A Multi-perspective View on AAL Stakeholders’ Needs

A User-centred Requirement Analysis for the Activeadvice European Project

Soraia Teles

1,2

, Diotima Bertel

, Andrea Ch. Kofler

, Stefan H. Ruscher

and Constança Paúl

1,2

Institute of Biomedical Sciences Abel Salazar, Department of Behavioral Sciences, University of Porto,

Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal

Center for Health Technology and Services Research (CINTESIS), Rua Dr. Plácido da Costa, 4200-450 Porto, Portugal

SYNYO GmbH, Otto-Bauer-Gasse 5/14, 1060, Vienna, Austria

Zurich University of Applied Sciences, Reidbach 8820 Wädenswil, Zurich, Switzerland

Keywords: AAL Stakeholder Ecosystem, User-centred Design, Participatory Design, ActiveAdvice European Project,

Stakeholder Requirements.

Abstract: This paper discusses the process of including a multi-perspective view on stakeholders’ needs into a specific

project, namely the European project ActiveAdvice. It highlights the factors supporting and hindering the

development and the implementation of the ActiveAdvice platform – as an integrated communication tool

targeted at bridging the gaps between AAL stakeholders by facilitating cooperation and information

exchange – regarding user requirements, preferences, acceptances and expectations. For this, a qualitative

study was carried out, taking into account not only the older adults as primary end-users but the whole AAL

stakeholder ecosystem. 23 semi-structured interviews with stakeholders of different groups – older adults

and their relatives, business as well as government representatives – were conducted. The results show that

even though different stakeholders can have conflicting needs, e.g. regarding online communication or

feedback, those can be integrated into the requirements analysis, thus including the whole stakeholder

ecosystem in the designing process. Furthermore, all three included stakeholder groups agree on the

importance of raising awareness of AAL solutions, technologies and products. In including not only

consumers but other secondary and tertiary stakeholders as well, ActiveAdvice has the chance to reach a

broader audience and thus raise public awareness of AAL.

1 INTRODUCTION

The emergency of political, economic, and social

challenges resulting from the current unprecedented

phenomenon of population ageing led many

countries to invest in policies that promote ageing in

place while maintaining healthier and independent

lifestyles (AAL Programme, 2014; Vasunilashorn et

al., 2012). Frequently, policies designed with this

purpose focus on the use of Information and

Communication Technology (ICT) and, more

precisely, on Ambient/Active Assisted Living

(AAL) technologies. Nevertheless, numerous

constraints have been found in the implementation

of AAL, namely associated with a lack of user-

centred design and low adherence by end-users

(Doyle et al., 2013; Michel & Franco, 2014; Peek et

al., 2014); business sustainability problems

(Ehrenhard et al., 2014); absence of interoperability

between systems (Balta-Ozkan et al., 2013;

Ehrenhard, et al., 2014; Perumal et al., 2011); and

limited evidence on interactions between technology

and society, on technologies’ impact and their cost-

effectiveness (Balta-Ozkan et al., 2013; Graybill,

McMeekin & Wildman, 2014). These, among other

constraints, suggest the need for better approaches

for conceiving new technological developments. In

particular, the requisite of involving multiple

stakeholders with heterogeneous competencies,

interests and needs in technological development

contributes to the abovementioned scenario. A close

involvement of end-users is challenging and can be

less successful when the user population is varied,

thus requiring researchers to find successful

strategies to motivate users and foment trust

(Leonardi et al., 2008; Queirós et al., 2014).

Older adults have been identified as the main

stakeholders of AAL technologies, yet including

also people with disabilities, cognitive impairments

or long-term diseases (Bygholm & Kanstrup, 2015;

Calvaresi et al. 2016; Clark & McGee-Lennon,

2011; Marschollek et al., 2007; Peek et al., 2016;

104

Teles, S., Bertel, D., Koﬂer, A., Ruscher, S. and Paúl, C.

A Multi-perspective View on AAL Stakeholders’ Needs - A User-centred Requirement Analysis for the Activeadvice European Project.

DOI: 10.5220/0006380701040116

In Proceedings of the 3rd International Conference on Information and Communication Technologies for Ageing Well and e-Health (ICT4AWE 2017), pages 104-116

ISBN: 978-989-758-251-6

van Hoof et al. 2011). Other stakeholder groups for

AAL frequently pointed out in literature include

relatives and informal caregivers such as friends and

neighbours; formal caregivers, health operators,

healthcare professionals, medical specialists

including GPs, community nurses, occupational

therapists, physiotherapists, and consultants; care

organizations and service providers; national

governments, local authorities and councils, decision

and policy makers, government officials; companies

producing or supplying the devices, methods or

infrastructure required for AAL technologies;

technology designers and developers, engineers and

researchers; insurance companies; NGOs and

voluntary groups; and mass media (Bygholm &

Kanstrup, 2015; Calvaresi et al., 2016; Clark &

McGee-Lennon, 2011; Cunha et al., 2013;

Damodaran & Olphert, 2010; Finn & Wright, 2011;

Kriegel et al., 2013; Peek et al., 2016; Reginatto,

2012; Ruscher et al., 2016; Sponselee et al., 2007;

van Gemert-Pijnen et al., 2011). It should be noted

that other groups of stakeholders can be a

combination of those categories, all with different

needs, expectations and goals regarding technology

and ageing.

Proposals to cluster this multitude of AAL

stakeholders or end-users into primary, secondary,

tertiary and even quaternary end-users were

advanced in the literature (Moschetti et al., 2013;

Nedopil et al., 2013). According to Nedopil et al.

(2013), primary end-users are older adults using

AAL solutions; secondary end-users are people

using AAL solutions for the benefit of a primary

end-user (e.g. informal caregivers); and tertiary end-

users are not directly in contact with AAL solutions

but contribute in organising, paying or enabling.

However, end-user categorization is not

straightforward, depending on the AAL solution

being discussed and other classifications can be

used. In the ActiveAdvice project

(http://project.activeadvice.eu), stakeholders are

divided into three groups in order to foster the actual

uptake and implementation of AAL solutions in

older adults’ home and living environment:

consumers (AAL2C), i.e. older adults and their

relatives, businesses (AAL2B), and governments

(AAL2G).

In a review about stakeholders’ involvement in

eHealth frameworks it was discovered that

differences between those frameworks include the

consideration of single or multiple stakeholder

groups; and the emphasis lies either on a user-

centred design approach – that takes mainly into

account the (primary) end-users’ needs – or in a

comprehensive overall approach that involves

different stakeholders and argues for a multi-

perspective view (van Gemert-Pijnen et al., 2011).

