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Image of the videophone that was presented to focus group participants via PowerPoint. 

Image of the videophone that was presented to focus group participants via PowerPoint. 

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Purpose: To develop a design concept for an easy-to-use videophone for people with dementia and to evaluate the design and need of such a product. Method: In this project, we have used an inclusive design approach that includes the target users in the design process. In an earlier study, the need of a videophone was examined and a requirement sp...

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... enable videophone use. They also evaluated the preliminary design concept. The procedure is presented in more detail below. The study was approved by one of the Regional Ethical Review Boards in Stockholm, with journal number 2010/1674-31/5. The first step in phase 3 was to develop a preliminary design concept of the videophone. Two master’s students in Human and Computer Interaction from Uppsala University were engaged to create this, based on the requirement specifications that were presented in an earlier study [10]. The preliminary design concept was created (by the master’s students) in PowerPoint and first evaluated by our research group, which consisted of OTs with PhD degrees, doctoral students, one professor and one engineer with a PhD degree. All members of the research group had experience in working with people with dementia or cognitive impairment. The research group discussed several versions of the concept in detail until consensus was reached about the design and functions. After feedback from the first author, the students amended the design and an ongoing process of feedback and refinement of the design concept ensued until a version was accepted by the research group. This version was presented to the participants in the focus groups to gather their views. Focus groups were chosen to capture the views of the target users, their SOs and OTs who work with people with dementia on issues. The issues included the need of a videophone, its design and functions, the users’ capabilities to use a videophone and their reflections on the design concept. The focus groups were also aimed at capturing the participants’ discussions of experiences, expectations, feelings and thoughts concerning the videophone. We first turned to OTs working with people with dementia as they were believed to have valuable knowledge of the topic. They have a central role in prescribing AT and it has been recommended that professionals who handle AT should be involved in developing AT for people with dementia [18]. Thereafter, we invited SOs of people with dementia, and finally persons who were diagnosed with dementia, to focus groups. The parallel analyses of the data collected from these first three focus groups revealed that it would be important to have an additional focus group with SOs and one with people with dementia. This was in order to get more data regarding their views of factors such as the advantages of the videophone and the possibility to use the videophone for monitoring. After these five focus groups had been completed, the data were considered to be rich enough to shed light upon the study issues, and no more participants were recruited. OTs were recruited by the first author through a network of OTs working with people with dementia. Potential OTs were invited via e-mail with information about the study. PWD and SOs of people with dementia were recruited through OTs working at a memory investigation unit. They were invited by telephone and by a letter with information. Inclusion criteria were that the persons recruited should be willing to participate in group discussions in Swedish. OTs had to be working with people with dementia and have more than 2 years’ experience in this position. SOs of people with dementia had to be a relative or a close friend of the person who had a dementia diagnosis and have good insight into the everyday life of this person. Persons with dementia had to have a dementia diagnosis and be able to participate in group discussions. 166 I.-L. Boman et al. Five focus groups were formed, and each focus group met for one session. The focus groups consisted of 2–8 participants, in total 24 participants (Table 1). These rather small groups were chosen to facilitate elaboration of views and issues between participants as recommended [16,22,23]. The sessions with OTs and the second sessions with SOs were conducted in a training apartment at one of the large hospitals in the region. All other sessions (Table 1) were conducted in an office at Karolinska Institutet, which is located near the memory investigation unit and is a familiar place for the PWD and their SOs, as recommended [16]. The focus group sessions were moderated by the last author (L.R.), with assistance from the first author (I-L.B.). Each session lasted between 2 and 3 h including refreshment breaks. Each focus group session started with a presentation of the purpose of the study, and the participants were encouraged to interact with each other during the session [24]. An interview guide with open questions was developed for this study, covering the participants’ current use of communication technology, the participants’ potential for using a videophone, ideas on design and functions of a videophone and evaluation of the design concept. In the latter part of each session, the first author showed our design concept, using PowerPoint, to give the participants an idea of how the videophone could look (for a description see Figure 1). The first author gave a brief explanation of the functions and said that a touch screen was suggested as interface. An iPhone and an iPad were shown and participants who had not used a touch screen before could try them briefly. The participants were encouraged to express their honest opinions when evaluating the design concept and not hold back too much to please the researchers. All