Empirical context

As mentioned above, the context of this research is ALFs for young adults with moderate to severe disabilities. In Norway, many people with disabilities in need of care and support services live in housing like ALFs (NOU 2016: 17; Tøssebro 2019). ALFs are complex settings. They come in many shapes and sizes but are often organized as group homes. This means that they may have common areas in addition to individual apartments, and they often have staff rooms as well.

The ALFs are the residents’ legal homes and hence the places where everyday lives are lived (Hoydal & Thygesen 2022). Residents’ lives vary in terms of several factors, including age, personal interests, the extent of disability, and individual needs for assistance. Some residents may go to work or school, while others may attend supported forms of employment or other daytime activities. Life at ALFs may also include leisure time and activities at the facilities or in the neighbourhood. ALFs’ strong focus on facilitating residents’ active participation in society is in line with Norwegian disability policy and the UN Convention on the Rights of Persons with Disabilities (Kulturdepartementet 2021; Söderström et al. 2021; Tøssebro 2016; UN 2008).

Carers play an important role as formal service providers at ALFs. Their main tasks are related to assisting the residents according to their individual needs and capabilities. As these needs and capabilities greatly differ in different situations, the carers’ responsibilities may vary substantially. Carer’s roles can go from assisting residents with most aspects of activities of daily living, including personal care, to accommodating needs for verbal guiding only.

In a broad sense, technologies and materialities are key actors at the ALFs as well. The material surroundings lay the premises for how everyday life may be lived and how much support from the carers may be needed (Hoydal & Thygesen 2022). In some ALFs, adaptations are made to the physical environment in order to accommodate individual needs. Kitchens, for example, may be altered to enable wheelchair users’ access to the cooktop or kitchen sink. Assistive technologies, including wheelchairs, lifts for transfer, and robot feeding arms, are also common technologies at ALFs. In addition, smart home technologies, including sensors for regulating the use of lights, heating, and alarm systems, are often in use. These are examples of technologies that may be an integrated part of the building’s technical infrastructure and, importantly, represent solutions which are common to all residents.

Policy and research

Nordic studies on disability have traditionally been closely linked to policy and service development. Within the Nordic tradition, both in terms of disability studies and in policy, there has been a strong awareness of the importance of materiality and technology in the lives of people with disabilities (Jacobsen 2020; Ravneberg & Söderström 2017). Hence, issues of individual needs, accessibility and participation in society has been a major theme (Kjellberg 2002; Lid 2020; Ravneberg & Söderström 2017; Ursin & Lotherington 2018).

The size and lay-out of individual apartments at ALFs, adaptations made to the physical environment, and access to individual assistive technologies are all part of formalized and policy-driven processes with an overall aim of ensuring equal opportunities in society (Erdtman, Rassmus-Grön & Hedvall 2021; Kulturdepartementet 2019; Kulturdepartementet 2021; Ness 2011; Ravneberg & Söderström 2017). In Norway, these processes are formalized, partly through legislation and regulations guiding the design of buildings and products (Lid 2020), and partly through the allocation of assistive technologies and housing adaptations through a state-financed system (Ness 2011). Universal design principles and legislation, for instance, guide standards for the size of buildings and lay-out of rooms, aiming to provide accessible and usable housing and environments (European Commission 2021; Lid 2020). Assistive technologies, on the other hand, are devices that are used to compensate for or improve individual limitations and capabilities (Ravneberg & Söderström 2017). Although both universal design principles and assistive technology provision are complex and sometimes disputed concepts within the disability studies field (Heylighen 2014; Ravneberg & Söderström 2017; Winance 2014), they are also recognized as important contributors to lowering disabling barriers in society (Lid 2020; Ravneberg & Söderström 2017; Steinfeld 2023).

In parallel with these policy developments, technologies and materialities–and their relations to care and service provision- have also been the subject of increased interest in research within the disability field (Ravneberg & Söderström 2017). This heightened interest in technology coincides with significant growth in the use of technology in society, including in healthcare services (Jacobsen 2020; Nickelsen 2019). Research has focused on issues of materiality and the importance of the physical environment for enabling participation in society (Hamraie 2017; Ryhl & Høyland 2018), the significance of architecture in health and social care contexts (Nettleton, Buse & Martin 2018; Ivanova, Wallenburg & Bal 2016), and design and development of accessible technology (Locke et al. 2022; Quintero 2022). In addition, technological innovations in health and service provision and the increasing use of telecare are important emerging fields of interest in policy and research within the disability field in Nordic countries (Buse, Martin & Nettleton 2018; Bødker, Christensen & Langstrup 2019; Jacobsen 2020; Schneider-Kamp & Fersch 2021). With regards to assistive technology there is also a growing number of studies on the process of assessing individual needs, user involvement, allocation, adaptation, and use of individual assistive technology, as well as the role and significance of assistive technology in the individual›s everyday life (see, for instance Meyer Larsen et al. 2020; Ravneberg & Söderström 2017; Söderström et al. 2021; Thordardottir et al. 2019; Wilson et al. 2019; and Øksnebjerg et al. 2020).