In resemblance to what was defended in past

researches (Dansky et al., 2008; Yusof et al., 2008),

the author concluded by defending a holistic

approach in the development of eHealth

technologies in order to favour its uptake and impact

(van Gemert-Pijnen et al., 2011). The current paper

is driven by said conclusion, deepening research

with the findings from the ActiveAdvice project

towards a holistic display of the highly complex

AAL stakeholder ecosystem.

2 STAKEHOLDER

INVOLVEMENT

It has been largely stated that a successful

implementation of AAL interventions depends on a

good understanding of stakeholders’ common and

divergent perspectives, since different agendas are

likely to affect the technology uptake (Bygholm &

Kanstrup, 2015; Clark & McGee Lennon, 2011;

Freeman, 1984; Lambooij & Hummel, 2013; Murray

et al., 2011). At European level, concerns were

expressed about the lack of suitable collaboration

and co-operation among stakeholders towards active

ageing and e-inclusion of older adults’ needs

(European Union Committee of the Regions, 2011).

In research conducted by Peek et al. (2016), all the

inquired stakeholders called for a change in attitudes

and policies towards a more collaborative approach,

targeted at bridging the gap between technologies

and individuals. These concerns find support in a

recent systematic literature review concluding that

the entire AAL ecosystem has been neglected in

solutions development (Calvaresi et al., 2016).

Applied to the field of AAL, the concept of

collaborative ‘ecosystem’ can be used to describe a

community of interconnected and interacting

entities, with the purpose of providing care and

assistance to older adults, who are also crucial

members of this complex socio-technical ecosystem

(Camarinha-Matos et al., 2015). By integrating a

diversity of actors, each with different value

systems, the AAL ecosystem forms a hybrid value

chain (Budinich, Reott & Schmidt, 2007). In fact,

the collaborative ecosystem rationale provides a

promising framework to orient new conceptual and

technological developments (Camarinha-Matos et

al., 2015).

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2.1 Participatory Development of AAL

Technologies

A growing number of studies have emphasized the

importance of a paradigm shift towards a

participatory development of AAL technologies,

which opens the design process to various

stakeholders, making it a collaborative effort

(Camarinha-Matos et al., 2015; Gudowsky &

Sotoudeh, 2015; Olphert et al., 2009). While this is

not the mainstream approach, there is a risk of

developing technologies and service delivery models

which are incapable of meeting users’ requirements,

and being adapted as these requirements change.

This was concluded in a recent systematic literature

review, noticing that existing AAL solutions seem to

be built on the available technology rather than on

stakeholders’ needs, attributes, consequences and

values (Calvaresi et al., 2016). This reflects a more

‘traditional’ techno-centric approach, opposed to a

socio-technical one, with the last mirroring the

ecosystem conception. Olphert et al. (2009) propose

the application of four theoretical approaches for the

design of digital assistive technologies: the socio-

technical approach (Cherns, 1976), where technical

and social components co-operate and co-evolve; the

participatory approach, where end-users participate

and engage in the decision-making in all stages of

the design process and not only in its use and

evaluation; the inclusive design, which recognizes

the need for including stakeholders with diverse

needs; and the information ecologies, where

stakeholders’ contexts are taken into account and

they are given the opportunity to share knowledge

and take decisions. An integrated approach should

then result in the development of a culture of

participation and engagement, promoting higher

levels of stakeholders’ influence and empowerment

as well as an enhanced sustainability of assistive

technology (Leonardi et al., 2008; Olphert et al.,

2009; Queirós et al., 2014; van Gemert-Pijnen et al.,

2011). It is widely agreed that both user-centred

design (UCD) and participatory design (PD) are

meaningful approaches in designing AAL solutions

and their importance is shown in a variety of

different studies (e.g. Lindsay et al. 2012; Mao et al.,

2005; Röcker, 2013). At the same time, however, a

lack of USD is observed (Peruzzini & Germani,

2014; Röcker, 2013).

Furthermore, most of the studies concentrate on

the integration of primary end-users, i.e. older

adults. Other stakeholders are considered very

seldom, even though secondary and tertiary

stakeholders can also be affected by AAL

technologies (McGee-Lennon et al., 2011). Whilst

this inclusion of older adults is a positive

development in the design of AAL technologies,

there is still a lack of involvement of other

stakeholders. As stressed by Leonardi et al. (2008),

stakeholders should not be treated as mere ‘servants’

of the technology development. Instead, according

to Freeman’s stakeholder theory (1984),

organizations hold a moral relationship with

stakeholders of creating for them as much value as

possible. In order to succeed and be sustainable over

time, organizations must keep the interests of

several stakeholders aligned and going in the same

direction (Freeman, 1984). In this line, Frooman

(1999) elicits the concept of stakeholder

management that can be seen as handling potential

conflicts stemming from diverging interests. Seeing

stakeholders’ mutual interests rather than their

opposite ones is challenging, since it’s not always

straightforward to find and accommodate all

stakeholders’ interests without trading off one

against another (Frooman, 1999). In a recent

systematic literature review it has been found that

solutions have been taken ‘patients’ (including older

adults) and ‘physicians’ much more into account

when compared to others stakeholders, thus

neglecting the entire AAL ecosystem (Calvaresi et

al., 2016). In this line, a recent study in the Austrian

AAL community shows that a comprehensive view

on the involvement of different stakeholders in AAL

projects is still missing; and while end-users are

involved in both requirements definition and

evaluation, other stakeholders like insurance

companies and public bodies are mostly left out

(Garschall et al., 2016). In fact, a growing number of

studies have emphasized the importance of a

paradigm shift towards a participatory development

of AAL technologies, which opens the design

process to various stakeholders, making it a

collaborative effort (Gudowsky & Sotoudeh, 2015;

Olphert et al., 2009).

A recent systematic literature review gives

account that besides the scarcity of studies on AAL

stakeholders’ convergent and divergent perspectives,

those studies don’t provide a complete

understanding of stakeholder’s positions and

relations (Peek et al., 2016). Therefore, before

addressing technical implementation issues, it is

vital to consolidate concepts bearing in mind the

mobilization and alignment of all the appropriate

stakeholders. In this paper, we discuss how a

specific project – ActiveAdvice – has been

approaching the goal of involving different

stakeholders in the process, illustrating results and

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conclusions drawn from it. The overall objective of

the ActiveAdvice project is to raise public awareness

on AAL solutions; and provide comprehensive and

comparable information for different stakeholder

groups. Hence, the aim of ActiveAdvice is to set up

a European-wide advisory and support platform that

brings together the broad range of available AAL

services, products, experts, users and related

technologies.

