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INTRODUCTION
Technology is a broad and polysemic term in the health field1,2. The World Health Organization (WHO) understands it as the application of knowledge and skills, using devices, medications, vaccines, procedures and the development of systems to deal with a health problem and improve populations’ quality of life. From this perspective, technology would be a set of devices that allow preventing and treating diseases, and rehabilitating people3,4.
For the Brazilian Ministry of Health, health technologies are represented by medications, materials, equipment and procedures, organizational, educational, information and support systems, programs and assistance protocols, through which healthcare and attention are provided to the population5.
Home care (HC) is part of Brazilian public health policies4, and is a type of care provided by the Unified Health System (In Portuguese, Sistema Único de Saúde - SUS) healthcare network. We have identified that this type of care is also offered in many countries around the world6. HC has the potential to produce ways of caring that permeate the projects of users, family members and the healthcare network, configuring new technical care arrangements7, and it has been evident that health technologies are significant in this context7,8.
It is understood that this innovative potential of HC is linked to the greater permeability of teams to the different aspects experienced by users and their families at home. Furthermore, it enables producing expanded care, capable of inducing technological innovations, characterized by the articulation of different knowledge and practices of users, family members or caregivers. From this perspective, HC can be configured as a field of work that enables producing and inventing care practices and assistance technologies7,8.
Since it involves care in a private environment, HC may require professionals to make some adaptations to provide care. Such adaptations may generate new technologies, since the purpose of this is, in principle, to meet social needs and become a way of reconfiguring the environment so that it contributes to care 9.
In HC, technology has often been associated with a set of knowledge and instruments that assist and favor the care process, whether with medications and materials or through professional care, with the aim of promoting or restoring health, thus presenting themselves as non-material technologies9.
This research is based on the premise that inventive and innovative creativity and the technologies present in the daily life of HC cannot, and should not, be reduced to static definitions. However, clarifying and presenting the concept of technologies in HC allows for a critical analysis of the different understandings associated with this term. This allows us to understand how health practices induce and are induced by technologies. We recognize that there are manifestations of technology, present in this context, that have not yet been explored.
The study of a concept provides a mental construction about a topic that represents a phenomenon, in order to build theoretical knowledge, elucidating its use in practice and favoring communication. It is common for a concept to vary over time, depending on the context10.
The process of analyzing a concept requires a scientific method that contributes to its clarification coherently11. This research chose the Walker and Avant framework, which understands that a concept can change over time and its analysis is never static. A solid concept clearly names the thing to which it refers, through a clear structure and a clear function12.
This framework has been used in scientific research to understand phenomena in different contexts of clinical practice12–15. However, no study was identified in the search for scientific productions that was dedicated to analyzing the concept of technologies in HC. Therefore, this research aimed to analyze the concept of health technologies in HC.
This study is timely, since the term is broad and can encompass different perspectives. It is expected that the clarification of the concept under investigation will favor its understanding and use in care practices, research and public policies.