sessions were audio-taped. After each focus group session, the moderator and the first author reflected on the discussion, also embracing immediate suggestions for issues that should be brought up in the next focus group. This meant that the interview guide was modified between the groups in order to capture issues that had been brought up by the authors. These discussions were also taped and added to the data. All interviews were transcribed verbatim by assistants, including the discussion notes. After each session, the digitally recorded focus group discussion was listened through to get an overall understanding of the material, and thereafter transcribed verbatim. After that the data were coded with an emphasis on capturing the essence of the discussions. Examples of codes from focus groups 1, 2 and 3 with OTs, SOs and PWD were better understanding of what the PWD are saying, ease of use, pleasure and enjoyment in use, starting to use the video phone at an early stage, complement to a regular telephone and mobile phone and ask how the PWD feels. The codes were given names close to the participants’ own wording and as the analysis proceeded they were compared and merged with codes from focus groups 4 and 5 with PWD and SOs. Parallel to the coding procedure, new questions were developed through the writing of analytic memos [25]. Examples of questions included: How do the participants think that the videophone should be implemented? In what way do the three groups opinions differ regarding the possibilities for persons with dementia to turn off the video camera? Answers to questions that arose during the analysis were continuously looked for in the data or ideas given for new questions for the following focus group. After that the codes were merged together into categories and discussed by the authors until they reached agreement. During the analysis, codes and categories were constantly compared to establish congruence in the analytical process. To be sure that the analysis was grounded in data, the categories were constantly compared with data from the focus groups. The first and the last author met regularly to discuss the emerging codes and categories until agreement was reached. The preliminary findings were critically examined by the second author (L.N.) to check the relevance and validity of the findings [25]. The three categories that emerged from the analyses were flexible design as a condition for acceptance, challenges in starting to use a videophone and advantages of a videophone. The categories are presented below together with their respective subcategories (see Figure 2). Participants in all focus groups stated that the videophone should have a flexible design that is easy to adjust to the users’ needs, habits, interests and abilities. A flexible design also implied the possibility for the user to go from a mobile to a stationary videophone. In all focus groups, the participants pointed out that in an early stage of the disease, people with dementia might need a mobile videophone that can be used both outdoors and in the home environment. They suggested that a mobile videophone could be used, for example, to guide the persons with dementia when they need help with something like turning on the television or finding their glasses. However, one problem that ...

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... Ideally, strategies could be taught early in the progression of cognitive decline when learning of new information requires less effort. 69 Hopefully, this would create the basis for more successful intervention in later stages. There may be situations in which early strategy teaching will not be feasible; further research will have to elaborate on this. ...
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Objectives: Dealing with memory loss is a major challenge for older people. Coping strategies for memory problems could enable cognitively impaired people to live independently for longer. We conducted a systematic review to summarize evidence on coping strategies for older people and people with cognitive impairment to stabilize everyday life functioning. Methods: We systematically searched the databases PubMed, PsychInfo, Scopus and WebofScience using a well-defined search string. Studies were included if they were published between January 1990 and February 2021 and written in English, German, Spanish, French, or Swedish language. Two blind researchers independently checked the studies for inclusion and exclusion criteria and evaluated the quality of the studies using Critical Appraisal Skills Programme-checklists. Evidence was summarized in a narrative synthesis. Results: A total of 16 relevant studies with adequate quality were identified. These studies reported on three categories of strategies: external, internal, and behavioral coping strategies. External strategies included reminder systems and integrated features in the environment and were used by people with and without cognitive impairments. Internal strategies such as visualization, verbalization, active remembering, and systematic thinking were reported less often by people with cognitive impairment than those without cognitive impairment. Behavioral strategies such as reducing expectations and acceptance of support was most frequently reported by people with cognitive impairment. Conclusions: The findings of our systematic review show a great number of coping strategies, which seem to depend on cognitive status. Appropriate training tools incorporating these strategies should be developed.
... Other reviewed research studied different devices that offer video-calls. Boman and colleagues studied a kind of videophone, which was newly developed specifically for older adults to connect with significant others such as their family and friends, from the design phase to the mock-up version (Boman et al. 2014a;Boman et al. 2014b). The videophone in their research included a touch screen, a camera on the top of the screen, a support holder to keep it standing, and a handset. ...
