and older adults without cognitive impairment. Disability & Rehabilitation: Assistive Technology, 5, 462-469. DOI: 10.3109/17483107.2010.496098
Malinowsky, C., Nygård, L., & Kottorp, A. (2011) Psychometric evaluation of a new assessment of the ability to manage technology in everyday life. Scandinavian Journal of Occupational Therapy, 18, 26-35. DOI: 10.3109/11038120903420606.
Publications that the META rests on:
Rosenberg, L., Nygård, L. & Kottorp, A. (2009). Everyday Technology Usage (ETUQ) – evaluation of the psychometric properties of a new assessment of competence in technology use. Occupational Therapy Journal of Research, 29 (2), 52-62. CI: 11.
Nygård L, Starkhammar S. (2007). The use of everyday technology by people with dementia living alone. Aging and Mental Health, 11(2), 144-155. CI: 20 / DOI: 10.1080/13607860600844168