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CARING FUTURES: a study protocol for transdisciplinary qualitative research on technology-mediated care practices and theory development for ethics of care

Introduction The world’s population is ageing. As older persons live longer and increase in number, society faces a greater disease burden and, in public welfare, a corresponding resource deficit. New technology is one solution to this deficit but there is scarce knowledge about ethical aspects of such innovations in care practices. In CARING FUTURES, we address this scarcity by interrogating how new technology in care can become ethically sound and, correspondingly, how ethics of care can become more technology aware. Our concern is to protect quality care for the future. Methods and analysis CARING FUTURES advances transdisciplinarity through knowledge exchange around technology-mediated care and ethics of care, involving key stakeholders. We rely on established and innovative methods to generate experience-near and practice-near knowledge. Through this empirical research, we seek to expand understanding of technology-mediated care and to enrich ethics of care theory. Ethics and dissemination Empirical studies have been approved or await approval by national ethics committees. CARING FUTURES is designed to create societal impact through Knowledge Transfer Events targeting stakeholders in health, care and welfare, and Educational Packages for students of care—providing knowledge-exchange forums for future academics and practitioners of care. The project’s societal impact is also ensured in that participating researchers are also practitioners and/or educators of care personnel for the future. Project findings will be disseminated through scientific publications and conference presentations. Through communication in both traditional and digital media platforms, we engage in dialogues between researchers, user groups, policy makers and the wider public.


INTRODUCTION Caring Futures
Future demands for care will likely outstretch the welfare state's capacity for care through its human and economic resources. In response to this anticipated resource deficit, suppliers and policy makers are increasingly promoting technology as a cost and labour-saving 'technomagic' solution for society's needs. 1 However, awareness and knowledge about the care ethical implications of new implementations in current technology-mediated care practices is scarce. [2][3][4][5][6] CARING FUTURES is a research project emerging from this knowledge deficit, as a knowledge-generating intervention to protect quality care for the future. We do so, first, by cross-sectoral empirical research to identify care ethical tensions between the current calls for increased use of Strengths and limitations of this study ► CARING FUTURES executes user-driven, needsbased, multistrand research, addressing what is at stake at micro, meso and macro levels across user groups and institutional sectors in healthcare and welfare. ► CARING FUTURES initiates a collaborative practice approach, meaning ongoing partnership between stakeholders and end-users, including professional practitioners, educators, clients/patients and researchers. ► The project relies on both established and innovative qualitative methods to generate experiencenear and practice-near knowledge of care ethical tensions. ► CARING FUTURES is scientifically ambitious, as evidenced by the bold choice of a transdisciplinary methodology, supporting investigations of unchartered entanglements between care policies, care practices, as well as care in lived experiences, narratives, imaginaries and relationships. ► The project's 4-year running period may limit the potential for wide-ranging impacts, and a long-term research strategy is therefore needed to sustain a lasting knowledge exchange with research, education, practice and policy fields.

Open access
new technologies in healthcare and welfare services and long-standing, deep-rooted relational and professional traditional care cultures. Second, we revisit ethics of care to redevelop state-of-the-art theory at a crucial time of reinvention in public welfare. [7][8][9][10] Our ambition in this 4-year project (2020-2024) is to contribute to ethically sustained caring futures.
Background and status of knowledge Arguably, technology innovations may be more powerfully shaped by the supply-side logics of manufacturers than by the demand-side logics of users and care systems. 11 Studies indicate that care ethical tensions can result from introducing new technology into professional practice. For example, Wastell and White 12 showed how embedded digital systems in social work invite more risky forms of practice, challenging professional autonomy. Further, and contrary to the intention, they found that digitalisation was said to reduce efficiency, thus inducing a range of unsafe practices. Introducing new technologies might also affect professionals' motivation and self-understanding to change their caring practices. 13 As a relational practice, caring implies a capacity for ethical conduct, 14 where the ability to put oneself in another person's place is central. For professionals, care ethical capacity thus requires 'use of self' and the ability and possibility to reflect on experiences at work. [15][16][17] Moreover, ethical conduct demands sensitivity to unequal power distributions in caring relationships. 18 19 Correspondingly, care ethics emphasise how decisions in practice must be founded in ethical reflection in concrete caring relationships and contexts rather than in instrumental or principle-based reasoning. CARING FUTURES will address these challenges by investigating policy, practices, experiences, relationships, narratives, imaginaries and concepts-moving from complex entanglements in different empirical fields towards transdisciplinary theory building for ethics of care. This is in line with Greenhalgh and Papoutsi's 20 recent call for a paradigm shift in care services research that can allow for studying 'dynamically changing inter-relationships and tensions' that can lead to 'rich theorising' and 'generative learning'.

AIM AND MAIN RESEARCH QUESTIONS
The project aims to develop a novel care ethics paradigm for technology-mediated care practices. The project is guided by two main research questions, which tie together the project's different objectives and methodologies with a view towards transdisciplinary knowledge creation: 1. What are the current care ethical tensions and dilemmas within existing technology-mediated care practices, across different care sectors? 2. How can care ethics be developed theoretically to sustain quality of care in the public health, care and welfare services?

METHODS AND ANALYSES Overall design
Through four empirical Work Packages (WPs) we will expand knowledge of current technology-mediated care with a view towards enriching ethics of care theory (WP5) (see Figure 1). To address and transcend the existing knowledge-split between these practice and theory fields, in WP5, we draw on a psychosocial approach to welfare 21 to interpret micro, meso and macro level implications of findings within and across the empirical strands. WP1-4 rely on both established and innovative qualitative methods to generate experience-near and practicenear knowledge.