... These benefits were also found in other research (Beringer et al. 2013;Hemberg et al. 2018;Tsai et al. 2010b). The reduced stress and anxiety were also perceived by others with whom older adults communicated (Boman et al. 2014b). The satisfaction degrees of nursing home residents in the study by Sacco et al. (2020) were greater with video calls when there was assistance to establish communication during the COVID-19 confinement period. ...
... In terms of supporting visual communication, videoconferencing was used as a conversation provoker as they can see each other. According to the study participants, being able to see each other made it easier to find topics for conversation (Boman et al. 2014a;Boman et al. 2014b). Being able to see the family members' face was also noted as an important aspect of maintaining aged care residents' connections with their family. ...
Conference Paper
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Videoconferencing has been increasingly used for social connectedness in residential aged care (RAC). In sensitive settings such as RAC, it is important that technologies are introduced with careful consideration of people's needs and experiences with the technology, to ensure that the desired benefits are realised. This paper reviews research evidence about older adults using videoconferencing for social connectedness and issues raised by that use in order to identify strategies RAC providers can adopt to achieve a greater likelihood of sustainability. Fourteen articles were included for in-depth review. Devices featuring videoconferencing in the studies reviewed ranged from tablets to telepresence robots. Most study participants perceived videoconferencing as beneficial for social connectedness. The implementation of videoconferencing in RAC is impacted by differences in sociotechnical systems. This paper contributes key considerations for the future design and implementation of videoconferencing for social connectedness in RAC and opportunities for future work in this area.
... Jamin et al. (2018) also emphasized that co-design with all stakeholders can make the overall experience more pleasurable but also more meaningful as it allows for the users to be kept at the centre of the decision-making process and adaptations can be made to new insights as they emerge. In several studies it was recognised that people with dementia continue to be one of the most excluded groups from research and the design of new services (Boman et al., 2014;Hanson et al., 2007). ...
... Some challenges were described in the involvement of people with dementia such as the risk of obtaining socially desirable answers (Boman et al., 2014;Meiland et al., 2012). However, this risk is not specific to this population and in general, is not uncommon in research. ...
... Having the right prerequisites in place prior to involvement can help overcome the challenges and to optimise the involvement of people with dementia. When it comes to the participants, prioritising their well-being and ensuring they are aware of the purpose and relevance of their involvement can help contribute to an enjoyable research experience (Boman et al., 2014;Hanson et al., 2007). Both findings from this review and suggestions from the PPI group members emphasized the need for skilled researchers, and the need for a comfortable research environment. ...
Thesis
Introduction: people with dementia may benefit from technology to enhance their quality of life (QoL), reduce social isolation and potentially improve cognition. Adapting existing interventions to digital platforms is a promising approach with prospective benefits. Group Cognitive Stimulation Therapy (CST) for people with dementia can benefit cognition and QoL. Individual CST (iCST) is delivered by a carer at home and can improve the relationship quality between the person with dementia and carer, and the QoL of carers. Given the lack of technological resources for the mental stimulation and engagement of people with dementia, there are potential benefits of combining iCST with touch-screen technology, which include improving global accessibility to iCST. Aims: to develop and evaluate a touch-screen version of iCST, and examine its potential for implementation internationally. Methods: this study employed a mixed methods approach to the development and evaluation of a novel iCST app. Development included a narrative synthesis systematic review supported by the Medical Research Council (MRC) Framework and the Centre for eHealth Research (CeHRes) roadmap, and following principles of action research and the agile approach to software development. Forty-one people with dementia and carers were involved in patient and public involvement (PPI) consultation meetings, focus groups, individual interviews, and usability questionnaires. Evaluation included a two-arm, feasibility randomised controlled trial (RCT) (n = 43) to investigate the usability of the iCST app, and feasibility of conducting a large-scale RCT. Three dyads participated in semi-structured, post- trial interviews. Feasibility of cultural adaptation and implementation internationally was investigated in Indonesia where 39 people with dementia, carers, and healthcare professionals participated in focus groups and a stakeholder meeting. Results: the systematic review led to best practice guidelines on how to optimise involvement of people with dementia in technology development. These guidelines informed the development of the iCST app through three iterative prototypes. The idea of an iCST app was well received in PPI consultation meetings, and feedback indicated that the design and navigation of the prototypes were appropriate. A need for a wider range of more relevant activities was identified in the focus groups and interviews. The third prototype of the iCST app was used for the feasibility RCT. Carers using the iCST app rated their QoL better at follow-up 2 (FU2) compared to the treatment as usual (TAU) control group (EQ-5D, MD = 6.34, 95% CI = .92 – 11.76, p = .02). No other significant differences were found. The exploratory work in Indonesia indicated that it is feasible to implement the iCST app given appropriate cultural adaptation and provided that logistical barriers to accessibility have been overcome. Conclusions: this is the first study to develop and evaluate an interactive, touch- screen version of iCST. Findings indicate certain modifications to the trial components including increased recruitment capacity and sample size, and an augmented version of the iCST app. Expansion of the iCST app is needed as most participants completed the activities more quickly than anticipated and therefore, did not receive the recommended dose. Given these adaptations to the study design, it is recommended to conduct a large-scale RCT to investigate formal effectiveness.
