Digital Inclusion of Nursing Home Residents: A Usability Evaluation
of the Digital Kiosk siosLIFE™
Carla V. Leite
1,2,3 a
, Daniel Carvalho
1,2,4
, Ivone Almeida
1,3,5
, Sofia Nunes
1,2,4
and
Ana Margarida Almeida
1,2 b
1
Department of Communication and Art, University of Aveiro, Aveiro, Portugal
2
Digital Media and Interaction Research Centre (Digimedia), University of Aveiro, Aveiro, Portugal
3
Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
4
Faculty of Arts and Humanities, University of Porto, Porto, Portugal
5
Research Centre on Didactics and Technology in the Education of Trainers (CIDTFF),
University of Aveiro, Aveiro, Portugal
Keywords: Digital Inclusion, Elderly Population, Active Ageing, Usability.
Abstract: The fast demographic ageing and technological progress are leading to a greater demand to develop digital
solutions that can foster communication, information, and socialization of the elderly population. In the past
decade, kiosks have been used to prevent digital exclusion and to promote the quality of life of this age group.
This paper analyses siosLIFE, a digital kiosk that is gradually getting attention from the public. The
methodology adopted consisted in a usability test with guided tasks, using a cognitive walkthrough and think
aloud protocol, with participants being residents from a nursing home. The results show that siosLIFE™
complies with some usability recommendations, but there are several improvements regarding the interface,
contents, integration of support systems, and assistive technologies that can be made.
1 INTRODUCTION
The use of digital services has changed drastically
since the early nineties, focusing on personal
entertainment, leisure and social contexts, instead of
being used solely for professional tasks (Lowgren,
2008). On the one hand, it allows and promotes new
sociability; on the other hand, it can lead to the
development of stereotypes and lead to exclusion
(Hamelink, 2000; Gorman and McLean, 2009). This
informal adoption plays an ever-increasing role, in
such a way that the global digital inclusion of all age
groups is currently viewed as a societal challenge.
The elderly population constitutes the age group with
the lowest usage of digital media (Keränen et al.,
2017), with this fact being attributed to different
factors, such as: the lack of opportunities to access
and becoming familiar with it, as a consequence of
economic, cultural and educational variables, the
inadequacy of digital platforms regarding
impairments, needs, and motivations of to this
a
https://orcid.org/0000-0001-5803-2775
b
https://orcid.org/0000-0002-7349-457X
particular age group and the physical and psycho-
sociological changes resulting from the ageing
process (Pfeil et al., 2009).
One of the main accomplishments of humanity,
strictly related to the progress in the health, education,
economic, political and social fields: the increase of
longevity; along with the decrease of the birth rate in
the last decades, are generating a worldwide
demographic aging phenomenon (Cabral et al, 2013;
Chau et al, 2012), especially noticeable in developed
countries (Nazareth, 2009). The World Health
Organisation estimates that, until 2050, the
proportion of people aged 60 or over will exceed 30%
in many countries (WHO, 2015).
Despite the fact of the aging process being
naturally universal, instigating changes in several
human dimensions, it is also individual, determined
by the unique experiences and particularities of each
individual, thus the very definition of the elderly
person becomes imprecise (Rocha, 2007). Three
relevant components can be highlighted in this
Leite, C., Carvalho, D., Almeida, I., Nunes, S. and Almeida, A.
Digital Inclusion of Nursing Home Residents: A Usability Evaluation of the Digital Kiosk siosLIFE
TM
.
DOI: 10.5220/0010349906930700
In Proceedings of the 14th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2021) - Volume 5: HEALTHINF, pages 693-700
ISBN: 978-989-758-490-9
Copyright
c
2021 by SCITEPRESS Science and Technology Publications, Lda. All rights reserved
693
process: physiological, social and psychological
ageing (Ferreira, 2013; Paúl, 2005).
Interactive systems should be able to respond to
different settings and support the behaviour of the
users, considering their struggles and needs; in
particular touch screen systems, widely used in kiosks
may constitute a promising and viable option
considering its capabilities (Moti et al., 2014;
Fonseca, 2011), for the elderly population. The
research regarding this subject, faces the elderly
population as part of the network society, promoting
their digital empowerment and inclusion (Wu et al,
2015).