In line with what was argued above, for the

ActiveAdvice platform development the integration

of stakeholders at a very early stage of the project

was a precondition. Therefore, this exploratory study

was conducted with the aim of answering the

following question: Which are the factors supporting

and hindering the development and, in the ongoing

process, the implementation of the ActiveAdvice

platform, regarding user requirements, preferences,

acceptances and expectations? Research objectives

included: (i) to explore stakeholders’ attitudes and

motivations, as well as their experiences and

problems with care structures, AAL products and

services currently offered; (ii) to understand how

stakeholders currently deal with problems in those

domains, i.e. coping strategies; (iii) to explore the

potential role of ActiveAdvice in the overall care

taking and giving process; and (iv) to clarify

whether and in which form the different stakeholders

could pro-actively contribute to build up a

community around the ActiveAdvice software

solution. The user requirement engineering process

therefore built on semi-structured interviews with

selected stakeholder representatives in five countries

participating in the ActiveAdvice project. The end-

user groups we intend to discuss in this article are

the ActiveAdvice ‘clients’ who are, as mentioned,

older adults and their relatives (summarised as the

stakeholder group AAL2C); the enterprises in the

business field of AAL (AAL2B), and governmental

bodies defining policies and providing services in

the field of health and care (AAL2G).

3 METHODOLOGY

Semi-structured interviews were conducted in

Austria, Switzerland, Belgium, the Netherlands and

the United Kingdom, with a total of 23 interviews

being finally included in the study. This approach

was chosen because qualitative interviews allow a

better understanding and in-depth learning on how

and why people argue, what they expect and how

individual circumstances determine their reasoning.

This, however, means that the results cannot be

generalized nor quantified; nevertheless, they give

insights in the stakeholders’ different perspectives

and needs. In the discussion on AAL solutions and

products, the following overall AAL domains were

reflected: health-related services; home care services

(nursing); home & living services (household related

services, family support); leisure, culture, tourism;

activities & sports & mobility; safety, security;

obtaining and sharing information; and

communication (social interaction).

3.1 Participants and Recruitment

Based on a comprehensive narrative literature

review previously carried out – with the aim of

exploring the extent to which the scientific

production refers to different stakeholders within the

AAL domain, concerning their needs, requirements,

interests and relationships – the stakeholder groups

were specified and segmented as the subjects of this

study. The three previously mentioned groups

(clients, businesses and governments) and nine

subgroups were defined as described in the

following:

Clients subgroup 1 (C1) – Older adults investing in a

new home: These are active seniors (55 to 70) who

decide to move to a potentially smaller housing unit,

and who wish to think ahead and adapt the house to

future loss of autonomy and upcoming chronic

illnesses;

Clients subgroup 2 (C2) – Older adults who are

facing loss of autonomy and wish to live longer at

home. In contrast to C1 they are forced to look for

solutions.

Clients subgroup 3 (C3) – Children of older adults

who wish to help and assist their older parent(s).

This can be because of effective loss of autonomy,

but also to prevent further degradation;

Businesses subgroup 1 (B1) – Suppliers of AAL

solutions (products, services or a combination);

Businesses subgroup 2 (B2) – Suppliers of solutions

and services that could take a role as ‘active advisor’

in the field of AAL and the ActiveAdvice

ecosystem;

Governments subgroup 1 (G1) – Suppliers of

services or solutions. This can be under normal

market conditions (e.g. a provision of home

assistance services), or under subsidized schemes for

specific target groups;

Governments subgroup 2 (G2) – Suppliers of

services assessing needs of older adults and directing

them towards the right solution or service. This

segment could also play a role as ‘active advisor’,

depending on national and regional responsibilities;

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Governments subgroup 3 (G3) – Policy makers at

local, regional and national levels, linked to ageing,

living longer at home, health services and homecare

services;

Governments subgroup 4 (G4) – Public Services,

senior organizations, interest groups, care

cooperatives.

The older adults’ segmentation is based on the

interlink of the following factors: (i) chronological

age; (ii) life course events; (iii) health and

functionality status; (iv) relationship with ICT

(particularly internet use); and (v) AAL related

needs and desires. Since literature has shown that

relatives are often the decision-makers or facilitators

regarding the acquisition of AAL products and

services, they are considered as a third segment for

‘clients’. Similarly, the ‘governments’ target

audience was segmented first, differentiating

between institutions which are aimed at supplying

services or solutions to older adults, from policy and

decision-makers who design policies at several

levels (local, regional and national); second, by

distinguishing between organizations that only

supply services or solutions to older adults from

those that also provides advisory services, in

resemblance with the segmentation established for

businesses; moreover, an additional segment was

created to include public services, senior

organizations and other groups of interest. It is

noteworthy that during the data collection it was

verified that some participants reunited criteria to

cluster in more than one subgroup (e.g. older adults

who simultaneously assists a relative).

Potential participants under these stakeholders’

sub-groups were approached through convenience

sampling strategy. The 23 semi-structured

interviews included in the preliminary analysis

discussed here were evenly distributed among the

different stakeholder groups: clients (8), business

representatives (8), and members of local and

regional governments or representatives of end-user

organizations (7); furthermore, all subgroups are

represented with a minimum of 1 (C1, G3) and a

maximum of 6 (B1) participants.

With respect to the stakeholder subgroups,

different objectives have been set as follows:

- To understand the importance of specific features

we plan to include in ActiveAdvice platform (in

order to make a hierarchy and prioritization) and to

understand the attitude and readiness for ICT-based

advisory service (peer-to-peer, peer-to-supplier and

peer-to-expert) (C1, C2, C3);

- To understand business models and distribution

channels (B1, B2, G1, G2);

- To understand challenges and problems when

trying to face customers (B1, B2, G1, G2, G4);

- To understand the potential added value of

ActiveAdvice (B1, B2, G1, G2, G3, G4);

- To understand how customers are advised today

and to explore how ActiveAdvice can reinforce their

advisory services (B2, G1, G2, G3, G4);

- To learn what products and services are currently

recommend to customers (G1, G2, G3, G4).

