Transforming aged care with virtual reality: How organisational culture impacts technology adoption and sustained uptake

OBJECTIVES

Virtual reality (VR) is not a common leisure activity in aged care, despite pilot studies demonstrating its value as a tool to combat inactivity and loneliness. This study investigated the organisational enablers and barriers to sustained uptake of VR among aged care staff and organisations, who may lack familiarity or confidence with the technology.

METHODS

Creative methods were adopted to co-design and develop a VR implementation toolkit tailored specifically for aged care staff. Three aged care homes in South-East Queensland participated, with 15 residents and seven staff engaging in up to four VR sessions facilitated by the research team. Participant observation of the VR sessions was complemented by interviews with aged care staff and residents.

RESULTS

Guided by Normalisation Process Theory, a reflexive thematic analysis identified four key themes: (1) Positively Appreciating the VR Experience, (2) Staff VR Champions and the Importance of Personal Use and Experimentation with VR, (3) Management Support and (4) Technical Challenges.

CONCLUSIONS

Our results indicate benefits and challenges of VR use in aged care, offering valuable insights into the factors that can lead to the long-term success of VR-based leisure activities for aged care. Providing time and resources for a VR champion to experiment and learn about the technology is critical. The development of an online implementation toolkit, based on our learning from this project, also provides aged care stakeholders with the evidence-based resources needed to ensure the successful implementation of VR-based leisure programs.

Video Calls as a Replacement for Family Visits During Lockdowns in Aged Care: Interview Study with Family Members

BACKGROUND

Lockdowns have been employed to prevent the spread of transmissible illnesses such as influenza, norovirus, and COVID-19 in care homes. However, lockdowns deny care home residents supplemental care and socioemotional enrichment that comes from seeing family members. Video calling has the potential to enable ongoing contact between residents and family members during lockdowns. Yet video calls can be considered by some as being a poor substitute for in-person visits. It is important to understand family members' experiences with video calling during lockdowns to ensure effective use of this technology in the future.

OBJECTIVE

This study aimed to understand how family members used video calls to communicate with relatives living in aged care during lockdowns. We focused on experiences during the COVID-19 pandemic, which involved extensive lockdowns in aged care homes.

METHODS

We conducted semi-structured interviews with 18 adults who had been using video calls with relatives living in aged care during pandemic lockdowns. The interviews focused on how participants had been using video calls, what benefits they gained from video-based interactions, and what challenges they encountered when using the technology. We analysed the data using Braun & Clarke's 6-phase reflexive approach to thematic analysis.

RESULTS

We developed 4 themes through our analysis. Theme 1 interprets video calling as a medium for continuation of care during lockdowns. Using video calls, family members were able to provide social enrichment for residents and engaged in health monitoring to uphold residents' welfare. Theme 2 highlights how video calling extended care by supporting frequent contact, by transmitting non-verbal cues that were essential for communication, and by negating the need for face masks. Theme 3 interprets organizational issues such as lack of technology and staff time as impediments to continuation of familial care through video. Finally, theme 4 highlights the need for two-way communication, interpreting residents' unfamiliarity with video calling and their health conditions as further barriers to continuation of care.

CONCLUSIONS

This study suggests that, during restrictions arising from the COVID-19 pandemic, video calls became a medium for enabling family members to continue participating in the care of their relatives. The use of video calls to continue care illustrates their value for families during times of mandatory lockdown, and supports the use of video to complement face-to-face visits at other times. However, better support is needed for video calling in aged care homes. This study also reveals a need for video calling systems that are designed for the aged care context.

CLINICALTRIAL

Content development and validation for a mobile application designed to train family caregivers in the use of music to support care of people living with dementia

Background

Music therapy is increasingly recognized as an effective support for people living with dementia. However, with incidences of dementia increasing, and limited availability of music therapists, there is a need for affordable and accessible ways that caregivers can learn to use music-therapy based strategies to support the people they care for. The MATCH project aims to address this by creating a mobile application that can train family caregivers in the use of music to support people living with dementia.