In this study, an interactive touch kiosk was
analysed siosLIFE™, composed of a multimedia
screen, a Kinect sensor, and a card reader, designed
to be used in nursing homes.
Its main goal is to promote cognitive stimulation
and physical exercise to the elderly population,
through games, video calls, music, and drawing
(ScaleUpPorto, 2016). A usability study was
conducted in order to analyse the digital inclusiveness
of this platform.
2 CONTEXTUALISATION
In the Portuguese context, there is a statistical rise of
the population over 65 years’ old which, at the
moment, which is the reference for the chronological
age of the elderly population (WHO, 2002). In 2015,
amongst the Portuguese from 65-74 age group the
average of the computer and Internet usage was 29%
(INE, 2015). It should be noted that this official report
does not present data for people aged 75 or over.
However, it is possible to conclude from other
international studies, that this age group uses digital
media even less (Keränen et al, 2017). In addition to
the exclusion factors felt by the younger peers, they
are presented as barriers: the difficulty felt and the
lack of access skills, even if the technology is at their
disposal (Ferreira, 2013; Friemel, 2016). When a
population is deprived of digital literacy, there is a
gap in the appropriation of the language, tools and
conceptual models, which are important to
understand and to use digital media (Ferreira, 2013).
Moreover, changes resulting from the ageing process
may interfere with the ability to use digital media, so
it is mandatory to properly consider the specific needs
of the elderly population during the survey of
requirements and design of a digital system (Ferreira,
2013). The benefits of using digital media by the
elderly seem to focus mainly on social interaction.
According to Dias (2012), the elderly population
value communication with family and friends, along
with interaction between different age groups. The
promotion of intergenerational relationships can
occur through discussion groups, chat or email, as
well as recreational activities such as interactive
games. The opportunities for communication, access
to information and entertainment generated by digital
media, may motivate the elderly to leave home and
participate in society (Chaumon et al, 2014). They
can also help them to focus on the future and develop
and invest more in their own life projects, and also
support the performance of daily life activities, health
monitoring and safety (Azevedo, 2013; Ashok and
Jacko, 2009; AGE, 2008; Dickinson and Gregor,
2006; Blit-Cohen and Litwin, 2004).
The elderly population can be involved in the
development of these technological solutions, just as
it already happens with other age groups. Those tools
should be oriented towards respect for the individual,
protection and fulfilment of human rights, following
principles of universality, non-discrimination and
equality, in order to achieve participation and
inclusion (AGE, 2008).
3 siosLIFE
TM
DIGITAL KIOSK
As stated previously, digital platforms can help
fighting limitations resulting from ageing (Blaschke
et al., 2009), contributing to a better quality of life of
the elderly (Czaja and Lee, 2007). These are the two
aims of the siosLIFE
platform, through the
promotion of cognitive stimulation and physical
exercise with games, contact with family and
relatives, music broadcasting, drawing and painting,
access to news and religious contents, contextualized
with the preferences of the Portuguese audience
(ScaleUpPorto, 2016).
The project was born in 2014 as a result of the
efforts of two graduate students who applied for a
business ideas competition (ScaleUpPorto, 2016). In
2016, siosLIFE
won theHealth and Wellbeing
category in the project Porto 3i, which allowed the
company to work directly with some institutions in
Porto, so as to validate the system, and since then, the
impact of siosLIFE
is being measured and followed
by an evaluation commission from School of Health
Sciences - Polytechnic of Porto (ScaleUpPorto,
2016). The creators provided the data needed to the
authors of this paper, and the conclusions of this study
contribute for the new versions that will be released.
Bearing in mind the particularities of the siosLIFE
system, it was designed to be integrated mainly in
institutions such as nursing homes, day care and
HEALTHINF 2021 - 14th International Conference on Health Informatics
694
social centres. However, we consider that its
integration may be relevant in other places and
services, such as libraries, parish councils and other
areas where the elderly population is likely to use it.