3.2 Data Collection and Analysis

For the data collection, a study information sheet

was first developed, consisting in a general

introduction section, a stakeholder oriented

specification and a clarification of the overall aims

of the interviews. Additionally, with support in the

narrative literature review previously carried out,

three semi-structured interview guidelines were

developed, resulting in different but analogous

versions for ‘clients’, ‘businesses’ and

‘governments’, to suit the diverse stakeholders’

backgrounds. The following requirements were

taken into account when developing the interview

guidelines:

Clients (C1, C2, C3) – perceived ease of

use/design/functionality motivation in using ICT in

general; perceived usefulness of provided

information & offers; attitudes about ICT-based

feedback/advice; attitudes regarding online

purchase; use and familiarity with social media;

knowledge, use and access to AAL products and

services.

Businesses (B1, B2) – perceived ease of

use/design/functionality; business models (current and

projected); distribution channels/concepts; perceived

added value of ICT-based distribution; perceived

advising concepts, actual use, needs and

opportunities; inclusion of customer feedback; interest

on ActiveAdvice platform and role as active advisor.

Governments (G1, G2, G3, G4) – perceived ease

of use/design/functionality; national/organizational

strategies regarding ICT and AAL; advice strategies

used/services provided; existing offers and concepts;

portal use (i.e. integration of new media and

solutions for policy making and information

distribution); existing programs and activities

regarding AAL and ICT awareness.

Both study information sheet and interview

guidelines were made available in four languages

(Dutch, English, French, German) and the interviews

were carried out in the stakeholders’ country and

languages by each ActiveAdvice project consortium

member. Moreover, local and national specifications

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were taken into consideration when conducting the

interviews (e.g. role of health insurances versus

social security). All participants received the study

information sheet and gave informed consent. Each

interview took between 30 to 45 minutes and was

carried out either face-to-face in a suitable setting, or

using teleconference or telephone, according to

interviewees preferences and availability.

For the data analysis, a common matrix was used

by all partners. Relevant contents were transferred

into the Matrix Analysis and the material was

analysed by following both a horizontal and vertical

scheme, i.e. with an intra- and inter-interview

comparison. This strategy allows a better

understanding of individual assumptions as well as a

comparison of assumptions across cases. The

collected data was grouped in units of analysis

(categories), which were based on the issues that

emerged from a first reading of the interviews. The

final scheme was built as the new features emerged

from an exhaustive classification of the features.

During the codification process, the semantic units

were selected as registration units, more specifically

the theme (Bardin, 2011).

In order to determine the most prominent user

requirements and, therefore, the most pressing

factors supporting and hindering the ActiveAdvice

platform, interviews findings were critically

analysed and compared to the literature published in

this field and previously reviewed.

4 RESULTS AND DISCUSSION

The following overview addresses the preliminary

results from 23 conducted interviews. The most

significant contents approached by interviewees –

clients (Cs), business representatives (BRs) and

government representatives (GRs) – are presented

below. These findings support a better understanding

of different and common stakeholders’ motivations,

intentions, needs and expectations in the scope of

ActiveAdvice.

4.1 Attitudes Towards ICT and

Internet Use

4.1.1 ICT Skills, Interest and Internet Use

In general, Cs have demonstrated interest in ICT-

based solutions. However, not all interviewees in

this group reported to use internet regularly, neither

to consult the web for health-related information.

This constraint was also identified by GRs, who

have shown concerns about whether or not older

adults would be able to access an advisory platform

in the first place. Perceived barriers for access

include older adults’ lack of ICT skills or fear of

technology; and missing access to technological

devices or internet connection. GRs also stressed

that different profiles for older adults must be taken

into account, since those in need for geriatric help

are very unlikely to use the internet.

For those older adults who use internet,

particularly to gather health information, a preference

for receiving information (e.g. via newsletters) rather

than actively searching for it has been expressed. Care

consultancy is more often sought to be found in the

virtual reality; but the use of internet is often reduced

to a first consultancy rather than an ongoing advice.

Regarding social media as a mean to look and provide

information, neither Cs nor BRs see it as a privileged

or priority channel. On the one hand, Cs tend to see

social networks as a mean for social interaction rather

than a platform for learning or getting informed about

products and services; on the other hand, BRs tend to

report lack of resources or skills to invest in the use of

social networks, although they wish to do it in a later

stage. Furthermore, Cs reported to only rarely have

used online catalogues (not necessarily of AAL

solutions) so far. On this topic, BRs consider that

ActiveAdvice must avoid to become just another

online catalogue providing a selling service.

Main observations by Cs and GRs on these

topics are in line with the vast literature concluding

that to the rejection of technology by older adults

contributing factors are: poor ICT skills, fear of both

the technology itself and the learning process, and

lack of financial resources to purchase devices and

internet access (Doyle et al., 2013; Finn & Wright,

2011; Lewin et al., 2010; Marschollek et al., 2007;

Sanders et al., 2012). However, concerns with older

adults’ fear of technology were expressed rather by

GRs than the older adults themselves, thus reflecting

the stereotypes on older adults use of technology,

discussed in chapter 1. Also, it is documented a

recognition by older adults that barriers associated

with ICT skills will tend to decrease in future

generations (Reginatto, 2012). In this study, some

Cs report to not search for health information online.

However, searching for health information was

identified as the activity most performed online by

seniors (Marschollek et al., 2007).

4.1.2 Knowledge on AAL Products &

Services

The three groups of stakeholders interviewed tend to

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consider that ICT products and services are not well

known by older adults and welcomed a possibility to

raise awareness and give information. GRs stressed

that older adults either do not know where to find

solutions or they only start looking once they are in

need. Hence, GRs considered that the ActiveAdvice

project should target the awareness rising as much as

offering advice. In the BRs perspective, more and

better information on AAL solutions is welcome in

order to make those solutions widely known.

Evidence from the literature pointed in that same

direction when concluding by the lack of general

public awareness about AAL technologies (Balta-

Ozkana, et al., 2013; Begley, 2010; Lewin et al.,

2010; Reginatto, 2012). For example, caregivers had

perceived a lack of relevant information available on

AAL technologies and its benefits, or its availability

only when a point of crises is reached (Begley,

2010; Lewin et al., 2010; Reginatto, 2012); while

business stakeholders identified it as an obstacle to

introduce and succeed with these products and

services in the market (Balta-Ozkana, et al., 2013).

4.1.3 Online Promotion of AAL Services &

Products

BRs report to use internet predominately for

marketing. However, some also stressed they do not

use it at all, one of the reasons being the fact that

while online promotion reduce costs from a customer

perspective, this is not automatically the case for

businesses. Internet was seen as an important mean

for promoting more simple solutions: the less service

a product needs the more suitable it is to be promoted

online. In BRs perspective, internet loses relevance

with B2B promotions, since negotiations are

dependent on time, experience and trust building.