... The term 'acceptability' was not used in the reviewed papers, but the terms 'accept' and 'acceptance' appeared in a few studies. Boman, Nygard, & Rosenberg (2014) stated that acceptance of technology was associated with the ability to maintain a desired self-image of being competent. Usability is thus a measure for the utility of ALT, whereas acceptance relates to the self-image or self-understanding of the user. ...
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... Fifth, another limitation is not having assessed the risk of bias and the quality of the studies; however, only articles published in scientific journals were used. Finally, comparing instruments that measure usability and UX was challenging, because there is no consensus on these broad terms (Sauer et al., 2020) and there are also few studies involving older people with dementia or MCI, which may be due to a certain skepticism about the level of feedback they can provide and doubts about the appropriateness of testing prototypes on them, since possible mistakes can make them feel confused and disappointed with new technologies (Boman et al., 2014;Holthe et al., 2018). ...
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Introduction Incorporating technology in cognitive interventions represents an innovation, making them more accessible, flexible, and cost-effective. This will not be feasible without adequate user-technology fit. Bearing in mind the importance of developing cognitive interventions whose technology is appropriate for elderly people with cognitive impairment, the objective of this systematic review was to find evidence about usability and user experience (UX) measurements and features of stimulation, training, and cognitive rehabilitation technologies for older adults with mild cognitive impairment (MCI) or dementia. Method The Medline, PubMed, Scopus, ScienceDirect, and PsycINFO databases were searched for literature published in the last 10 years (2009–2019), and three researchers independently reviewed potentially eligible studies, following specific inclusion criteria. A systematic review of the studies was conducted, presenting a qualitative synthesis of usability and UX measures with their outcomes, study characteristics and features of the cognitive intervention technologies. Results Ten studies were selected: five were cognitive stimulation and five were cognitive training. Most of them (60%) were computer-based programs with a serious game format. Efficiency and effectiveness were the most frequent measurements used for collecting objective usability data, showing that elderly people with cognitive impairment require more time (45%) and help (40%) but can complete tasks (60%). Regarding UX or subjective usability data, questionnaires and scales were the most used methods, reporting positive experience despite certain difficulties with the interface in five studies. Conclusion Measuring usability and UX in cognitive intervention technologies for older adults with MCI or dementia provides an integrated view that can contribute to their development according to the needs and characteristics of the target population. More research is required to include this population group in usability and UX studies, as well as standardized tools and consensus on the relationship of these terms to guarantee the future effectiveness of cognitive intervention technologies. Review registration This review was registered in the PROSPERO (CRD42020158147) International Register of Systematic Review Protocols.
... A standardized data extraction form was developed by the primary researcher (HR), in which the review team members recorded the extracted data from the final studies, including the study quality rating (Multimedia Appendix 1) [6,7,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]. ...
... • Behavioral observations [17,20], focus groups [6,7,18,[21][22][23][24], interviews [6,18,19,22,[24][25][26][27], workshops [7,25], questionnaires [17], and user tests [6,7,[18][19][20]22] Feasibility and piloting ...
