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. 2026 Jan 15;39(1):e70173. doi: 10.1111/jar.70173

Digital Pathways to Family Bonds: Exploring WhatsApp Video Calls Adoption by Older Adults With Intellectual Disability in Out‐of‐Home Residence

Carmit‐Noa Shpigelman 1,✉, Michal Isaacson 2, Adi Cohen‐Nudelman 3
PMCID: PMC12808865  PMID: 41540640

ABSTRACT

Background

The increased longevity of persons with intellectual disability (ID) means growing numbers are moving to out‐of‐home residence, affecting their contact with family members. Digital technologies may provide a venue for maintaining contact. This study sheds light on their adoption process.

Method

Sixteen older adults with ID who live in supported accommodation used tablets for WhatsApp video calls with family members for a month. They were interviewed before and following this intervention.

Findings

Two main themes were found regarding the implications of technology use: (1) video calls contributed to the residents' sense of closeness to their families and their well‐being and (2) free access to technology and ongoing accessibility were essential to successful adoption.

Conclusions

Using WhatsApp video call and its visual aspect made the residents become more active in contacting their families. However, technology adoption depends also on reciprocity and an accommodated supportive environment within the context of resident‐family‐staff.

Keywords: digital communication technologies, family, intellectual disability (ID), older adults, out‐of‐home residence, well‐being

Summary

  • WhatsApp video calls, and especially the visual aspect of communication, can contribute to older adults with intellectual disability in residential settings in increasing their sense of closeness to family and overall well‐being.

  • The adoption of digital technology depends not only on persons with intellectual disability but also on the collaboration and support of family members and staff.

  • Free access to digital communication technologies in routine, as well as ongoing technical, emotional and relational support, is needed to engage older adults in residential settings in using these technologies for communication with their families.

1. Introduction

Recent years have seen an increase in the relative number of persons with intellectual disability (ID) who enter old age (García‐Domínguez et al. 2020). According to the World Health Organization (2005), old age begins at 50 for people with ID, and about 45 for people with Down syndrome. Although people with ID tend to cope with health issues attributed to old age at a younger age (Bowers et al. 2014; García‐Domínguez et al. 2020), this period is marked by cognitive improvement, as predicted by compensation age theory (Lifshitz 2020). According to this theory, the developmental delay of people with ID in younger ages is compensated for later in life, that is, the maturity and life experience of older persons with ID help them learn and acquire life skills better than in earlier ages. Therefore, it is recommended to promote intervention programmes for people with ID in older ages, particularly, in order to acquire new skills in various life domains (Thalen et al. 2022).

The social networks of older adults with ID are limited compared to their peers without disabilities, due to stigma, housing and employment in segregated non‐community settings and the need for intensive care that limits their social network to primary caregivers and service providers (Harrison et al. 2021). Language and communication difficulties may also pose substantial barriers to social participation of older adults with ID who live in out‐of‐home residential settings (Bigby 2008; Smith et al. 2020). It was found that older adults with ID who have lower adaptive and communicative skills may receive less positive staff contact in the residential setting and may be offered fewer stimulating activities, which in turn limit their social interactions with others (Maes et al. 2007). Reduced mobility, which may stem from physical disabilities, reliance on caregivers for transportation or lack of accessible community environments, can further limit opportunities for social engagement, especially for older adults with ID who live in out‐of‐home residence (Bigby 2008; Cleaver et al. 2009; McCausland et al. 2023). This situation may increase their social isolation and decrease their well‐being (Burke et al. 2014; Schepens et al. 2019).

The social networks of older adults with ID can become even more limited when their parents age, move to a nursing home or pass away (Burke et al. 2014; Schepens et al. 2019). Such loss of the primary caregivers and transition to an out‐of‐home residence is often accompanied by a sense of abandonment, loneliness and depression. It can weaken the bonds with other family members and worsen the mental conditions of older adults with ID (Bigby 2002; van Heumen et al. 2025). Studies indicate that relatives of these adults also experience stress due to this disconnection (Kanthasamy et al. 2024). Thus, although the objective burden on the family is reduced due to the transition to out‐of‐home residence, a subjective burden is still experienced in terms of guilt feelings and concern for the family member with ID (Werner et al. 2009). To promote successful ageing and well‐being at old age, it is therefore important to develop interventions for sustaining and expanding social and, particularly, family relations.

Digital communication technologies can help preserve and promote social interactions and using them can meet the need for older adults with ID to remain in contact with their families (Caton and Chapman 2016; Shpigelman 2018). It was found that such technologies can relieve loneliness among older adults in the general population (Chopik 2016; Leist 2013). Nevertheless, their adoption by older adults with ID has yet to be studied in depth. To meet this gap, the present study examines the process of adopting digital communication technology among older adults with ID in order to maintain contact with family members, based on an intervention programme implemented in out‐of‐home residence.

1.1. Adoption of Digital Communication Technologies at Old Age

The past decades have seen the accelerated development of digital communication technologies. Lee and Coughlin (2015) proposed a theoretical framework for the adoption of such technologies in old age, including four key aspects: the older adult, the technology, society and the way the product is provided. They also proposed 10 major factors affecting technology adoption: value, usability, affordability, accessibility, technical support, social support, emotion, independence, experience and confidence. Specifically, Lee and Coughlin examined how the various factors affected the adoption of technologies such as smartphones, tablets, computers and social media by older adults from the general population and found that the most significant ones were value, experience, affordability, social support and emotion.