METHODOLOGY
This is a conceptual analysis study, guided by the Walker & Avant12 framework, operationalized from an integrative literature review 17.
The theory applied in the study of the concept has as its main characteristic the exploration of a phenomenon. In this regard, the study of a concept consists of understanding which set of characteristics is frequently associated with it, i.e., phenomena that precede it and what the presence of the concept produces (consequents). To this end, a study of this nature must consider the attributes, also called defining characteristics, which are qualities or attributes capable of defining or referring to the event, i.e., they make the concept unique. Moreover, it needs to consider the antecedents, which are characterized or represented by events that occur before the existence or occurrence of the concept analyzed, and the concept consequents, which represent events or results of concept occurrence, locating it in its own phenomenon12.
To this end, this research adopted the following framework stages: 1 - selection of concept that will be the study’s object of analysis; 2 - establishment of analysis objectives; 3 - identification of possible concept uses; 4 - determination of attributes; 5 - identification of antecedents and consequents; 6 - elaboration of a model case; 7 - identification of an additional or contrary case; 8 - empirical evidence12.
The integrative literature review allowed identifying possible concept uses, and in this stage, the following stages were adopted: a) research problem identification and question elaboration; b) literature search based on search strategies; c) study assessment and stratification, methods used and data viability; d) data analysis, extraction and synthesis of results found; e) review presentation16.
To define the question that guided the literature search, the mnemonic PICo (Population, Phenomena of Interest, Context)17 was adopted. In the present study, Population refers to health technology; Phenomenon of Interest refers to the study of concept (attributes, antecedents and consequents); and Context refers to HC in the world. Thus, the question was: What are the attributes, antecedents and consequents of the concept of health technology in HC?
From a preliminary search in the literature, it was noticed that the descriptors “technology”, “home care services” and “concept formation” were frequent, which were adopted in this study. Literature search was carried out in four databases: Latin American and Caribbean Literature in Health Sciences (LILACS), PubMed, Embase and Web of Science (WoS).
Articles in Portuguese, English and Spanish were included. Articles that did not address the concept of “health technology” and/or the concept outside the context of HC services were excluded. Concerning time limit, documents published from 2007 onwards were considered, the year in which the WHO officially described the definition of health technology3.
The search was conducted between November 2021 and March 2022. A total of 8,275 files were found. After duplicates were excluded, studies were screened by two researchers independently, reading the title and abstract. Any discrepancies in screening were resolved in a meeting with a third researcher. From the initial analysis, 103 studies remained for analysis and full reading. After full reading, 81 articles, listed in the chart attached to this article, remained for concept analysis.
To extract the data, an electronic spreadsheet was created in Microsoft Office Excel 2019, consisting of the following fields: platform; original title; year; country of origin; context; article journal and main results; attributes defining the concept, antecedents, and consequents of the digital object identification (DOI). The information extraction process was carried out by two researchers independently and reviewed in a meeting with the research team for consensual definitions. The identified attributes, consequents, and antecedents constituted an extensive database, which underwent a careful separation process.
The instances that make up the concept were grouped according to the similarity of their nature as they were repeated in the observed contexts12. Grouping was carried out in periodic meetings among the researchers, and groups of characteristics were generated in each phase (attribute, consequent and antecedent), which represent the concept according to the similarity of terms found in included studies.
The analysis process to identify attributes, antecedents and consequents allowed developing model, borderline and contrary cases. A model case clearly and explicitly demonstrates all the essential attributes of the concept, being an evident example of what the manifestation of the concept in action is. A borderline case deals with an example that would apparently, superficially, be confused with the concept in everyday life, in order to make clear what the concept is and what cannot be considered as a concept representation. A contrary case expresses a situation in which no attribute is present, being the opposite of the model case12.
RESULTS
The list of references that make up the database of this study is available in the material attached to this article and were coded as follows: letter A followed by a number corresponding to its identification in the text (e.g., A23, A24, A25, A26...). We started this coding with the number 23 because it is sequential to the references cited in this article, and this can favor the identification of the articles that made up the review.
The sample consisted of studies, which were quantified in parentheses (n), with the following distribution by country, such as United States of America (n29) A24–A50, Brazil (n13) A51–A58, Norway (n11) A59–A68, China (n8) A69–A75, Netherlands (n4) A76–A79, Switzerland (n4) A80–A83, United Kingdom (n2) A84,A85, South Korea (n2) A86,A87 and Australia (n2) A88,A89. And one study was identified in each of the following countries: Canada A90; Germany A91; Denmark A73; Slovenia A92; New Zealand A93; and Italy A94. In relation to the year of publication, there was a significant increase in studies in 2020. Among the selected studies, 17 included older adults A24, A25, A27, A29, A35, A36, A40, A62, A71, A73, A75, A82, A83, A86, A91, A92, A94 and with chronic diseases A27, A30, A31, A40, A83, A86, A92, A94, and three studies aimed to increase independence and postpone the admission of older adults to Nursing Homes A35, A73, A82. Among the included studies, 13 were carried out in situations involving technology-dependent children A30,A46,A50–A54,A66,A87,A90,A95; nine addressed chronic diseases, but the age range was not specified A47,A48,A52,A71,A72,A81,A83,A89,A93; and 16 addressed healthcare professionals working in HC (their perceptions, their difficulties) and/or their means of action (discussing, implementation of auxiliary devices such as websites, programs or specific platforms) A26,A27,A31,A32,A34,A37,A55,A59–A61,A63,A76,A80,A88,A93.
Article analysis allowed us to group the characteristics of attributes, according the similarity of their nature, into five categories, which sought to represent the phenomenon of technology in HC. Some studies were grouped into more than one category, as the authors mention the distinct characteristics related to technology in different ways, as shown in Chart 1. We clarify that the attributes related to the concept were extracted from all the articles analyzed, but in Chart 1 some examples of empirical evidence were chosen and presented that allow us to clarify the understanding of the attribute and its description.
Chart 1: Attributes and empirical evidence of the concept of technology in home care

By identifying the concept antecedents, it was possible to group them as shown in Chart 2.


Chart 2 - Background of the concept of technology in home care


When analyzing the consequents of the concept of technology in HC, it was possible to see that the presence of the concept generated many results. The variables analyzed were grouped according to the nature of the phenomena generated from the concept, as shown in Chart 3.

Chart 3- Consequents of the concept of technology in home care

Figure 1 represents the attributes, antecedents and consequents found in this study and the concept developed.

Chart 4 presents the three cases (model, borderline and contrary) designed to elucidate the concept “technologies in HC”.




Chart 4 – Fictional cases that illustrate the presence or absence of technology in home care