WP descriptions
In the following, the five WPs are described with regard to objectives (defined for each WP to operationalise the overall aim), research questions, work tasks and societal impact through Knowledge Transfer Events (KTEs) and Educational Packages. WP1: digital assessment template technology in child welfare services-a comparative study The objective of WP1 is to highlight care ethical dilemmas and quality of care in digitalised technology-mediated child welfare practices.
Research question: How do digital tools in child welfare services affect relational care practices and ethical conduct?

Work tasks
The WP will be carried out as one research project, one KTE and one educational package. 1. Investigate digitalised work practices in two municipal child welfare agencies in Norway Data collection through institutional ethnography. 22 23 Fieldwork will be conducted, gathering observational, material and interview data on digital child welfare practices. 2. All data, including a sample of digital texts from assessment templates, are subject to ethnomethodological discourse analysis.

WP5: a care ethics paradigm for caring futures
The objective of WP5 is to conceptualise a new care ethics paradigm with implications for policy, education and practice. WP5 foregrounds the project's two overall research questions: What are the current care ethical tensions and dilemmas within existing technology-mediated care practices, across different care sectors? How can care ethics be developed theoretically to sustain quality of care in the public health, care and welfare services?
Work tasks 1. Synthesising empirical data from the four WPs with the aim of theory development.

Method
A seminar (Project Group (PG) and Scientific Advisory Board (SAB)) to exchange preliminary findings and ideas during the midway symposium (autumn 2022).
A 2-day workshop (PG+SAB) (spring 2024) to present empirical findings and identified care ethical tensions from WPs 1-4. We work together to elaborate key care ethical tensions emerging from each empirical case.
A second 2-day workshop (autumn 2024) (SAB+WPls with selected experts from WP1-4), where the panel works on interpretation of care ethical tensions identified in the first workshop, across the cases and in synthesis.
Patient and public involvement CARING FUTURES complies with the Norwegian Ministry of Health and Care's task plan for increased user orientation in services by promoting a collaborative practice approach, with user involvement and knowledge exchange at the forefront. 29 Stakeholder contributions consist of higher education institutions and students (future care personnel), care providers (management, personnel), as well as users at the receiving end of care (clients, patients, next of kin). End-users have participated in the proposal's planning stages, identifying relevant areas for our investigations of care ethical tensions in technology-mediated care practices.

ETHICS AND DISSEMINATION Ethics
Three key studies in the project, processing personal data, have already obtained approvals from Norwegian Centre for Research Data (NSD) (Nos. 426984, 982327, 556960) with three more in process due to new recruitment of academic staff in the project. One research project will need approval from Regional Ethical Committees (REK). This application is currently under assessment.
All part projects adhere to guidelines from the National Committee for Research Ethics in Social Sciences and the Humanities (NESH). Participants will be fully informed and consented. Recorded data will be anonymised, with secure data storage according to new EU GDPR legislation/NESH guidelines.
Beyond the required formal ethical approvals and procedures, our experience and practice-near research ethics invite care ethical and reflexive awareness of how we as researchers engage with research participants and data. This involves ongoing reflection on how we are affected by our research experiences, and in turn how we ourselves affect the research object in our intersubjective engagements with participants, our colleagues and the empirical material (see, eg. Gripsrud). 30

Dissemination
To expand experience-near knowledge of technology mediation in care practices, we will invite a broad range of participations. These include care receivers, professionals and institutions that use, and are in the process of implementing, care technologies. Through our communication strategy and media engagement, we aim to create dynamic dialogue between researchers, user groups, policy makers and the general public. This is in line with Horizon Europe's Responsible Research and Innovation (RRI), which encourages bringing together societal actors (eg, citizens, researchers, organisations) during research and innovation processes to better align process and outcomes with society's values, needs and expectations.
CARING FUTURES' results will be presented at national and international academic conferences and seminars, and finally published in scientific articles and a PhD thesis.
In addition to the described KTEs, we will arrange a transdisciplinary midway symposium, featuring a CARING FUTURES Art Exhibition. The exhibition provides a transdisciplinary intervention into the project, simultaneously generating empirical material and disseminating knowledge about care ethics and technology-mediated care practices. Concretely, CARING FUTURES communicates Open access via a web page and on social media (Facebook, Twitter, Instagram) using the #CaringFutures hashtag. We communicate the project through academic social media platforms such as LinkedIn, ResearchGate and Academia. We will also launch a podcast series directed at users in the professional and research communities.
A final international conference will be organised in Stavanger, Norway, inviting a broad audience within and beyond academia.

Twitter Birgitta Haga Gripsrud @BHGripsrud
Contributors ER, BHG and IFH have contributed substantial intellectual content by collaborating on the initial conception and design of the project, as well as the first outline of the protocol. ER is the principal investigator of the project and drafted the original protocol manuscript submitted here, as well as administrating and conducting manuscript revisions. ER is the corresponding author. BHG has contributed to parts of the project design, as well as drafting and revising the article as a whole. ÅEV has contributed to parts of the project design, as well as drafting and revising parts of the article. All authors have approved the final version of the manuscript and are accountable for all aspects of the work.
Funding This work was supported by The Research Council of Norway, grant number 301827. The University of Stavanger, Norway, The University of Agder, Norway, and Roskilde University, Denmark, support the project with in-kind funding.
Competing interests None declared.

Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
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