When carrying out this study, the project was
available in 91 institutions, reaching around 1200
elderly people.
The terminal of the user platform consists of a
touchscreen, a card reader and a Kinect, which are
portable and resistant, as shown in Figure 1. Each user
owns a numbered card to log into their account. The
institution provides the cards and fills in their data
online. The software entirely depends on the internet
connection and has artificial intelligence, adapting the
level of the games to the user’s performance.
Figure 1: SiosLIFE™ digital kiosk.
4 PROCEDURE
siosLIFE
is divided into three user profiles with
specific functionalities: elder user, institution and
family. This study is focused solely on the first profile
created for the elderly people usage, called the ‘user’
profile from now on.
The authors of this study were granted access to
the siosLIFE
system, with the most recent software
version at that time, in an institutional context, in the
nursing home that promotes more initiatives of active
aging in Portugal. They had contact with it several
times, in order to analyse, evaluate and gather data.
After analysing the system, it is important to orient
and map out the scope of the study. Formulating the
starting points allows expressing what is intended to
be known, elucidated and better understood, having
in consideration clarity, viability, and relevance
(Quivy and Campenhoudt, 2008). Trying to attend
those criteria, the following question was drawn:
Does siosLIFE
comply with accessibility,
usability and inclusive design for the elderly
population?
A usability test was conducted in December 2017,
with two of the researchers present, one reading a
guideline of seven tasks, and the other observing and
taking notes. The set goal was to test with six
participants - three women and three men, who were
full-time in the facility and aged over 64. The average
age of the group turned out to be 77 years. Moreover,
some clinical conditions could be considered
exclusion criteria, since they were likely to influence
the interaction with the platform, but since the nursing
home is a small institution and only few elderly
individuals were interested and motivated to
participate in the study, their uniqueness were taken
in consideration during the tasks completion to avoid
their frustration. Three participants had visual
impairments, another one had cognitive deficit and
two others had mobility limitations (one of them
being a wheelchair user and with reduced mobility of
the upper limbs).
It was followed a think aloud protocol to be
possible to understand their thinking process and
experience during the interaction (Hartson and Pyla,
2012). Autonomy, Errors, Time and Path to complete
the task were assessed, along with Gestures, Body
posture, Facial expression, Comments and Reported
difficulties caused by motor, sensorial and cognitive
limitations, were the dimensions of the observation
grid.
To complete the first task, participants were asked
to: adjust the monitor, read the instructions showed in
the monitor, log in, confirm who was the user logged
in, and visualise the main menu, as illustrated in
Figure 2.
For the second task, it was requested to select the
Games menu, selecting the required game Smashing
bugs, illustrated in Figure 3, and play until the
objective was completed.
In the third task, participants were asked to go
back to the Main menu, select another game Picking
Figure 2: Part of Task 1.
Figure 3: Part of Task 2.
Digital Inclusion of Nursing Home Residents: A Usability Evaluation of the Digital Kiosk siosLIFE
TM
695
fruit that can be seen in Figure 4, then follow the
instructions to start and play until finishing the round.
Figure 4: Part of Task 3.
In the fourth task, participants needed to go back
again to the Main Menu and select Listen to music
option, then choose a specific artist they were familiar
with, and select a specific song, as shown on Figure
5. Moreover, they were requested to
increase/decrease the sound volume.
Figure 5: Part of Task 4.
To complete the fifth task, the participants were
requested to go back once more to the Main menu and
select the News option. Afterwards they had to
identify the category Sports and read a specific
section of the soccer news, as illustrated in Figure 6.
The sixth task consisted in going back to the Main
Menu once again, but this time to select the Call one,
then pick a specific contact and make the phone call,
as it is possible to observe in Figure 7.
And finally, the user had to log out, removing the card
and check the light changes in the NFC reader.
5 RESULTS AND DISCUSSION
All the participants completed the full set of tasks,
some autonomously and others with the help of the
researcher who was reading the tasks guideline when
requested.
The first and last tasks were related to the
interaction and customisation of the hardware of the
kiosk, so their results are grouped in Table 1.