As in the general population, recent years have seen an increase in the rate of persons with ID who use digital communication technologies, including social media. The literature indicates that persons with ID use mainly social media, which contributes significantly to their social interactions (Anderson et al. 2023). Social media use by persons with ID helped them maintain contact with family and friends as well as form new relations (Shpigelman 2018). In addition, the use of social media contributed to enjoyment and self‐esteem and reduced loneliness among users with ID (Caton and Chapman 2016). Ramsten et al. (2020) found that one of the significant predictors of communication technology adoption by persons with ID was family support. Another study found that the use of social media helped maintain contact with family and friends as well as form new relations (Shpigelman 2018). Note, however, that most studies focused on younger rather than older persons with ID (Marnewick et al. 2022). Furthermore, most studies still focus on the dangers of using the Internet at the expense of its benefits for people with ID (Werner and Shpigelman 2019).

As in the general population, during COVID‐19, the use of digital communication technologies increased among older adults with disabilities, particularly, those in out‐of‐home residence. It helped them cope with social distancing restrictions and contributed to their own and to their family members' mental health (Anderson et al. 2021; Kim et al. 2021; McCausland et al. 2021; Shpigelman and Araten‐Bergman 2024). Nevertheless, these studies focused on the results of technology use and less so on understanding the process of its adoption. Moreover, it was usually the family members who had initiated the use of technology, with the help of the staff in the residential setting and based on their availability and willingness to help (Araten‐Bergman and Shpigelman 2021; Shpigelman and Araten‐Bergman 2024). Thus, the process of adopting digital communication technologies by older adults with ID deserves further research attention. For example, we do not know whether the adoption factors proposed by Lee and Coughlin (2015) regarding the general population are relevant to older adults with ID and to what degree. There may be other factors unique to that population. Accordingly, the objective of the present study was to understand and describe the process of adopting and implementing a digital communication technology among older adults in out‐of‐home residence, including the user experience, needs and challenges involved in using such technology for contact with family members.

The research questions were as follows: (1) What is the experience of using a digital communication technology by older adults with ID in supported accommodation seeking to maintain contact with their family? (2) How relevant are Lee and Coughlin's (2015) technology adoption factors to that experience and does the adoption process include additional factors unique to older adults with ID in supported accommodation?

2. Method

A qualitative descriptive phenomenological approach was applied to gain a deeper understanding of the lived experiences of older adults with ID who live in supported accommodation and use a digital communication technology (WhatsApp video calls) to communicate with their families (Giorgi 2012). The data were collected in Israel from January to August 2022. During that period, there were no longer national lockdowns and many of the general restrictions, such as wearing a mask in public places and testing requirements, were reduced. Still, settings considered high risk (e.g., nursing homes or disability residences) continued to impose some restrictions; for example, older adults with disabilities infected with the COVID‐19 virus or exposed to verified patients were isolated, meaning that those residents had to stay in different apartments in their residential setting.

2.1. Participants

Purposeful sampling was used, based on the following inclusion criteria: (1) people with ID aged 45 and above (2) living in out‐of‐home residential settings, from institutions and group homes to supported community living (3) with no prior experience with video calls. Table 1 presents the participants' demographics. As the table shows, their ages ranged from 45 to 74 (M = 60.1; SD = 8.7). Most were with mild to moderate levels of cognitive impairment. The sample included 16 participants, based on the data saturation principle, as commonly used in qualitative research (Guest et al. 2006). Following this principle (Guest et al. 2020), the interviews were transcribed and coded concurrently with data collection and the research team conducted ongoing analysis of the data to identify emergent themes. Saturation was considered achieved when no new themes emerged in at least six consecutive interviews in each subgroup (mild and moderate levels of ID).

TABLE 1.

Participants' demographics (n = 16).

Pseudonym Gender Age Disability level Type of residential setting Communication partner Frequency of contact
Tomer M 45 Mild SCL Aunt Weekly
Hannah F 70 Moderate GH Sister Weekly
Shalom M 65 Mild GH Sister Several times a year
Tzipi F 67 Mild SCL Brother Daily
Iris F 60 Moderate SCL Brother Fortnightly
Pnina F 61 Moderate Institution Brother Weekly
Shuli F 57 Moderate Institution Brother Daily
Alex M 74 Mild SCL Sister Monthly
Ehud M 46 Severe Institution Brother Weekly
Esther F 48 Moderate Institution Parent Weekly
Sophi F 58 Mild Institution Sister Weekly
Gidi M 61 Mild Institution Sister Daily
Ilana M 52 Mild GH Sister Weekly
Batia F 69 Mild GH Brother Weekly
Nissan M 62 Moderate GH Brother Weekly
David M 67 Mild SCL Brother Bimonthly
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Abbreviations: GH = group home; SCL = supported community living.

In Israel, residential settings for people with disabilities include: (a) institutions and group homes shared by four to eight unrelated people with disabilities who live under one roof or in one site and for whom 24/7 staff support is available. Institutions are larger than group homes and typically host people with disabilities who have severe functional impairment or highly complex support needs; (b) supported community residential settings—a range of accommodations where people with disabilities share an apartment and receive drop‐in support and supervision managed by professional disability organisations. These services are designed for people who can manage many aspects of their daily lives but require some support to help them live independently in the community (Merrick et al. 2011; Stancliffe et al. 2011). As for the participants of the present study, about a third lived in the community, a third in a group home and a third in an institutional setting. Furthermore, half of the participants were women.

