A study on community older people's willingness to use smart home-an extended technology acceptance model with intergenerational relationships

Older Adults' Perspectives on Adopting Smart Home Technology for 'Proactive Health': A Qualitative Study

AIM

Smart home technology, as an emerging innovation, holds significant potential to support proactive health by enabling accurate prediction and intelligent warning of health issues. This study aims to explore older adults' perceptions of adopting smart home technology to promote proactive health.

DESIGN

An exploratory qualitative study.

METHODS

Focus groups and one-on-one interviews were held with 20 older adults recruited from a retirement activity center, a nursing home, and the geriatrics department of a tertiary hospital in China between June and October 2024. The interview transcripts were analysed using thematic analysis and further examined through the framework of the Technology Acceptance Model.

RESULTS

The analysis identified four themes: (1) The need for care is the primary determinant for older adults' consideration of adopting smart home technology. When care is needed, factors such as self-care ability, care from children and the caregiving capabilities of smart home technology play a crucial role in their decision-making process. (2) Older adults expect smart home technology to deliver essential healthcare services, including health monitoring and counselling, emergency assistance and emotional support. (3) Individual differences, interplay with life experiences, significantly influence older adults' willingness to adopt smart home technology. (4) The perceived effectiveness of technology, age-friendly design, potential technical malfunctions and privacy concerns are also critical factors affecting adoption decisions. All themes were also matched to perceived usefulness, perceived ease of use and attitude in the Technology Acceptance Model.

CONCLUSION

This study provides valuable insights into older adults' perspectives on adopting smart home technology and serves as a reference for its development in geriatric health management. To enhance the applicability of these technologies, nurses should collaborate with developers, integrating their expertise in elderly care and daily living needs.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The findings offer guidance for advancing smart home technology to better address the health needs of older adults. By integrating these technologies into practice, nurses can more effectively respond to the unique health conditions of older adults, optimise nursing workflows and enhance the overall quality of care. Ultimately, this ensures that older adults remain the primary beneficiaries of technological advancements in healthcare.

REPORTING METHOD

The study adhered to the Consolidated Criteria for Reporting Qualitative Research guidelines.

PATIENT OR PUBLIC CONTRIBUTION

Limited patient and public involvement was incorporated, focusing on feedback on data analysis.

Enhancing Older Adults' Lives Through Positive Aging Perception, Quality-of-Life Enhancement, and Social Support to Drive Acceptance and Readiness Toward Indoor Assistive Technology: Cross-Sectional Study

BACKGROUND

The growing aging population faces increasing mobility limitations, highlighting the need for assistive technologies as potential solutions. These technologies support the independence and well-being of older adults and individuals with mobility challenges. Indoor mobility is essential for daily activities and significantly impacts their lives. Limited indoor mobility can reduce quality of life and heighten the risk of falls.

OBJECTIVE

This study explores how positive aging perceptions, quality-of-life enhancements, and social support influence the acceptance and readiness of indoor assistive technologies among older adults.

METHODS

A cross-sectional study was conducted at a gerontechnology laboratory, requiring participants to visit the facility in person. Each 60-minute session included demonstrations of various indoor assistive technologies and the completion of a questionnaire. The assistive technologies showcased encompassed a wide range of devices. Participants' positive aging perceptions, quality-of-life enhancements, social support, technology acceptance, and readiness were measured using validated scales. Data were analyzed with AMOS (version 28; IBM Corp) and SPSS (version 28; IBM Corp), using structural equation modeling and multivariate analysis of covariance to assess the effects of predictors while controlling for demographic factors.

RESULTS

A total of 104 older adults aged 60 years and older participated, with a mean age of 67.92 (SD 5.68) years. Structural equation modeling indicated that positive aging perception has a significant influence on older adults' control beliefs (P=.095), comfort (P=.047), and confidence (P<.001) in gerontechnology. Multivariate analysis revealed significant combined effects of quality-of-life enhancement (P=.01) and social support (P=.03) on technology acceptance and readiness, wherein quality-of-life enhancement (P=.001) and social support (P=.008) negatively impacted security perception. Among demographic variables, educational level significantly impacted gerontechnology confidence (P=.004) while ethnicity influenced optimism (P=.003).