... A total of 2 studies included needs assessments, followed by discussions about the design of future technology using qualitative methods. Boman et al [21] used focus groups to capture experiences, expectations, and thoughts concerning a videophone and its design concepts. The design had to be flexible to meet the needs of people with dementia, be easy to use, and not look like assistive technology. ...
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Background: Technology can be helpful in supporting people with dementia in their daily lives. However, people with dementia are often not fully involved in the development process of new technology. This lack of involvement of people with dementia in developing technology-based interventions can lead to the implementation of faulty and less suitable technology. Objective: Thissystematicreviewaimstoevaluatecurrentapproachesandcreatebestpracticeguidelinesforinvolvingpeople with dementia in developing technology-based interventions. Methods: A systematic search was conducted in January 2019 in the following databases: EMBASE (Excerpta Medica database), PsycINFO, MEDLINE (Medical Literature Analysis and Retrieval System Online), CINAHL (Cumulated Index to Nursing and Allied Health Literature), and Web of Science. The search strategy included search terms in 3 categories: dementia, technology, and involvement in development. Narrative synthesis wove the evidence together in a structured approach. Results: A total of 21 studies met the inclusion criteria. Most studies involved people with dementia in a single phase, such as development (n=10), feasibility and piloting (n=7), or evaluation (n=1). Only 3 studies described involvement in multiple phases. Frequently used methods for assessing involvement included focus groups, interviews, observations, and user tests. Conclusions: Most studies concluded that it was both necessary and feasible to involve people with dementia, which can be optimized by having the right prerequisites in place, ensuring that technology meets standards of reliability and stability, and providing a positive research experience for participants. Best practice guidelines for the involvement of people with dementia in developing technology-based interventions are described.
... Reviewing the evidence even taking the assumptions above, reveals that there is very little research that has investigated the experience of older care home residents with dementia using tablets or screens for video calls. There is a little research which indicates that people with dementia may find the additional visual input of body language and facial expression on a video call is helpful in taking part in an interaction (Boman et al., 2014;Meiland et al., 2017;Moyle et al., 2020a) and that such calls can help to reduce isolation and loneliness (Guo et al., 2016). There is some experience that colour contrasts may be perceived differently, and that the light and sound in the environment should be managed to make the screen and the sound as clear as possible for the resident (Boman et al., 2012). ...
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Context: The work presented in this paper was undertaken during the first three months of the COVID-19 crisis in the UK. Objectives: The project is aimed to respond to questions and concerns raised by front-line care staff during this time, by producing research-based ‘Top Tips’ to complement emerging COVID-19 policy and practice guidelines. Methods: Eight rapid, expert reviews of published, multidisciplinary research evidence were conducted to help answer care home workers’ questions about ‘how’ to support residents, family members and each other at a time of unprecedented pressure and grief and adhere to guidance on self-distancing and isolation. A review of the emerging policy guidelines published up to the end of April 2020 was also undertaken. Findings: The rapid reviews revealed gaps in research evidence, with research having a lot to say about what care homes should do and far less about how they should do it. The policy review highlighted the expectations and demands placed on managers and direct care workers as the pandemic spread across the UK. Implications: This paper highlights the value of working with the sector to co-design and co-produce research and pathways to knowledge with those who live, work and care in care homes. To have a real impact on care practice, research in care homes needs to go beyond telling homes ‘what’ to do by working with them to find out ‘how’.
... Potential conflicts between the interests and expectations of carers and persons with dementia have been noted previously. For example,Boman, Nygård and Rosenberg (2014) pointed out that 'significant others' often have worries about the person with dementia and therefore wish to use technology to monitor from afar. However, the implicit assumption that technologies that help carers will also be beneficial for the person with dementia does not necessarily hold true. ...
... However, the implicit assumption that technologies that help carers will also be beneficial for the person with dementia does not necessarily hold true. Technological solutions can challenge the self-determination and sense of freedom of the person with dementia(Boman et al., 2014). This is, however, a point of individual difference as some people with dementia find renewed freedom and independence in travel with the reassurance of knowing that they can, if needed, be located through an application on their smartwatch (see chapter 3:Vermeer et al., 2019b)."New ...