Methods

This study details the development and validation of training material for the MATCH mobile application. Training modules developed based on existing research were assessed by 10 experienced music therapist clinician-researchers, and seven family caregivers who had previously completed personalized training in music therapy strategies via the HOMESIDE project. Participants reviewed the content and scored each training module based on content (music therapists) and face (caregivers) validity scales. Descriptive statistics were used to calculate scores on the scales, while thematic analysis was used to analyze short-answer feedback.

Results

Participants scored the content as valid and relevant, however, they provided additional suggestions for improvement via short-answer feedback.

Conclusion

The content developed for the MATCH application is valid and will be trailed by family caregivers and people living with dementia in a future study.

Understanding Older Adults' Experiences With Technologies for Health Self-management: Interview Study

BACKGROUND

Many older adults now use technologies such as wearable devices and telehealth services to support their health and well-being while living independently at home. However, older adults vary in how they use these technologies, and there is a lack of knowledge regarding the motivations that influence their acceptance and use of health-related technologies in home environments.

OBJECTIVE

This study aimed to understand the types of technologies that older adults use to support their health and the factors that motivate them to use their chosen technologies to support their health. In addition, we aimed to understand the factors that enable the effective use of technologies for health self-management and to identify the barriers that can negatively affect the adoption of technologies.

METHODS

A total of 22 older adults participated in semistructured interviews regarding their experiences of using technologies for health self-management. Interview transcripts were analyzed through an in-depth thematic analysis.

RESULTS

The interviews revealed that a range of technologies, such as videoconferencing software, fitness trackers, and other devices, were being used by older adults to support their health. Interviews showed that participants were motivated to use technologies to monitor health issues, to stay active and connected, and to record and change their behavior in the light of foreseen risks related to their future health status. Enablers that facilitated the effective use of technologies include social and organizational influence, convenient access to health care and safety provided by the technology, and easy setup and low cost of the technology. Barriers include information overload and a sense of futility about future health decline; telehealth being an inadequate substitute for in-person consultation; concerns about trust related to privacy and accuracy; and technologies being stigmatizing, uncomfortable to use, expensive, and unfamiliar.

CONCLUSIONS

This study suggested that older adults were using a variety of technologies to prevent or prepare for future health decline, evidencing a resilient attitude toward health and aging. In addition, older adults were willing to continue using the technology when there was a perceived need. The enabler mentioned by most participants was the social and organizational influence that included health care staff, family, friends, and organizations. This analysis provides a better understanding of how older adults use technologies to support their health and can guide the provision of appropriate health technologies for them.

A Participatory Design Approach to Creating Echolocation-Enabled Virtual Environments

As virtual environments—in the form of videogames and augmented and virtual reality experiences—become more popular, it is important to ensure that they are accessible to all. Previous research has identified echolocation as a useful interaction approach to enable people with visual impairment to access virtual environments. In this paper, we further investigate the usefulness of echolocation to explore virtual environments. We follow a participatory design approach that comprised a focus group session coupled with two fast prototyping and evaluation iterations. During the focus group session, expert echolocators produced a series of seven design recommendations, of which we implemented and trialed four. Our trials revealed that the use of ambient sounds, the ability to place landmarks, directional control, and the ability to use pre-recorded mouth-clicks produced by expert echolocators improved the overall experience of our participants by facilitating the detection of openings and obstacles. The recommendations presented and evaluated in this paper may help to develop virtual environments that support a broader range of users while recognising the value of the lived experience of people with disability as a source of knowledge.

Technology-Mediated Enrichment in Aged Care: Survey and Interview Study

Background

Digital technologies such as virtual reality (VR), humanoid robots, and digital companion pets have the potential to provide social and emotional enrichment for people living in aged care. However, there is currently limited knowledge about how technologies are being used to provide enrichment, what benefits they provide, and what challenges arise when deploying these technologies in aged care settings.

Objective

This study aims to investigate how digital technologies are being used for social and emotional enrichment in the Australian aged care industry and identify the benefits and challenges of using technology for enrichment in aged care.