CONCLUSIONS

This study sheds light on key factors affecting older adults' acceptance and readiness to adopt indoor assistive technologies. Findings highlight the importance of fostering positive aging perceptions through these technologies. Addressing issues related to control beliefs, comfort, and confidence in gerontechnology is essential to enhance technology acceptance and readiness among older adults. Future research should investigate the underlying mechanisms and create targeted interventions to support successful technology adoption in this population.

Demand, utilization, and supply of community smart senior care services for older people in China

Objective

Although smart senior care services offer numerous benefits, they have not yet gained widespread acceptance among the general populace, particularly seniors. Numerous related issues have surfaced, with the structural imbalance between supply and demand being most prominent. Currently, there is a lack of research distinguishing between the various categories of demand for smart ageing services and the associated behaviors of older individuals. In this study, we aimed to identify the types of demand and utilization of smart senior care services among Chinese older adults to understand their diverse characteristics and the factors that facilitate certain behaviors. We also analyzed the imbalance between supply and demand for smart senior care services and explored the factors influencing it, thereby providing a reference for optimizing smart senior services.

Methods

We conducted a cross-sectional study from January to March 2023 and analyzed 1037 valid questionnaires. Three types of smart senior care services were investigated: intelligent information, intelligent consultation, and intelligent monitoring. We identified the demand, utilization, and supply of these services among older individuals. Latent class analysis (LCA) was used to differentiate the heterogeneity of older adults in terms of service demand and utilization. Factors influencing service preferences were analyzed using binary logistic regression based on Andersen's behavioral model.

Results

Based on the LCA findings, service demand, and utilization were divided into two categories: positive demand (desire to use the services) or negative demand, and taking action or negative action to use the services. The persons with high demand but low utilization comprised the largest number of older people in this study (69.35%). The results indicated that the number of children (odds ratio (OR) = 1.491), community-provided smart devices (OR = 1.700), number of chronic diseases (OR = 1.218), and self-care capacity (OR = 0.214) are associated with positive demand. Meanwhile, pre-retirement employment, income sources, community device provided, community promotion, region, and self-care ability were significant predictors (p < 0.05) of taking action to use the services. In terms of community supply outcome, income situation had a significant effect on intelligent information services. Income sources were associated with intelligent information and intelligent monitoring services. Pre-retirement employment and housing type variables showed effect on IC services. Community promotion and self-care ability were associated with all three types of service supply (p < 0.05).

Conclusion

Older adults expressed a strong demand for smart ageing services; however, difficulties using smart technology remain a serious problem. Further investigation of how family support contributes to the perception and use of care services for older people is needed. Specific policies, such as financial assistance, should be established to support service use. Communities should expand their support and promotion of smart ageing services, focusing on enhancing digital health literacy among seniors to facilitate product utilization. Furthermore, personalized recommendations and applications tailored to the physical conditions of older adults are essential.

Understanding older adults' acceptance of Chatbots in healthcare delivery: an extended UTAUT model

Background

Chatbots are increasingly integrated into the lives of older adults to assist with health and wellness tasks. This study aimed to understand the factors that enhance older adults' acceptance of chatbots in healthcare delivery.

Methods

This study proposed an extended Unified Theory of Acceptance and Use of Technology model (UTAUT), including aging factors of perceived physical condition, self-actualization needs, and technology anxiety. The model was tested by PLS (Partial Least Squares) with data collected from 428 Chinese citizens aged 60 and above.

Results

The results reveal that performance expectancy, effort expectancy, and social influence significantly affected older adults' behavioral intention to use chatbots. The facilitating conditions, self-actualization needs, and perceived physical condition significantly affected the actual use behavior of chatbots by older adults, whereas technology anxiety did not. Furthermore, the influence of effort expectancy and social influence on behavioral intention were moderated by experience.

