Exploring Trade-offs in the Attitude towards Digital Technologies like

AAL: An Empirical Study on Conditionals for AAL Acceptance

Eva-Maria Schomakers

, Anne Kathrin Schaar

and Martina Zieﬂe

Human-Computer Interaction Center, RWTH Aachen University, Aachen, Germany

Keywords:

Technology Acceptance, Ambient Assisted Living, Ageing, Ethical Dilemmas.

Abstract:

Currently the digitisation entails a wide portfolio of technical solutions that are perceived to be useful for

care and support of older people in the future. In approaches like Ambient Assisted Living (AAL), different

(medical) technologies are merged to customizable concepts that offer support for an independent and safe

living at home. Based on the principles of ubiquitous computing health relevant services, e.g., measurement

of vital parameters, can be provided and take serious actions if necessary. Beside the challenge to integrate

the technological issues, the attitude of potential users is still not fully understood and far from predictable.

Especially when it comes to formation of a general attitude towards AAL technologies there is relatively little

knowledge about the trade-offs in the decision-making process. That is why this paper focuses on conditionals

and trade-offs in the acceptance process of AAL technologies. The chosen mixed-method approach consisting

of a qualitative study (n=10) and a questionnaire survey (n=177) revealed a set of inﬂuencing factors that are

related to privacy and situational and ethical conﬂicts.

1 INTRODUCTION

Would you decide for you mother to use AAL

in her home if the only alternative for her is

moving to a nursing home?

Would your decision change if she is against

AAL monitoring?

What if your mother suffers from dementia

and does not comprehend the consequences

of using AAL anymore?

With these questions in mind, this introduction fo-

cuses on the consequences of digitisation as well as

social and structural change processes to motivate the

investigation of the acceptance of Ambient Assisted

Living (AAL) technologies.

Currently the fundamental digitisation of our so-

ciety leads to massive technological progress in all

spheres of life. In the context of ageing, care, and

medical support these new technological opportuni-

ties offer solutions for challenges that arise from the

demographic change. Especially in western industrial

countries where ageing societies require solutions for

https://orcid.org/0000-0002-7650-2686

https://orcid.org/0000-0002-8643-6213

https://orcid.org/0000-0002-6105-4729

a declining number of caregivers, rare places in nurs-

ing homes, and an increasing amount of people with

need for support (Abbing, 2016), this potential should

be turned into value. Besides technological aspects,

the user’s attitude towards such technologies is an in-

tegral part of a successful implementation. Especially

in the context of AAL where the associated technolo-

gies become part of their users home environment the

acceptance of potential users is essential.

Therefore, the presented research aims to inves-

tigate conditions of AAL acceptance. Research has

already gained insights into pro and contra motives

for acceptance and use of AAL technologies (for a

review, see e.g., (Peek et al., 2014)), but so far the

conditions of usage and their impact on the decision-

making process are not fully understood. To under-

stand the complex process of AAL acceptance or re-

jection, more insights into the trade-offs that are per-

formed during this process are needed. That is why

our focus is primarily on conditions that are posed for

the use of AAL, particularly conditions regarding the

circumstances of AAL use as well as ethical aspects.

A mixed-method scenario-based approach was

chosen to reveal conditions for AAL acceptance with

focus on existing moral concepts of potential users

and their inﬂuence on AAL acceptance in the future.

Thereby, the integrated interview study is executed

Schomakers, E., Schaar, A. and Zieﬂe, M.

Exploring Trade-offs in the Attitude towards Digital Technologies like AAL: An Empirical Study on Conditionals for AAL Acceptance.

DOI: 10.5220/0009370700690076

In Proceedings of the 6th International Conference on Information and Communication Technologies for Ageing Well and e-Health (ICT4AWE 2020), pages 69-76

ISBN: 978-989-758-420-6

to identify a factor space to understand trade-off de-

cisions and ethical considerations holistically. The

questionnaire study (n = 177) aims to quantify the

inﬂuence of ethical concepts on the decision-making

process for or against AAL technologies.