Most (14 out of 16) of the family members who were the participants' communication partners were their siblings. The frequency of contact was usually higher than monthly (only two participants maintained contact at a lower frequency). Most (14 out of 16) of the participants did not own a mobile phone; of the remaining two, one had a smartphone. This later participant who had a private smartphone was diagnosed with a relatively high functioning level and his family asked to allow him to have a cellphone. It should be noted that the institutional residential settings that participated in the present study did not allow having a technological aid in the resident's room due to fear that it would be damaged. These institutional settings usually host people with ID who have severe functional impairment or highly complex support needs. Some residential settings had tablets but for rehabilitation purposes; the tablets were stored in the staff room and the staff gave them to the residents for specific activities. In general, the residents who participated in the present study have not been exposed to digital communication technologies before our intervention; this can be explained by stigmatic beliefs about the ability of older adults with ID to use such technologies as well as accessibility barriers (Álvarez‐Aguado et al. 2025; Rocheleau et al. 2020).

2.2. Intervention Programme

The intervention included practicing video calls using WhatsApp, installed in tablets distributed to the participants. Before using the tablets, one of the researchers, who is also an occupational therapist, provided the participants with individual guidance on how to use the app, especially in order to call the family. Four to six short guidance sessions were held with each participant until they were able to send and receive video calls independently. That researcher also provided guidance to the communication partner, as required.

After the practice sessions, the participants were able to use their tablets to communicate with a family member of choice for a month. Note that this situation differed from the ordinary routine in the residential settings, each of which had a designated time, once or several times a week, when the resident could contact the family, usually through a phone under a staff member's responsibility. Thus, the intervention also aimed to empower the participants by allowing them free and personal access to the communication technology. In addition to the preliminary guidance, each residential setting had a professional, such as a social worker or social coordinator, who provided ongoing technical support for the participants.

2.3. Data Collection

In the first stage of the data collection, before the intervention, semi‐structured in‐depth interviews were conducted with each of the participants, in order to learn about their relations with their families, the frequency of contact, the family member who would serve as their communication partner and their expectations from the programme (e.g., ‘With which family member do you keep in touch?’; ‘How often do you speak with him/her?’; ‘Are you happy or not with the number of times you talk with your family member?’; ‘How do you feel about participating in the program? Do you have any concerns?’).

Following the intervention, semi‐structured in‐depth interviews were once again conducted with the participants in order to learn about their subjective experience of adopting the technology (e.g., ‘How did you feel when you talked in a video call with your family member?’; ‘What did you get from the video calls with your family?’; ‘Are you planning to continue using the tablet and WhatsApp for video calls with your family? Why?’; ‘Would you recommend to other residents to use tablet and WhatsApp for video calls with their families? Why?’).

Note that the interview guides had been simplified linguistically by a professional before using them. They were then piloted on two older adult residents with ID in order to make sure the questions are in plain language adapted to the participants' cognitive ability. Following the pilot, some of the questions were revised.

In addition to the qualitative data, quantitative data were also collected—tracking the usage patterns of each participant, including who initiated each video call and the frequency of the calls (see Table 2). Table 2 indicates that six of the participants adopted the technology, that is, they conducted over six video calls during the period under study. We set six as the cutoff because the residents received a maximum of six guidance sessions on how to use the tablet for sending and receiving video calls. In addition, we expected the residents to communicate with their families at least twice a week, more than once a week as they usually do in routine. The remaining 10 participants engaged in few calls or none. Except for one resident (Tzipi), the majority talked with their families on average up to 5 min. The relatively short calls can be explained by the content of the calls. Although the video calls were not recorded due to ethical issues and the fact that the aim of the study was the technology adoption process (not the content), oral conversations with the family members who were engaged in the process indicated that the content of the calls included checking about the residents' health condition (both physical and emotional), especially due to the COVID‐19 and updating and sending greetings related to special family occasions, such as birthdays and holidays. Another plausible explanation for the relatively short calls is the participants' cognitive and linguistic abilities. The family members reported that most residents, even those who were diagnosed with a mild level of ID, had communication difficulties, especially due to cognitive decline associated with old age. The families said that when the residents meet them face‐to‐face (in routine), their conversations are usually concrete and short. However, note that most of the video calls in the current intervention were initiated by the residents and only a few were initiated by their family members (i.e., communication partners). Regarding calls initiated by family members and not answered by the participants (see Table 2), it could be explained by the fact that in some residential settings the tablets were stored in the staff room and when a resident wanted to call his or her family, he or she had to ask for it from the staff. In general, in most cases of missed calls, the residents or the family members who initiated the calls tried to reach the person and called him or her again.

TABLE 2.

Data on the participants' video calls.

Pseudonym Incoming connected calls (n/%) Outgoing connected calls (n/%) Unanswered calls—initiated by resident Unanswered calls—initiated by family Total calls Average call duration (min)
Tomer 3 (3%) 28 (31%) 33 (37%) 25 (28%) 89 2:45
Hannah 0 5 (83%) 1 (17%) 0 6 9:21
Shalom 0 7 (19%) 11 (30%) 9 (51%) 37 4:09
Tzipi 2 (11%) 6 (33%) 7 (39%) 3 (17%) 18 20:32
Iris 1 (17%) 3 (50%) 2 (33%) 0 6 3:21
Pnina 0 7 (33%) 14 (67%) 0 21 8:19
Shuli 0% 50% 50% 0% 4 3:24
Alex 0 0 0 0 0
Ehud 0 1 (100%) 0 0 1 5:31
Esther 0 1 (50%) 1 (50%) 0 2 4:21
Sophi 0 1 (100%) 0 0 1 4:32
Gidi 0 11 (33%) 21 (64%) 1 (3%) 33 3:43
Ilana 0% 0% 1 (100%) 0% 1
Batia 0% 0% 0% 1 (100%) 1
Nissan 0% 0% 0% 0% 0
David 1 (1%) 22 (17%) 109 (82%) 1 (1%) 133 1:46
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Note that the participants who adopted the technology (over a total of six calls) had demonstrated high technological skills during the training sessions. Moreover, among the non‐adopters, three participants made no use of the tablet (no outgoing and incoming calls), despite the fact that they did manage to use the technology during the training sessions. This may be explained by the fact that they needed ongoing technical support in using the technology, which was not always available (as indicated in the qualitative findings below). Moreover, the tablet was not in their room but kept by the staff.