In this article, on the other hand, we zoom in on the use of seemingly trivial objects in everyday life and care at ALFs. These are objects that have no formal role in care or service provision, or within policy.

The STS field, which this article draws upon for theoretical and analytical resources, has traditionally been concerned with materiality and technology and their relations to human enterprises (Ravneberg & Söderström 2017). Within a subsection of the STS-field; science, technology, and medicine (STM), several studies address the human-material intersection of everyday practices in the context of disability, including care- and service provision (see, for instance Dahler, Petersen & Andersen 2018; Lemos Dekker & Pols 2020; Moser 2006; Nickelsen 2013, 2019; and Pols 2016). Within this body of literature, there is increasing interest in the role of materialities and things that may go unnoticed or be perceived as mundane or unimportant. This includes items such as clothing, photographs, hygiene products, and household objects (see, for instance Araujo et al. 2020; Buse, Martin & Nettleton 2018; Latimer 2018; and Pasveer 2020).

Despite this heightened interest, however, researchers have pointed to a lack of studies on the technological and material side of disability (Bøhler & Giannoumis 2018; Ravneberg & Söderström 2017; Ursin 2017), especially the role and significance of mundane objects in service provision in the context of home and care arenas (Cleeve, Borell & Rosenberg 2020; Lee & Bartlett 2021; Molterer, Hoyer & Steyaert 2019; van Hout, Pols & Willems 2015). According to Buse, Martin, and Nettleton (2018: 244), several aspects of material culture in healthcare remain unnoticed, and as Latimer (2018: 381) suggests, drawing attention to the role of ‘neglected things’ may help illuminate how these objects contribute to a better understanding of how care is practiced, felt, and lived.

With this article’s focus on incidental and easily overlooked objects in a combined home and care setting, we aim to contribute to this diverse body of literature.

Methods and participants

The empirical data for this article stems from a larger study on the role of technology and materiality in everyday life in assisted housing for young people with disabilities, conducted by the first author (Hoydal, Lid & Thygesen 2020). The study was designed as a multiple case study (Marcus 1995) using ethnographic fieldwork with participatory observation (Fangen 2010) in three different ALFs over a period of eight months. The three ALFs were the homes of a total of 23 young men and women ages 18 to early 30s, all with moderate to severe physical and/or cognitive disabilities.

The first author participated to varying degrees in the on-going everyday activities at the ALFs, observing where, when, how and which activities were going on, as well as who and what materialities were involved. Participatory observation made it possible to observe, trace, describe and reflect on different practices from inside actual situations, including topics that are not mentioned or conscious for the individuals involved (Fangen 2010). In addition, the observations provided opportunities to gain insight into the ideals and values embedded in practices (Pols, Althoff, & Bransen 2017). Being present also enabled conversations in natural situations as well as follow-up questions from observations, either in the actual situations or at a later occasion.

During the fieldwork, the first author made short notes and sketches from observations, as well as quotes or key words from conversations. These notes were transcribed into fieldnote text promptly after each session of fieldwork.

The empirical material, then, consisted of extensive fieldnotes with descriptions of activities, practices, conversations, and non-verbal reactions, as well as sketches of rooms and movement patterns at the different premises. In addition, the empirical material encompassed transcripts of a total of ten individual and group interviews involving some of the residents, carers, and relatives. In the interviews, participants were invited to describe their experience of living in, working in, or visiting the ALFs. In addition, the interviews provided opportunities for the researcher to follow-up on observations and preliminary interpretations (Fangen 2010).

Like many of the carers at the ALFs, the first author has a background in a healthcare profession and has experiences working with people with different disabilities and their relatives. Consequently, she sometimes experienced a mix of roles during fieldwork: both being recognized as an insider based on her theoretical and communication skills in settings like ALFs, and also having the role of a researcher with an outside perspective. Being a partial insider can be considered both an advantage and a disadvantage. The advantage is that it enables good contact and access to individuals’ everyday life and experiences through shared expertise. The disadvantage, however, is that this increases the risk of previous experiences influencing the observations and interpretations, potentially leading to overlooking important details. Additionally, there is a risk that the researcher is perceived as an employee, along with the corresponding expectations of her participation. Several methodological strategies were adopted to avoid previous experiences and understanding interfering with the research and knowledge production: awareness of these risks, providing clear information about the study and the researcher, using follow-up questions, and asking for confirmation or disapproval of preliminary interpretations during fieldwork and interviews, as well as joint discussions in the analytical process.