With more knowledge about internal and social

trade-offs, emergence of decision dilemma, and rele-

vance of acceptance parameters , scope for action can

be opened up, especially at the societal level. This

knowledge can be used to stimulate a social debate

on how to deal with data protection in different areas

of life, or with patient empowerment in a healthcare

system 4.0 (Zieﬂe and Schaar, 2014). Currently the

time is right to integrate scientiﬁc ﬁndings to shape a

society that is more digital and networked than ever

before.

1.1 Technology Acceptance

Research on technology acceptance usually focuses

on the adoption or rejection of technological artefacts

with focus on a speciﬁc acceptance subject, object

and context (Lucke and Hasse, 1998). Triggered by

an increasing diffusion of information and communi-

cation technologies [ICT] in the working context in

the 1980s, the interest in predicting the acceptance of

these products increased massively. Established the-

ories are based on empirical studies that have identi-

ﬁed perceived ease of use and perceived usefulness to

be central predictors for the behavioural intention to

use ICT as the central element of acceptance (Davis,

1989). Models such as TAM (Davis, 1989), UTAUT

(Venkatesh et al., 2003) and their extensions are still

the central scientiﬁc basis of technology acceptance

research today. With the extensions of the models,

further factors were integrated which allow a more

holistic view, also in other areas than the work con-

text. Still, these established technology acceptance

models are criticised to not fully suit to special con-

texts like health technologies and AAL (Vassli and

Farshchian, 2018; Holden and Karsh, 2010).

1.2 Acceptance-relevant Factors in the

Context of AAL Technologies

The application of ﬁndings from technology accep-

tance research to the ﬁeld of AAL calls for a consid-

eration of its speciﬁc circumstances of use:

First: AAL technologies are usually conceptu-

alised for a special target group, often older adults.

Due to the special addressees it is essential to take into

account that the attitude towards technology might

change with increasing age (Niehaves and Plattfaut,

2014). Often the decrease of cognitive performance

and a lack of mental models are reasons for a decline

in willingness to use technology or learn new operat-

ing concepts. For health related technologies similar

patterns were identiﬁed (Arning and Zieﬂe, 2009) .

Second: Due to the special circumstances of use,

voluntariness as well as the inﬂuence of relevant

stakeholders (e.g. relatives, physicians) must be con-

sidered to include more relevant variables.

Third: At the same time we have to consider that

the attitude towards AAL or other medical related

technologies is heavily entangled with the perception

of digitisation in general and thus the whole public

debate about privacy and data security. Digital tech-

nologies, which are based on the collection, analysis,

and storage of large amounts of (personal) data, trig-

ger privacy concerns as users feel to have lost control

over their data (European Commission, 2015). More-

over for AAL, technologies are integrated into our

home environments, for many a safe haven of privacy

in our networked world. Therefore, privacy concerns

have been identiﬁed as one of the main barriers for the

acceptance of AAL (Peek et al., 2014).

Fourth: Ageing, care, and illnesses are intimate

aspects of life that touch the dignity of affected per-

sons. Besides cost savings, technological feasibility,

and the mere usability of technologies, the implemen-

tation of AAL should also place importance to the in-

dividual wishes, needs, and resentments of each se-

nior. Not enough is yet known about the conditions

regarding the circumstances and ethical dilemmas in

the adoption of AAL.

In summary, it can be said that AAL acceptance

has to be considered as a multi-factorial and multi-

criteria construct. Considering this, it is essential to

focus on the dynamics of individual, social but also

ethical inﬂuences and their interplay.

2 THE RESEARCH APPROACH

Addressing the above mentioned challenges and op-

portunities in the context of innovative medical tech-

nological approaches such as AAL, we have chosen a

two-step scenario-based empirical approach with fo-

cus on situational and ethical aspects of AAL use and

acceptability with the aim to better understand deci-

sions regarding the acceptance or rejection of AAL.

The included scenarios target trade-off decisions and

ethical questions.

First, in interviews, motives, barriers, and condi-

tions for users’ acceptance of AAL technologies are

assessed regarding AAL in general and within spe-

ciﬁc scenarios (see ﬁgure 1).