2.4. Data Analysis

Inductive thematic analysis was undertaken to gain an in‐depth understanding of the explored phenomenon (Braun and Clarke 2006). First, one of the authors coded the transcripts to identify units of meaning (codes) that exemplified the participants' experiences of using WhatsApp for video calls with their families. She also conducted a deductive content analysis to identify factors of the technology adoption process based on the conceptual framework developed by Lee and Coughlin (2015). Next, she sorted the codes into potential themes. In the third phase, the other authors audited the initial analysis to enhance trustworthiness. In the fourth, the entire group of authors reviewed and refined the identified themes. Finally, the entire dataset was reread to refine the themes and to elucidate the essential structure of the explored phenomenon.

2.5. Ethics

The study protocol was approved by the ethics committee of the Faculty of Social Welfare and Health Sciences, University of Haifa, Israel (no. 520/20) and the Israeli Ministry of Welfare.

3. Results

Content analysis of the interview transcripts indicated two main themes. The first refers to the implications of participating in the intervention (i.e., the use of video calls to communicate with family members) for the nature of the relationship between the participants and their families. The second theme presents the significant factors of the process of adopting a digital communication technology by older adults with ID. These factors have been examined with reference to factors found to be relevant for older adults from the general population (Lee and Coughlin 2015).

3.1. The Implications of Technology Use on Contact With the Family

More than a third of participants (6 out of 16) described an improvement in their contacts and relations with their family members since starting to communicate via video calls. At the beginning of the intervention, Shalom, for example, described the frequency of his sister's calls to him as ‘Little, little, little … once a month’. At the end, when asked whether the relationship improved, he said: ‘Yes, yes, nice, nice!’. Note that during the one‐month intervention, Shalom held video calls with his sister at least once a week.

Some participants felt that the technology enabled them to initiate the calls, as opposed to the pre‐intervention situation where the family members were the ones initiating the calls. Hannah described how the technology provided her with more opportunities to talk to her sister: ‘[Using the tablet] gives you many things. More possibilities … to talk … to chat …’. Hannah also said it was important for her to keep using the tablet for video calls even after the intervention, ‘because I need to talk to [my sister] Vered – she doesn't call me all the time’.

It seems that there was added value to the visible communication enabled by the video calls, particularly as they took place during COVID‐19, when face‐to‐face meetings between the residents and their families were prohibited. Gidi, for example, described in his second interview how the video calls enabled him to communicate with his sister despite the fact that she was infected with the COVID virus and could not meet or talk to him: ‘Because she's with COVID then I can't reach her [on the phone] … She was sick … No, she answered me, it was simply hard for her to talk on the phone … Yes, it was good to see her on video’.

The other participants did not report any change in their contacts with their families following the intervention. Most of those who reported no change are also those who used the technology very infrequently due to lack of access and technical support, as elaborated in the second theme. Some of them reported that their contacts with their families used to be frequent before the intervention. Tzipi, for example, talked to her brother regularly using a basic mobile phone (not a smartphone). It appeared the video calls had no added value in her case—she described a good relationship with her brother and highly frequent calls, even before the intervention: ‘I talk [to my brother] all the time’.

Apart from the digital technology's contribution to maintaining contact with the family, it also involved some new complexities. On the one hand, free access to the digital communication technology increased most participants' motivation to call their family, as arising from the quantitative data. On the other hand, the fact that family members were not always available for video calls had a negative effect on the participants' well‐being. The use of this new technology made the families' unavailability more painfully evident, particularly, among participants who had not initiated calls to their family previously and became more active in that regard following the intervention. Thus, in the course of the study, they experienced a sense of rejection for the first time. Shalom, for example, who maintains contact with his sister Shlomit, described this in the second interview: ‘But she didn't answer me yesterday! … I felt … bad’. David, who maintains contact with his brothers and nephews, experienced a powerful sense of rejection after his family members kept not answering his video calls. It should be noted that David called his family during day hours and sometimes in the evening. When they did not answer or return to him, he continued to call them again and again. This experience was so powerful that by the end of the intervention, he was no longer willing to use the tablet for video calls: ‘No [I don't want to continue using the technology]. They [family members] much don't answer me. Much don't answer me … No, no, not good feeling’.

3.2. Significant Factors in Adopting Digital Communication Technology

The findings indicated several significant factors in the process of digital communication technology adoption by older adults with ID. Based on the theoretical framework developed by Lee and Coughlin (2015), we found six factors that were shared by older people with and without ID: value, emotion, technical support, social support, usability and confidence. Note that four other general‐population factors were found less relevant to older adults with ID: affordability, independence, experience and accessibility. The latter was defined by Lee and Coughlin as awareness of the technological product's market availability, clearly less relevant to older adults with ID in out‐of‐home residence who are unable to purchase any product without their family's approval and help. Usually, the staff is responsible for the technological products available for the residents' use. Finally, the present study identified two factors unique to the adoption of digital communication technology by older adults with ID: ongoing accessibility and physical access. Below are descriptions of all the factors found significant to the research population.