Methods

A web-based survey (N=20) was distributed among people working in the Australian aged care sector. The survey collected information about the types of technologies being deployed and their perceived value. The survey was followed by semistructured interviews (N=12) with aged care workers and technology developers to investigate their experiences of deploying technologies with older adults living in aged care. Survey data were analyzed using summary descriptive statistics and categorizing open-ended text responses. Interview data were analyzed using reflexive thematic analysis.

Results

The survey revealed that a range of commercial technologies, such as VR, tablet devices, and mobile phones, are being used in aged care to support social activities and provide entertainment. Respondents had differing views about the value of emerging technologies, such as VR, social robots, and robot pets, but were more united in their views about the value of videoconferencing. Interviews revealed 4 types of technology-mediated enrichment experiences: enhancing social engagement, virtually leaving the care home, reconnecting with personal interests, and providing entertainment and distraction. Our analysis identified 5 barriers: resource constraints, the need to select appropriate devices and apps, client challenges, limited staff and organizational support, and family resistance.

Conclusions

This study demonstrates that technologies can be used in aged care to create personally meaningful enrichment experiences for aged care clients. To maximize the effectiveness of technology-mediated enrichment, we argue that a person-centered care approach is crucial. Although enrichment experiences can be created using available technologies, they must be carefully selected and co-deployed with aged care clients. However, significant changes may be required within organizations to allow caregivers to facilitate individual technology-based activities for enrichment.

Dignity, Autonomy, and Style of Company: Dimensions Older Adults Consider for Robot Companions

Research into companion robots for older adults, including those who are socially isolated and lonely, continues to grow. Although some insight into older adults' preferences for various robotic types and functionality is emerging, we lack research examining how these robots fulfil or challenge a range of values and aspirations individuals have in later life. This study examines the attitudes and perspectives of 16 older adults (aged 65+) living independently but alone in their own homes, who were interviewed and shown videos depicting three distinctive companion robots: a talking assistant; a roving toylike vehicle; and a robotic dog. This approach illuminated values, preferences, and needs amongst older people that are vital for understanding the potential of companion robots. In comparing the robots, participants expressed concerns about the impact of different companion robots on their abilities and skills, their sense of autonomy and control over their lives, and the maintenance of several kinds of dignity. These results inform user-centered design and use of companion robots for older people living alone and independently.

Echolocation as a Means for People with Visual Impairment (PVI) to Acquire Spatial Knowledge of Virtual Space

In virtual environments, spatial information is communicated visually. This prevents people with visual impairment (PVI) from accessing such spaces. In this article, we investigate whether echolocation could be used as a tool to convey spatial information by answering the following research questions: What features of virtual space can be perceived by PVI through the use of echolocation? How does active echolocation support PVI in acquiring spatial knowledge of a virtual space? And what are PVI’s opinions regarding the use of echolocation to acquire landmark and survey knowledge of virtual space? To answer these questions, we conducted a two-part within-subjects experiment with 12 people who were blind or had a visual impairment and found that size and materials of rooms and 90-degree turns were detectable through echolocation, participants preferred using echoes derived from footsteps rather than from artificial sound pulses, and echolocation supported the acquisition of mental maps of a virtual space. Ultimately, we propose that appropriately designed echolocation in virtual environments improves understanding of spatial information and access to digital games for PVI.

Virtual visits: Reminiscence in residential aged care with digital mapping technologies

OBJECTIVE

Digital technologies can support reminiscence and lifestyle enrichment in residential aged care. This study explores potential benefits and risks of virtual visits using digital maps, tablet computers and virtual reality technologies.

METHODS

Reminiscence sessions were conducted with metropolitan aged care facility residents (n = 7), using digital mapping applications to 'visit' places of personal significance. Residents and family members (n = 4) were interviewed.

RESULTS

Some older adults found virtual visits valuable and all reminisced in various ways about personal, family and social experiences. Family members felt that virtual visits would be enriching for loved ones and that they supported sharing of life stories. Our results also highlight that VR usability improvements are needed to better suit older people.