Table 1: Task 1 and 7 results.
Completed
without
help
Completed
with help
Lo
g
in with car
d
4 2
Monitor ad
j
ustment 3 3
Lo
g
out removin
g
the car
d
1 5
The participant who stated that uses the computer
and internet daily in the nursing home, found it easy
and quick to log in/out using the card, doing it without
help and faster than the average. On the other hand,
this participant had difficulty adjusting the screen due
to upper limbs mobility limitations and weight of the
screen. The other five participants had to use both
hands to adjust the screen. Two participants who
completed the log in without help removed the card
and placed it back repeatedly, in order to check
changes in the hardware. They showed satisfaction
about the light feedback of the NFC reader. Two
participants, who stated that did not use informatic
systems autonomously, they were unaware that the
log in could be completed using a card. On the other
hand, one of the participants comment the fact that the
card should keep being personal since it is practical
to log in using it. One of the participants searched for
feedback on the monitor after the log out, mimicking
the log in behaviour.
In the second task, as shown in Table 2, all
participants played until the level was finished. Two
participants, who stated not to be familiar with
informatic systems, continued playing
enthusiastically, even after being asked to exit the
game because the level was already completed. It was
observed that half of the participants did not lean on
the wrist while playing.
Table 2: Task 2 results.
Completed
without help
Completed
with help
Open Games menu 5 1
Select Smashing bugs
g
ame
2 4
Play and complete the
level
6 0
Figure 6: Part of Task 5.
Figure 7: Part of Task 6.
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The navigation for five participants was done by
selecting page numbers, and requesting help to do it
properly, instead of using the Next page button. Only
one participant with visual impairment could not read
the game information status. Another participant that
is illiterate stated that he could not read the captions,
so it was only possible to identify the game from the
picture since the name was suggestive.
Four of the participants asked for help to change
the game (reach the games menu and select a specific
one - Picking fruit), as can be seen in Table 3.
Table 3: Task 3 results.
Completed
without help
Completed
with help
Change game 2 4
Follow start instructions 4 2
Play and complete 3 3
Furthermore, two participants needed help to
understand the game instructions, since they needed
to stand up and be 3 metres away from the Kinect.
Also, the game instructions did not mention the
interaction needed, i.e. how to pick the fruit that was
dropping from the top of the screen.
Every time this game is selected begins a trial
mode to calibrate the sensor, however it does not
change the interaction input when the user does not
move both hands together as a shell. The participant
with cognitive deficit showed to be unsure how to
proceed and confusion. The acceptance of the game
was high, all the participants enjoyed playing it. Half
of them used both hands since the beginning, with
two of them clapping when the fruit was virtually
close. The participant with severe mobility limitations
did not show frustration and tried different
interactions methods, even tried to stub the fruit with
his head. Half of the participants faced difficulties
because of the parallax effect, not knowing where to
find the apple in real space according to its virtual
representation. Moreover, four participants, including
those with visual limitations, could not read their
performance from a three metres distance.
During the fourth task completion, both
participants with visual impairments and one
illiterate, along with another participant, they all
could not associate the image of the Music menu,
moreover they hesitated between the image and the
caption as selection input of the singer and the song.
Two participants were able to understand how to
navigate in the Music area using the arrows, what may
be explained by their familiarity with the metaphor,
since they are mobile and computer users and the
applications/software/websites to listen to music
commonly follow the same approach, as can be seen
in Table 4.
Table 4: Tasks 4, 5 and 6 results.
Completed
without
help
Completed
with help
Change to
M
usic menu 2 4
Select artist and son
g
2 4
Increase-decrease volume 1 5
Chan
g
e to
ews menu 4 2
Change to Sports menu
and select soccer o
p
tion
4 2
Chan
g
e to Call menu 4 2
Do the call and hang up 4 2
When participants were asked to increase the
sound volume, only one managed to do it without
help. Another participant, despite identifying the
icons related to volume, did not differentiate the icon
of increase from the decrease volume. The other
participants approached the corner of the screen
where the volume buttons are located but could not
visualise them. This difficulty may be related to their
visual impairments, as well as due to the icons small
size and buttons location - lower part of the screen.
