Trust is the expectation of people's social role behavior in uncertain and risky environments (1). This expectation includes believing the other party is capable, caring, honest, and reliable (2). Additionally, trust is seen as essential in building positive long-term care relationships that benefit care receivers and caregivers (3). Bordin et al. (4) explored the relationship between care receivers and caregivers, highlighting that it evolves from mutual trust. This trust fosters collaboration, enabling both parties to reach shared caregiving objectives. When the bond of caring develops into a more protected recess of inner experience, deeper trust and attachment are needed and cultivated. Existing studies analyzed the trust dynamics between care receivers and caregivers, which are generally based on fundamental theories of trust. According to Mayer et al. (5), the Model of Interpersonal Trust includes trustworthiness characteristics, trust, and risk. Three trustworthiness characteristics, including competence, integrity, and benevolence, must be present before trust can exist. Zhang et al. (6) further divided the trust dynamics into three stages: trust attitudes, intentions, and behaviors developing from initial trust to more vital trust and even evolving into behavioral habits after long-term interaction.

For care receivers, high levels of trust lead to better care receivers' satisfaction with care, reduced anxiety, and increased autonomy and willingness to participate in care. Therefore, in a long-term care relationship, a strong trust relationship can create a positive nursing environment, improve communication, and enhance nursing coordination, which is necessary for a satisfactory and effective caring relationship (7). Additionally, being trusted by caregivers is described as a favorable and verified situation, promoting self-esteem and self-confidence (8).

For caregivers, trust can be conceptualized as the adequate availability of healthcare services and the effective delivery within the care relationship (9). At this level, trust can be assessed based on humanism (listening, accurately understanding, and taking action to address care receiver and family concerns), communication, caregiver knowledge, reliability or competence, and caregiver team functionality (10). Without trust, caregivers may hesitate to provide the necessary care and support, and care receivers may feel vulnerable and apprehensive about receiving assistance (11). However, when trust is established, it can help in creating and sustaining meaningful connections with those they care for, ultimately improving the overall quality of long-term care.

Additionally, assistive technology is crucial in the long-term care relationship between care receivers and caregivers. Ghasemzadeh et al. defined assistive technology as a range of devices, services, and systems that enhance the functional capacities of individuals with disabilities (12). The World Health Organization categorizes assistive technology into six functional domains based on different disabilities: mobility, vision, hearing, communication, cognition, and self-care (13). Examples of assistive technology include a balancing spoon for feeding assistance for Parkinson's patients and an eye tracker for communication assistance for individuals with Amyotrophic Lateral Sclerosis. According to Rani (14), improving a care receiver's ability to live independently can enhance autonomy, self-esteem, self-confidence, and quality of life. For caregivers, assistive technology can simplify and streamline the care process, improve the working environment, and allow more efficient use of time (15). Additionally, assistive devices can foster a stronger and more collaborative long-term care relationship between care receivers and caregivers, as they promote care receiver enthusiasm and confidence in actively participating in their care while reducing caregivers' workload (16).

However, some articles reported that using assistive technology may also bring challenges. Some care receivers find the devices complicated, troublesome, and embarrassing or feel that they do not meet their expectations and fail to gain their trust (17). For example, a study on exoskeleton technology found that 33.8% of care receivers experienced unintended misuse when using exoskeleton robots, and 50.8% of care receivers encountered accidental device activation, which decreased their trust in assistive technology (18). Trust is essential for users to embrace assistive technology. It's crucial to comprehensively analyze the role of trust in the long-term care process, as it directly impacts the quality of care provided through assistive devices.

Therefore, if the care receiver's physical condition gradually deteriorates in long-term care, the demand for assistive technology from both care receivers and caregivers will increase, making its use the norm. Moreover, as the care receiver's physical condition becomes more fragile, they become more sensitive to potential care risks, affecting the trust between care receivers and caregivers. Therefore, examining the dynamics of trust in long-term care settings involving assistive technology is essential.

Assistive technology plays a significant role in care relationships and should not be overlooked in discussions about trust in long-term care. Ignoring the context of assistive technology use can lead to a misunderstanding of the power dynamics between care receivers and caregivers (19). For instance, care receivers using wheelchairs can move independently, leading to increased confidence and a decreased need for caregiver assistance, ultimately giving care receivers more independence in decision-making. However, current research often fails to consider the practical impact of assistive technology on trust in long-term care (20). This review aims to address this gap by considering the context of assistive technology when discussing trust in long-term care.

This review followed a structured approach to retrieve and screen articles by the PRISMA guidelines to address the question (21): What are the trust dynamics between care receivers and caregivers when using assistive technologies in long-term care settings? This review explores the care receiver's trust in assistive technology, the caregiver's trust in assistive technology, and the mutual trust between care receivers and caregivers involving assistive technology. By analyzing these relationships, the review aims to clarify the critical role of assistive technology in trust dynamics in long-term care settings and the factors influencing them. The findings of this review could potentially contribute to a better understanding of trust in long-term care through assistive technology, thereby enhancing the effectiveness of long-term care.

