In the first theme of 'self-esteem’ there was a real sense of powerlessness when participants were talking about their illness and that there was no real alternative to having these medical devices in their lives. Being diagnosed with a chronic illness can undermine one’s sense of personal control and lead to tension and psychological distress including decreased levels of self-esteem [18, 19]. Part of the adjustment process to a threatening event (e.g. chronic illness) is control or 'mastery’ over the event in order to manage the condition and express a sense of personal control [20, 21]. This can be seen in the present study by participants using the device to monitor their condition and using the results to modify behaviour. Another expression of mastery can be achieved by assuming control over related aspects of an illness such as treatment and becoming an expert in how to use the device itself.
This theme also described examples of where the medical device facilitated participants' ability to derogate others and point out that other people with similar conditions and devices were doing less well or using their devices incorrectly. This is consistent with the literature in that when faced with a threat to self-esteem, individuals can often make downward self-enhancing comparisons that increase subjective well-being by comparing themselves with less fortunate others . Similarly, individuals may also derogate or devalue other persons in a bid for self-enhancement .
Device use also impacted on the lives of device users’ partners and wider social circle as described in the second theme 'the social device’. The literature has tended to focus on that of the role of 'family caregiver’, an individual who lives with or close to the ill person who provides unpaid assistance with social and medical care . Studies that have looked at spousal carers of individuals suffering from chronic diseases have noted the impact of role change as the role of husband/wife is eroded and is absorbed in to that of carer . Little evidence was found to support this suggestion in this study as the users required very little in the way of assistance and the role of husband/wife remained intact. The reason for this is unclear but could be the result of the equipment acting to supplement informal care and promote independence [26, 27]. This meant the relationship between the spouse and the device was different to that of the relationship between the device and the user. In this study the spouse and user are required to share the same physical environment and the resultant consequences of noise and aesthetics with the spouse not directly benefiting from device use (any benefits from the device for the spouse would be deemed as being indirect). The fact that some of these devices were used in the shared bedroom meant that sleep was disturbed or sleeping arrangements had to be altered (changing sides of the bed, sleeping in another room). There were also other emotional consequences of device use on partners. While one husband reported a certain amount of embarrassment when out with his wife while she was using her device, another user reported the very act of using the device in front of her husband caused the husband to become annoyed. While this may have been an expression of concern for his wife’s health it could also be that it had a detrimental effect on the way he thought about himself. Steele, Spencer and Aronson  proposed that situational cues that identify a person as belonging to a devalued, low status social group lead to social identity threat. In this case conspicuous medical device use might have caused discomfort because it reminded him of his own age and mortality. The influence on spousal identity has also been discussed in relation to assistive devices used by people suffering a stroke which reported similar findings .
The effect on others was not entirely negative. One example of the positive effects on others was the benefit they received from the shared use of medical devices with regards to symptom relief or physical function. Also, the use of devices in some cases was not hidden away from grandchildren but actually became a part of the social interaction with the grandchildren 'helping’ with the equipment or 'using’ it as part of supervised play. While much has been written around how families experience chronic illness (for a review of the literature see ) little has specifically addressed the effect of medical devices on the relationship between grandparent and grandchild. The ways that devices were being used in play may be an example of normalization strategies used to decrease disruption and maintain family processes .
In general, participants expressed positive feelings about their devices and the impact that the device had on their lives, and the users themselves expressed an overall feeling of satisfaction and were often not able to think of ways to improve the device. A possible contributing factor to this might be found in the literature that has identified a link between age and satisfaction. Analysis of patient satisfaction surveys in the UK identifies age, as opposed to other socio-demographic factors, as having the strongest influence on satisfaction levels. Older people are consistently more likely to express greater levels of satisfaction with regards to health care than younger people . This may in part be due to older people’s greater experience of healthcare and its potential shortcomings resulting in decreased expectations and a resultant increase in their satisfaction .
There is no doubt that the emotional content of design in everyday products is becoming increasingly important but it is proposed that the reaction to meaning and emotional response that is triggered by a particular product varies between generations, cultures, social groups and nationalities . This implies that devices could be specifically designed for older people in order to prompt a positive emotional response.
The use of opportunity and snowball sampling might have limited the diversity of participants and consequently the generalizability of the findings. Anecdotally, many of the participants in this study reported that they had replied to the adverts out of a sense of 'gratitude’ and wanting to give something back which might have biased the interviews. Gratitude bias can be seen, particularly in public funded service such as the National Health Service, when participants are reluctant to criticise and have a tendency to gloss over any negative concerns they have about services and treatments because they feel they should be grateful with what they receive . Whether this biased the results of this study is hard to determine however, as on the whole there did seem to be a great deal of praise for the treatment they received and the healthcare staff they encountered.
While interviewing the user and partner together allowed them to prompt and remind each other of instances and issues during the course of the interview it may also have resulted in a less open and frank discussion. For example it might be very hard for a next of kin to express negative experiences and emotions of having the technology in the home in front of the user, who may be medically dependent on the device. In general the older people in this study seemed less willing to talk about their feelings towards their medical devices than was expected. There also seemed a difficulty in focusing the talk on the device itself as opposed to the medical condition which demonstrates the inextricable links between the condition and device, and vice versa.
While the use of thematic analysis allowed for a rich description across the data set, the nuances contained in individual accounts tend to be lost, thus limiting complexity and the reporting of individual aspects of the situation from within the data. In this case thematic analysis was used to provide a broad description of the interview content as opposed to making any high order theoretical claims.