We conducted a qualitative descriptive study to directly capture participants’ perspectives on how technology is used to support caregiving activities. Using a community-engaged research approach, we collaborated with Care Partners, a Houston-based community services and advocacy group that delivers high-quality programming for older adults and people with dementia, including family caregivers (such as support groups, educational programming, and in-home visits for caregiver consultation). The organization serves over 2500 older adults in the Houston area. We sought to examine caregivers’ experiences using technology to facilitate their caregiving activities and triangulated these data with information shared by clinicians and key informants—specifically around barriers and facilitators to integration and consistent use. The study followed guidelines for the COREQ (Consolidated Criteria for Reporting Qualitative Research).

From July to November 2023, a purposive sample of caregivers and key informants were recruited from CarePartners’ roster of volunteer caregivers, clinicians, and community key informants to triangulate data from multiple sources. Consistent with Braun and Clarke reflexive thematic analysis [28], sample adequacy was evaluated based on the richness of the data and the analytic objectives rather than the achievement of data saturation. Recruitment continued until the research team judged that the dataset provided sufficient depth and breadth to address the research question.

Eligibility criteria consisted of the following: informal, unpaid, caregivers of older adults (>60 y old), who were aged over 21 years old, fluent in English, residing in the same home as the older adult, and providing more than 12 hours of care per week; clinicians currently working with CarePartners; and community key informants (eg, community leaders and elder care advocates). Multiple modalities were used to recruit participants: (1) engaging in direct outreach to caregivers participating in online support groups, sharing information with support group moderators, and joining online meetings to provide details about the study; (2) disseminating information about the study through a weekly electronic CarePartners newsletter, which is shared with its membership; and (3) posting physical flyers in common spaces. Prospective participants contacted CarePartners staff to complete an electronic form so that a member of the research team could follow up and determine study eligibility. A trained research nurse assessed participants for study eligibility, obtained informed consent, and scheduled an interview date and time with the participant.

The study team comprised investigators with expertise in nursing, medicine, psychology, public health, and qualitative methods—all of whom are experienced in working with patients with chronic illness and their families. We acknowledge that our clinical and research backgrounds, as well as our commitment to improving caregiver support and health equity, informed the framing of the research questions and interpretation of the findings. To promote reflexivity, team members engaged in ongoing discussions throughout data collection and analysis to examine assumptions, challenge interpretations, and consider alternative explanations. Coding and thematic development were conducted collaboratively, with analytic decisions documented to enhance transparency and ensure that findings remained grounded in participants’ accounts.

Quantitative survey data collected in REDCap were exported to SPSS (version 29; IBM Corp) for data management and analysis. Descriptive statistics were performed to characterize the study sample. Qualitative interview data collected in person were professionally transcribed and reviewed by members of the research team, while virtual interviews for which transcript data were automatically transcribed were similarly reviewed to verify transcript accuracy. All data (including digital audio and Zoom meeting recordings and raw interview transcripts) were stored on a secure, institutional drive. Finalized transcripts were deidentified and uploaded to ATLAS.ti (version 5.22.1; Lumivero, LLC) to assist with analysis. Data were analyzed using methods for thematic analysis [28] to assist with addressing the goals of our study. Two members of the research team with prior qualitative research experience first read and reread the entire deidentified, transcribed interview dataset to become familiar with the data. Then, each coder independently developed initial codes (semantic and underlying) to represent interpretive labels for the data that addressed the research question. The codebook contained a comprehensive list of codes with exemplar excerpts from the dataset. Coders met upon completion of the initial coding to discuss diverging assumptions, interpretations, and conceptual insights. Disagreements between coders were treated as opportunities to explore deeper, underlying patterns within the data. After all data were coded, an initial thematic map was developed by grouping together multiple codes sharing similar underlying concepts into higher-order themes and subthemes. The research team then met to review and refine the initial themes, discussing how accurately these represented the coded data (and the entire dataset) and whether to discard or merge themes as needed. Detailed descriptions of the final themes and subthemes were then finalized.

To ensure qualitative rigor and trustworthiness as described by Lincoln and Guba [32], we maintained a detailed audit trail, practiced reflexive memoing, held team discussions throughout the analytic process, and used data source triangulation methods to cross-validate the findings.

Participants were offered a US $100 gift card for their time and contribution to the study. Ethics board approval for human subjects research was provided by the UTHealth Houston Institutional Review Board (number HSC-SN-22‐0575). A trained research nurse (and member of the study team) obtained participants’ informed consent using REDCap’s e-consent feature. All participants were advised of the voluntary nature of study participation, encouraged to ask questions, and informed that they could withdraw from participation at any time.