3.2.1. Adoption Factors Shared by Older People With and Without Disability

3.2.1.1. Value

This factor was defined by Lee and Coughlin (2015) as the perceived value and benefit of using the technology. Usually, older adults do not adopt a technological product just because it is innovative, but if it meets a certain need. In other words, the expected value of using the technology must be very clear to them. In the present study, the majority (11 out of 16) identified the value of video calls for maintaining contact with the family and were therefore eager to participate in the intervention programme and use the technology. Some highlighted the visual aspect—the ability not only to talk with the family members but also to see them. Tomer described this in his first interview: ‘Instead of talking on the phone I could talk on the tablet … you can see each other … we could talk to one another’. In his second interview, he said, ‘It was lots of fun, it was nice for me, I had a lot of fun talking in the video call’.

Some of the participants expressed a desire to use the technology in order to assuage their loneliness. For example, in response to the question ‘Why do you want to participate in the program?’, Shalom said in his first interview: ‘I don't have friends here. No‐one to talk to—so [I could talk to] my sister’. In his second interview, he once again said he had nobody to talk to in the residential setting and that he therefore wanted to continue the video calls with his family. Others perceived the technology as an opportunity to learn something new and alleviate their boredom. For example, Batia said, ‘It's good, I'm learning from it’. And Tzipi said, ‘I want to [learn how to use the tablet]. I'm bored’. Note that in their second interview, most of the participants (14 out of 16) expressed the wish to keep using the communication technology.

3.2.1.2. Emotion

Older adults would prefer a technology with psychological and emotional benefits—in other words, one that can promote social interactions and a sense of closeness (Lee and Coughlin 2015). Three‐quarters of our participants (12 out of 16) reported positive emotions following the adoption of the technology. Some of them used the word ‘fun’ several times when asked in the second interview about their video call experience. Referring to his video calls with his sister, Shalom said, ‘My heart opened’. Some participants describe the video calls as uplifting and calming, as Esther said: ‘It calms me down … so I don't become irritated. I'm happy … gives me a [good] mood’. Note that even residents with low functioning levels and significant communication difficulties were able to describe their positive feelings during the technology adoption process. For example, Sophi, who had difficulty expressing herself, described how she felt when talking on a video call with her sister: ‘Está bien [Spanish: It's good]’.

3.2.1.3. Technical Support

This factor refers to the availability and quality of professional support throughout the use of the technology. Older adults are liable to experience more stress when adopting new technology, so they need technical support to increase their confidence in using it (Lee and Coughlin 2015). Our participants lived in out‐of‐home residence which provided them support in the various areas of life needed ongoing support during technology use. However, technical support in residential settings depended on the availability of the staff. Indeed, most participants (13 out of 16) felt they did have ongoing technical support during the intervention. Seven out of them felt fully supported. According to Hannah, for example, she could turn to a staff member at any moment and get help: ‘Yes, I ask for help that they help me with the tablet … From the hostel instructors … Yes, [social worker] Sarah, yes, ehh … and [leisure instructor] Betty … also helped me with the tablet’.

However, three participants felt they did not receive technical support from the staff. This could be due to the work burden, as Shalom described: ‘I was alone … first of all, Deborah [the social worker] she's very busy. She's busy, she can't help me’. In other cases, staff members were available but lacked the knowledge and skills to help the residents: ‘But, but the substitutes, they don't know … some of them don't know’ (Pnina). Even when she turned to a member of the permanent staff, this did not always help. Pnina also described a situation where a permanent staff member did not know how to help her: ‘I told Joseph [the instructor], so he talked to you [the researcher], right? He called you … No, but in the end I didn't talk, he said he'd tell you that it [the tablet] doesn't work’. This problem was solved only after the researcher arrived. Note that some participants had trouble seeking help. Shalom, for example, said that he had trouble connecting the tablet due to a faulty socket in his room: ‘[It was hard] to put it here {pointing to the socket}, and it fell’. When asked what he then did, he said, ‘I gave up’. Thus, Shalom did not turn to the staff for help. Similarly, when Tzipi had trouble charging her tablet, she did not ask the staff for help but used her mobile phone to talk to her brother.

Overall, in residential settings that provided more intensive support for residents with lower levels of functioning, such as institutions and group homes, it seemed that the staff initiated support more often. In these cases, they also kept the tablet and initiated its use (about once a week). For some users, regular times were set for the video calls.

3.2.1.4. Social Support

This factor refers to the opinions and attitudes of persons from the immediate environment, such as family and friends, on the technological product. These opinions and attitudes have been found to affect the motivation of the older adult to use the technology (Lee and Coughlin 2015). In the present study, social support was significant in the process of technology adoption. Most participants (10 out of 16) referred to family support—the opinion of their family members had a decisive impact on the participants' desire to use the tablet for video calls. Hannah, for example, described how her sister supported her and even learned how to use the tablet herself: ‘Yes, they [the family] want [me to learn how to use the tablet], because my sister also learns with the tablet’. Indeed, during the intervention, Hannah was highly motivated to use the tablet for video calls, although she did need the staff's assistance.

Conversely, note that in two cases where the residents were not interested in using the tablet for video calls after the intervention, the family had provided no support and commitment to the process. For example, in Alex's case, his sister Anna provided her initial consent to be his communication partner. Nevertheless, she was usually unavailable for video calls and preferred that Alex talk with her daughter, something he was not interested in doing. Throughout the intervention, Alex did not receive any family encouragement to use his tablet.