Conclusion

The behavioral intentions of older adults with low experience are more strongly influenced by social influences and effort expectancy. Furthermore, healthcare providers, designers, and policymakers should emphasize the impact of facilitating conditions, self-actualization needs, and perceived physical conditions on chatbot applications among older adults.

An Analysis of How Smart Home Product Attributes Influence Older Adults' Avoidance Psychology: The Sequential Mediation Role of Product Identity and Trust

As an effective method of improving the quality of life of older adults, smart home products have seen significant development and increased popularity in recent years. However, studies on the anti-consumption behaviors of older adults regarding these products remain relatively limited. Therefore, this study aims to investigate the avoidance behavior of older adults toward smart home products by investigating product attributes. The study proposes a theoretical model, "product attributes-product Identity-trust-avoidance behavior", to explore the underlying mechanisms of avoidance behavior from both the psychological and the behavioral perspectives. Based on data from 506 valid questionnaires, the findings reveal that product attributes, product identity, and trust can significantly and negatively impact the avoidance behavior toward smart home products. In addition, product identity and trust play significant mediating and serial mediating roles between product attributes and smart home product avoidance behaviors. These findings provide valuable insights for smart home product manufacturers seeking to understand the avoidance behavior of older adults concerning their products. They also offer valuable guidance on design concepts, marketing strategies, and market formulation, providing new theoretical and practical recommendations for expanding the smart home market for older adults.

Developing Independent Living Support for Older Adults Using Internet of Things and AI-Based Systems: Co-Design Study

Background

The number of older people with unmet health care and support needs is increasing substantially due to the challenges facing health care systems worldwide. There are potentially great benefits to using the Internet of Things coupled with artificial intelligence to support independent living and the measurement of health risks, thus improving quality of life for the older adult population. Taking a co-design approach has the potential to ensure that these technological solutions are developed to address specific user needs and requirements.

Objective

The aim of this study was to investigate stakeholders' perceptions of independent living and technology solutions, identify stakeholders' suggestions on how technology could assist older adults to live independently, and explore the acceptability and usefulness of a prototype Internet of Things solution called the NEX system to support independent living for an older adult population.

Methods

The development of the NEX system was carried out in 3 key phases with a strong focus on diverse stakeholder involvement. The initial predesign exploratory phase recruited 17 stakeholders, including older adults and family caregivers, using fictitious personas and scenarios to explore initial perceptions of independent living and technology solutions. The subsequent co-design and testing phase expanded this to include a comprehensive web-based survey completed by 380 stakeholders, encompassing older adults, family caregivers, health care professionals, and home care support staff. This phase also included prototype testing at home by 7 older adults to assess technology needs, requirements, and the initial acceptability of the system. Finally, in the postdesign phase, workshops were held between academic and industry partners to analyze data collected from the earlier stages and to discuss recommendations for the future development of the system.

Results

The predesign phase revealed 3 broad themes: loneliness and technology, aging and technology, and adopting and using technology. The co-design phase highlighted key areas where technology could assist older adults to live independently: home security, falls and loneliness, remote monitoring by family members, and communication with clients. Prototype testing revealed that the acceptability aspects of the prototype varied across technology types. Ambient sensors and voice-activated assistants were described as the most acceptable technology by participants. Last, the postdesign analysis process highlighted that ambient sensors have the potential for automatic detection of activities of daily living, resulting in key recommendations for future developments and deployments in this area.

Conclusions

This study demonstrates the significance of incorporating diverse stakeholder perspectives in developing solutions that support independent living. Additionally, it emphasizes the advantages of prototype testing in home environments, offering crucial insights into the real-world experiences of users interacting with technological solutions.