DISCUSSION
The analysis of the concept allowed us to identify the diversity of countries that produce evidence on the topic addressed. It was observed that this production is related to their population profile, with studies from developed countries being predominant. In these countries, population aging demands strategies to meet health needs, with HC being a care modalityA61. As in this investigation, other studies indicate that the prevalence of the population assisted by HC in the world is older adults and patients with chronic diseases, as well as children and adolescents dependent on technology due to the chronicity of vascular and/or neurological conditions15.
The analysis of attributes indicated that technologies in HC are significantly characterized by equipment, materials and/or electronics. Despite the important benefits that these components bring to innovation and improvements in HC care, it is not appropriate to reduce technologies to this single characteristic or adopt it as a synonym, given the dynamic, inventive and relational nature in which technologies are produced.
Assistive products for patients are attributes associated with technology to support them during health recovery. As for these products, their usage time varies according to individuals’ clinical condition. Some products, such as wheelchairs and crutches, can be part of patients’ routine for the rest of their lives. Others are installed temporarily, such as relief or delay tubes and feeding tubes. Thus, technologies in HC can be permanent or temporary. All of these products contribute to maintaining patients’ daily care, enabling and assisting in HCA79.
Electronic information equipment was found as an attribute and is represented by a set of physical devices capable of facilitating exchange of health information, such as telephones, webcams, computers, digital cameras and tablets. They enable data to be recorded and assistance to be requested in cases of health problems A61.
Knowledge applied to care is an attribute of HC technology, consisting of a set of actions, elaborations of critical thinking and practices. They are present in product and care management, execution of programs, development of techniques and procedures, creation and use of protocols and manuals. It is identified that there are different types of knowledge necessary to work in home settings. Among them, it is essential that professionals have the ability to combine scientific and popular knowledge 16-18.
It became evident that non-material technical-scientific knowledge, characterized as problem-solving skills, active listening and management skills, are also attributes of technologies in HC and were identified in the study 6,A24,A58. Studies show that the ability to apply different knowledge creatively is favorable for professionals’ performance in home settings, always maintaining professional perspective and holistic care 16,17,19.
The use of resources and strategies for health communication is another attribute of technologies in HC that allows assistance to be provided and recorded for continuity of care, regardless of distance, using instruments such as Telehealth, telemedicine, consumer health information technology applications and electronic health records. Data analysis allowed us to identify that during the COVID-19 pandemic, communication tools proved to be opportune and enabled communication, monitoring and the viability of healthcare, gaining notoriety for the significant contribution used to minimize risks to public health A99.
The attributes found when studying the concept under investigation express the etymological dimension of technologies, since “techno” comes from “techné”, which means know-how, and “logy” comes from “logos”, which means study and reason. Hence, technology expresses the reason for knowing how to do 20. These attributes also characterize technologies as social practices to the extent that it is within relationships, in their different contexts, that the senses, meanings and purposes of the use of technologies will configure care production at home.
Based on the results of this research and considering that studies 6,16 indicate that there is a health praxis in HC that composes a dialectical territory of reflections and actions on doing, knowing and knowing how to do, it is observed that there is potential for this space as a dynamic and historical territory for producing technologies that materialize in modes of operation involving professionals, family members and caregivers. In this regard, the defining attributes of technologies in HC highlight a set of devices, knowledge, communications and actions that characterize the concept under investigation.
Considering all of the above, it is identified that the attributes were shaped, adapted or created to enable meeting healthcare demands as well as to favor professionals’ work process. Thus, the meeting of healthcare needs was expressively evident as an antecedent of the concept under investigation.
Changes in the population, both in terms of age and health and illness, lead to creating means that can promote rehabilitation, therapy, assistance and well-being for individualsA61. However, HC is only possible through people and/or physical instruments capable of assisting in an extra-hospital reality and this was clear in the cases developed from the results of the present study of the concept.
The health needs that precede technology in HC vary according to patients’ conditions 21. Thus, technologies are generated or demanded not only by biological aspects, as in the case of children who depend on mechanical ventilation and professional counseling to maintain life, but also by environmental aspects. These situations are exemplified by the case of older adults who need to adapt the environment to facilitate access and monitoring by professionals, with the help of digital locks and/or to prevent injuries such as falls by means of security alarms and safety bars. Thus, the need to take care of health at home encourages creating the necessary means to provide care.
The need for interaction/communication and monitoring of professionals with care users was the second antecedent that stood out. Studies show that there are patients who have pathologies that require long treatment periods and need to be constantly monitored. The need to create technologies that enable these resources at home proved to be timely, allowing constant communication with the health team, providing safety for family members, dehospitalization and comfort during treatment A63,A80,A86. Interaction generated through technology requires an organization process so that the care provided is continuous and of high quality. Thus, the need to generate, organize and store data was also an antecedent identified.
HC and monitoring of patients requires data organization and storage so that they can be used by different professionals in different scenarios. As an example of this, we can mention the case of the Brazilian Ministry of Health, which, in order to organize and store information, implemented more than 37 Health Information Systems (HIS), with interfaces created to structure access, registration and exchange of information22,23. In HC, a study addressed this organization in the creation of a software, Information System for Care Management in the Home Care Network (In Portuguese, Sistema de Informação para a Gestão do Cuidado na Rede de Atenção Domiciliar - SI GESCAD), which assists in the expanded clinic, in the coordination and continuity of care for patients in HCA98.
Data organization mechanisms can also be called health information technologies (HIT), which support decision-making in healthcare 22. HIT in home services are an opportune solution to meet the need to improve the management of the care provided; this was another antecedent identified and we understand that it contributes to expanding access to HIS through websites, applications and platforms to provide continuity in HC, including as support for the nursing team.
The need to invest, improve and create solutions is another precedent found when analyzing the concept of technologies in HC. Investments in strategies allow patients to seek information about their health and disease process, favor the monitoring of chronic patients and allow greater control of the health of older adults who live alone A86, A93. Improvement allows individuals to participate, and makes it necessary for them to be involved in their own health condition, through self-monitoring, so that they can maintain HC and take the necessary measures in complication casesA69.