Second, this is supplemented by a quantitative as-

ICT4AWE 2020 - 6th International Conference on Information and Communication Technologies for Ageing Well and e-Health

Figure 1: Scenarios Used in Interviews and Survey.

sessment of AAL acceptance in general and in the

scenarios with n = 177 participants. In the following,

both studies are presented subsequently.

3 UNDERSTANDING

CONDITIONS FOR AAL

ACCEPTANCE

This section presents the qualitative study with fo-

cus on an initial understanding of conditions of AAL

acceptance including the presentation of the method-

ological approach, the sample, and the results.

3.1 The Methodological Approach

In 10 interviews, the participants’ opinions to AAL,

in general, and speciﬁc usage scenarios (see Figure

1) were explored. The interviews were conducted us-

ing a semi-structured guideline, were audiotaped and

transcribed verbatim. In a conventional content anal-

ysis (Hsieh and Shannan, 2005), categories were de-

rived for perceived barriers, beneﬁts, and conditions

for AAL acceptance. The interviews were conducted

in German. Selected quotes are translated to English

for publication.

The interviews started with a general explanation

of AAL technologies. A scenario-based approach was

used to set the participants in a situation of two sib-

lings who try to decide whether their mother should

use AAL technologies or not. Afterwards the par-

ticipants were asked to state their opinions and ex-

plain their reasoning. Questions targeted under which

circumstances the participants would accept AAL.

Thereafter, further scenarios were presented and eval-

uated by the participants.

Figure 2: Stated Motives and Barriers for the Acceptance of

AAL. Grey Numbers Indicate the Number of Participants

Who Mentioned This Topic.

After the interview, the participants were asked

to ﬁll out a short questionnaire containing questions

about demographic data, experiences with technolo-

gies and care, as well as technical self-efﬁcacy (Beier,

1999).

3.2 The Sample

The participants were acquired via the social network

of the authors with the aim to have a diverse sam-

ple regarding age, gender, and afﬁnity for technol-

ogy. 10 participants in an age range from 24 to 72

years (M = 45.5, SD = 15.6) (50% women) were in-

terviewed. Occupation ranged from students, engi-

neers, teachers, and nurses to pensioners. All partic-

ipants are regular smartphone users. Their technical

self-efﬁcacy varied between 3 and 6 (M = 4.4, SD =

1.1; on a scale between 1 (low) and 6 (high)). Eight

of ten participants have experienced close relatives to

have dementia – the topic of scenario 2.

3.3 The Results

This chapter presents ﬁndings about motives and bar-

riers of AAL use as well as conditions of using AAL.

3.3.1 Motives and Barriers

The participants mentioned multiple motives and bar-

riers for the acceptance of AAL, which are depicted in

Figure 2. Motives and barriers for the acceptance of

AAL have already been widely studied in qualitative

and quantitative empirical approaches (Peek et al.,

2014; Offermann-van Heek and Zieﬂe, 2019). There-

fore, the focus of this analysis lies on a short summary

and on the trade-off arguments between them.

Our results show again, that privacy is the most

often mentioned obstacle against AAL use. Inter-

estingly, some participants indicated not to have pri-

vacy concerns for two different reasons: Some partici-

pants stated, that there is so much data collection from

Exploring Trade-offs in the Attitude towards Digital Technologies like AAL: An Empirical Study on Conditionals for AAL Acceptance

other technologies that the additional data collection

would not matter. Another participant estimated her

own vulnerability to privacy risks as very low (the so-

called ’optimism bias’ (Baek et al., 2014)).

Most important beneﬁts are security and support

of family caregivers. One participant just stated that

“humanity will beneﬁt from it” (54, female) without

specifying beneﬁts.

One main result of the analysis is that the partic-

ipants clearly weigh between the barriers they see –

with privacy concerns being the most prominent one

– and the beneﬁts they perceive. The barriers and ben-

eﬁts are not evaluated separately but in relation and

in trade-off with other relevant ones (cf. following

quotes). This privacy-utility trade-off seems to be the

key to understand AAL acceptance and has been stud-

ied in other contexts under the label ’privacy calculus’

(Dinev and Hart, 2006).