Demographic characteristics for caregiver participants are summarized in Table 1. Caregivers were an average age of 67.6 (SD 10.79) years, female (28/32, 87.5%), a combined category of Black Hispanic (14/32, 43.75%), college degree holders (12/32, 37.5%), and most (20/32, 62.5%) had an average annual income of US $30,000 to US $49,999. Data regarding care recipients were not collected. Caregivers had spent a mean of 7.15 (SD 3.31) years caring for their loved one. They reported having insufficient social connections according to the LSNS-Revised scale (mean 14.38, SD 4.54), while caregiver burden as measured through the Zarit Burden Interview was moderate (mean 7.44, SD 2.90). Finally, technology acceptance measured by the technology acceptance model questionnaire was relatively high (mean 95.00, SD 13.31) among participants, and most respondents (14/32, 43.75%) rated their health as “good.”

Through our qualitative interviews, participants shared an overarching sentiment that using technology to support their caregiving activities is a balancing act that is largely dictated by their care recipient’s needs. Overall, caregivers described a paradoxical relationship with technology, valuing its ability to provide practical assistance, enable emotional connection with others, and provide reassurance, while also recognizing that poorly designed, expensive, or difficult-to-learn technologies could increase the caregiving burden. As such, 3 themes emerged from the data illustrating the competing tensions regarding technology that exist for caregivers of homebound older adults: (1) These Technologies Aren’t Designed for People Like Us, Facing These Problems, (2) Balancing the Scales, and (3) Preserving a Sense of Self. The 8 related subthemes are further described below.

Caregivers described using technology as a means of Preserving a Sense of Self amidst their all-consuming caregiving role. Participants shared that they personally used technology to buoy their sense of self through the following 2 subthemes of (1) Maintaining Social Connectedness and (2) Promoting Wellness/Self-Care, enabling them to persevere in their respective caregiving journeys.

Caregivers of older homebound adults describe complicated perspectives on using technology in their caregiving. Nationally, most caregivers of older adults are younger than 64 years old [33]. That most caregivers in our study were older adults themselves presents a unique perspective on technology use in this population, and the tensions they encounter in incorporating technology into their caregiving activities. Our sample was interviewed as COVID-19 restrictions were easing, which reflects the unique experience of those who may have been technology-averse but were forced, due to circumstances created by the pandemic, to integrate modes of virtual interaction into their daily lives. Although most participants found that keeping health appointments with providers was beneficial, allowing them to learn new technologies such as Zoom and other virtual meeting dashboards, this did not translate into a general embrace of technology beyond instrumental activities of daily living such as banking, shopping, or medication management. While participants reported high levels of technology acceptance on the technology acceptance model questionnaire, the qualitative interviews revealed nuanced experiences characterized by frustration, uncertainty, and hesitation when engaging with specific technologies. This divergence may reflect differences between general attitudes toward technology and the practical realities of its use in everyday contexts [34,35]. Previous literature generally supports the notion that research participants are more forthcoming in reporting sensitive topics through anonymous survey questionnaires [36]. It is possible that the context of a group discussion normalized participants’ experiences [37] on the barriers they experience when using technology. While participants recognized the potential value of technology in improving communication, support, and some daily tasks, their narratives highlighted barriers to usability, confidence, technical difficulties, and needs for assistance. These findings suggest that technology acceptance should not be interpreted solely as a willingness to use technology but should also consider the contextual factors that influence sustained engagement. Our first theme aligns with previous work, indicating that physical impairments, in addition to dispositional and technical factors, may limit technology use [38,39]. Nonetheless, the subthemes represent a glaring gap for technologies that are designed expressly for caregivers—there are few that combine their shared concerns (safety, connection to others in their situation, local resources, and clinical expertise). That caregivers expressed a need for resources that combine multimodal types of support aligns with recent guidance to enhance reach and accessibility for technology among older adults [40,41]. Thus, co-designing technologies with caregivers leverages their unique experiential expertise, increasing the chances that digital solutions will not only address explicit caregiving needs but also the subtle, often invisible demands, workarounds, and emotional complexities that shape daily caregiving and are unlikely to be identified through researcher or clinician-driven design alone.

The second theme, Balancing the Scales, illustrated the sentiment echoed across participants that caregivers wear many hats in their role, often feeling like the odds are stacked against them. This theme addressed facilitators to technology use on a broad level, indicating that tailored education and training that meets caregivers where they are in their caregiving journey may address the barriers identified in Theme 1. Its related subthemes further highlighted drivers of technology use as issues of practicality. Using technology to assist with instrumental activities of daily living allows caregivers to simplify their daily routines as they carry a significant mental load in managing their homes and loved ones’ condition. The third subtheme, Promoting Sense of Security, centered around balancing caregivers’ sense of vigilance—the idea of always being present or “on duty”—with their needs for peace of mind. However, some participants expressed privacy invasion concerns regarding technologies used for surveillance of their loved ones. An important ethical concern for the use of technologies such as home monitoring devices for adults with dementia and cognitive impairment is the appropriate balance between autonomy and safety. A balance between protecting individuals from harm while preserving independence and dignity is essential and should be negotiated carefully [42].