Professional training proved to be a relevant antecedent, requiring caregiver training so that care can be provided at home, especially when it comes to complex devices such as feeding pumps, mechanical ventilators, and vital sign monitors. Considering the antecedents of technologies in HC, we identified the need to encourage developing something that favors structured provision of care for current conditions, which demands the presence of the concept studied. The presence of the “technological” phenomenon generates an impact on HC and consequences for both those who use it and those who will mediate care through it.
In relation to the consequents of technology in HC, we identified positive and negative impacts. The benefits arising from the presence of the concept in the home context were manifested in many studies through improved communication between users and professionals, facilitating continuity of care A45. Another benefit was the possibility of monitoring patients as well as the possibility of performing maintenance of vital functions and increasing self-care. Studies indicate that the adoption of technology contributes to the effectiveness of HC by encouraging co-responsibility for careA65, A69. A negative consequent of technology in HC is caregiver physical and/or emotional overload. Studies argue that taking full responsibility for the care of a person at home is a stressful factor A46. It is necessary to recognize that, in addition to the demand generated by care, additional technology, be it knowledge or equipment, for instance, can make the process more challenging, as they are additional demands imposed on the people who provide care at home. Added to this is the fact that non-material technology encompasses aspects such as care provision and care management A54, A87. In the health unit, this is done by qualified professionals who take turns providing care.
Providing technologies in HC, whether material or not, increases the costs for the system and patient, as discussed in some studies. Healthcare system costs are related to hiring qualified people for HC, carrying out training, using technologies implemented in the service and acquiring equipment for carrying out teleconsultations A29. In the same perspective, despite there being assistance from the public healthcare system, patients or their families often bear the costs of supplies and devices, as in some cases of children who depend on technology to surviveA57.
On the other hand, cost reduction for the healthcare system and for some users was also a consequent found. The care process in a family environment results in a reduction in the length of patient stay in the hospital, avoids unnecessary hospitalizations, and in some cases, such as older adults, delays the need for hospitalization in Nursing Homes, institutions that generate considerable costs for family membersA57.
Insecurity of using technology in HC by caregivers was also identified as a consequentA79. Caregivers are insecure about taking on care, even with health team support. Studies show that these challenges are linked to emotional aspects such as fear, worry and the lack of technical and scientific knowledge to deal with unforeseen eventsA53, A65,A76. Another negative consequent identified was failures in HC due to incorrect handling of materials or equipment that could compromise care provision, causing infections or incorrect monitoringA71, A79.
On the other hand, patient monitoring can become a favorable activity considering the use of technologies such as social robots that provide support in daily care, through appointment signaling, reminders to take medication and control of fluid balance. Studies show that such monitoring technologies can contribute to patient safety, independence and quality of life in their own homes, facilitating the logistics of careA61. Linked to this, environmental monitoring is also a strategy to assist in HC by providing information about changes in daily life activities and thus preventing domestic accidents and family stressA83.
Improvement in access, care and data and/or information management is also a consequent of technology in the home, as it enables the integration, sharing and access to patient data in the health network, facilitating the visualization of health history, the prescription of procedures and medications and the intersectoral interaction between pharmacies and places of care and/or consultationsA29, A36. In this context, such communication measures also enable the viability of remote care, as shown in some studies that portray depression treatment via videoconferencing, in addition to favoring care in areas that are difficult to accessA25, A74.
Dehospitalization was a positive consequent found because it was linked to reduced health complications. Studies report that the use of technologies in HC makes it possible to avoid and/or reduce the length of patient stay, especially in those with chronic diseases, by providing less exposure to external risks, disease management, decision-making and autonomy regarding careA78, A93.
Finally, improvement in user satisfaction with the care provided was also one of the consequents. The presence of the concept contributed to improving symptoms, maintaining health in cases of dependency, and increasing confidence in patients who live alone and in professionals who are able to monitor clinical progress more closelyA44, A78. The concept, whether in its material or non-material form, generally promoted health management in the healthcare network (In Portuguese, Rede de Atenção à Saúde - RAS) using the attributes combined or not, conveying knowledge through devices and software, favoring continuity and access to healthcare A29, A55.
Finally, we pointed out that the elaboration of cases was an exercise in trying to clarify how the concept “health technologies in HC” (model) manifests itself, when it can be confused with another situation because it is very similar (borderline) and another scenario in which the concept is not present because it does not have any of its attributes (contrary). These cases, although illustrative and fictitious, support the identification of the presence or absence of the attributes of health technologies in HC.
Based on the cases and evidence in this study, it is clear that the physical presence of supplies, medications, professionals as well as knowledge and communication resources are not enough to see the actual manifestation of the concept in its entirety. The intentionality and availability of professionals, caregivers and patients to establish interactions is a decisive aspect for providing recovery and/or life-sustaining care. This may indicate that the most powerful and innovative technology in the context of HC is human interaction.
CONCLUSION
This study made it clear that the attributes of health technologies in HC are knowledge applied to care, resources and strategies for health communication, assistive products for patients, electronic equipment and objects for adapting and monitoring the environment. Patients’ health needs and improvements in care management and provision stood out as antecedents. Among the consequents, improvements in access, care, communication and data and/or information management stood out.
The study of the concept, based on the adopted theoretical framework, indicated that health technologies in HC are revealed as applied knowledge, resources and strategies for health communication, objects, materials and electronic or non-electronic equipment, used to monitor, adapt, generate information and interactions and assist, continuously, in person or remotely, in health rehabilitation, recovery and/or maintenance.
We recognized that other databases, in addition to those included in the integrative review, and gray literature could provide additional information to this research, and this represents a limitation of this study. However, it is identified that the analysis of included articles allowed us to answer the integrative review question, study the concept in depth and achieve the proposed objective.