3.2.1.5. Usability

This factor refers to the ease of learning and using the technological product—for older adults in particular, technology use must be as straightforward and intuitive as possible (Lee and Coughlin 2015). Most of the participants in the present study (10 out of 16) viewed the tablet as easy to master and use and even recommended it to their roommates. Note that the technology provided to the residents had been adapted to make it accessible for older adults with ID. For example, the desktop was adapted so that its background would be uniform, and the icons and fonts of the various applications were enlarged, particularly WhatsApp. Nevertheless, several usability difficulties recurred, with using the touchscreen, with hearing the conversation partner, and with unreliable Wi‐Fi networks. Hannah described the first difficulty as follows: ‘The lines of the electricities—that was hard … Yes, of the electricities of the tablet … like this, like this {illustrating the use of a touch screen with her finger}’. In this case, as in others, the researcher responsible for the intervention decided to make additional adjustments, such as the use of a thick marker for the touch screen, with easier and stable grip on the marker, and, for participants with hearing impairment, using larger earphones with a built‐in microphone.

3.2.1.6. Confidence

This factor refers to the user's sense of confidence with the technology, without the sense of threat or anxiety. Older adults may experience higher anxiety and threat when studying and using a new technology, and may even decide not to use it if they are not confident (Lee and Coughlin 2015). In the present study, most (9 out of 16) participants were not threatened by the tablet. For some, it even provided a sense of security and calm. A few were threatened, however, particularly by the possibility of inadvertently damaging the tablet. Shalom, for example, asked in the first interview: ‘This tablet is gentle, right?’ He felt he could not use it without destroying it. In these cases, the staff usually decided to store the tablet away from the participant and only have them use it at certain times.

3.2.2. Adoption Factors Unique to Older Adults With ID

3.2.2.1. Ongoing Accessibility

Beyond the usability factor, that is, one‐time adjustments of the technological product to meet the needs of the participants—older adults with ID—the findings highlighted the need for ongoing accessibility, that is, making the product accessible during the process. This refers to both the accessibility of the usage environment and to emotional accessibility, that is, allaying the participants' fears. Some participants, such as Ehud, Nissan and Sophi, managed to use the tablet for video calls during the instruction meetings, but when given the option to use the tablet freely to communicate with their family during the intervention, they needed their usage environment to become more accessible by helping them take the tablet to where it was stored, turning it on and locating it in front of their face so that they would be clearly visible. Some of the participants, such as Hannah, Ilana, Tzipi, Nissan and Shalom, found it difficult to remember the sequence of activities required, such as entering WhatsApp and making a video call, as well as charging the tablet from time to time: ‘I do it … Yes, I know [how], but I don't remember’ (Ilana). Others, such as Alex and Shuli, expressed the need for emotional accessibility, and were afraid to take responsibility for the product. Even then the tablet was stored by the staff away from the residents' rooms; some were afraid to ask for it from the staff, lest they damage it.

3.2.2.2. Physical Access

As described in the Method, following the instruction sessions, the participants received their tablets and were allowed to use them freely. In practice, however, most (9 out of 16) participants were not allowed free physical access to their tablet. Most of those (6 out of 9) were residents with medium‐low level of functioning, so the staff doubted their ability to use the tablet without damaging it. The staff stored the tablets and lent them to participants who asked for them. Sophi said several times during her interview that she did not know where the tablet was: ‘I don't know where … yes, but it's gone … I don't know where’.

The remaining participants (7 out of 16) enjoyed full access to the tablet and accessories (such as charger and headphones), which were stored in their own rooms. Note that these participants had a relatively high level of functioning. Their free access to the tablets enabled them to attain greater independence than did the residents without access to the tablets. Nevertheless, some of them still found it hard to turn to the staff for help.

4. Discussion

The objective of the present study was to understand and describe the process of digital communication technology adoption—including user experience, needs and challenges—by older adults with ID in out‐of‐home residence for contacting their families. Although the quantitative data regarding the technology adoption indicated no change in frequency of contact for most residents due to various reasons (e.g., frequent contact before the intervention, lack of physical access to the tablets, limited technical support and unanswered calls), it seems that their sense of closeness to their families was increased due to their active engagement in the process and the visuality aspect of the video calls.

Research conducted during the COVID‐19 pandemic, particularly its first waves, has pointed to an accelerated process of communication technology adoption by people with disabilities, especially when living in residential settings, due to the social distancing imposed on the residents and their families (Araten‐Bergman and Shpigelman 2021; Embregts et al. 2022; Lifshitz et al. 2022). The literature also indicated that the use of these technologies helped reduce emotional distress and loneliness among residents of different ages (Anderson et al. 2021; Lifshitz et al. 2022; McCausland et al. 2021).

The findings of the present study highlight the unique contribution of video calls as they enabled visual and not only vocal communication with family members. Visuality contributed significantly to retaining the sense of closeness to the family members, particularly given the social distancing restrictions forbidding face‐to‐face meetings. This finding is supported by studies conducted in the general population in both routine times and during COVID‐19, showing that remote video calls helped cope with the lack of physical presence, thus reducing loneliness and contributing to well‐being (Bastoni et al. 2021; Hietanen et al. 2020). The visual dimension was also related to the value factor found significant in the process of new technology adoption among older adults from the general population. As mentioned, this factor relates to the perception of the value added by using the technological product (Lee and Coughlin 2015). The participants suggested that the video calls, and especially their visual aspect, provided them with another alternative—in addition to ordinary phone calls—to keep contact with their families.

Another adoption factor that was found among both older adults from the general population and our participants was technical support. Given that the participants lived in out‐of‐home residence, technical support referred mainly to the staff's ability to help when needed. The findings of the present study showed that in most cases, the residents felt that the staff provided technical support. Few experienced lack of support, which led to a sense of frustration and delayed the technology adoption process. Note that when technical support was not provided, this was usually due to the staff's unavailability and, in some cases, to their lack of knowledge or skills. Their unavailability could be due to the high workload in residential settings and the resulting burnout, particularly, in larger residential settings such as institutions and group homes (McMahon et al. 2020; Ryan et al. 2021).