The fifth task, related to News, was the one
causing less general confusion. Four of them
recognised the categories on the menu and chose
accordingly. Nevertheless, it was noticeable a
common navigation error: returning too many times
on the “back” arrow, since it is always shown in the
same place and has no delay time for the interaction.
Curiously, one of the participants made the
gesture (without touching) to flick through the pages
and comment that would be a satisfactory input to be
developed. Only one participant showed preference
for reading the news in the digital format, instead of
on paper, while the others were neutral or stated they
preferred it on paper.
During the sixth task, related to making the call,
four participants completed the steps requested
without any help. The participant with cognitive
limitations did not recognise the phone icon as
clickable and with the call function, so the participant
looked at the table and searched for a phone. Only
after verbal explanation this participant could
complete the task.
6 CONCLUSIONS
The increase of life expectancy and the demographic
ageing constitute a growing reality, making it
necessary to promote actions focused on active
Digital Inclusion of Nursing Home Residents: A Usability Evaluation of the Digital Kiosk siosLIFE
TM
697
ageing and on the quality of life of the elderly
population. Digital media represent an effective
support for the elderly population, with potential
benefits in regard to the quality of life of this age
group. They can be used as a strategy to compensate
for some alterations that may arise from the ageing
process; thus, it becomes necessary to assess and
adjust them in order to meet the needs and skills of
the elderly population (Arch et al., 2009; Ferreira,
2013). It is therefore necessary to adopt an
interdisciplinary, innovative, and integrative
approach, such as gerontechnology, a field of study
that aims to develop and distribute products,
environments and technological services that
contribute to a better quality of life during the ageing
process, promoting health, social participation, and
independence of the elderly population (Fozard,
2001).
As societies have evolved, ageing has been the
object of several studies, with a clear investment in
policies that advocate it as an active and positive
experience. These predict continuous opportunities
and promote a lifestyle that maintains a healthy body
and mind, through good habits of nutrition,
involvement in interesting and intellectually
stimulating activities, maintenance of self-concept,
and maintenance of a social support system,
throughout the life cycle (Lima, 2004). It is also
relevant to mention that facilitated access to
interaction, information and communication,
informal learning through the exchange of
experiences and the confrontation of opinions should
be guaranteed (Rogers, 2004).
In this contexts, it was considered important to
analyse and assess the siosLIFE
platform, in terms
of usability and inclusive nature, so this study could
contribute to raise awareness to a set of problems
regarding the interface, interaction, content and
terminals so this pioneer project could be more
successful in its mission of promoting active ageing,
contribute for health and wellbeing of the elderly
population in nursing homes. The short time and
location set made it difficult to gather participants
with similar limitations into specific groups, so the
study could only gather results from a single, small
and heterogeneous group. A complementary
approach will be considered to help determine if the
results observed would also occur among users
presenting no or less severe limitations.
All participants managed to complete the tasks
and were very enthusiastic. On the whole, being aged
did not hinder their interaction with this technology
but it limited their performance, increasing the time
to fulfil the tasks. Further research related to active
aging through digital devices should be encouraged
and carried out, since it can benefit a wide number of
people.
ACKNOWLEDGMENTS
All authors would like to thank: the nursing home
Centro Comunitário da Gafanha do Carmo for
providing the opportunity for the data collection, and
all its residents who showed interest in participating
in the study; siosLIFE
entrepreneurs for the
technical support and the information provided; Paulo
Silva for his careful text revision; the two anonymous
reviewers for the most helpful comments; and the
HEALTHINF 2021 organisation committee for the
registration grant provided, and the Secretariat for
their diligent work; and, the University of Aveiro and
António Moreira in particular, for all the support
provided.
CVL and IA would like to acknowledge the fund
support through the Doctoral Programme in
Technology Enhanced Learning and Societal
Challenges (PD/00173/2013) by FCT, through their
research grants PD/BI/135241/2017 and
PD/BI/135221/2017, followed by doctoral grants
PD/BD/143077/2018 and PD/BD/143054/2018,
respectively.
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