Ethical considerations

As described, the residents at the ALFs included in the study had moderate to severe physical and/or cognitive disabilities. Some residents also used alternative communication. In line with Norwegian research guidelines (NESH 2021), ethical considerations regarding research design, distributions of information, consent, and approach were therefore given extra consideration before and throughout the research process (Hoydal, Lid & Thygesen 2020). This included close dialogue, supervision, and approval from the Norwegian Centre for Research Data (project number 54048). Prior to the fieldwork, all the ALFs and residents received written information about the project. In addition, the first author participated in staff and information meetings for residents and relatives at the ALFs. During fieldwork, written information about the project, which included contact information, was posted in the common areas at the ALFs. Residents, relatives, and carers who wanted to participate in interviews were encouraged to contact the researcher either directly or through staff or the local management.

To ensure anonymity, all names of persons and places used in this article are fictitious. We use male names for residents and female names for carers.

Methodological and theoretical approach

The article is based on a praxiographic approach. This approach sees knowledge as enshrined in and created through socio-material practices: in situations, activities, buildings, routines, etc. (Mol 2002: 32). This means that objects and persons are intertwined in practices that take place in specific situations and environments. The focus of this study, therefore, was to follow and describe human-material relations and practices at ALFs. Detailed studies of everyday situations hence form the empirical basis of the article.

The empirical data were analysed and discussed using the concepts of fit, misfit and tinkering (Mol, Moser & Pols 2010; Pols 2012). The notions of fit and misfit refer to the active process of balancing humans and technologies/materialities. Achieving a fit is hence a relational activity (Pols 2012). Materialities and technologies need to be adapted–made to fit–to the people and the situations they are a part of. What makes a fit therefore needs to be understood in context. Moreover, as a person’s functional capabilities, needs, and situations (including the material surroundings) change, establishing fit is an ongoing process that requires considerable work and effort to maintain. According to Pols (2012), because the solution(s) that may contribute to achieve fit or for how long are not given, ‘users and devices have to continually establish what may fit where’ (2012: 39). The notion of fit thereby expresses whether something is adapted and whether a solution is perceived as good in the situation (Pols 2012). If something is not well adjusted, the result may be a misfit, that is, a human-material relation that is not perceived as a good or relevant solution, or, in the worst case, a solution that may disrupt or make a situation worse (Pols 2012).

To establish a fit is closely linked to everyday life and the work of carers at ALFs. In this article, we use the notions of fit and misfit to draw attention to how carers mobilize and adjust different materialities to ‘make things work’ in everyday situations at ALFs. Puig de la Bellacasa (2017: 70) uses the term doings, describing care work as ‘a manifold range of doings needed to create, hold together, and sustain life and continue its diverseness’. This highlights a ‘focus on the doings required to sustain everyday life’ (Eidenskog 2021: 28).

The notions of fit/misfit are closely related to the practices of tinkering. To tinker is ‘to quibble, to handle, to adjust, to experiment, to change tiny details in order to see if it works’ (Winance 2010: 102). Tinkering is necessary, as technologies and materialities do not work in or of themselves but depend upon being used and adapted to suit the situation at hand (Mol, Moser & Pols 2010: 14–15). To tinker is therefore a part of the work involved in achieving fit in everyday situations, as technologies and materialities are an integrated part of human relations and practices at ALFs.

The analytical process

Analysis of the empirical data can be described as a hermeneutical process. Both authors were involved, going back and forth between the data and our understanding of it, continually gaining new insights and re-interpretations (Fangen 2010). We followed Miles, Huberman, and Saldaña’s (2020) recommendations of early and continuous readings of the empirical material to look for emerging themes. In the analysis, we started with an open and non-biased approach (Fangen 2010). The reiterated rounds of reading and analysis led us to identify how small and seemingly incidental or trivial objects were involved in everyday activities and situations. These objects seemed to be ubiquitous, and the analysis revealed that these objects played an important role in situations characterised by misfit and the everyday practices of ‘making things work’ at the ALFs.

As an analytical strategy for this article, we used Nicolini’s (2009) notion of zooming in and zooming out. First, we zoomed in on the empirical data to identify situations involving fit/misfit, and then we zoomed out to understand the role and characteristics of these objects, including the work involved in handling instances of misfit.