Similarly, GRs also seem to use multiple formats for

AAL products and services promotion, including

ICT-based promotion, but also other strategies (e.g.

events). GRs stress that regardless of the channel

used, promotion should include co-creation with older

adults, a focus on services rather than on

technologies, in order to guarantee solutions’ quality

and flexibility, i.e. allowing easy entry for companies

to promote services and products. As argued in the

theoretical explanation in Section 2, interviewees’

statements are aligned with the extensive literature

calling for a greater collaboration among

stakeholders. As postulated in the socio-technical

theory (Cherns, 1976), these participants seem to

endorse a co-operation and co-evolution of technical

and social components in the development of ICT-

based solutions.

4.1.4 Face-to-face (f2f) Contact

Both Cs and BRs have shown a preference for f2f

contact with each other. For clients, either buying or

getting advice online still competes with the f2f

experience which is perceived as more trustworthy.

For BRs, the f2f approach allows customers to get to

know and build a relationship with the company.

Moreover, complex solutions need to be adapted,

tested and introduced to settings, reason, as buying

online only without guaranteeing support and

service is perceived as too risky. GRs also stress that

in technological innovations, social interaction and

prevention of loneliness are important issues to

consider. In resemblance, literature produced on

usability evaluations have shown that solution’s

uptake can be hindered by older adults’ fear of

losing social interaction, f2f contact and becoming

lonely (Damodaran & Olphert, 2010; Novitzky et

al., 2015; Olphert et al., 2009; Siegel et al., 2014).

However, it has been reported that if technologies

are seen as facilitators of new social interactions

rather than a replacement of human interactions, this

apprehensiveness can be partially minimized (Lewin

et al., 2010).

4.1.5 Client-business Online Interaction

BRs have shown to be more receptive to online

interaction then Cs. While the former considered

online interaction with potential customers as very

important, the latter might experience businesses

directly communicating with them (e.g. via social

networks) as an invasion of their privacy. The

emergence of the privacy topic in this data collection

is not surprising, since older adults’ concerns about

security and privacy in ICT use – particularly when

health and well-being data is involved, or when it

comes to online transactions – has been extensively

mentioned in the literature (Clark & McGee-Lennon,

2011; Damodaran & Olphert, 2010; Nordgren, 2013;

Olphert et al., 2009; Peek et al., 2014; Wright,

2010). In spite of BRs’ more favourable positions

regarding online interaction, some deterrents were

also mentioned by these actors. In particular, it was

stressed that everyday activities are dominated by

the f2f and problem focused approach: BRs

appreciate to get in contact with their customers as

quickly as possible but they understand it as an

action-and-reaction communication pattern.

Moreover, they stress that communication must not

take place in a ‘public sphere’, a statement also

extended to feedback and advice.

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110

4.2 Feedback and Advice in an Online

Environment

4.2.1 Trustworthiness and Usefulness of

Online Feedback

Most important for Cs is feedback about AAL

solutions, preferably by other end-users. Cs tend to

value feedbacks offering a description of the product

or service (e.g. price, functionalities) and personal

experiences with those; information on the service

providers; information on the website or platform

presenting the solutions; and information on the

feedback giving person. Cs declare to value family

members’ and friends’ comments for evaluating

whether or not a product or a service is reliable,

useful or trustworthy. However, even with feedbacks

from reliable customers or experts, trust is still the

biggest concern for them when accessing the web –

thus, the f2f experience is preferred. In the position

of giving feedback themselves, Cs report to be

driven by negative incentives such as complaints

about unfulfilled expectations. For BRs, these

negative incentives are a reason to be hesitant about

feedback in a ‘public sphere’. When customers

interact, and discuss their positive and negative

experiences, companies of course run the risk that

too much negative feedback starts to affect the

promotion of a product. However, they also have the

chance to learn first-hand about how their product or

service is perceived and accepted in the market

(Youngtae & Thoeni, 2016). Nevertheless, for BRs,

whereas real user testimonials (on the own website

or on a meta-site) are welcomed, they doubt the need

for and usefulness in general of online customer

feedback.

Moreover, businesses typically do not

appear on websites where customers can leave their

reviews. Furthermore, Cs’ willingness to provide

feedback can be dependent on the age-generation.

Literature in that respect clearly differentiates

between Millennials and Baby Boomers, with the

latter preferring to give feedback in a f2f rather than

in the virtual reality, especially as the privacy cue

has primacy for them (Obal & Kunz, 2013). Yet, in

general, interviewed Cs expressed interest in

becoming more active and successful users as well

as commenters in a secured, easy-to-use

environment.

4.2.2 Neutrality as Precondition for Advice

In general, both Cs and BRs considered advice as an

important and needed service. Cs demonstrated

willingness to learn about the best products or

services for them. However, if asking for advice is

something that Cs would like to do, at present it

seems that they are not doing it. Lack of trust in

online-advice is one of the reasons invoked for that.

In this line, both GRs and BRs stress that quality of

data and neutrality are important features for them to

get involved, and for clients to trust in online advice.

Moreover, both GRs and BRs highlighted that when

providing advice, it is important to understand what

the customer really wants and thereupon offer them

a customized, specific support, and one-to-one

advice for a perceived added value. Regarding the

question of who should provide advice, BRs

consider that, on the one hand, advice is best given

by those who sell a product, but on the other hand,

becoming themselves advisors was not seen as an

option due to a lack of resources and the disruption

of the neutrality condition. Therefore, a ‘neutral’

body or a virtual agent is suggested to perform this

task. GRs suggest that a panel of older adults could

test products and the platform itself, and, similarly,

volunteers could act as advisors on the platform.

When it comes to digital and virtual advice, it

was argued that use of virtual agents, particularly in

the e-commerce context, is especially relevant to

older adults due to the expected decline on physical

and cognitive abilities (Chattaraman et al., 2011).

Studies have supported the strong impact of virtual

agents in the context of online-shopping, arguing for

their relevance to address age related navigational

needs (Rickel & Johnson, 2000). However, building

trust is challenging, depends on different conditions

and is contradictory (Bart et al. in Obal & Kunz,

2005). For example, consumer cohorts have

different trust understandings and thereby reference

systems; furthermore, peer-endorsement seems to

have different impact on consumer behaviour

depending on the national context (Bart et al. in

Obal & Kunz, 2005). Moreover, trust is dependent

on web site-interface variables; while provider's

brand strength, online expertise or web site

familiarity were less influential (Bart et al. in Obal

& Kunz, 2005). The presence of provider advice,

privacy cues and community features have higher

influence (McKnight et al., 2002; Liang & Lai, 2002

in Obal & Kunz, 2005).