Privacy-utility trade-off: "And if I were

the one to decide, I’d think about it: What

is more important? That some outsider will

tap into the data at some point, or that my

father will be monitored every day? Then,

despite my reservations, I would opt for the

technology." (62, female)

"I see the benefits more than the negative

aspects. The benefit is higher than anything

else I think." (34, female)

"Of course, it always depends on who you

disclose your data to. But if there is a

meaningful benefit, I am not that concerned."

(36, male)

3.3.2 Conditions for AAL Acceptance

As this paper focuses on the conditions that are posed

for AAL acceptance, especially in ethical dilemmas,

the results regarding conditions for AAL acceptance

are presented in detail in the following. For an

overview, the identiﬁed categories are depicted in Fig-

ures 3 and 4. Many conditions centre around the char-

acteristics and abilities of the technology. Here, one

large cluster regards privacy. Other conditions centre

around the circumstances of the senior and AAL ap-

plication and hence show a more situational perspec-

tive on AAL acceptance. Especially in the scenarios,

the opinion of the senior becomes an important con-

dition.

Technology Centred Conditions: Nine out of ten

participants stated that it is very important for pri-

vacy WHO HAS ACCESS TO THE COLLECTED DATA

and that the patient has the choice. Important is also

WHAT KIND OF DATA IS ASSESSED. For example,

one participants would accept only ’necessary’ data

to be collected; others reject videos. Another impor-

tant factor is the PURPOSE OF DATA USE. TRANS-

Figure 3: Identiﬁed Technology Centred Conditions for

AAL Acceptance (Grey Numbers Indicate the Number of

Participants Who Mentioned This Topic).

PARENCY and DATA SECURITY should be guaranteed

for AAL.

The following quotes of participants illustrate

these privacy related conditions:

Who has access to the data: "I’d be

worried that maybe strangers might have

access to the data. And I don’t think that’s

so nice. Only the children or the doctors or

someone like that should have access to it.

But no third party." (59, male)

What data is assessed: "There are no

videos of it. [...] At most I see some

physiological values [of my mother]. And

I think that’s okay. Or at what time she

went to the toilet. That’s not so bad." (36,

male)

Purpose of data use: "But not that it’s

being used for advertising purposes." (72,

male)

Closely related to privacy is the condition of CON-

TROLLABILITY OF THE TECHNOLOGY. The partici-

pants want to be able to switch off functions, decide

whom to grant access to data, and when to send data.

Controllability: "Of course, with the

restriction that I still have control over

[the technology] myself: That I can switch

it off, for example. Let’s take Alexa as

an example, it should not be the way that

she always listens. That’s exactly how it

shouldn’t be with the devices. They should

not always be active, but I should have

control over when they are switched off and

when the data is passed on and when not."

(45, male)

Further technology-related conditions are the RE-

LIABILITY OF THE TECHNOLOGY, especially that

emergency situations are detected reliably. AAL tech-

nologies like fall detection are also only useful if

HELP ARRIVES FAST IN EMERGENCIES. Addition-

ICT4AWE 2020 - 6th International Conference on Information and Communication Technologies for Ageing Well and e-Health

Figure 4: Identiﬁed Situation Centred Conditions for the

Acceptance of AAL (Grey Numbers Indicate the Number

of Participants Who Mentioned This Topic).

ally, a good TECHNICAL SUPPORT should facilitate

the interaction with the technology.

This technology centred perspective shows that

there are certain limits on what is acceptable, e.g., for

privacy invasions, even if the beneﬁt is perceived to

outweigh these concerns. Still, these limits vary be-

tween individuals and are ﬂexible dependent on other

trade-off factors.

Situation Centred Conditions: Looking from a sit-

uational perspective which was triggered by the spe-

ciﬁc scenarios, the OPINION OF THE SENIOR is im-

portant for most participants as well as NECESSITY

OF SUPPORT and AVAILABLE ALTERNATIVES.

