**4. Conclusion**

the research on telemonitoring showed that not every person is able or willing to take responsibility for their own healthcare. Secondly, there are dilemmas related to autonomy, privacy and dignity, and safety and control. For example potential conflict was attributed to telecare: (service user) autonomy and (healthcare professional) control. Moreover, with regard to surveillance technology, competing values around safety versus autonomy were described. On the one hand use of surveillance technology with movement sensors (such as GPS) or video surveillance was seen as enhancing personal freedom and autonomy of persons living with dementia. On the other hand it confronted care professionals with issues around guarding the patients safety. Also, some technology was found to have a negative impact on the individuals' privacy and dignity or to hamper personal freedom. These examples show that whilst technology claims to increase the autonomy of service users, it may also compromise their feelings of dignity. Moreover, it challenges healthcare professionals, service users and their significant others to re-consider the weight given to valuing service users' physical safety above other (psychological, social and spiritual) values such as autonomy and freedom of movement [32, 33]. In other words it is important to acknowledge that technological innovations can cause the phenomenon of competing values within healthcare, not only between different stakeholders' groups, but also *within* groups and individuals. These results correspond with literature on surveillance technology for persons living with dementia in which intra-personal/professional conflicts were identified [33–36]. This highlights the need and the difficulty of realizing engagement and involvement of all relevant stakeholders in the implementation of technology in daily practice, which refers to the construct of cognitive participation in the NPT, and elaborates on this construct by including other stakeholders apart from

Finally the results showed dilemmas around practicality: improper use of surveillance technology and the need for tailor made solutions disclosed a paradox. In the pursuit of greater safety, this safety was rather impeded by the use of new technologies than improved. One could argue that the examples around practicality illustrate the importance of acknowledging human-centered design of assistive technology. It underlines the necessity to pay attention to the *inspiration phase,* to understand what service users feel, think and experience, the i*deation phase* in which prototypes are tested and refined after feedback is collected from users, and the i*mplementation phase* in which the final product or service is evaluated, to test the impact of the technology when it is used in care practices. Finally the examples showed that the condition of collective action of the NPT to actually facilitate the use of technology in practice, was not realized. This draws special attention to one of the facilitating conditions of the UTAUT model: the realization of supportive infrastructures (both

The described dilemmas arising when using technology in healthcare, confront us with the need to explicate choices: what do we value most, and in what situation? When using technology, roles, tasks and responsibilities of healthcare professionals and service users should be made explicit and agreed upon between all stakeholders involved. Also there is a need to regularly/continuously evaluate changes to the care relationship and the perspectives of different stakeholders (cf. reflexive monitoring) during its introduction and thereafter [37].

healthcare professionals.

106 Assistive Technologies in Smart Cities

organizational and technical).

The integration of assistive technology into healthcare practice is not only dependent on the intention to use a (technological) innovation but also relates to role and process changes. In health care, professional roles are based on values inspired by personal relations between healthcare professionals and patients or service users. Therefore, for technology to be applied in a successful manner the perspectives of different stakeholders during and after the introduction of technology should be identified and evaluated.