The database search retrieved 1,935 references, and 257 duplicate articles were removed. 1,632 articles were excluded through the title and abstract screening stage. The remaining 46 articles were reviewed in full text. Out of these, 14 articles were discarded because they did not meet the inclusion criteria (see Figure 1).

Compared with the trust dynamic between care receiver and caregiver without assistive technology, care receiver-caregiver trust involving assistive technology includes the process of trust in assistive technology, and trust in assistive technology impacts care receiver-caregiver trust by interacting with their trustworthiness characteristics and trust attitude. According to existing research discussing care receiver-caregiver trust, trustworthiness characteristics are necessary to promote trust between care receivers and caregivers. For example, Mikesell et al. (62) reported that care receivers trust caring offered by caregivers with competence, knowledge, and integrity. However, this conclusion cannot fully cover some actual long-term care scenarios of using assistive technology, such as care receivers accepting care from family members with limited nursing knowledge but knowing how to use assistive technology. This review summarizes the mechanism of care receiver-caregiver trust involving assistive technology, which can explain the trust dynamics between care receivers and caregivers when using assistive technology.

On the one hand, trust in assistive technology interacts with care receivers' and caregivers' trustworthiness characteristics. Trust in assistive technology empowers care receivers' and caregivers' trustworthiness characteristics. Sun et al. (49) reported that personal health assistive technology can promote care receivers' recognition of caregivers' caring ability by strengthening communication between care receivers and caregivers. Care receivers' and caregivers' trustworthiness characteristics can also support trust in assistive technology. According to Otten et al. (61), care receiver's trust in assistive technology is built on not only factors like function, empathy, transparency, and communication but also the professional competence of caregivers who recommend the assistive technology, especially when care receivers use assistive technology for the first time. However, the critical effect between trust in assistive technology and care receivers' and caregivers' trustworthiness characteristics may also be harmful. For example, the difficulty in operating social assistive robots will put pressure on care receivers with dementia and cause them to resist caregivers' work (58).

On the other hand, trust in assistive technology interacts with care receivers' and caregivers' trust attitudes. Assistive technology affects care receivers' and caregivers' trust attitude through risk management. For example, Pettersson et al. (40) reported that mobility assistive devices can reduce care receivers’ risk of falling, which leads to the care receiver's family agreeing care receivers to leave alone and even take care of household chores while using mobility assistive devices. However, assistive technology also brings potential risks. For example, Fairbrother et al. (43) argued that the use of telehealth detectors may cause care receivers' loss of patience and confidence in the caregivers' caring, as this assistive technology brings potential risks resulting in care receivers overly focusing on their physical data, and getting anxiety about the physical condition.

Therefore, when using assistive technology, it is necessary to develop personalized guidelines for using assistive technology based on the characteristics of care receivers and caregivers. The guidelines for using assistive technology involve guiding the selection of assistive technology and standardizing caregivers' introducing, teaching, and using assistive technology for care receivers. Standardized guidelines will promote the trust of care receivers and caregivers, as they can control the risks of assistive technology and give full play to its advantages.

Assistive technology-related factors play a critical role in the relationship between care receiver-related factors and caregiver-related factors, which promotes coordination between influencing factors and ultimately impacts the trust dynamic. This review found that assistive technology's perceived usefulness and reliability coordinate the care receiver's physical condition and the caregiver's communication skills and collaboration. Firstly, most articles mentioned the care receiver's physical condition because the deterioration of physical condition leads to an increase in care needs, which is the core of long-term care. For example, as the physical condition of care receivers with chronic obstructive pulmonary disease changes, on the one hand, they need to adjust their expectations of their physical condition. On the other hand, they need to rely on more care, such as using a ventilator to maintain survival (63). Therefore, the increase in care receivers' care needs and the intervention of assistive technology pose new challenges to caregivers' work. Secondly, caregivers' communication skills and collaboration are important factors in adapting to care receivers' physical changes. When assistive technology is involved in long-term care, caregivers must adjust their roles and provide care receivers with operational assistance and emotional support. For example, when care receivers use digital personal health monitoring devices, caregivers need to assist care receivers in understanding their health data and establishing correct expectations about their physical condition. Otherwise, incorrect cognition and operation of assistive technology will cause the care receiver to feel anxious and have low self-esteem regarding their physical condition (64). Finally, assistive technology's perceived usefulness and reliability promote cooperation between care receivers and caregivers. The perceived usefulness and reliability of assistive technology encourage care receivers to participate in care activities more actively, as assistive technology provides care receivers with the expectation of improving their physical function. Additionally, assistive technology guides caregivers to participate in care efficiently and gain the recognition of care receivers. For example, digital personal health monitoring devices provide diet planning for diabetic care receivers, guide caregivers to prepare diets that suit the care receiver's physical condition, and promote care receivers' recognition and trust in the professional ability of caregivers (65).

