This study used a 2-stage approach to develop and refine the content and format of the guidelines (Figure 1). Each stage includes multiple components. In the first stage (knowledge generation), data were sourced from the results of a literature review, a survey of in-home aged care clients, and surveys and interviews with in-home aged care staff to inform the guidelines’ content. In the second stage (guideline development), a participatory design approach was used in which data from stage 1 was integrated to develop content and then further refined with aged care staff, consumers, and researchers in a participatory workshop. The draft guidelines were then tested using a real-life case study and the content and layout finalized.

Ethics approval for the client survey, staff survey, and interviews was obtained from the Silver Chain Group (SCG) Low and Negligible Risk Ethic Review Panel (LNR; LNR EC Project Numbers RG-054 and RG-061). Informed consent was obtained from all participants, as per the approved LNR protocol. A data management plan was approved, meeting all privacy and confidentiality requirements. Survey data were deidentified; interview data transcripts were analyzed in reidentifiable form, with participant codes kept separate from the anonymized transcripts as per protocol. No compensation was provided to participants.

FB, SW, KH, and KL are researchers at a national aging research institute, with FB and SW previously working as physiotherapists in health and aged care settings. MD, BK, and TED are researchers embedded within an in-home aged care provider, with TED also being a clinical psychologist. BK is also a physiotherapist working within in-home aged care and hospital settings, with qualitative and quantitative methodology training. TW and HJ are people with lived experience of aged care at home. BK, MD, and TED are employees of the in-home aged care provider at the time of the research. This was a deliberate choice to ensure the inclusion of the views of frontline aged care staff in shaping the direction of this study and ensuring its relevance and usability for aged care organizations. The majority of the qualitative data collection was conducted by SW, and the co-design workshop was co-facilitated by FB and an experienced workshop facilitator from the aged care provider to manage potential biases in data collection. The analysis of the survey and interview data and case study testing were led by BK to incorporate the views of frontline staff in interpreting the results. However, BK discussed the analysis and interpretation with the research team throughout the research process to ensure potential biases were discussed and managed.

Following the collation and analysis of all data sources, 7 overarching domains and 19 subthemes that should be considered for successful implementation of digital technology were identified (Table 2). For each subtheme, enablers, barriers, and practical tips for implementation were also identified to help providers systematically approach technology implementation. Examples for 2 subthemes are provided in Table 3, and an example of the pathway to the development of a subtheme is provided in Table 4.

In addition to the main domains and subthemes, the guidelines also provided information about how to use the guidelines, including the need to critically evaluate whether technology is the best solution to achieving a specific outcome and the need for careful consideration of those impacted by the introduction of a technological solution. Suggestions about how to use the implementation checklist (Multimedia Appendix 2) were also provided, including the potential benefits of using the checklist at multiple time points during implementation.

In this study, user-friendly practical guidelines specific to the implementation of digital technology in the Australian in-home aged care setting were developed. A multicomponent, participatory approach was used to ensure that the guidelines were evidence-informed, grounded in the real-world, were practical, and recognized the unique nature of in-home aged care. The evidence informing the guidelines came from stage 1 of this study. The results of the stage 1 components supported the complexity of implementing technology into in-home aged care services and workflow. The enablers and barriers to implementation were identified in all data sources—published literature and clients and staff of a large in-home service provider. The guidelines are freely available for organizations to support the implementation of technology and increase the likelihood of successful integration. Without a systematic approach, attempts to incorporate technology into aged care settings are at risk of failing. Offering practical tips to enhance enablers and to minimize barriers was an important aspect to incorporate into the guidelines.

The guidelines offer specific implementation strategies addressing client- and staff-specific factors that may impede implementation. For example, from the client survey data, nearly two-thirds of older people surveyed did not feel technology was needed or necessary and, hence, do not use technology for their care. In response, practical implementation strategies that could address these factors were included in the guidelines, including educating staff and clients about the potential benefits of technology and linking it to their specific needs, and assessing the end users’ digital literacy levels for suitability to use technology. These strategies recognize that, at the individual level, staff and client digital literacy, confidence, and perceived need influence readiness to engage with technology.

Acknowledging that the 7 main domains are not unique to in-home aged care and have been identified in other contexts for digital technology implementation, these guidelines nonetheless provide a novel and important framework that provides details specific to in-home aged care, an area of increasing importance in Australia and throughout the world. The in-home aged care setting differs from other settings, such as residential aged care or hospital, in that the delivery of care is decentralized and occurs in a person’s home without the physical, digital, or data infrastructure or ecosystems associated with physical institutions. Staff travel between clients and mostly work on their own; therefore, they may experience digital connectivity issues, and their access to IT or other support is more limited when compared to care staff who work in hospitals or in aged care facilities. Clients may also have greater reliance on staff for technical support.

There were some similarities between staff and clients in relation to enablers and barriers to technology implementation. Based on the client survey, we identified that care recipients had good access to technology; however, support systems may not be as easily accessible. Technology and peer support are more readily available to staff through their organizations, whereas older people receiving in-home aged care often rely on the in-home aged care staff for their technology support (especially if family are not available or not close by). This highlights the interpersonal nature of technology implementation in in-home aged care, where relationships between clients, family carers, and care workers shape trust, communication, and willingness to trial technology.