ACKNOWLEDGMENTS
To CNPq for funding from a scientific and technological initiation grant.

REFERENCES
1. Silva HP, Elias FTS. Incorporação de tecnologias nos sistemas de saúde do Canadá e do Brasil: perspectivas para avanços nos processos de avaliação. Cad Saude Publica. 2019; 1-14.

2. Rajão FL, Martins M. Atenção Domiciliar no Brasil: estudo exploratório sobre a consolidação e uso de serviços no Sistema Único de Saúde. Cien Saude Colet. 2020; 25:1863–1877.

3. World Health Organization (WHO). Everybody’s business strengthening health systems to improve health out comes who’s framework for action. World Health Organization. 2007.

4. Brasil. Portaria no 825, de 25 de Abril de 2016. Redefine a Atenção Domiciliar no âmbito do Sistema Único de Saúde (SUS) e atualiza as equipes habilitadas. Diário Oficial da União, 2016; 25 de Abr.

5. Brasil. Portaria no 2510, de 19 de Dezembro de 2005. Institui Comissão para Elaboração da Política de Gestão Tecnológica no âmbito do Sistema Único de Saúde - CPGT. Diário Oficial da União, 2005; 19 de Dez

6. Feuerwerker LCM, Merhy EE. A contribuição da atenção domiciliar para a configuração de redes substitutivas de saúde: desinstitucionalização e transformação de práticas. Rev Panam Salud Publica. 2008; 24: 180-188.

7. Silva KL, Braga PP, Silva AE, Lopes LFL, Souza TM. Discursos sobre tecnologias na atenção domiciliar: contribuições entre inovar, inventar e investir. Rev Gaúcha Enferm. 2022; 43:1-11.

8. Palmira I, Zagonel S. Análise de Conceito: Um Exercício Intelectual em Enfermagem. Cogitare Enfer. 1996. p. 13-14.

9. Madureira VSF, Silva DMGV, Trentini M, Souza SS. Métodos de análise conceitual na enfermagem: uma reflexão teórica. Escola Anna Nery. 2021; 1-7.

10. Euzebia V, Santos P, Barreto F, Chiavone T, Bezerril SR, et al. Concept Analysis Of The Safe Care Term In The Perspective Of Walker And Avant. New Trends in Qualitative Research. 2019; 1-13.

11. Cláudia AF, Patrício A, Azevedo M, Ferreira M, Feitosa B, et al. Análise de conceito da vulnerabilidade ao HIV/aids em mulheres profissionais do sexo. Rev. Eletr. Enf. 2018; 1-18.

12. Wallker LO, Avant KC. Strategies for Theory Construction in Nursing. 6th edition. Boston: Pearson, Prentice Hall, 2019.

13. Firth K, Smith K, Sakallaris BR, Bellanti DM, Crawford C, Avant KC. Healing, a concept analysis. Glob Adv Health Med.2015; 4:44–50.

14. Bennett PN, Wang W, Moore M, Nagle C. Care partner: A concept analysis. Nurs Outlook. 2017; 65(2):184–194.

15. Aromataris E, Munn Z. JBI Manual for Evidence Synthesis. JBI, 2020. ISBN: 978-0-6488488-0-6.

16. Andrade AM, Braga PP, Lacerda MR, Duarte ED, Borges LHJ, Silva KL. Standards of knowledge that found nursing performance in home care. Texto Contexto Enferm. 2020; 1-29.

17. Andrade AM, Silva KL, Seixas CT, Braga PP. Atuação do enfermeiro na atenção domiciliar: uma revisão integrativa da literatura. Rev Bras Enferm. 2017; 210-219.

18. Björnsdóttir K. The place of standardisation in home care practice: an ethnographic study. J Clin Nurs. 2014.

19. Lacerda MR. Tornando-se profissional no contexto domiciliar: vivência do cuidado da enfermeira. [Tese Doutorado] Florianópolis (SC): Universidade Federal de Santa Catarina.2000.

20. Pinto AV. O conceito de tecnologia. Ed Contraponto, organizador.1 ed., Rio de Janeiro; 2005.

21. Freitas GC, Flores JA, Camargo Jr. KR. “Necessidades de saúde”: reflexões acerca da (in)definição de um conceito. Rev Bras Leprol, 2022.

22. Coelho GCN, Chioro A. Afinal, quantos Sistemas de Informação em Saúde de base nacional existem no Brasil?. Cad Saude Publica. 2021.

