Sustainable Assistive-Technology Procurement in Swedish Public Healthcare: Tensions and Paradoxes in Managers’ Decision-Making

Assistive technology (AT) supports participation, independence, and well-being but also presents sustainability challenges for public healthcare organisations. This qualitative study explored sustainability tensions and paradoxes arising in AT decision-making. Semi-structured interviews were conducted with 24 managers and analysed using reflexive thematic analysis informed by paradox theory. The findings show that managers must simultaneously pursue competing economic, environmental, and social sustainability objectives, giving rise to four interconnected tensions: purchasing new AT versus reconditioning existing products; prolonging product life through donations versus organisational responsibility; providing digital AT versus enabling reuse; and expanding digital AT provision versus developing the knowledge and skills required to support it. While managers employed various strategies to navigate these tensions, the underlying contradictions persisted. The study contributes to both AT research and paradox theory by demonstrating how sustainability tensions in AT decision-making evolve into persistent paradoxes that require continuous managerial navigation rather than permanent resolution.