Even though the empirical data from all three ALFs formed the basis of the analysis and support our findings, only excerpts from two of the three ALFs involved in the study are included in the following presentations of results. The reason for this is partly related to space limitations, but more importantly, the most interesting and illustrative examples happened to be from two of the ALFs. The two ALFs included are referred to as The Sunstone and The Diamond.

Handling misfits in everyday life

Heading home from a social arrangement, Henrik’s electrical wheelchair would not connect to the wheelchair attachment of the car. Despite several attempts, a red light at the car’s dashboard continued to indicate “not attached”. Carer Nina opened the passenger front door and used the flashlight on her mobile phone in order to see from the side why the attachment had failed. It was clear that the safety handle that usually opens when pushing a button at the dashboard did not open. This handle is positioned underneath the centre of the wheelchair and must be in an open position for the wheelchair to get attached. So, what to do? Driving without the wheelchair being properly attached to the car is dangerous, and not an option. Also, the possibility of Nina using her hand to manually hold the safety handle down was ruled out, as it would mean that Henrik would have to drive his heavy wheelchair over the arm, causing injuries. Nina rummaged in her bag to search for possible solutions, before removing the key-card strap she had around her neck. She attached one side of the strap to the safety handle and pulled the safety handle open from the front end, while Henrik drove into place (fieldnotes, The Sunstone).

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In Ari’s apartment there is a narrow electric panel next to the door. The panel has small pieces of tape attached, with writing on it. One of them says “mirror on”, the others “off” and “ceiling on”. Looking closely at the panel it is clear that the panel consists of several flat switches with tiny white icons, indicating different functions for the lights, including dimming. Later, when speaking to Liv, one of the carers, she explained that the bits of tape with writing was put on the panel as Ari kept pressing the wrong switches, getting frustrated and resulting in him often sitting in the dark or leaving the lights on all the time (fieldnotes, The Diamond).

These two excerpts from fieldwork exemplify common, everyday situations at the ALFs. The first describes an acute incident wherein the attachment handle in the car did not work, making it impossible to fasten Henrik’s wheelchair, leading carer Nina to use the flashlight from her mobile phone and a key-card strap to open the handle manually. The second excerpt shows how writing on pieces of tape solved Aris’s problems with the smart home light switches in his apartment. The smart home panel, although sleek in design, was too complex and difficult to operate for Ari, who has a learning disability. Through the bits of tape with writing on it, the functions of the different switches were made clear, hence enabling him to operate them on his own.

The two excerpts share certain features. Firstly, they both address issues related to technologies and materialities and their use in everyday situations at the ALFs. Moreover, they both involve different forms of technology failures. However, they are also different in important ways. The story of the breakdown of the attachment handle exemplifies an acute situation where a here-and-now solution is called for. Ari’s problems with administering the smart home panel, on the other hand, calls for a more long-term solution.

Combined, these two excerpts exemplify how carers are involved in different tinkering practices, with an aim of ‘making things work’ at the ALFs in order to handle or reduce the impact of misfits. At the same time, our analysis of the excerpt contributes to highlight the roles and characteristics of the materialities involved in solving these problems, both here-and-now and in relation to misfits that call for more stable solutions.

The point we are making is that these kinds of objects have a key role in everyday life and service provision at the ALFs.

In the following we elaborate on the roles and characteristics of incidental objects.

Compensating for challenges in common solutions

At the Sunstone several doors to the residents’ rooms are kept open onto the internal corridor. This is despite all doors having automatic door closing systems attached. Two doors had its door automatic system dismantled. Another was kept open by a large box, placed in the doorway. Carer Solveig explained that some of the residents prefer having their door open when they are at home. It enables them to hear what is going on and makes them feel safe and included. Where they are unable to keep the door open by dismantling the automatic doors, something heavy is placed in the doorway instead (fieldnotes, The Sunstone).

The Sunstone has a common main entrance, and all individual apartments and common areas are linked by an internal corridor. The doors leading into the residents’ apartments comply with fire-restriction regulations and are designed to stay in a closed position. In the above excerpt, heavy boxes are used to keep the doors in an open position, in line with the needs and preferences of individual residents. The automatic and fireproof doors are one example of the many common solutions installed at the ALFs. Another example is the smart home panel described above, in the excerpt about Ari at The Diamond. However, as exemplified by both these stories, the common solutions do not fit all the residents. Hence, individual adjustments are called for, as a compensation for the misfits created by the common solutions. Our argument is that incidental objects, such as heavy boxes and writing on bits of tape, play important roles in solving these kinds of challenges at the ALFs.