Annex: Chart 5. References included as data
Code Citation
A23 Reis GFM, Jericó MC, Maloni AAS, Bedin SC, Gasques PCA, Kawata SLM. Perfil de pacientes e indicadores de um serviço de atenção domiciliar. Enfermagem Brasil. 2021; 20(2):191–205.
A24 Stephens CE, Halifax E, David D, Bui N, Lee SJ, Shim J, et al. “They Don’t Trust Us”: The Influence of Perceptions of Inadequate Nursing Home Care on Emergency Department Transfers and the Potential Role for Telehealth. Clin Nurs Res. 2020; 29(3):157–68.
A25 Kim E hae, Gellis ZD, Bradway CK, Kenaley B. Depression care services and telehealth technology use for homebound elderly in the United States. Aging Ment Health. 2019; 23(9):1164–73.
A26 Johnson KA, Valdez RS, Casper GR, Kossman SP, Carayon P, Or CKL, et al. Experiences of technology integration in home care nursing. AMIA Annu Symp Proc. 2008; 389–93.
A27 Wolbring G, Lashewicz B. Home care technology through an ability expectation lens. J Med Internet Res. 2014; 16(6):e155.
A28 Terry MP, Grande E. Information technology and home healthcare: the new frontier in home care. Home Healthc Nurse. 2014; 32(3):194–5.
A29 Koru G, Alhuwail D, Topaz M, Norcio AF, Mills ME. Investigating the Challenges and Opportunities in Home Care to Facilitate Effective Information Technology Adoption. J Am Med Dir Assoc. 2016; 17(1):53–8.
A30 Mendes MA. Parents’ descriptions of ideal home nursing care for their technology-dependent children. Pediatr Nurs. 2013; 39(2):91–6.
A31 Alhuwail D, Koru G, Mills ME. Supporting the information domains of fall-risk management in home care via health information technology. Home Health Care Serv Q. 2016;35(3–4):155–71.
A32 Dowding DW, Russell D, Onorato N, Merrill JA. Technology Solutions to Support Care Continuity in Home Care: A Focus Group Study. Journal for Healthcare Quality. 2018; 40(4):236–46.
A33 Brown TD, Michael M, Grady DS. Implementation of Smart Pump Technology With Home Infusion Providers. Journal of Infusion Nursing. 2018; 41(6):344–9.
A34 Phongtankuel V, Adelman RD, Reid MC. Mobile health technology and home hospice care: promise and pitfalls. Prog Palliat Care. 2018; 26(3):137–41.
A35 Matlabi H, Parker SG, McKee K. The contribution of home-based technology to older people’s quality of life in extra care housing. BMC Geriatr. 2011; 11(1):68.
A36 Anderson WL, Wiener JM. The Impact of Assistive Technologies on Formal and Informal Home Care. Gerontologist. 2015; 55(3):422–33.
A37 Beer JM, McBride SE, Mitzner TL, Rogers WA. Understanding challenges in the front lines of home health care: A human-systems approach. Appl Ergon. 2014; 45(6):1687–99.
A38 Reeder B, Demiris G, Marek KD. Older adults’ satisfaction with a medication dispensing device in home care. Inform Health Soc Care. 2013; 38(3):211–22.
A39 Dowding D, Merrill JA, Barrón Y, Onorato N, Jonas K, Russell D. Usability Evaluation of a Dashboard for Home Care Nurses. CIN: Computers, Informatics, Nursing. 2019; 37(1):11–9.
A40 Williams K, Blyler D, Vidoni ED, Shaw C, Wurth JE, Seabold D, et al. A randomized trial using telehealth technology to link caregivers with dementia care experts for in-home caregiving support: FamTechCare protocol. Res Nurs Health. 2018; 41(3):219–27.
A41 Young R, Willis E, Cameron G, Geana M. “Willing but unwilling”: attitudinal barriers to adoption of home-based health information technology among older adults. Health Informatics J. 2014; 20(2):127–35.
A42 Chi NC, Demiris G. A systematic review of telehealth tools and interventions to support family caregivers. J Telemed Telecare. 2015; 21(1):37–44.
A43 Radhakrishnan K, Xie B, Berkley A, Kim M. Barriers and Facilitators for Sustainability of Tele-Homecare Programs: A Systematic Review. Health Serv Res. 2016; 51(1):48–75.
A44 Min A, Currin F, Razo G, Connelly K, Shih PC. Can I Take a Break? Facilitating In-Home Respite Care for Family Caregivers of Older Adults. AMIA Annual Symposium Proceedings. 2021; 850-859
A45 Sezgin E, Noritz G, Elek A, Conkol K, Rust S, Bailey M, et al. Capturing At-Home Health and Care Information for Children With Medical Complexity Using Voice Interactive Technologies: Multi-Stakeholder Viewpoint. J Med Internet Res. 2020; 22(2).
A46 Toly VB, Blanchette JE, Al-Shammari T, Musil CM. Caring for technology-dependent children at home: Problems and solutions identified by mothers. Appl Nurs Res. 2019; 50.
A47 Or CKL, Karsh BT, Severtson DJ, Burke LJ, Brown RL, Brennan PF. Factors affecting home care patients’ acceptance of a web-based interactive self-management technology. J Am Med Inform Assoc. 2011; 18(1):51–9.
A48 Casper GR, Brennan PF, Burke LJ, Nicolalde D. HeartCareII: Patients’ Use of a Home Care Web Resource. Stud Health Technol Inform. 2009; 146:139.
A49 Or CKL, Valdez RS, Casper GR, Carayon P, Burke LJ, Brennan PF, et al. Human factors and ergonomics in home care: Current concerns and future considerations for health information technology. Work. 2009; 33(2):201–9.
