Designing Care Beyond the Hospital: Revealing Hidden Care Demands in Hospital-At-Home Services

BackgroundHospital-at-home (HaH) services are increasingly implemented as digitally supported alternatives to inpatient care. While these models promise efficiency, continuity, and patient-centredness, they also redistribute responsibility from healthcare organisations to patients and family caregivers. This shift introduces health literacy demands related to timing, role clarity, and digitally mediated decision-making, which remain underexplored in digital health research.MethodsThis qualitative study draws on ten in-depth interviews with patients, family caregivers, and healthcare professionals involved in hospital-at-home services in Norway. Interviews examined experiences of decision-making, remote monitoring, coordination, and follow-up in digitally supported home-based care. Following inductive thematic analysis, a service blueprint was developed as an analytical synthesis to examine how care demands and responsibilities were distributed across the service trajectory.ResultsCaregiver burden was shaped less by individual capability than by service configurations that assumed high levels of availability, confidence, and digital competence. Family caregivers frequently assumed quasi-clinical and coordinative roles without adequate preparation or support. Health literacy demands clustered at key transitions, including decision-making, at-home monitoring, and discharge, where digital tools mediated responsibility and risk. These demands accumulated over time, generating vulnerabilities related to equity and sustainability.ConclusionDigitally supported HaH services rely on implicit assumptions about patients' and caregivers' capacity to manage care at home. Design-informed analysis can reveal transition-located health literacy demands and digitally mediated responsibility shifts, supporting more inclusive and resilient digital health service models.