Conference Paper
Globally technology has become a popular response to the challenges of ageing populations. Dementia presents a particular problem for family carers and policy makers for which surveillance technologies (STs) such as monitoring devices are posited as solutions. ST products are marketed online focusing on their capacity to empower people with dementia; however, these products are developed without considering (potential) user input. The literature about dementia and surveillance was reviewed as was the nature of the ST market. The involvement of users in setting the parameters and utilities of such products was investigated through qualitative research. This interdisciplinary research undertook a tripartite approach studying: production (what is on the market); audience reception (what do users need); and media content (what media techniques are used to attract attention) in the United Kingdom, Sweden and the Netherlands. The key finding across studies was that there was little recognition that people with dementia have different needs from those of carers. A “wanderer” discourse gave minimum representation to people with dementia interacting with technology stressing instead the dangers of wandering from carers’ perspectives. This dichotomy was reflected in the different interpretations that each group made of advertisements. Carers focused on wanting small trackers for covert use. People with dementia conversely thought ST was not for them as it stigmatised them. People with dementia are not passive. They have individual needs for independence and these can conflict with those of carers. These findings are relevant to technology designers and advertisers by highlighting their assumptions about this gap in the (civil rights) movement market.
... The themes of the interview guide were developed by the research group and decided in discussions based on APs' and IBs' earlier experiences of prescribing AT and on previous research projects where AT were developed and adjusted to the needs of cognitive impairments [18,25,26]. The interview guide covered the following topics: Four focus group sessions were conducted at a large hospital. ...
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Background: There is lack of knowledge on how occupational therapists (OTs) assess daily time management (DTM) for persons with dementia (PwDs) and on which aspects affect prescription of time assistive technology (AT). Aim: To explore OTs’ experiences of assessing the need for and prescribing time AT for PwDs. Material and methods: Focus group interviews with OTs that prescribe time AT for PwDs analyzed via qualitative content analysis. Results: A main category and four categories were identified. The categories illustrated a complex and time-consuming prescription process, which was facilitated if the PwD was supported by a significant other (SO). Support from a SO was especially important during implementation and follow-up. OTs had to take individual responsibility for staying informed about time AT. Organizational limitations and time constraints were barriers for OTs striving to work according to national prescription guidelines. Conclusions and significance: High demands are made on SO’s participation during the prescription process. PwDs with no support from SOs are at risk not receiving or fully benefitting from time AT. To avoid inequalities, specific forms of support need to be developed and targeted at PwDs without SOs to ensure that they have sufficient opportunities to access and use time AT.
... Potential conflicts between the interests and expectations of carers and persons with dementia have been noted previously. For example, Boman et al. (2014) pointed out that "significant others" often have worries about the person with dementia and therefore wish to use technology to monitor from afar. However, the implicit assumption that technologies that help carers will also be beneficial for the person with dementia does not necessarily hold true. ...
... However, the implicit assumption that technologies that help carers will also be beneficial for the person with dementia does not necessarily hold true. Technological solutions can challenge the self-determination and sense of freedom of the person with dementia (Boman et al., 2014). This is, however, a point of individual difference as some people with dementia find renewed freedom and independence in travel with the reassurance of knowing that they can, if needed, be located through an application on their smartwatch (Vermeer et al., 2019a). ...
Article
Purpose This paper aims to interrogate online comments from consumers with dementia and family carers on surveillance technology products used by or for people with dementia. Design/methodology/approach A naturalistic, observational study of qualitative posts (N = 120) by people with dementia (n = 7) and family carers (n = 38) to discussion threads on surveillance technology (ST), hosted by an online dementia support forum in the Netherlands. Kozinet’s (2002) typology was used to describe respondent characteristics, and comments on features of ST products were analysed within a pre-existing framework. Findings Forum users were mainly “tourists” interested in ST, with some “insiders” interested in sharing experiences of ST use. They expressed a lack of trust in information from marketers and providers to the experience of being provided with poor information. Consumer-to-consumer comments on products triangulated with previous face-to-face qualitative studies. Carers prioritised “peace of mind” through location monitoring. In contrast, people with dementia prioritised user-friendliness (simple, with capability and compatible with daily routines). Practical implications Using online discussions of ST products provides a rapid approach to understanding current consumer needs and preferences in the ever-changing world of technology. Originality/value No previous study is known to have explored the views of carers and people with dementia in online discussions about ST.