CONCLUSIONS

Virtual visits could offer valuable opportunities for positive reminiscence for some older adults in residential aged care. Digital technologies need to provide better support for older users and people who assist them.

THE HIGHWAY OF LIFE: SOCIAL VIRTUAL REALITY AS A REMINISCENCE TOOL

A large body of research demonstrates the positive impact that reminiscence activities can have on older adult wellbeing. Within this space, researchers have begun to explore how virtual reality (VR) technology might be used as a reminiscence tool. The immersive characteristics of VR could aid reminiscence by giving the sense of being fully present in a virtual environment that evokes the time being explored in the reminiscence session. However, to date, research into the use of VR as a reminiscence tool has overwhelmingly focussed on static environments that can only be viewed by a single user. This paper reports on a first-of-its-kind research project that used social VR (multiple users co-present in a single virtual environment), and 3D representations of personal artifacts (such as, photographs and recorded anecdotes), to allow a group of older adults to reminisce about their school experiences. Sixteen older adults aged 70-81 participated in a four-month user study, meeting in groups with a facilitator in a social virtual world called the Highway of Life. Results demonstrate how the social experience, tailored environment, and personal artifacts that were features of the social VR environment allowed the older adults to collaboratively reminisce about their school days. We conclude by considering the benefits and challenges associated with using social VR as a reminiscence tool with older adults.

Privacy in Aged Care Monitoring Devices (ACMD): The Developers' Perspective

"Aging in place" refers to older adults remaining in their home as they age to maintain their independence and attachment with their community. The preference to "age in place" has led to increasing use of aged care monitoring devices to monitor the health, safety and wellbeing of older adults while living alone in their home. However, these devices raise privacy concerns as they are designed to collect, use and share sensitive data from the older adults' private life in order to provide its real-time monitoring capabilities. This study involved interviewing developers from companies that design or deploy aged care monitoring devices about how they view privacy. The study found that developers mostly link privacy to unauthorized/uncontrolled access to users' data, data security risks and human errors. We advocate aged care monitoring devices companies to expand their view of privacy and to adopt a sociotechnical approach when addressing privacy in their developed devices. This involves considering human issues when addressing privacy, rather than focusing exclusively on technical solutions for privacy problems.

Combatting social isolation and increasing social participation of older adults through the use of technology: A systematic review of existing evidence

OBJECTIVES

There are growing concerns that social isolation presents risks to older people's health and well-being. Thus, the objective of the review was to explore how technology is currently being utilised to combat social isolation and increase social participation, hence improving social outcomes for older people.

METHODS

A systematic review of the literature was conducted across the social science and human-computer interaction databases.

RESULTS

A total of 36 papers met the inclusion criteria and were analysed using a four-step process. Findings were threefold, suggesting that: (i) technologies principally utilised social network services and touch-screen technologies; (ii) social outcomes are often ill-defined or not defined at all; and (iii) methodologies used to evaluate interventions were often limited and small-scale.

CONCLUSION

Results suggest a need for studies that examine new and innovative forms of technology, evaluated with rigorous methodologies, and drawing on clear definitions about how these technologies address social isolation/participation.

Privacy and the Internet of Things (IoT) Monitoring Solutions for Older Adults: A Review

The rapid increase in the number of older adults in developed countries has raised concerns about their well-being and increasing need for healthcare. New technologies, including Internet of Things, are being used to monitor older adults' health and activities, thus enabling them to live safely and independently at home as they age. However, Internet of Things monitoring solutions create privacy challenges that need to be addressed. This review examines how privacy has been conceptualised in studies proposing new Internet of Things solutions for monitoring older adults. The literature reviewed mostly links privacy with information security and unauthorised accessibility threats. There is a limited consideration of other aspects of privacy such as confidentiality and secondary use of users' information. We argue that developers of Internet of Things solutions that aim to monitor and collect health data about older adults need to adopt an expanded view of privacy. This will ensure that safeguards are built in to Internet of Things devices to protect and maintain users' privacy while also enabling the appropriate sharing of data to support older adults' safety and wellbeing.