DigiDOP: A framework for applying digital technology to the Differential Outcomes Procedure (DOP) for cognitive interventions in persons with neurocognitive disorders

We present a framework -Digi-DOP- that includes a series of evidence-based recommendations to design and apply cognitive interventions for people with Neurocognitive Disorders (NCDs) using a relatively new approach, the Differential Outcomes Procedure (DOP). To do so, we critically review the substantial experimental research conducted with relevant clinical and non-clinical populations, and the theoretical underpinnings of this procedure. We further discuss how existing digital technologies that have been used for cognitive interventions could be applied to overcome some of the limitations of DOP-based interventions and further enhance DOP benefits. Specifically, we present three digital DOP developments that are currently being designed, investigated and/or tested. Finally, we discuss constraints, ethical and legal considerations that need to be taken into account to ensure that the use of technology in DOP-based interventions proposed here does not widen disparities and inequalities. We hope that this framework will inform and guide digital health leaders and developers, researchers and healthcare professionals to design and apply DOP-based interventions for people with NCDs.

Assessing the cognitive decline of people in the spectrum of AD by monitoring their activities of daily living in an IoT-enabled smart home environment: a cross-sectional pilot study

Introduction

Assessing functional decline related to activities of daily living (ADLs) is deemed significant for the early diagnosis of dementia. As current assessment methods for ADLs often lack the ability to capture subtle changes, technology-based approaches are perceived as advantageous. Specifically, digital biomarkers are emerging, offering a promising avenue for research, as they allow unobtrusive and objective monitoring.

Methods

A study was conducted with the involvement of 36 participants assigned to three known groups (Healthy Controls, participants with Subjective Cognitive Decline and participants with Mild Cognitive Impairment). Participants visited the CERTH-IT Smart Home, an environment that simulates a fully functional residence, and were asked to follow a protocol describing different ADL Tasks (namely Task 1 - Meal, Task 2 - Beverage and Task 3 - Snack Preparation). By utilizing data from fixed in-home sensors installed in the Smart Home, the identification of the performed Tasks and their derived features was explored through the developed CARL platform. Furthermore, differences between groups were investigated. Finally, overall feasibility and study satisfaction were evaluated.

Results

The composition of the ADLs was attainable, and differentiation among the HC group compared to the SCD and the MCI groups considering the feature "Activity Duration" in Task 1 - Meal Preparation was possible, while no difference could be noted between the SCD and the MCI groups.

Discussion

This ecologically valid study was determined as feasible, with participants expressing positive feedback. The findings additionally reinforce the interest and need to include people in preclinical stages of dementia in research to further evolve and develop clinically relevant digital biomarkers.

Family caregiver readiness to adopt smart home technology to monitor care-Dependent older adults: A qualitative exploratory study

AIMS

The aim of this study was to explore factors that influence family caregiver readiness to adopt health smart home technology for their care-dependent older adult family member. Health smart homes are designed to remotely monitor the health and wellness of community-dwelling older adults supporting independent living for as long as possible. Accordingly, if the health smart home is deployed into the home of a care-depended older adult, it can potentially support family caregivers by facilitating workforce participation and give piece of mind to the family caregiver who may not live close to the older adult. However, wider adoption of health smart home technologies into the homes of community-older adults is low, and little is known about the factors that influence the readiness of family caregivers to adopt smart home technologies for their care-dependent older adults.

DESIGN

A qualitative Descriptive study design was utilized.

METHODS

Qualitative data were collected between 2019 and 2020 via semi-structured interviews. Thematic analysis of interviews was completed, and data were organized into themes.

RESULTS

Study findings show that caregiver readiness (N = 10) to adopt smart home technology to monitor older adult family members were influenced by five primary themes including a 'big brother effect', 'framing for acceptance', 'data privacy', 'burden' and 'cost.'

CONCLUSION

Family caregivers were open to adopting smart home technology to support the independent living of their older adult family members. However, the readiness of family caregivers was inextricably linked to the older adults' readiness for smart home adoption. The family caregiver's primary concern was on how they could frame the idea of the smart home to overcome what they viewed as hesitancy to adopt in the older adult. The findings suggest that family caregivers endeavour to balance the hesitancy in their older adult family members with the potential benefits of smart home technology.

IMPACT

Family caregivers could benefit if their care-dependent older adults adopt smart home technology. Recognizing the role of caregivers and their perspectives on using smart home technologies with their care-dependents is critical to the meaningful design, use and adoption.