A50 Toly VB, Blanchette JE, Musil CM. Mothers caring for technology-dependent children at home: What is most helpful and least helpful? Appl Nurs Res. 2019; 46:24–7.
A51 Floriani CA. Cuidados paliativos no domicílio: desafios aos cuidados de crianças dependentes de tecnologia. J Pediatr (Rio J). 2010; 86(1):15–9.
A52 Lima MF, Paulo LF, Higarashi IH. Crianças dependentes de tecnologia: o significado do cuidado domiciliar estudo descritivo. Online braz j nurs (Online). 2015; 14(2):178–89
A53 Lima MF, Coimbra JAH, Rodrigues BC, Neto BM, Uema RTB, Higarashi IH. Crianças dependentes de tecnologia, um desafio na educação em saúde: estudo descritivo. Online braz j nurs (Online). 2017; 16(4):399–408.
A54 Santos VT, Minayo MCS. Mães que cuidam de crianças dependentes de tecnologia em atendimento domiciliar. Physis: Revista de Saúde Coletiva. 2020; 30(4).
A55 Pires MRGM, Gottems LBD, Vasconcelos Filho JE, Silva KL, Gamarski R. Sistema de Informação para a Gestão do Cuidado na Rede de Atenção Domiciliar (SI GESCAD): subsídio à coordenação e à continuidade assistencial no SUS. Cien Saude Colet. 2015; 20(6):1805–14.
A56 Rabello CAFG, Rodrigues PHA. Family health and infant palliative care: listening the relatives of technology dependent children. Cien Saude Colet. 2010; 15(2):3157–66.
A57 Drucker LP. Rede de suporte tecnológico domiciliar à criança dependente de tecnologia egressa de um hospital de saúde pública. Cien Saude Colet. 2007;12(5):1285–94.
A58 Andrade AM, Silva KL, Seixas CT, Braga PP. Nursing practice in home care: an integrative literature review. Rev Bras Enferm. 2017; 70(1):210–9.
A59 Wälivaara BM, Andersson S, Axelsson K. General practitioners’ reasoning about using mobile distance-spanning technology in home care and in nursing home care. Scand J Caring Sci. 2011; 25(1):117–25.
A60 Kleiven HH, Ljunggren B, Solbjør M. Health professionals’ experiences with the implementation of a digital medication dispenser in home care services – a qualitative study. BMC Health Serv Res. 2020;20(1):320
A61 Gl Glomsås HS, Knutsen IR, Fossum M, Halvorsen K. User involvement in the implementation of welfare technology in home care services: The experience of health professionals-A qualitative study. J Clin Nurs. 2020; 29(21–22):4007–19.
A62 Stokke R. The Personal Emergency Response System as a Technology Innovation in Primary Health Care Services: An Integrative Review. J Med Internet Res. 2016; 18(7).
A63 Oelschlägel L, Dihle A, Christensen VL, Heggdal K, Moen A, Osterlind J, et al. Implementing welfare technology in palliative homecare for patients with cancer: a qualitative study of health-care professionals’ experiences. BMC Palliat Care. 2021; 20(1):146.
A64 Stokke R. “Maybe we should talk about it anyway”: a qualitative study of understanding expectations and use of an established technology innovation in caring practices. BMC Health Serv Res. 2017;17(1):657.
A65 Glomsås HS, Knutsen IR, Fossum M, Halvorsen K. ‘They just came with the medication dispenser’- a qualitative study of elderly service users’ involvement and welfare technology in public home care services. BMC Health Serv Res.2021; 21(1):245.
A66 Dybwik K, Nielsen EW, Brinchmann BS. Home mechanical ventilation and specialised health care in the community: Between a rock and a hard place. BMC Health Serv Res. 2011; 11.
A67 Solli H, Hvalvik S. Nurses striving to provide caregiver with excellent support and care at a distance: a qualitative study. BMC Health Serv Res. 2019; 19(1).
A68 Lyngstad M, Hofoss D, Grimsmo A, Hellesø R. Predictors for assessing electronic messaging between nurses and general practitioners as a useful tool for communication in home health care services: a cross-sectional study. J Med Internet Res. 2015; 17(2).
A69 Kuo MH, Wang SL, Chen WT. Using information and mobile technology improved elderly home care services. Health Policy Technol. 2016; 5(2):131–42.
A70 Gao S, Hou Y, Ma R, Kaudimba KK, Jin L, Wang H, et al. A Novel Management Platform Based on Personalized Home Care Pathways for Medicine Management and Rehabilitation of Persons With Parkinson’s Disease—Requirements and Implementation Plan of the Care-PD Program. Front Neurol. 2021; 12.
A71 Zhao B, Zhang X, Huang R, Yi M, Dong X, Li Z. Barriers to accessing internet-based home Care for Older Patients: a qualitative study. BMC Geriatr. 2021; 21(1):565.
A72 Kuo YH, Chien YK, Wang WR, Chen CH, Chen LS, Liu CK. Development of a home-based telehealthcare model for improving the effectiveness of the chronic care of stroke patients. Kaohsiung J Med Sci. 2012; 28(1):38–43.
A73 Lin M, Ma L, Ying C. Matching daily home health-care demands with supply in service-sharing platforms. Transp Res E Logist Transp Rev. 2021; 145:102177.
A74 Su CJ, Chiang CY. IAServ: an intelligent home care web services platform in a cloud for aging-in-place. Int J Environ Res Public Health. 2013; 10(11):6106–30.