The guidelines also recognize that the implementation of technology is multilayered, with multiple potential end users. The guidelines take into consideration that in-home aged care involves clients, their family members or other unpaid carers, and the aged care workforce, with care encounters occurring within a home environment. At the organizational level, leadership, training, resourcing, workflow design, and implementation support influence whether technology can be embedded into routine practice. The practical tips and checklist are aimed at aged care providers implementing new technology but can also be used by any of the potential end users to identify areas for improvement for better implementation or integration. These levels are interdependent; for example, a client’s willingness to use technology may be undermined if staff lack confidence, if technical support is unavailable, or if connectivity is unreliable.

This study has several limitations. First, while the guidelines were developed using a robust, multicomponent participatory process, the client perspective was not directly captured through interviews, potentially impacting the comprehensiveness of the guidelines. Although a client survey was conducted and consumers were represented on the research team, richer qualitative insights from clients may be needed to ensure the guidelines fully reflect their lived experiences and preferences, particularly around aspects of privacy, trust, preferences for care, and perceived benefits. Future work should include direct engagement with clients through interviews or focus groups to strengthen this component. This additional evidence may require further refinement of the guidelines. Also, family carers were not directly included in surveys, interviews, or workshops, and their perspectives would strengthen the guidelines if included.

Second, the guidelines were field tested using a single case study involving smart glasses. While this provided valuable insights into real-world applicability, broader testing across different technologies and care contexts is needed to assess generalizability and scalability. Additional trials in diverse settings and with varied technologies will help refine the guidelines and ensure their relevance across the sector.

Third, the study was conducted in partnership with a single aged care provider. Although this enabled deep engagement and practical relevance, perspectives from other providers, including smaller organizations and those operating exclusively in rural or remote areas, may differ. In addition, the resources available to a large national provider, including IT infrastructure, workforce development capacity, and dedicated implementation support, may not be available to smaller providers or organizations operating in more geographically isolated settings. Expanding the scope to include a wider range of providers could enhance the inclusivity and applicability of the guidelines. Finally, while the guidelines aim to be practical and user-friendly, their implementation may be influenced by organizational readiness, resource availability, and staff capacity. Ongoing evaluation and support will be essential to ensure successful uptake and sustained use. This could be conducted with the current single aged care provider and also in future studies evaluating the framework for additional implementation outcomes such as acceptability and feasibility. Future testing should also examine how the guidelines could be adapted for providers with different funding models, workforce profiles, and digital infrastructure.

The limited financial and other resources for the project led to data collection and analysis methodological choices, which could be strengthened in future work. For example, due to time and cost constraints, only 1 reviewer conducted the full-text screening in the literature review. Convenience or purposive sampling for the staff surveys and co-design workshop may have led to sample bias.

Finally, this study focused on the development of guidelines and did not evaluate implementation outcomes such as adoption, fidelity, cost-effectiveness, or impact on care. Future research should examine whether the use of these guidelines improves implementation processes across different types of technology, provider types, and client groups.

The findings align with previous work related to technology adoption by older adults. An integrative systematic review on the facilitators and barriers to technology adoption by community-dwelling older adults with chronic diseases identified 5 domains: demographic or socioeconomic, health-related, dispositional, technology-related, and social factors [27]. The findings from the review are highly relevant to in-home aged care due to the high prevalence of chronic diseases in people receiving in-home aged care; however, our work extends beyond these factors to also include the factors relevant to the implementation within aged care, rather than just the individual-level factors. Another review outlines the categories of factors affecting the implementation of health care technologies relevant to older adults, including factors that may have more or less applicability in different settings [28]. Factors such as user and caregiver attitudes and perceptions, organizational and governance factors, and contextual factors are also aligned with our findings, but our work included significant stakeholder input to support preliminary validation of the guidelines and ensure they have specificity and applicability to the in-home aged care sector.

Broad implementation science frameworks provide information on ways including enablers and barriers to ensure successful uptake of new programs and products. Our pragmatic, practical guidelines are specific to in-home aged care. The enablers and barriers to technology implementation within in-home care are similar to other aged care settings. Many Australian aged care organizations deliver both residential aged care and in-home aged care services, and the guidelines specific to the in-home aged care setting may be applicable to residential aged care settings. For example, staff attitudes and negative perceptions of technology have been reported in residential aged care settings [29], and cost and lack of skills have also been reported as barriers [30,31]. One study examining technology-mediated care in residential aged care found that staff identified resource constraints, client challenges, limited staff and organizational support, and family resistance as barriers to technology implementation [32]. Another systematic review of the enablers and barriers to the implementation of socially assistive humanoid robots in health and social care found that technical problems and lack of perceived usefulness of the device were barriers to robotic technology implementation [33]. Use of change agents in residential aged care facilities has been found to be an important factor for technology implementation for support, training, and troubleshooting [34]. However, as mentioned above, factors that are unique to in-home aged care were not included in these past papers.

The guidelines provide a comprehensive, evidence-based tool for aged care providers who are wanting to implement digital health technology in their organizations with their clients. This is the first step in tool development—broader testing across multiple providers, technologies, and client groups is still needed. By addressing the specific needs and challenges of the in-home aged care sector, the guidelines aim to improve the quality and efficiency of care for older people and potentially make aged care services more responsive, personalized, and sustainable.