Journal of Cross-Cultural Gerontology

, Volume 30, Issue 1, pp 51–67 | Cite as

A European Perspective on the Service Delivery Systems for Assistive Technology – Differences and Similarities Between Latvia and Sweden

  • Marianne Kylberg
  • Charlotte Löfqvist
  • Signe Tomsone
  • Judith Phillips
  • Zane Liepina
  • Susanne Iwarsson


National laws and regulations on service delivery systems (SDS) for assistive technology (AT) in Europe aim to support the activity and participation of people with disabilities. The aim of this paper was to study similarities and differences in the SDS for AT of one Eastern and one Western EU member state. The legislation and regulations, and their operationalization were described from the perspective of key actors, with a focus on the ageing population. Semi-structured interviews (N = 14) were conducted in Sweden and Latvia. The informants had various professional backgrounds and organizational roles, and represented different areas of work. Similarities found were connected to legislation and policy, the aim of AT provision, the growth of a private sector and how financial resources affect the SDS. Differences were related to the availability of AT, and to how, and for and by whom the devices were provided, with Latvia prioritizing certain groups over others and excluding older people. In Latvia, despite it not being stated in the legislation, a medical perspective on AT provision was applied, whereas in Sweden, in congruence with the legislation, the perspective was explicitly biopsychosocial. Despite similarities on the legislation and policy level, interpreted based on the perceptions of professionals there are marked differences between Latvia and Sweden in the operationalization of the SDS of AT. To support activity and participation for the ageing population, the services connected to AT need to be carefully thought out and executed, making efficient use of financial resources and professional competencies.