The present study also found that the participant's ability to seek technical help from the staff was a significant technology adoption factor. Some of the residents, particularly those who became able to use the technology independently after the instruction meetings, found it hard to turn to the staff for help when encountering a technical issue during the intervention. According to previous studies, this could be due to difficulty in self‐advocacy and acquired helplessness among people with ID (Bridges et al. 2020; Yenioglu et al. 2021). This finding can also be understood in view of the social model of disability (Shakespeare 2006), according to which people with ID find it difficult to make their voice heard and express their needs due to lifelong stigmatising, leading to self‐stigmatising and a negative self‐perception (Callus 2013). This emphasises the need to acquire self‐advocacy and help‐seeking skills among older adults with ID before asking them to adopt a new technology. The residents' and staff's view that the goal was independent use without help, particularly by residents with high‐level functioning, also runs counter to critical disability studies approaches, which challenge the concept of independent functioning, including in the technological context (Bennett et al. 2018; Leshota 2015). According to these approaches, the idea of ‘independence’—being able to do something without help—is fundamentally wrong, particularly for persons with ID who need support throughout their lives. The alternative term they suggest—interdependence—emphasises the level of support required by every individual with disability (Fine and Glendinning 2005; White et al. 2010).

The present study also found a factor unique to technology adoption by older adults with ID—the need not only for one‐time adjustments such as enlarging the font or using earphones but for ongoing accessibility. This refers both to the accessibility of the technology use environments—such as help and mediation in taking the tablet from where it is stored and recalling the tablet activation sequence—and to emotional accessibility or the allaying of fears related to the new product.

This finding supports another factor found among all older adults, which is the sense of confidence in technology use. Using the product without fear appeared even more significant in the context of new technology adoption by older people with ID in residential settings. This is because these settings, particularly, institutions, are characterised by rigidity of routine, social distance and depersonalization (Roebuck 2021). Apparently, the medical model of disability, which emphasises the biological impairment and pathology (McKenzie 2013), seemed to be dominant in the institutional settings: the staff did not trust the residents, while the residents seemed to internalise the view that they were unable to keep the tablets away from harm.

Another unique factor found in the present study was free physical access. A basic requirement for the adoption of new technology is the availability of the product, enabling constant practice and use. Lee and Coughlin's (2015) theoretical framework referred to the product's availability in terms of accessibility, meaning market availability and affordability. However, in the case of older adults with ID in residential settings, the product may be available, but they are not free to access it. Apparently, the type of setting affected the staff's ability to allow free use of the tablets. In institutional settings, housing people with more severe levels of disability, tablets were stored in the staff room, while in settings such as supported community apartments, housing people with a mild level of disabilities, the tablets were usually stored in the residents' rooms and they could use them freely. The attitude of the staff in the institutional settings—limiting access to the tablet given a low appreciation of the residents' ability to keep it from harm—is consistent with the medical model of disability (Kozma et al. 2009; Roebuck 2021), which views persons with disabilities as essentially impaired and incapable, including with regard to using new technologies. The staff in these residential settings feared that the tablet may be damaged by the participants or their roommates; therefore, it was stored in a safe place. This situation prevented free and independent communication.

Beyond the various factors contributing to technology adoption, the present study found that the use of the tablets contributed to the participants' sense of closeness to their families due to gaining a sense of control on the communication, that is, the ability to initiate the video calls. No matter their families' degree of cooperation, they became active in contacting their family members for the first time. People with ID are used to being passive in interpersonal interactions (Björnsdóttir et al. 2015; Tedman‐Jones and Buys 2004), due among other things to stigmas held by service providers (Groot et al. 2022) and overprotectiveness by their families (Mill et al. 2010). Moreover, living in a structured environment with fixed schedules for meeting or talking to the family means that people with ID internalise the organisation culture often based on the medical model of disability (Oliver 1996), and on clear power relations between the staff and residents, including lack of autonomy for the residents, particularly, if their functioning level is low (Bigby et al. 2012). The present study shows that once the residents were empowered by lending them the technological equipment for free use, they became active in their contacts with the family, which further empowered them.

Note that in a few cases, however, the technology exacerbated the family relationship. In these cases, the communication partner's unavailability (unanswered calls) made the participants frustrated. In cases such as David's case, the participants did not know how to cope with no answer from their families; they had no pre‐guidance or ongoing support for such situations, so they continued to call and tried to reach their families. It seemed that this situation of no response elevated their emotional distress; in response, they continued to call and tried to reach their families, which led to a ‘vicious circle’—increased level of distress. Previous studies among the general population also indicated that non‐response to social media messages or calls is sometimes interpreted as social rejection or avoidance, causing anxiety to the sender (Agarwal and Lu 2020). The communication partner (i.e., the receiver who is the one ignoring or not able or willing to respond) may also experience a number of negative emotions such as anxiety, stress, exhaustion, apathy or anger (Agarwal et al. 2022). Apparently, the use of digital communication technology created a new situation and some family members in the present study found it difficult to adjust to, preferring to maintain the relatively low frequency of contact with the resident (although this was never admitted of course). According to the interpersonal adaptation theory (Burgoon et al. 1995), when communicators adapt to the needs, expectations and desires of each other, match their behaviour and synchronise their timing, it leads to increased closeness but when the communicators behave in dissimilar ways it leads to decreased closeness and may negatively impact the sender–receiver relationship (Agarwal et al. 2022). This negative impact on the sense of closeness among the resident‐family relationship was also indicated in the findings of the present study.

