An investigation into the use of smart home devices, user preferences, and impact during COVID-19

With the goal of designing smart environments that can support users' physical/mental well-being, we studied users' experiences and different factors that can influence success of smart home devices through an online study conducted during and after the COVID-19 restrictions in June 2021 (109 participants) and March 2022 (81 participants). We investigated what motivates users to buy smart home devices, and if smart home devices may have the potential to improve different aspects of users' well-being. As COVID-19 emphasized a situation where people spent a significant amount of time at home in Canada, we also asked if/how COVID-19 motivated purchase of smart-home devices and how these devices affected participants during the pandemic. Our results provide insights into different aspects that may motivate the purchase of smart home devices and users' concerns. The results also suggest that there may be correlations between the use of specific types of devices and psychological well-being.

Is research on 'smart living environments' based on unobtrusive technologies for older adults going in circles? Evidence from an umbrella review

CONTEXT AND AIMS

To enable ageing in place, innovative and integrative technologies such as smart living environments may be part of the solution. Despite extensive published literature reviews on this topic, the effectiveness of smart living environments in supporting ageing in place, and in particular involving unobtrusive technologies, remains unclear. The main objective of our umbrella review was to synthesize evidence on this topic.

METHODS

According to the PRIOR process, we included reviews from multiple databases that focused on unobtrusive technologies used to analyze and share information about older adults' behaviors and assessed the effectiveness of unobtrusive technologies to support ageing in place. Selection, extraction and quality appraisal were done independently by two reviewers.

RESULTS

By synthesizing 17 published reviews that covered 191 distinct primary studies, we found that smart living environments based on unobtrusive technologies had low to moderate effectiveness to support older adults to age in place. Effectiveness appears to be strongest in the recognition of activities of daily living. The results must, however, be interpreted in light of the low overall level of evidence, i.e., low methodological value of the primary studies and poor methodological quality of the literature reviews. Most reviews concluded that unobtrusive technologies are not mature enough for widespread adoption.

CONCLUSION

There is a necessity to support primary studies that can move beyond the proof-of-concept or pilot stages and expand scientific knowledge significantly on the topic. There is also an urgent need to publish high quality literature reviews to better support policy makers and funding agencies in the field of smart living environments.

Design and Evaluation of Personalized Services to Foster Active Aging: The Experience of Technology Pre-Validation in Italian Pilots

Assistive devices could promote independent living and support the active and healthy aging of an older population; however, several factors can badly influence the long-term use of new technologies. In this context, this paper presents a two-step methodology called “pre-validation” that aims to identify the factors that can bias the use of new services, thus minimizing the risk of an unsuccessful longer trial. The proposed pre-validation methodology is composed of two main phases that aim to assess the usability and the reliability of the technology assessed in a laboratory environment and the usability, acceptability, user experience, and reliability of the technology in real environments. The tested services include the socialization scenario, in which older adults are better connected to the community via technological solutions (i.e., socialization applications), and the monitoring scenario, which allows for the introduction of timely interventions (technologies involved include environmental monitoring sensors, a telepresence robot, wearable sensors, and a personalized dashboard). The obtained results underline an acceptable usability level (average System Usability Scale score > 65) for the tested technologies (i.e., socialization applications and a telepresence robot). Phase Two also underlines the good acceptability, user experience, and usability of the tested services. The statistical analysis underlines a correlation between the stress related to the use of technology, digital skills, and intention of use, among other factors. Qualitative feedback also remarks on a correlation between older adults with low digital skills and an anxiety about using technology. Positive correlation indexes were highlighted between the trust and usability scores. Eventually, future long-term trials with assistive technology should rely on motivated caregivers, be founded on a strong recruitment process, and should reassure older adults—especially the ones with low digital literacy—about the use of technology by proposing personalized training and mentoring, if necessary, to increase the trust.

An ambient assisted living architecture for hospital at home coupled with a process-oriented perspective

The growing number of next-generation applications offers a relevant opportunity for healthcare services, generating an urgent need for architectures for systems integration. Moreover, the huge amount of stored information related to events can be explored by adopting a process-oriented perspective. This paper discusses an Ambient Assisted Living healthcare architecture to manage hospital home-care services. The proposed solution relies on adopting an event manager to integrate sources ranging from personal devices to web-based applications. Data are processed on a federated cloud platform offering computing infrastructure and storage resources to improve scientific research. In a second step, a business process analysis of telehealth and telemedicine applications is considered. An initial study explored the business process flow to capture the main sequences of tasks, activities, events. This step paves the way for the integration of process mining techniques to compliance monitoring in an AAL architecture framework.

Influence of 2 Digital Exercise Modules of a Multimodular System on Balance and Leg Strength Under Consideration of Use Adherence: Prospective Cohort Study

Background

To empower healthy aging, digital solutions embed multiple modules for physical activity, cognitive health promotion, and social engagement. Integrating new empowering technologies such as digital exercise monitoring requires assessment measures and analysis procedures, considering variable compliance of users with different modules.