4.2.3 AAL Solutions, Platform Features and

Usability

When questioned about the AAL services and

products most relevant for end-users, GRs stressed

that platforms must include products that take the

older adults’ needs and their physical and cognitive

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ageing process into account. Both Cs and GRs

referred that besides offering information on AAL

products and services and their suppliers, the

ActiveAdvice platform should contain information

about social services, care organizations and other

informative websites (e.g. for dementia, epilepsy).

Moreover, Cs expected the inclusion of so called

‘flow charts’ in the platform, as a tool to help older

adults solving problems or improving situations step

by step, as well as guidelines for ordering products

online.

When reflecting on the features that a platform

like ActiveAdvice should have, both Cs and GRs

stressed the importance of inclusive design.

Furthermore, a clear communication strategy and a

simple and a well-structured web-layout can help to

build trust. This is shown by Ruscher et al. (2016),

clearly stating that mistakable wording can lead to

negative emotional reactions. It was suggested by

GRs that one possibility to address the problem of

accessing online information is to design the website

in a way that allows neatly formatted printouts that

can be easily read. Cs highlighted platform features

influencing its use, such as the website organization;

used colours; the amount of information included;

and, as a critical factor, security and safety. The

security topic was highly valued by BRs, as it was

the neutrality one, i.e. the platform needs to

guarantee impartiality in the presentation of products

and services. Neutrality was also valued by GRs,

who suggested that the quality standards should be

transparent, such as the criteria and guidelines on

how products and services are going to be evaluated.

BRs have suggested that specific functionalities

of ActiveAdvice must include videos (with

comments by developers and users) and ‘qualitative

photographs’. Both should help to best describe the

solution as well as its functionality; and also include

eExpert stories. Moreover, testimonials for the

platform itself and not only for the single services

can be a way to assess and improve platform

reliability. BRs also mentioned that both the

products and the platform need to be certified as this

is a guarantee for quality management; and thus, a

valuable and reliable offer – for both the businesses

and the customers. Additional features such as the

inclusion of a telephone number by country and the

presentation of the platform administration were

considered by GRs as relevant for raising the

website’s credibility.

4.2.4 ActiveAdvice Perceived Added Value

All stakeholder groups appear to anticipate and

recognize positive effects of a European advisory

platform. GRs value the potential benefit of the

ActiveAdvice platform for experience exchange

between organizations; in stimulating older adults to

use ICT solutions; in offering their own product(s) or

specific assistance on local municipal/communal

level; and, most of all, in offering information on the

AAL market, such as data on suppliers and services

and feedback from end-users that could feed into

evaluation process for procurement. In addition, it

could possibly serve as basis for policies for care for

older adults. On the other hand, ICT support was

considered helpful for businesses promoting AAL

solutions, with interoperability with other systems

being seen as an opportunity. A platform such as

ActiveAdvice was also seen as posing an opportunity

for smaller suppliers to promote their products.

Nevertheless, some BRs have raised concerns and

shown reluctance in contributing to the platform due

to a potential risk of competition. Also, for the

occurrence of the benefits pointed above, both GRs

and BRs stressed that ActiveAdvice must guarantee

quality of products and services, as well as security,

and, as already mentioned, neutrality. Those are

baseline conditions for these stakeholder groups to

let their products and services being promoted

through the platform and to promote the platform

themselves. BRs asked for transparency with respect

to the business model and responsibilities and

expressed that they need to make sure that the

platform is accepted and reliable. GRs suggested that

creating a trustworthy quality label customers

ensures reliability and trust; as well as, mobilizing a

wider support from governments, large associations

with high reputation, suppliers and local persons

providing services (e.g. general practitioners). The

involvement of municipality and local authorities

was considered by GRs as central to better promote

the platform and to increase trust in it among older

adults.

The above analyzed interviews gave valuable inputs

on the stakeholders’ attitudes – towards the AAL

products themselves, the web communication within

a community and web services which will be

provided in ActiveAdvice. Multiple and bidirectional

relationships among the above discussed categories

can be identified. At a baseline level, the lack of

public awareness about AAL solutions, stressed by

all groups of stakeholders, influences the interest

towards those solutions, since its benefits are not

identified. However, interest in ICT-based solutions

is not the only attitudinal factor influencing its

uptake, as demonstrated by the group of Cs, who, in

spite of showing interest in those solutions, have

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shown preference for f2f contact. This preference

seems to be, in turn, related with a lack of trust in

web communication and services, namely in online

advice and purchase; with worries regarding privacy

breaks and loss of social interaction. From the data

gathered, trust emerged as a key attitudinal factor for

AAL solutions uptake as well as for the use of

ActiveAdvice platform. It seems to influence the

interest in using AAL solutions, as well as the

preference for f2f contact demonstrated by

stakeholders (Cs, BRs). On the other hand, trust

seems to be influenced by the communication

strategy and web-layout; by the perception of

neutrality regarding the information provided and the

individuals providing that information; as well as by

the perceived quality of that information (Cs, BRs,

GRs); by the access to real users’ feedback (Cs); and

by the perception that feedbacks are ‘fair’, i.e. not

exclusively guided by negative incentives (BRs). In

spite of the added value of an European advisory

platform such as ActiveAdvice – that is recognized

by all stakeholders - trust, in the AAL products, in

the advice platform, as well as in the stakeholders

belonging to the AAL ecosystem – is a key aspect to

consider when developing the project.

5 CONCLUSIONS

Stakeholders hold different backgrounds and

experiences, and further research is required to

understand their needs and how divergent or

congruent those needs might be. A planned and

systematic stakeholder engagement must be

promoted as a foundation for raising stakeholders’

awareness, gathering requirements, building a

participative process around development and

making informed decisions, and building consensus,

namely around the stakeholders’ needs and

requirements on AAL technologies.

The results of this paper demonstrate that there

are parallels as well as contradictions in the different

stakeholders’ needs; and that the inclusion of these

different perspectives and needs is worthwhile. As

stressed by Camarinha-Matos et al. (2015), members

in an ecosystem hold different value systems, e.g. a

business-oriented system or a social-oriented

system. Nevertheless, beyond the different values

systems, those actors share one common goal:

providing better services for older adults and foster

social innovation. Despite the difficulties mentioned

in literature as pointed out in Section 2,

ActiveAdvice has shown that it is feasible to include

different stakeholders’ needs into a requirement

analysis, thus adding a new perspective on the

involvement of a whole stakeholder ecosystem.