It varies between participants and between scenar-

ios how important the acceptance of the senior is to

the participants (hypothetically in the situation of a

child deciding for the parent). Most participants want

to go along with the consent of the senior – even if

the senior’s dementia is so advanced that he/she may

not be able to fully understand the technology any-

more. For others, this depends on how much the se-

nior still comprehends (COMPREHENSION BY THE

SENIOR) and how strong resentments against AAL

are (FEELINGS OF THE SENIOR). For one participant,

the decisive argument is who is legally responsible,

e.g. as a legal guardian.

Feelings of the senior: "If it’s someone

who doesn’t mind it, then my opinion is still

positive. But if someone suffers from it and

feels unwell, one should refrain from the use

of AAL." (45, male)

Comprehension by the senior: "If she

doesn’t notice anything, she won’t mind."

(62, female)

Legal situation: "Since she then has

a legal guardian, who is not arbitrarily

decided on, I find it okay [if this guardian

decides regardless of her opinion]." (36,

male)

If the situation makes a support by AAL technol-

ogy more necessary (c.f., scenario 3), the security of

the senior is taken into account and weighed against

his/her acceptance. Important factors are the NECES-

SITY OF SUPPORT, e.g. how dangerous living alone is

for the senior, and whether there are ALTERNATIVES

for the care of the senior. Here again, trade-off deci-

sions are made between the beneﬁts of the technology

and the perceived barriers.

Necessity of support: "I’d rather do

it against her will and try to convince the

person than see her suffer alone or vegetate

at home." (24, female)

Available alternatives: "The mother can

no longer cope completely on her own. What

are the alternatives? Is there a nurse, can

she go into a nursing home?" (62, female)

Summing up the results, people trade-off between

perceived beneﬁts and barriers to decide on accep-

tance of AAL and pose certain conditions that need to

be fulﬁlled. Most relevant beneﬁts are the improved

security for the senior and the support for family care-

givers. As barriers, privacy concerns and the reliabil-

ity of the technologies are foreground. Using the eth-

ical dilemmas in the scenario-based approach empha-

sised not only technology centred conditions like pri-

vacy and reliability, but also a situational perspective.

The opinion of the potential senior user, the neces-

sity of support, and available alternatives are impor-

tant trade-off factors to be considered when deciding

about the use of AAL.

With the qualitative approach, we could identify

relevant factors of AAL acceptance. All participants

evaluated AAL very positively in the interviews and

most were also in favour of AAL in the scenarios. Be-

cause of the small sample size, these results need to

be conﬁrmed using a larger sample to make a general

statement. Therefore, in a second step, AAL accep-

tance in general and in the scenarios was quantiﬁed

with a larger sample.

4 QUANTIFYING AAL

ACCEPTANCE

Based on the interview results, a short survey was de-

veloped to assess opinions regarding AAL by a larger

sample. In the following, subsections the method-

ological approach is presented.

4.1 The Questionnaire

After an introduction to the topic AAL, the question-

naire started with demographics (age, gender, and ed-

ucation level). Since the focus of the study covers

technology acceptance and privacy is one of the fore-

Exploring Trade-offs in the Attitude towards Digital Technologies like AAL: An Empirical Study on Conditionals for AAL Acceptance

ground barriers, scales for technology commitment

(Neyer et al., 2012), which represents a general atti-

tude and acceptance of technologies, and privacy dis-

position (Li, 2014) are included, which represents the

personality trait of how much one values ones privacy.

In the main part, AAL technologies were intro-

duced and acceptance of AAL in general was assessed

on a 1-item scale. In the following section of the ques-

tionnaire, the scenarios (cf., Figure 1) were presented

and participants were asked again to indicate their ac-

ceptance for each scenario. All items were measured

using 6-point Likert Scales ranging from 1 (low) to 6

(high). The reliability of the scales technology com-

mitment and privacy disposition was conﬁrmed by

calculating Cronbach’s Alpha (α > 0.7).

4.2 The Sample

In total 177 participants completed the questionnaire.