The choice of heavy boxes to solve the misfits of the closed doors can be understood as pragmatic. The boxes were there, readily available in the apartment or staff rooms, and, importantly, heavy enough to prevent the doors from closing. Thus, the boxes contributed to fit in the form of workable individual solutions. In the same way, tape and a pen were at hand in Ari’s apartment and contributed to a quick, simple, and individual fit.

Creating flexibility and agility

The analysis also identified how incidental objects contributed to create flexibility and agility, as the following fieldnote excerpt exemplifies:

Outside Adrian’s front door an empty plastic bottle is attached to his doorknob. Also, there are more plastic bottles next to his door, on the floor of the outdoor corridor that connects the residents’ apartments to the staff rooms at the corner. Carer Anne explains that Adrian, who has an intellectual disability, often tries to leave his apartment at night, and that this is a safety issue, as the outdoor corridor leads straight to the parking lot. Also, Adrian sometimes tries to enter other residents’ apartments and may be aggressive. Anne explains that different solutions have been tried without success. For a period, a night carer stayed in his apartment at night. This solution did not work for Adrian, who expressed a need to be alone. The question, then, was how to ensure Adrian’s and the other residents’ safety, while at the same time meeting Adrian’s need to be alone at night? Currently the carers are waiting for an alarm system to be installed, Anne explains. And in the meantime, the empty bottles are used to alert the carers if he opens the door at night (fieldnotes, The Diamond).

As described in the excerpt, the empty bottles have an important function in alerting the carers if Adrian opens his door at night. But the story also reveals another important detail: that the staff was waiting for an alarm system to be installed. Hence, the empty bottles at Adrian’s door at night are a temporary arrangement. In disability housing, such as the ALFs, processes related to procuring assistive technologies or other technical installations are often expensive and time consuming, as formal procedures must be followed. In the meantime, the situation at hand needs to be addressed using the available resources. In situations like these, we identified incidental objects serving an important role in creating the necessary flexibility and agility for everyday life to go on, all while providing appropriate care.

Enabling values

A final part of our argument on the roles of incidental objects is that they are instrumental in enabling different values at the ALFs. The use of boxes to keep the residents’ doors open allowed carers to cater to individual preferences. The open doors made residents feel safe and included, reassuring them that the carers would hear them if something happened.

The bottles at Adrian’s door at night also enabled some degree of safety and security, for both Adrian and the other residents, as the bottles alerted night carers when Adrian opened his front door. At the same time, the solution also made it possible for Adrian to have his preference of being alone in his apartment at night.

For Ari, the bits of tape and writing enabled him to manage the light switches on his own and thus increased his experience of independence and self-management. And for Henrik, the key-card strap enabled him to travel home safely despite the breakdown of the automatic wheelchair attachment-handle in the car.

The characteristics of incidental objects

So far, we have shown that incidental objects play an important role in everyday life and service provision at the ALFs, that they contribute to solving breakdowns and here-and-now situations, that they compensate for misfits and challenges in common solutions, and that they enable flexibility and agility and reflect different values. As such, incidental objects are often crucial as part of the tinkering processes involved in ‘making things work’.

But there is more to these incidental objects, namely in relation to their characteristics. The choice and use of bits of tape and empty bottles, for example, may seem entirely random. However, our analysis revealed that this is not the case.

Through our analysis of the stories presented above, we identified five partly overlapping characteristics of the incidental objects.

A first key feature is that they are available or ‘at hand’ when needed, ready to be adapted and tinkered with in the situation. The empty bottles, for example, were already there in the staff rooms. Another example is the key-card strap that was used to manually open the attachment handle for Henrik’s wheelchair. The point is that these objects were used because they were available in the situation. In this regard, the use of objects can be seen as coincidental: other available objects may just as well have been used. But our analysis showed that this was not the case. Incidental objects also share a second characteristics in that they have a pragmatic purpose: to solve the issue at hand. Hence, not any available item will do. But in this respect, it is also necessary to keep in mind that it is never given outside the actual context that these particular objects would solve the situation, neither here and now nor in a more long-term perspective.

A third characteristic of these pragmatically available objects is that their use does not require any planning or formal procedures to be used. In the situations described above, no forms needed to be filled in, no approvals given, and no purchases made. This is a vital part of what made these objects accessible to be tried and tinkered with in the situation ’at hand’. In this way, the incidental objects are substantially different from assistive technologies and most other technologies used at the ALFs.

A fourth characteristic of incidental objects is that they may be considered trivial or modest. Key-card straps, empty bottles, pens, bits of tape, and boxes are all examples of objects that are usually in the background or may be taken for granted in everyday life at the ALFs.

Finally, a fifth common feature of incidental objects is that they represent relatively unstable solutions. This means that they are interchangeable objects that may easily be replaced when the situation requires it.