The scientific literature in AAL field is prolific

in calls for greater collaboration and co-ordination

among stakeholders in order to overcome or

minimize the digital divides currently separating

many older adults from mainstream European

society. While stakeholders in general have been

aware of this digital divide for a long time, a limited

understanding of older people’s technology-related

needs still prevails. This is related to a scarce

collaboration and co-ordination of stakeholders in

order to meet those needs (Wright, 2010). This call

for multi-stakeholder partnerships comes not only

from the academic stakeholders but also from other

major interested parties in AAL fields, such as

industry and CSOs, as well as governments, with

several policy documents, European Commission

(EC) communications and research reports being

published in that matter (Finn & Wright, 2011;

Wright, 2010).

A hesitant but existing AAL ecosystem

development can be identified; yet, we still speak of

prototypes rather than success stories. Literature

analysis has confirmed that the development of a

platform that supports both sharing of information,

knowhow and products, and building up networks

between different stakeholders is considered to be a

challenging task. As platforms annul the typical f2f

interaction in health care, the users’ acceptance of it

has to be a priority concern of developers and

promoters. In a next step, therefore, the identified

stakeholder needs, interests and expectations will be

transferred into requirements and finally into

measurable qualities. User-centred requirements

engineering methodology involves users right from

the beginning, allowing them to give feedback to

developers and researchers about their requirements,

preferences, acceptances and expectations. For the

ActiveAdvice platform development, it was essential

to integrate different stakeholders at a very early

stage of the project. The results of these efforts are

the foundation for decisions in specification of

technical requirements, the creation of content

structures, decision support logics and service

module functionalities. Especially on the topic of

personalized feedback and advice, ActiveAdvice

will provide added value as there are only few

examples to learn from and it is not yet common to

provide personalized feedback and advice.

Considering the interviewed Cs’ value of feedback,

this is an important aspect.

For ActiveAdvice, taking a stakeholder approach

can contribute to the identification of groups of

A Multi-perspective View on AAL Stakeholders’ Needs - A User-centred Requirement Analysis for the Activeadvice European Project

113

actors who have a legitimate stake in the process of

introducing, especially the software solution and the

advisory network, and result in better choices in the

design process and system development. It can

elucidate about the interdependencies between

technology, people and their sociocultural

environment (Van Gemert-Pijnen et al., 2011).

Ideally, stakeholders should be aware of these

complex relationships, thus contributing to the

awareness of each stakeholder about the expected

effects for other stakeholders. This can possibly

broaden stakeholders’ perspectives and lead to more

successful implementations of AAL technologies in

general.

Based on this qualitative encounter,

ActiveAdvice could in a next step promote a ‘AAL

Barometer’, i.e. a quarterly online survey, which

helps to learn and even better understand the varying

and changing interests of potential stakeholders to

finally best serve their interests; and thus, adapt the

platform according to their needs.

ACKNOWLEDGEMENTS

The authors would like to acknowledge the co-

financing by the European Commission AAL Joint

Programme and the related national agencies in

Austria, Belgium, the Netherlands, Portugal,

Switzerland and the United Kingdom.

AUTHOR’S NOTES

The narrative literature review mentioned

throughout the paper will be the focus of discussion

on a separate paper. The interview guidelines used to

gather the interviews are available upon request to

the authors.

REFERENCES

AAL Programme (2014). Stategy 2014-2020 for the Active

and Assisted Living Programme. Retrieved from:

http://www.aal-europe.eu/wp-content/uploads/2015

/11/20151001-AAL-Strategy_Final.pdf

Balta-Ozkan, N., Davidson, R., Bicket, M., & Whitmarsh,

L. (2013). Social barriers to the adoption of smart

homes. In Energy Policy, 63, 363-374.

doi:10.1016/j.enpol.2013.08.043

Bardin, L. (2011). Análise de conteúdo. Lisboa: Edições

70.

Begley, P. (2010). 360 degrees of care. In Quality in

Ageing and Older Adults, 11(4), 47-50.

doi:10.5042/qiaoa.2010.0717

Budinich, V., K. M. Reott, and S. Schmidt. 2007. Hybrid

Value Chains: Social Innovations and the

Development of the Small Farmer Irrigation Market in

Mexico. In Business Solutions for the Global Poor:

Creating Social and Economic Value, edited by V.

Kasturi Rangan, J. A. Quelch, G. Herrero, and B.

Barton. San Francisco, CA: Jossey-Bass.

Bygholm, A., & Kanstrup, A. M. (2015). The Living

Challenge of Ambient Assisted Living – a literature

review. In Proceedings of the 13th Scandinavian

Conference on Health Informatics, June 15-17, 2015,

Tromsø, Norway.

Calvaresi, D., Cesarini, D., Sernani, P., Marinoni, M.,

Dragoni, A. F., & Sturm, A. (2016). Exploring the

ambient assisted living domain: a systematic review.

In Journal of Ambient Intelligence and Humanized

Computing. doi:10.1007/s12652-016-0374-3

Camarinha-Matos, L. M.,, Rosas, J., Oliviera, A. I., and

Ferrarda, F. (2015). Care Services Ecosystem for

Ambient Assisted Living. In Enterprise Information

Systems, 9(5-6), 607-633.

Chattaraman, V., Kwon, W.-S., Gilbert, J. E., and Shim,

Sh. (2011). Virtual agents in ecommerce:

representational characteristics for seniors. In Journal

of Research in Interactive Marketing, 5(4), 276-297.

Cherns, A. (1976). The principles of sociotechnical

design. In Human Relation, 29 (8), 783-792.

Clark, J., & McGeeLennon, M. (2011). A stakeholder

centred exploration of the current barriers to the

uptake of home care technology in the UK. In Journal

of Assistive Technologies, 5(1), 12-25.

doi:10.5042/jat.2011.0097

Cunha, D., Trevisan, G., Samagaio, F., Ferreira, L.,

Sousay, F., Ferreira-Alves, J., & Simoes, R. (2013).

Ambient Assisted Living Technology: Comparative

perspectives of users and caregivers. In 2013 IEEE

15th International Conference on e-Health

Networking, Applications and Services (Healthcom

2013). doi:10.1109/healthcom.2013.6720635

Damodaran, L., & Olphert, W. (2010). User Responses to

Assisted Living Technologies (ALTs) — A Review of

the Literature. In Journal of Integrated Care, 18(2),

25-32. doi:10.5042/jic.2010.0133

Doyle, J., Bailey, C., Ni Scanaill, C., & van den Berg, F.

