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The purpose of this paper is to present a research method which offers insights into the factors which affect the optimal use and implementation of telecare, or which may lead to its rejection by older people with support needs – factors pertinent to those involved in the design and delivery of both telecare research studies and of services.

The methodology outlined, influenced by Chicago School and Science and Technology Studies, emphasises the importance of context when examining social phenomena, such as the use of technology. The multi-method approach identified key patterns which provide insights into how telecare was used by a sample of older adults, including information on its suboptimal use and rejection.

The study of telecare use in real-life situations – and the investigation of other complex social interventions – requires an approach which fully considers the importance of context in explaining social phenomena. The main value of the method and findings lies in the insights offered to designers of larger studies which seek to generalise results, including telecare randomised control trials, as well as for those involved in the delivery of telecare services to achieve optimal adoption and use.

The study methods described combined ethnographic, longitudinal and qualitative methodologies and creative research tools in an innovative way to allow exploration of how context affects the uptake and use of telecare.

Following publication of a new vision for the English National Health Service (NHS) in 2014, known as the NHS Five-Year Forward View, a Vanguard programme was introduced by NHS England charged with the task of designing and delivering a range of new care models (NCMs) aimed at tackling deep-seated problems of a type facing all health systems to a greater or lesser degree. Drawing upon recent theoretical developments on the multilevel nature of context, we explore factors shaping the implementation of five NCM initiatives in the North East of England.

Data collection was based on semi-structured interviews (66 in total) between December 2016 and May 2017 with key informants at each site and a detailed review of Trusts' internal documents and policies related to the implementation of each NCM. Our analysis explores factors shaping the implementation of five NCM pilot sites as they touched on the multiple levels of context ranging from the macro policy level to the micro-level setting of workforce redesign.

It is far too early to conclude with any confidence that a successful outcome for the NCM programme will be forthcoming although the NHS Long-Term Plan seeks to build on the earlier vision set out in the Five-Year Forward View. Early indications show some signs of promise, especially where there is evidence of the ground having been prepared and changes already being put in place prior to the official launch of NCM initiatives. At the same time our findings demonstrate that all five pilot sites experienced, and were subject to, unrealistic pressure placed upon them to deliver outcomes.

Our findings demonstrate the need for a deeper understanding of the multilevel nature of context by exploring factors shaping the implementation of five NCMs in the North East of England. Exploring the wider national policy context is desirable as well as understanding the perceptions of front-line staff and service users in order to establish the degree of alignment or, conversely, to identify where policy and practice are at risk of pushing and pulling against each other.