Implications for using assistive technology in long-term care setting. (1) Promote interpersonal interaction and social support through assistive technology. For care receivers, using assistive technology can promote their autonomy, but it does not mean they can maintain complete independence without interacting with the caregiver. Assistive technology can complement, rather than replace, caregivers by offering professional advice and strengthening care-receiver-caregiver interactions. For example, using an AI health management system does not mean that care receivers do not need the help of caregivers. Instead, it provides more professional advice through AI to promote care receivers' recognition of caregivers and strengthen the interaction between care receivers and caregivers (66). (2) Focus on the care receiver's physical condition and pay attention to the care receiver's emotional support. In everyday life, care receivers may experience multiple health issues. Those with diverse medical conditions often have mixed feelings regarding assistive technology, as they see its potential to create opportunities and offer a sense of security while being aware of its limitations and concerns (60). On the one hand, assistive technology's customizable and adaptable nature supports its capacity to address personalized needs and eliminate barriers caused by various physical conditions. Conversely, assisting care receivers in understanding their multiple health issues and providing positive emotional support can help them adjust their expectations, thus increasing their trust in assistive technology. For example, Huniche et al. (43) reported that caregivers need to provide positive emotional support for care receivers when using health-detecting technology. Physical data health from assistive technology is not neutral to care receivers but feedback on their physical status, which they are mostly concerned with. Therefore, it is necessary to pay attention to assistive technology's positive or negative emotional value. (3) From care receiver dependence on assistance to collaborative assistance. Care receiver-centered care tends to heighten care receivers' dependence on their caregivers, which in turn worsens their social stigma. When care receivers must rely on caregivers for daily tasks, they often experience diminished decision-making power, leading to a decline in self-worth and increased social labelling as disabled. The resulting social stigma and dependency pressures can make care receivers resistant to assistive technology (67). On the other hand, collaborative assistance promotes the active participation of care receivers in their care, bolstered by assistive technology, which can enhance their sense of self-worth and alleviate caregiver burdens. Research has indicated that effective collaborative care correlates with improved management of health indicators and greater treatment success (68). However, it's essential to recognize that not every care receiver wishes to engage actively in care decisions; some may prioritize pleasing their caregivers over participating in these decisions (69). Therefore, tailoring the caregiver-care receiver relationship is crucial when applying collaborative care approaches.

This review's findings also highlight several limitations. Firstly, the use of various interrelated terms related to trust, with unclear definitions, led to interpretation challenges, as these terms can be understood differently. The authors of the articles cited may have differing interpretations, and this terminology variation might have caused some articles to be excluded. Additionally, including studies without a formal quality assessment increases the risk of incorporating research with varying levels of methodological rigor. Without assessing quality, the findings may not accurately represent the true state of the literature. For instance, including studies with methodological flaws can lead to overestimations or underestimations of effects, ultimately affecting the reliability of the conclusions drawn. Consequently, the overall conclusions of the review may combine both high-quality and low-quality evidence, potentially distorting the understanding of the topic. Secondly, the limited number of assistive technologies analyzed and the lack of significant quantitative differences among the types of assistive technologies make it challenging to draw meaningful conclusions regarding their impact on trust in long-term care. Thirdly, grey literature, including books and theses, was excluded for feasibility reasons. Focusing solely on published data may also overlook the effects of publication bias on this review, potentially limiting the comprehensiveness of the assessment. Additionally, without restricting physical conditions, we have obtained the trust dynamics in long-term care settings. Perhaps this is not applicable to every disease. Nonetheless, the insights from this review are valuable. They will assist operators of long-term care facilities in making informed decisions about technology adoption in care service strategies, ultimately enhancing the quality of long-term care.

This review examined long-term care involving assistive technology. As for the implications, it highlights the critical role of assistive technology in the care receiver-caregiver trust dynamic. The trust dynamic involves prompters, trustworthiness characteristics, trust in assistive technology, trust attitude, trust intention, trust behavior, evaluation, and habit. Additionally, this review summarized the factors that influence the trust dynamic; they included care receiver-related factors, caregiver-related factors, and assistive technology-related factors, which cover demographics, finance, sociability, experience, and morality etc. Furthermore, it revealed that assistive technology-related factors promote coordination between care receiver-related and caregiver-related factors, ultimately impacting the trust dynamics. Based on these findings, this review proposed pathways to encourage trust in long-term care by using assistive technology, promoting social support, providing positive emotional support, and focusing on collaborative assistance. This review provides theoretical guidance to long-term care facility operators, helps to build trust in long-term care settings, and promotes care receivers' well-being.