Objective

This study aims to assess the influence of a tablet-based and a feedback system–based exercise module on balance and leg strength by considering use adherence instead of the use of the entire multimodular system.

Methods

In the prospective cohort study within the fit4AAL project, 83 users (n=67, 81% women; n=16, 19% men; mean age 66.2, SD 2.3 years) used the 2 digital exercise modules of a multimodular physical activity promotion system for >18 weeks. A data-driven clustering method based on the average use frequency of the exercise modules determined the number of user types that met the World Health Organization–recommended training frequency of at least twice per week. On the basis of this use adherence, statistical analysis was performed with features of functional performance tests (unipedal stance, 30-second chair rise, Y-balance, and hurdle step tests). The tests were conducted 6 months before the intervention, immediately before the intervention, and after the intervention, comparing the baseline phase with the 3 feedback use groups of the study (using only the tablet, the tablet and the feedback system, or only the feedback system).

Results

Of the 83 users, 43 (52%) met the World Health Organization–recommended frequency of muscle-strengthening activities. Overall, the feedback use groups achieved, on average, more chair rises in 30 seconds than the baseline group (P=.01; moderate effect size of 0.07). Of the 43 users, 26 (60%) additionally used the feedback system–based exercise module. They improved in balance compared with the users using either the tablet or the feedback system (P=.02). In addition, they improved their leg strength within the group (P=.04) and compared with the baseline (P=.01).

Conclusions

The additional use of a feedback system showed a tendency to positively maintain and influence the already exceptionally high functional performance of older adults. Considering use adherence in future multimodular system studies is crucial to assess the influence of single and combined use of exercise modules on functional performance.

Security Mechanisms of a Mobile Health Application for Promoting Physical Activity among Older Adults

Physical activity contributes to the maintenance of health conditions and functioning. However, the percentage of older adults who comply with the recommendations for physical activity levels is low when compared to the same percentages on younger groups. The SmartWalk system aims to encourage older adults to perform physical activity (i.e., walking in the city), which is monitored and adjusted by healthcare providers for best results. The study reported in this article focused on the implementation of SmartWalk security services to keep personal data safe during communications and while at rest, which were validated considering a comprehensive use case. The security framework offers various mechanisms, including an authentication system that was designed to complement the pairs of usernames and passwords with trusted execution environments and token-based features, authorization with different access levels, symmetric and asymmetric key cryptography, critical transactions review, and logging supported by blockchain technology. The resulting implementation contributes for a common understanding of the security features of trustful smart cities' applications, which conforms with existing legislation and regulations.

Methodological Quality of User-Centered Usability Evaluation of Ambient Assisted Living Solutions: A Systematic Literature Review

This study aimed to determine the methodological quality of user-centered usability evaluation of Ambient Assisted Living (AAL) solutions by (i) identifying the characteristics of the AAL studies reporting on user-centered usability evaluation, (ii) systematizing the methods, procedures and instruments being used, and (iii) verifying if there is evidence of a common understanding on methods, procedures, and instruments for user-centered usability evaluation. An electronic search was conducted on Web of Science, Scopus, and IEEE Xplore databases, combining relevant keywords. Then, titles and abstracts were screened against inclusion and exclusion criteria, and the full texts of the eligible studies were retrieved and screened for inclusion. A total of 44 studies were included. The results show a great heterogeneity of methods, procedures, and instruments to evaluate the usability of AAL solutions and, in general, the researchers fail to consider and report relevant methodological aspects. Guidelines and instruments to assess the quality of the studies might help improving the experimental design and reporting of studies on user-centered usability evaluation of AAL solutions.

SmartCards as Analogous Tools to Operate Tablet Computers for Elderly-A Feasibility Study

BACKGROUND

Older adults sometimes shy away from using modern digital communication devices due to lacking experience and fear of failure. Within the present project, SmartCards were developed as analogous means to operate tablet computers for older adults with little previous computer experience. We investigated whether the SmartCards-Tablet-System would (a) increase use of digital communication and (b) affect loneliness, autonomy, cognitive ability and wellbeing of the users.

METHODS

The suitability and acceptance of the system was evaluated during a three month trial period with seniors in retirement homes, seniors with home assistance care and a waiting control group.

RESULTS

Acceptance, duration of use and frequency of use were high in both experimental groups. Cognitive ability significantly improved after three months' use in both experimental groups. Effects on loneliness, autonomy and wellbeing could not be observed.

DISCUSSION

Our results indicate that seniors are very much able and curious to use modern digital devices if the interface and hardware are adjusted to their needs and capabilities without being stigmatizing. The use of modern communication services and the World Wide Web can promote contact of seniors with their (younger) relatives.

Ambient assisted living and European funds: a bibliometric approach

Purpose

The authors analyse the impact of European funding research programmes on the topic of Ambient Assisted Living by considering its status, future context, and the implications for prospective knowledge management.

Design/methodology/approach

The authors apply our variation of classical Systematic Literature Review – Systematic Literature Network Analysis, which also includes bibliographic networks – to identify the readership cliques of the associated technological publication outputs.