Furthermore, the families' ‘responsiveness’ should be viewed as co‐constructed within a resident‐family‐staff context and not only as a binary of availability or unavailability. Especially in times of crisis, such as COVID‐19, many families faced competing care demands and occupational and social disruptions which limited their ability to meet and communicate with their relatives with ID in residential settings (Hochman et al. 2022; Shpigelman and Araten‐Bergman 2024). Following the ecological systems theory (Bronfenbrenner 1979), responsiveness should be conceptualised as an emergent phenomenon that arises from the interactions among residents, family members and staff or service providers (Araten‐Bergman and Shpigelman 2021; Bigby 2008; Zambrino and Hedderich 2021). Accordingly, the staff in residential settings should integrate digital communication in routine; this practice should include acquiring norms of distance communication (e.g., the meaning of missing calls and scheduling call times) and interpersonal conversation skills accommodated to the person's abilities. The staff should also mediate and support the distant communication so it will be effective to both sides—the residents and their families.

5. Limitations and Future Directions

The present study had several limitations. First of all, the sample was heterogeneous in terms of the participants' level of functioning, such as in some cases where their cognitive level was relatively low, their responses to the interview questions were shorter and less informative than may be expected in a qualitative study. Second, social desirability could be a significant factor given the current sample, given the participants' disability, so that their desire to please would make it difficult to capture their authentic voice (Latteck and Bruland 2020). Note, however, that the interviewer made efforts to minimise the participants' social desirability by strategies that were found to be effective in interviewing people with ID (Corby et al. 2015; Hollomotz 2018): First, she asked the same question from different angles. She also simplified the key questions and included probes (yes/no questions). When needed, she used picture cards to explain some question. Second, she added questions as necessary and repeated the participants' statements in their own words in order to encourage them to express themselves more. Third, when a participant became tired of talking, she stopped the interview and they took a break. Fourth, as described in the Method, the interview guide had been simplified linguistically and was piloted. Finally, the interviewer was the one who conducted the intervention, so the participants had already known her and felt comfortable to talk to her. Her professional experience as an occupational therapist who had worked with people with ID also created a positive and supportive atmosphere in the interviews. All these strategies encouraged the participants to share their experiences.

Another limitation was that the present study included only interviews with the residents, that is, older adults with ID, whereas it would have been interesting to interview their communication partners (i.e., family members) and staff, which we recommend for future studies. The calls' content was not documented in the present study, so interviewing the family members may shed light on this aspect. Due to the fact that many of the participants had language and communication difficulties and the video calls were not recorded, we recommend in the future to observe the participants as they use the technology to provide additional information on the adoption process. Another methodological recommendation is to compare residents with different functioning levels in terms of technology adoption. Finally, to better understand the adoption process, we recommend follow‐up studies that will examine the same users over the long term.

6. Conclusions

The present study expands the theoretical knowledge on the adoption of new technologies by older adults to refer also to older adults with ID. Specifically, the findings contribute to understanding the process of adopting a digital communication technology to maintain contact between older adults with ID in out‐of‐home residence and their families. Apparently, the technology enabled the participants to be more active in contacting their families: they initiated video calls, contributing to their sense of closeness and their overall well‐being. The findings emphasise the potential of the adoption of digital communication technology—in this case, WhatsApp video calls using a tablet—by older adults with ID, particularly, in times of crisis when face‐to‐face meetings are impossible, as in the time of COVID‐19. Our findings also pinpoint factors unique to the adoption of such technologies by older adults with ID: ongoing accessibility and physical access. Finally, the findings emphasise the importance of reciprocity of the triangle of the resident‐family‐staff. Moreover, adopting new communication technology in residential settings requires acquiring online communication norms and interpersonal skills.

Based on these findings, we recommend creating opportunities for older adults with ID to use video calls for ongoing contact with their families in routine. This would require personalised intervention programmes for learning and adopting digital communication technologies. These programmes would ideally address issues of online communication norms, in terms of call frequency and times and how to interpret and cope with a lack of response. Furthermore, it is recommended to make the environment more accessible for using the technology in residential settings, for example, training a staff member to provide technical, emotional and relational support for the residents (the users). The staff may engage the families in the process by conducting periodically online meetings to inform them about the life in the residential setting. The staff can also develop online social activities in collaboration with the residents and their families, for example, greeting each other on special occasions. Moreover, developing a structured template for video calls may engage all in the process and enable accommodated and meaningful communication. In the case of residents with limited language and communication skills, the staff should think of creating ways to engage them in using the technology, for example, by using symbols, images or photos.

Funding

This study was supported by the Israeli Shalem Foundation for the development of services and resources for people with intellectual and developmental disabilities throughout the country (Grant 890‐168‐2019/2023).

Ethics Statement

The study protocol was approved by the ethics committee of the Faculty of Social Welfare and Health Sciences (no. 520/20), University of Haifa, Israel, and the Israeli Ministry of Welfare.

Conflicts of Interest

The authors declare no conflicts of interest.

Acknowledgements

We are very grateful to the older adults with ID in supported accommodation who participated in the intervention and study and shared their experiences. We also thank the staff and the family members who were involved in this process.

Shpigelman, C.‐N. , Isaacson M., and Cohen‐Nudelman A.. 2026. “Digital Pathways to Family Bonds: Exploring WhatsApp Video Calls Adoption by Older Adults With Intellectual Disability in Out‐of‐Home Residence.” Journal of Applied Research in Intellectual Disabilities 39, no. 1: e70173. 10.1111/jar.70173.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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