A75 Zhang Q, Li M, Wu Y. Smart home for elderly care: development and challenges in China. BMC Geriatr. 2020; 20(1).
A76 Haken IT, Allouch SB, Harten WHV. Education and training of nurses in the use of advanced medical technologies in home care related to patient safety: A cross-sectional survey. Nurse Educ Today. 2021; 100:104813.
A77 Barakat A, Woolrych RD, Sixsmith A, Kearns WD, Kort HS. eHealth Technology Competencies for Health Professionals Working in Home Care to Support Older Adults to Age in Place: Outcomes of a Two-Day Collaborative Workshop. 2013; 2(2):e10.
A78 Peeters JM, Wiegers TA, Friele RD. How technology in care at home affects patient self-care and self-management: a scoping review. Int J Environ Res Public Health. 2013; 10(11):5541–64.
A79 Ten Haken I, Ben Allouch S, Van Harten WH. Reporting incidents involving the use of advanced medical technologies by nurses in home care: a cross-sectional survey and an analysis of registration data. BMJ Qual Saf. 2020; 30(5):380–7.
A80 Munck B, Sandgren A. The impact of medical technology on sense of security in the palliative home care setting. Br J Community Nurs. 2017;22(3):130–5.
A81 Fex A, Flensner G, Ek AC, Söderhamn O. Health-illness transition among persons using advanced medical technology at home. Scand J Caring Sci. 2011; 25(2):253–61.
A82 Etemad-Sajadi R, Dos Santos GG. The impact of connected health technologies on the quality of service delivered by home care companies: Focus on trust and social presence. Health Mark Q. 2020; 1–10.
A83 Pais B, Buluschek P, DuPasquier G, Nef T, Schütz N, Saner H, et al. Evaluation of 1-Year in-Home Monitoring Technology by Home-Dwelling Older Adults, Family Caregivers, and Nurses. Front Public Health. 2020; 8.
A84 Curnow E, Rush R, Gorska S, Forsyth K. Differences in assistive technology installed for people with dementia living at home who have wandering and safety risks. BMC Geriatr. 2021; 21(1):613.
A85 Bowles KH, Baugh AC. Applying Research Evidence to Optimize Telehomecare. J Cardiovasc Nurs. 2007; 22(1):5–15.
A86 Son H, Kim H. A Pilot Study to Test the Feasibility of a Home Mobility Monitoring System in Community-Dwelling Older Adults. Int J Environ Res Public Health. 2019; 16(9).
A87 Choi YH, Kim MS, Kim CH, Song IG, Park JD, In Suh D, et al. Looking into the life of technology-dependent children and their caregivers in Korea: lifting the burden of too many responsibilities. BMC Pediatr. 2020; 20(1).
A88 Bradford NK, Young J, Armfield NR, Herbert A, Smith AC. Home telehealth and paediatric palliative care: clinician perceptions of what is stopping us? BMC Palliat Care. 2014; 13(1):29.
A89 Li J, Varnfield M, Jayasena R, Celler B. Home telemonitoring for chronic disease management: Perceptions of users and factors influencing adoption. Health Informatics J. 2021; 27(1):146045822199789.
A90 Rose L, McKim DA, Katz SL, Leasa D, Nonoyama M, Pedersen C, et al. Home mechanical ventilation in Canada: a national survey. Respir Care. 2015; 60(5):695–704.
A91 Schaepe C, Ewers M. “I see myself as part of the team” – family caregivers’ contribution to safety in advanced home care. BMC Nurs. 2018;17(1):40.
A92 Cimperman M, Brenčič MM, Trkman P, Stanonik M de L. Older Adults’ Perceptions of Home Telehealth Services. Telemedicine and e-Health. 2013;19(10):786–90.
A93 Gaikwad R, Warren J. The role of home-based information and communications technology interventions in chronic disease management: a systematic literature review. Health Informatics J. 2009; 15(2):122–46.
A94 Giordano A, Bonometti G Pietro, Vanoglio F, Paneroni M, Bernocchi P, Comini L, et al. Feasibility and cost-effectiveness of a multidisciplinary home-telehealth intervention programme to reduce falls among elderly discharged from hospital: study protocol for a randomized controlled trial. BMC Geriatr. 2016; 16(1):1–7.
A95 Floriani CA. Home-based palliative care: challenges in the care of technology-dependent children. J Pediatr (Rio J). 2010; 86(1):15–20.
A96 McKenzie B, Bowen ME, Keys K, Bulat T. Safe home program: a suite of technologies to support extended home care of persons with dementia. Am J Alzheimers Dis Other Demen. 2013; 28(4):348–54.
A97 Vilstrup DL, Madsen EE, Hansen CF, Wind G. Nurses’ Use of iPads in Home Care-What Does It Mean to Patients?: A Qualitative Study. Comput Inform Nurs. 2017; 35(3):140–4.
A98 Pires MRGM, Gottems LBD, Vasconcelos Filho JE, Silva KL, Gamarski R. Sistema de Informação para a Gestão do Cuidado na Rede de Atenção Domiciliar (SI GESCAD): subsídio à coordenação e à continuidade assistencial no SUS. Cien Saude Colet. 2015; 20(6):1805–14.
A99 Savassi LCM, Reis GVL, Dias MB, Vilela LO, Ribeiro MTAM, Zachi MLR, et al. Recomendações para a Atenção Domiciliar em período de pandemia por COVID-19. Revista Brasileira de Medicina de Família e Comunidade. 2020;15(42):2611.