Their age ranged between 15 and 81 years (M =

37.85, SD = 14.2). 63% were women. Participants

from all education levels were included with a major-

ity having a higher educational attainment (23.7% up-

per secondary education, 52% university education).

Our sample can be described as having an afﬁnity

for technology with a result that is slightly higher than

the mean of the scale (M = 3.89, SD = 0.77). Addi-

tionally ﬁndings show that privacy is a relevant topic

within our sample. With M = 4.17, SD = .87 the score

for privacy disposition is rather high.

4.3 The Results

The evaluation of acceptance for AAL in general and

within the three scenarios is depicted in Figure 5. The

overall result of the study revealed a quite high ac-

ceptance of AAL. In all scenarios, at least two thirds

evaluate AAL as acceptable.

A closer look on the results shows that 87.6% of

participants accept AAL in general. With a higher

perceived necessity for support (scenario 1) accep-

tance is still higher. Only 9% of the sample reject

AAL in this case. In contrast, when the potential se-

nior user is not able to comprehend the technology

and give consent to its use (scenario 2), AAL is the

least accepted. 31.6% reject AAL in that case. With

no alternatives of care available (scenario 3), AAL is

again more accepted. In this case, more than half of

the sample fully accepts AAL with only 12.4% reject-

ing this technology support as last resort.

These results show how the special circumstances

and situational conditions change the acceptability of

AAL. Still, the results are overall positive for AAL

despite the ethical conﬂicts.

5 DISCUSSION & CONCLUSION

The fact that we are currently facing a fundamental

digitisation within all areas of life leads to the neces-

sity to explore trade-offs in users attitude towards dig-

ital services and products. This aspect of understand-

ing users acceptance of technologies is becoming in-

creasingly important, especially considering the capa-

bility of digital technologies to mitigate global mega-

challenges such as the demographic change.

AAL solutions offer the potential to adequately

support the care of elderly or frail people in times

of declining resources in the health care system.

Through the integration of sensors, medical devices

and suitable interfaces users homes can become an in-

telligent living space that can take on tasks and offer

services in a targeted manner. However, the integra-

tion of sensors, intelligent data processing, and the ex-

ploitation of ubiquitous computing principles can also

lead to barriers for the acceptance by potential users.

Derived from gaps in the understanding of technology

acceptance, this paper was focused on the investiga-

tion of conditions for the acceptance of AAL tech-

nologies. Particularly, the chosen approach focused

on ethical dilemmas in the decision for or against

AAL technologies. To understand these situation-

related aspects and ethical dilemmas – which have

been mostly neglected in previous research on accep-

tance of AAL – is important for a comprehension of

the complex genesis of acceptance.

Looking at the results, it can be concluded that the

chosen mixed-method design was suitable to answer

our research questions and add to the understanding

of potential users’ decision for or against AAL tech-

nologies. In the qualitative interviews, we could, on

the one hand, replicate already known ﬁndings and,

on the other hand, add to a situational understanding

of acceptance conditions. Known beneﬁts, such as

security for the senior and the relief of relatives as

well as barriers like privacy concerns and the reliabil-

ity of the technologies were conﬁrmed. In addition,

our study highlighted the genesis of technology ac-

ceptance: It made it possible to observe participants

trading off beneﬁts and barriers to come to a ﬁnal de-

cision for or against AAL technologies. This trade-off

process is central to the acceptance decision.

With the use of ethically sensitive dilemmas, two

types of conditions were disclosed (technology- and

situation-related). Technology-related conditions like

reliability, controllability or type of data access have

already been discussed before (e.g., (Schomakers and

Zieﬂe, 2019)) and are here analysed in detail. As new

stimuli in the context of AAL acceptance, this study

put the spotlight on situation-centred conditions that

ICT4AWE 2020 - 6th International Conference on Information and Communication Technologies for Ageing Well and e-Health

Figure 5: Acceptance of AAL: Percentage of Participants with Agreement to Each Scale Point (N = 177).

have previously been neglected in research. These are

the opinion of the potential users, the necessity for

support, and the existence of alternatives.