Ethics in Evaluating a Sociotechnical Intervention With Socially Isolated Older Adults

The purpose of this article is to consider how ethical principles can inform the effective design and implementation of technology-based interventions that aim to promote the well-being of socially isolated older adults. We evaluated a new iPad application with small groups of older adults. In this article, we reflect on the ethical issues encountered at each stage of the research process. Drawing on the ethical principles of beneficence, research merit and integrity, justice, and respect, we identify key issues to consider in the future design and implementation of social isolation interventions that use new technologies. Key issues include (a) providing sufficient support to facilitate ongoing social interactions, (b) managing older adults' expectations, (c) providing encouragement without coercion, and (d) responding to individual needs. We conclude that it is important to report on ethical challenges incurred when evaluating social isolation interventions to inform future research in this important area.

Exploring ethical frontiers of visual methods

Visual research is a fast-growing interdisciplinary field. The flexibility and diversity of visual research methods are seen as strengths by their adherents, yet adoption of such approaches often requires researchers to negotiate complex ethical terrain. The digital technological explosion has also provided visual researchers with access to an increasingly diverse array of visual methodologies and tools that, far from being ethically neutral, require careful deliberation and planning for use. To explore these issues, the Symposium on Exploring Ethical Frontiers of Visual Methods was held at the University of Melbourne, Australia, on 4 March 2014. The symposium was hosted by the Visual Research Collaboratory, a consortium of Australian and Canadian visual researchers, with support from Melbourne Social Equity Institute, University of Melbourne. The symposium represented the culmination of a process to develop a resource outlining principles of ethical practice for visual researchers and ethics committee members, the Guidelines for Ethical Visual Research Methods, which were launched at the event. The Guidelines present a framework for considering ethical matters in visual research, distinguishing six groups of issues united by an overarching theme: confidentiality; minimizing harm; consent; fuzzy boundaries; authorship and ownership; and representation and audiences.

The individual in multiple interacting activity systems: IT-supported diabetes management

Purpose

– The purpose of this paper is to examine how pregnant women with type 1 diabetes integrate new information technology (IT) into their health management activities, using activity theory as an analytical framework.

Design/methodology/approach

– The research is a multiple case design, based on interviews with 15 women with type 1 diabetes who were pregnant, considering pregnancy, or had recently given birth. A thematic analysis, sensitised by activity theory, was used to analyse the data.

Findings

– Health management in this setting involves negotiations and contradictions across boundaries of interacting activities. Participants play an active role in managing their health and using new IT tools in particular ways to support their health management. Using new technologies creates both opportunities and challenges. IT-enabled healthcare devices and other information systems open up new treatment possibilities, but also generate new contradictions between interacting activity systems.

Research limitations/implications

– The research was conducted with a small sample in a specific context of health management. Further research is needed to extend the findings to other contexts.

Practical implications

– Healthcare providers need to accommodate a bottom-up approach to the adoption and use of new technologies in settings where empowered patients play an active role in managing their health.

Originality/value

– The findings highlight opportunities to further develop activity theory to accommodate the central role that individuals play in resolving inherent contradictions and achieving alignment between multiple interacting activity systems when incorporating new IT tools into health management activities.

Designing a mobile augmented reality tool for the locative visualisation of biomedical knowledge

Mobile augmented reality (MAR) may offer new and engaging ways to support consumer participation in health. We report on design-based research into a MAR application for smartphones and tablets, intended to improve public engagement with biomedical research in a specific urban precinct. Following a review of technical capabilities and organizational and locative design considerations, we worked with staff of four research institutes to elicit their ideas about information and interaction functionalities of a shared MAR app. The results were promising, supporting the development of a prototype and initial field testing with these staff. Evidence from this project may point the way toward user-centred design of MAR services that will enable more widespread adoption of the technology in other healthcare and biomedical research contexts.