Interestingly, participants did not describe the feeling of a 24/7 responsibility as a burden during their interviews, despite reporting moderate caregiver burden (ZBI-4 scores), but rather as an inherent feature of their situation. It may be that these caregivers have normalized their caregiving demands as an expression of commitment or responsibility due to their familial relation (spouse, adult child, and grandchild) to the care recipient.

The final theme, Preserving a Sense of Self, speaks to the idea that caregivers also have personally driven needs for technology use that may buffer the strains of caregiving. Although it was beyond the scope of this study to examine participants’ personal motivations for caregiving, it was evident that a sense of duty and obligation were underlying drivers and that the toll of the caregiving experience called for respite. The subtheme of Maintaining Social Connections and Promoting Wellness further enforces the importance of caregivers maintaining relationships and interests that are critical for their own identities and tempering the role loss experienced by caregivers that has been described by others [43,44]. That caregivers’ LSNS scores suggested that participants were experiencing social isolation aligns with this final theme, expressing needs for connection and support. Indeed, loneliness and isolation are pervasive among caregivers of older adults [45,46] and deleteriously affect their mental and physical health [47]. Left unaddressed, declines in caregiver health may negatively impact care recipients [48]. Interestingly, caregiver respondents rated their health as “good,” suggesting that caregivers may perceive themselves as physically healthy while nonetheless experiencing substantial psychosocial demands associated with caregiving. This distinction underscores the importance of assessing caregiver well-being across multiple domains, as self-rated health alone may not fully capture the emotional and social consequences of the caregiving role. Finally, despite the robust evidence-base of interventions to reduce loneliness and isolation for older adults, caregivers are less frequently the intended target population [49]. Our findings suggest that while caregivers value technology as a means of accessing information and support, digital tools are likely to be most effective when they foster meaningful human connection rather than replacing it.

There are several limitations to our study. First, our sampling frame draws from participants enrolled with one community service agency in Houston, which may not comprehensively represent the diversity of caregiving experiences or those in the general US population. Similarly, geographical differences in access to resources, internet connectivity, and linguistic preferences may have influenced adoption and use of technology among caregivers. As such, the linguistic ability within our research team and our partner organization was limited to English, so our study does not address important issues surrounding digital inclusivity and the application of these approaches across a variety of sociocultural situations.

That the majority of the sample comprised women reflects the larger picture of caregiving in the United States, where females disproportionately (55%) assume caregiving roles [50]. Further, variations in the treatment burden among caregivers according to the type, frequency, and intensity of care provided are difficult to discern, as we did not collect detailed information regarding the care recipients. Finally, since this study was conducted during the post-COVID context, it is difficult to disentangle the lasting consequences of the pandemic from those that reflect broader technological and societal trends in adopting technology in this population. Given the rapidly evolving technological landscape, participants’ experiences may reflect practices specific to the post-COVID period, which limits the transferability of the findings as digital tools and technology continue to change.

Caregivers and their care recipients navigate chronic illness in-tandem, using available resources such as technology to alleviate the burdens of care. While technology has considerable potential to support caregiving, it is not a solution in and of itself. As reflected in participants’ narratives, technology can also impose additional burdens when it is difficult to use or fails to address their evolving needs. The present technological landscape requires that caregivers and older adults seek out and initiate the process of adopting new technology to integrate it into their lives; its potential is optimized when individuals are not only adequately trained but also fully aware of its capacities and limitations. Our study demonstrates that caregivers of homebound older adults adopt technology tools that reduce their concrete burdens such as time, travel, and monitoring. However, they underuse technologies that introduce financial, cognitive, or emotional costs. These dueling tensions should be recognized by researchers, clinicians, and technology developers as contextual determinants to using technology across the caregiving trajectory. Our findings highlight that targeted, multisectoral efforts toward digital inclusivity among vulnerable groups such as caregivers and their care recipients are sorely needed. Toward that end, it is imperative that health providers, social services clinicians, and tech developers are fully engaged with end users, such as caregivers, in co-design approaches that ensure not only the acceptability and usability of technology but that these technologies are ethically designed while considering caregivers’ everyday limitations, financial constraints, emotional workload, and digital confidence.