Findings

The authors’ main conclusion suggests that there was an increase in scientific production on AAL fields just after the start of the two EU funding programmes (2008 and 2014). Three main research directions were identified: activity and vital sign recognition, human-computer interaction and technology acceptance.

Originality/value

To date, previous reviews on Ambient Assisted Livig focus on specific aspects, such as the study of technology. The present review provides a complete overview of Ambient Assisted living technology and it grasps how the European funds have impacted on the development of this technology.

Measuring the Use of the Active and Assisted Living Prototype CARIMO for Home Care Service Users: Evaluation Framework and Results

To address the challenges of aging societies, various information and communication technology (ICT)-based systems for older people have been developed in recent years. Currently, the evaluation of these so-called active and assisted living (AAL) systems usually focuses on the analyses of usability and acceptance, while some also assess their impact. Little is known about the actual take-up of these assistive technologies. This paper presents a framework for measuring the take-up by analyzing the actual usage of AAL systems. This evaluation framework covers detailed information regarding the entire process including usage data logging, data preparation, and usage data analysis. We applied the framework on the AAL prototype CARIMO for measuring its take-up during an eight-month field trial in Austria and Italy. The framework was designed to guide systematic, comparable, and reproducible usage data evaluation in the AAL field; however, the general applicability of the framework has yet to be validated.

From A to Z: Wearable technology explained

Wearable technology (WT) has become a viable means to provide low-cost clinically sensitive data for more informed patient assessment. The benefit of WT seems obvious: small, worn discreetly in any environment, personalised data and possible integration into communication networks, facilitating remote monitoring. Yet, WT remains poorly understood and technology innovation often exceeds pragmatic clinical demand and use. Here, we provide an overview of the common challenges facing WT if it is to transition from novel gadget to an efficient, valid and reliable clinical tool for modern medicine. For simplicity, an A-Z guide is presented, focusing on key terms, aiming to provide a grounded and broad understanding of current WT developments in healthcare.

What are the key contextual factors when preparing for successful implementation of assistive living technology in primary elderly care? A case study from Norway

OBJECTIVE

To identify contextual factors at different organisational levels to guide the implementation of an assistive living technology intervention in Norwegian primary home care.

DESIGN

A single embedded case study design was carried out in an urban municipality in Western Norway to get an overview of key contextual factors from the municipality's perspective.

DATA COLLECTION AND ANALYSIS

The data collection was based on a triangulation of methods involving document analysis, semi-structured individual interviews and focus group interviews to get a broad insight when preparing for an intervention. Data were collected on three levels of the healthcare system: (1) national policy documents and regulations (macro), (2) five individual interviews with senior managers and municipal strategy documents (meso) and (3) two focus group interviews with nurses and nurse managers in direct patient care (micro). The Model for Understanding Success in Quality framework was used as a guide in the data analysis.

RESULTS

The main contextual factors identified were external motivators and project sponsorship (macro level); leadership, workforce focus and maturity (meso level);and motivation to change and maturity (micro level). Strategies developed in policy documents affected upper management in the municipality, but healthcare personnel at the micro level were not so familiar with strategies and emphasis on assistive living technologies. Healthcare personnel in our study were motivated to use technological solutions, but lack of data infrastructure and resource availability hindered this.

CONCLUSIONS

Aligning interests across multiple stakeholders remain a challenge when planning for an assistive living technology intervention in primary care. In the studied municipality, integration of technological solutions into healthcare services was more a vision than a reality because of a low level of organisational readiness.

Participatory and persuasive telehealth

Technological advances in telehealth systems are primarily focused on sensing and monitoring. However, these systems are limited in that they only rely on sensors and medical devices to obtain vital signs. New research and development are urgently needed to offer more effective and meaningful interactions between patients, medical professionals and other individuals around the patients. Social networking with Web 2.0 technologies and methods can meet these demands, and help to develop a more complete view of the patient. Also many people, including the elderly, may be resistant to change, which can reduce the efficacy of telehealth systems. Persuasive technology and mechanisms are urgently needed to counter this resistance and promote healthy lifestyles. In this paper, we propose the participatory and persuasive telehealth system as a solution for these two limitations. By integrating connected health solutions with social networking and adding persuasive influence, we increase the chances for effective interventions and behavior alterations.

Healthy ageing supported by technology--a cross-disciplinary research challenge

During the last decade, the challenges of an ageing society became focus for extensive scientific, public and political discussions. From discussions in scientific fora within each discipline, there is now a shift towards cross-disciplinary scientific approaches. The aim of this article is therefore, to collect and describe different scientific viewpoints in this regard and to point out research gaps to be addressed in the future. The article is based on a number of review articles and keynote lectures given by the author, and complemented with informal interviews of experts from different scientific fields engaged in the field of technology and ageing. Results show that research has emerged from being technology-focussed to scenario-based taking different scientific perspectives into account. However, the biggest challenge still is to accommodate the need for a holistic integrated service which means to provide personalised services and adapt technology and content to individual needs of different stakeholders. Further, cross-disciplinary research is needed that relates informatics and technology to different stages of the aging process and that evaluates the effects of proposed technical solutions.