In order to come to an acceptance decision, the

participants weighed positive and negative aspects of

AAL use against each other. These trade-off between

different conﬂicting factors, e.g., the support of the

senior by AAL vs. the seniors rejection of AAL vs.

available alternatives of care, are central to accep-

tance decisions. The ability to weigh the conﬂicting

arguments for ethical reasoning is developed in child-

hood and throughout life (Kohlberg, 1971). Consider-

ing the ongoing digitisation and corresponding ethical

dilemmas of technology use, education should sup-

port young people in learning to make these decisions

and to reach an advanced level of ethical reasoning.

The quantitative survey approach could conﬁrm

the positive attitude towards AAL technologies that

was also indicated by the interviews. Moreover, the

inﬂuence of situation and ethical dilemma was de-

picted by the shifts in acceptance between the sce-

narios and ethical dilemmas. Most accepted is AAL

when there is a high necessity for support. Resent-

ment by the senior using the technology reduces ac-

ceptance. But still even in this scenario, more than

two thirds of the participants would accept AAL tech-

nologies for their relatives. This result emphasises

how important a discourse about the application of

AAL in different situations and ethical dilemmas is.

Also, the relevance of available alternatives of care for

seniors highlights another aspect: for life in dignity

and according to individual standards and wishes of

each senior, the available alternatives of care should

not be reduced to technological options. It is the opin-

ion of the authors, that each senior should have alter-

natives to choose from how she wants to grow old and

be cared for. There will always be differences in what

each individual can afford. But in our opinion, seniors

with less monetary resources should still be able to

age in a self-determined and digniﬁed way.

In addition to the discussion of the ﬁndings and

their applicability, restrictions should also be pointed

out at this point: It is obvious that the study presented

can only be understood as a ﬁrst step. Future work

will have to go more into detail, consider the impact

of diversity factors, e.g., age or gender, and check

whether the trade-offs are the same in reality in con-

trast to our scenario-based approach. Additionally,

the acceptance and trade-offs regarding speciﬁc AAL

technologies in contrast to our general approach needs

to be assessed. It will also be necessary to examine to

what extent cultural differences have an inﬂuence on

the trade-off process.

All in all, we would like to use this study to

stimulate a differentiated, user-focused examination

of the acceptance process, including ethical compo-

nents which are an inherent part of people’s living en-

vironment. With the development of technologies like

AAL a discourse about the beneﬁts and drawbacks of

technology use should be aimed at. Despite other ben-

eﬁts, AAL should be used to improve the users quality

of life and enable seniors a life in dignity. What this

means and how this can be achieved is one task of

user-centred research. Only if we create a deep under-

standing of the acceptance genesis and the inﬂuences

and conditions for technology acceptance we will be

able to develop suitable technologies. If one has a

reliable state of knowledge on inﬂuencing factors, it

would be conceivable, for example, to advise affected

persons, relatives, but also professional stakeholders

Exploring Trade-offs in the Attitude towards Digital Technologies like AAL: An Empirical Study on Conditionals for AAL Acceptance

in the decision-making process in order to alleviate,

for example, the psychological burden on relatives as

a result of decisions.

In the context of cognitive decline or dementia,

concepts similar to those of living wills are conceiv-

able. Why should one not be allowed to decide in

advance on wishes and personal borders for the use

of digital assistive technologies? This would relieve

burdens from relatives and caregivers in times when

the senior can no longer decide on her own.

This research in the special context of AAL which

deals with intimacy, privacy, ageing and care high-

lights the importance to consider situational and eth-

ical aspects for the adoption of digital technologies.

However, this should not only be applied to AAL

technologies, but to digital technologies in general. A

constructive discourse on how to deal with new dig-

ital technologies is important to guide technological

developments and roll-outs. Profound understanding

of decision processes, inﬂuencing factors and condi-

tions is essential for this.

ACKNOWLEDGEMENTS

The authors would like to thank all participants that

participated in the survey as well as Anna Rohowsky

for her supportive performance.

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