Active ageing Comparative study Mobility devices Social exclusion 


  1. Bankauskaite, V., & O’Connor, J. (2008). Health policy in the Baltic countries since the beginning of the 1990s. Health Policy, 8, 155–165.CrossRefGoogle Scholar
  2. Botev, N. (2012). Population ageing in Central and Eastern Europe and its demographic and social context. European Journal of Ageing, 9, 69–79.CrossRefGoogle Scholar
  3. Bryman, A. (2012). Social research methods (4th ed.). Oxford: Oxford University Press.Google Scholar
  4. Burnard, P., Gill, P., Stewart, K., Treasure, E., & Chadwick, B. (2008). Analysing and presenting qualitative data. British Dental Journal, 204, 429–432.CrossRefGoogle Scholar
  5. Esping-Andersen, G. (1990). The three worlds of welfare capitalism. Princeton: Princeton University Press.Google Scholar
  6. Estreen, M. (2010). Europe with free choice of assistive technology: The provision of assisitve devices in specific European countries. Vällingby: Swedish Institute of Assistive Technology.Google Scholar
  7. European Commission. (2003). Access to assistive technology in the European Union. Retrieved 10th of April 2013, from
  8. European Commission. (2012). The EU Contribution to active ageing and solidarity between generations. Luxembourg: Publications Office of the European Union.Google Scholar
  9. European Union. (2012). Public Health - good health for everybody. Retrieved 23rd of May 2013, from
  10. Häggblom-Kronlöf, G., & Sonn, U. (2007). Use of assistive devices - a reality full of contradictions in elderly persons’ everyday life. Disability and Rehabilitation. Assistive Technology, 2, 335–345.CrossRefGoogle Scholar
  11. Hantrais, L. (2009). International comparative research theory, methods and practice. Basingstoke: Palgrave Macmillan.Google Scholar
  12. Hjälpmedelsinstitutet. (2009). Statistik om hjälpmedel - en översikt av nationella undersökningar. Vällingby: Hjälpmedelsinstitutet.Google Scholar
  13. International Organization for Standardisation (ISO). (2011). ISO 9999:2011 assistive products for persons with disability - classification and terminology. Genova: ISO Copyright office.Google Scholar
  14. Kraskowsky, L. H., & Finlayson, M. (2001). Factors affecting older adults’ use of adaptive equipment: review of the literature. American Journal of Occupational Therapy, 3, 303–310.CrossRefGoogle Scholar
  15. Krippendorf, K. (2004). Content analysis - an introduction to its methodology. London: SAGE Publications.Google Scholar
  16. Löfqvist, C., Nygren, C., Szeman, Z., & Iwarsson, S. (2005). Assistive devices among very old people in five European countries. Scandinavian Journal Occupational Therapy, 4, 181–192.CrossRefGoogle Scholar
  17. Löfqvist, C., Nygren, C., Brandt, Å., Oswald, F., & Iwarsson, S. (2007). Use of mobility devices and changes over 12 months among very old people in five European countries. Aging Clinical Experimental Research, 6, 497–505.CrossRefGoogle Scholar
  18. Mc Millen, A.-M., & Söderberg, S. (2002). Disabled person’s experience of dependence on assistive devices. Scandinavian Journal of Occupational Therapy, 9, 176–183.CrossRefGoogle Scholar
  19. Nordic Centre for Rehabilitation Technology [NUH]. (2007). Provision of assistive technology in the Nordic Countries (2nd ed.). Vällingby: Nordic Cooperation on Disability.Google Scholar
  20. Patton, M. Q. (2002). Qualitative research and evaluation methods (3rd ed.). Thousand Oaks: Sage Publications.Google Scholar
  21. Phillips, J., Ajrouch, K., & Hillcoat-Nallétamby, S. (2010). Key concepts in social gerontology. London: SAGE Publications Inc.Google Scholar
  22. Pressler, K. A., & Ferraro, K. F. (2010). Assistive device use as a dynamic acquisition process in later life. The Gerontologist, 3, 371–381.CrossRefGoogle Scholar
  23. Quilgars, D., Elsinga, M., Jones, A., Toussaint, J., Ruonavaara, H., & Naumanen, P. (2009). Inside qualitative, cross-national research: making methods transparent in a EU housing study. International Journal of Social Research Methodology, 1, 19–31.CrossRefGoogle Scholar
  24. Ripat, J., & Booth, A. (2005). Characteristics of assistive technology service delivery models: stakeholder perspectives and preferences. Disability and Rehabilitation, 24, 1461–1470.CrossRefGoogle Scholar
  25. Saltman, R. B., & Bergman, S. E. (2005). Renovating the commons: Swedish health care reforms in perspective. Journal of Health Politics, Policy and Law, 1–2, 253–275.CrossRefGoogle Scholar
  26. Scherer, M. J., Sax, C., Vanbiervliet, A., Cushman, L. A., & Scherer, J. V. (2005). Predictors of assistive technology use: the importance of personal and psychosocial factors. Disability and Rehabilitation, 21, 1321–1331.CrossRefGoogle Scholar
  27. SFS (1982):763. Hälso- och sjukvårdslagen. Retrieved 13th of May 2013, from
  28. Silver, H. (2008). Social exclusion and social solidarity - three paradigms. In D. Byrne (Ed.), Social exclusion: critical concepts in sociology. London: Routledge.Google Scholar
  29. Skymne, C., Dahlin-Ivanoff, S., Claesson, L., & Eklund, K. (2012). Getting used to assistive devices: ambivalent experiences by frail elderly persons. Scandinavian Journal of Occupational Therapy, 2, 194–203.CrossRefGoogle Scholar
  30. SOSFS (2008):1. Användning av medicintekniska produkter inom hälso och sjukvård. Retrieved 13th of May, 2013, from
  31. Steel, E. J., & de Witte, L. P. (2011). Advances in European assistive technology service delivery and recommendations for further improvement. Technology and Disability, 23, 131–138.Google Scholar
  32. Sund, T., Iwarsson, S., Andersen, M. C., & Brandt, Å. (2013). Documentation of and satisfaction with the service delivery process of electric powered scooters among adult users in different national contexts. Disabilty and Rehabilitation: Assistive Technology, 2, 151–160.Google Scholar
  33. Sundin, J., Hogstedt, C., Lindberg, J., & Moberg, H. (2005). Svenska folkets hälsa i historiskt perspektiv. Stockholm: Statens folkhälsoinstitut.Google Scholar
  34. The Regulation of the Cabinet of Ministers No. 1472 “Order how Latvian Society of Blind and Latvian Society of the Death provides services of social rehabilitation and provides persons with assistive aids- surdotechniques and typhlotechniques”. (Ministru kabineta noteikumi Nr. 1472 “Kārtība, kādā Latvijas Neredzīgo biedrība un Latvijas Nedzirdīgo savienība sniedz sociālās rehabilitācijas pakalpojumus un nodrošina tehniskos palīglīdzekļus – tiflotehniku un surdotehniku”). Retrieved 4th of September 2013, from
  35. The Regulation of the Cabinet of Ministers No. 1474 “Technical Aids Regulations “. (Ministru kabineta noteikumi Nr. 1474 “Tehnisko palīglīdzekļu noteikumi”). Retrieved 4th of September 2013, from
  36. The Regulation of the Cabinet of Ministers No. 265 “Regulations of procedures on medical records in medical institutions”. (Ministru kabineta noteikumi Nr.265 “Medicīnisko dokumentu lietvedības kārtība”). Retrieved 4th of September 2013, from
  37. Townsend, E. A., & Polatajko, H. J. (2007). Enabling occupation II: Advancing an occupational therapy vision for health, well-being, & justice through occupation. Ottawa: CAOT Publications ACE.Google Scholar
  38. Wilcock, A. A. (2006). An occupational perspective on health (2nd ed.). Thorofare: SLACK Incorporated.Google Scholar
  39. World Health Organisation. (2002). Active Ageing - A Policy Framework, A contribution to the World Health Organization to the second United Nations World asssembly on ageing. Madrid, Spain.Google Scholar
  40. World Health Organisation. (2011). Word report on disability. Geneva: Author.Google Scholar
  41. Wressle, E., & Samuelsson, K. (2004). User satisfaction with mobility assitive devices. Scandinavian Journal of Occupational Therapy, 11, 143–150.CrossRefGoogle Scholar
  42. Zaidi, A., Gasior, K., Hofmarcher, M. M., Lelkes, O., Marin, B., Rodrigues, R., Schmidt, A., Vanhuysse, P., & Zolyomi, E. (2012). Active ageing index 2012 concept, methodology and final results. Viennana: European Centre.Google Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Marianne Kylberg
    • 1
    • 4
  • Charlotte Löfqvist
    • 1
  • Signe Tomsone
    • 1
  • Judith Phillips
    • 2
  • Zane Liepina
    • 3
  • Susanne Iwarsson
    • 1
  1. 1.Department of Health Sciences, Faculty of MedicineLund UniversityLundSweden
  2. 2.Centre for Innovative AgeingSwansea UniversityWalesUK
  3. 3.Faculty of RehabilitationRiga Stradins UniversityRigaLatvia
  4. 4.Department of Health SciencesLund UniversityLundSweden

Personalised recommendations