(2013). Lessons learned in deploying independent

living technologies to older adults’ homes. In

Universal Access in the Information Society.

doi:10.1007/s10209-013- 0308-1

Ehrenhard, M., Kijl, B., & Nieuwenhuis, L. (2014).

Market adoption barriers of multi-stakeholder

technology: Smart homes for the aging population. In

Technological Forecasting and Social Change, 89,

306-315.

Finn, R. L., & Wright, D. (2011). Mechanisms for

stakeholder coordination in ICT and ageing. In

Journal of Information, Communication and Ethics in

Society, 9(4), 265-286. doi:10.1108/

14779961111191066

ICT4AWE 2017 - 3rd International Conference on Information and Communication Technologies for Ageing Well and e-Health

114

Freeman, R. E. (1984). Strategic Management: A

Stakeholder Approach. B. The politics of stakeholder

theory: Some future directions. In Business Ethics

Quarterly, 4(4), 409-421.

Frooman J. (1999). Stakeholder influence strategies. In

Academy of Management Review, 24(2), 191-205. doi:

10.5465/AMR.1999.1893928

Garschall, M., Neureiter, K., Hallewell, J., Bertel, D.,

Krainer, D., Moser, C. 2016. Investigating user-

centered design practices in Austrian AAL projects. In

Proceedings of Smarter Lives.

Graybill EM, McMeekin P, Wildman J. Can aging in place

be cost effective? A systematic review. In PLoS One.

2014;9(7):e102705. doi:

10.1371/journal.pone.0102705

Gudowsky N., Sotoudeh, M. (2015). Citizens’ visions on

active assisted living. In Studies on Health Technology

and Informatics, 212, 43-9.

Kriegel, J., Schmitt-Rüth, S., Güntert, B., & Mallory, P.

(2013). New service development in German and

Austrian health care – bringing e-health services into

the market. In International Journal of Healthcare

Management, 6(2), 77-86. doi:10.1179/

2047971913y.0000000034

Lambooij, M. S., & Hummel, M. J. (2013). Differentiating

innovation priorities among stakeholder in hospital

care. In BMC Medical Informatics and Decision

Making, 13(1), 91. doi:10.1186/1472-6947-13-91

Leonardi, C., Mennecozzi, C., Not, E., Pianesi, F., &

Zancanaro, M. (2008). Getting older people involved

in the process of ambient assisted living research and

development. In Proceedings of the International

Symposium of Gerontechnology ISG08, 7(2).

doi:10.4017/gt.2008.07.02.089.00

Lewin, D., Adshead, S., Glennon, B., Williamson, B.,

Moore, T., Damodaran, L., & Hansell, P. (2010).

Assisted living technologies for older and disabled

people in 2030. In Annexes to a draft final report to

Ofcom. Plum Consulting, London. Retrieved from:

https://www.ofcom.org.uk/__data/assets/pdf_file/0033

/44889/assistedannexes.pdf

Lindsay, S., Jackson, D., Schofield, G., & Olivier, P.

(2012, May). Engaging older people using

participatory design. In Proceedings of the SIGCHI

conference on human factors in computing systems.

ACM, 1199-1208.

Mao, J. Y., Vredenburg, K., Smith, P. W., & Carey, T.

(2005). The state of user-centered design practice. In

Communications of the ACM, 48(3), 105-109.

Marschollek, M., Mix, S., Wolf, K.-H., Effertz, B., Haux,

R., & Steinhagen-Thiessen, E. (2007). ICT-based

health information services for elderly people: Past

experiences, current trends, and future strategies. In

Medical Informatics and the Internet in Medicine,

32(4), 251-261.

McGee-Lennon, M. R., Wolters, M. K., & Brewster, S.

(2011, May). User-centred multimodal reminders for

assistive living. In Proceedings of the SIGCHI

Conference on Human Factors in Computing Systems.

ACM, 2105-2114.

Michel, J. & Franco, A. (2014). Geriatricians and

Technology. In JAMDA 15, 860-862. Retrieved from:

https://www.researchgate.net/publication/269179860_

Geriatricians_and_Technology

Moschetti, A., Fiorini, L., Aquilano, M., Cavallo, F., &

Dario, P. (2014). Preliminary Findings of the

AALIANCE2 Ambient Assisted Living Roadmap. In

Ambient Assisted Living

, 335-342. doi:10.1007/978-3-

319-01119-6_34

Murray E, Burns J, May C, Finch T, O'Donnell C, Wallace

P, Mair F. (2011) Why is it difficult to implement e-

health initiatives? A qualitative study. In

Implementation Science, 6(6). doi: 10.1186/1748-

5908-6-6

Nedopil, C., Schauber, C. & Glende I. (2013). AAL

stakeholders and their requirement. In Report by the

Ambient and Assisted Living Association.

Nordgren, A. (2013). Personal health monitoring: ethical

considerations for stakeholders. In Journal of

Information, Communication and Ethics in Society,

11(3), 156-173. doi:10.1108/jices-06-2013-0015

Novitzky, P., Smeaton, A. F., Chen, C., Irving, K.,

Jacquemard, T., O’Brolcháin, F., Gordijn, B. (2015).

A Review of Contemporary Work on the Ethics of

Ambient Assisted Living Technologies for People

with Dementia. In Science and Engineering Ethics,

21(3), 707-765. doi:10.1007/s11948-014-9552-x

Obal, M., & Kunz, W. (2013). Trust development in e-

services: a cohort analysis of Millennials and Baby

Boomers. In Journal of Service Management, 24(1),

45-63.

Olphert, W., Damodaran, L., Balatsoukas, P., &

Parkinson, C. (2009). Process requirements for

building sustainable digital assistive technology for

older people. In Journal of Assistive Technologies,

3(3), 4-13

Peek, S. T. M., Wouters, E. J., Luijkx, K. G., & Vrijhoef,

H. J. (2016). What it Takes to Successfully Implement

Technology for Aging in Place: Focus Groups With

Stakeholders. In Journal of Medical Internet Research,

18(5), e98. doi:10.2196/jmir.5253

Peek, S. T. M., Wouters, E. J. M., van Hoof, J., Luijkx, K.

G., Boeije, H. R., & Vrijhoef, H. J. M. (2014). Factors

influencing acceptance of technology for aging in

place: A systematic review. In International Journal

of Medical Informatics, 83(4), 235-248.

Perumal, T., Ramli, A.R., Leong, C.Y., 2011.

Interoperability framework for smart home systems. In

IEEE Transactions on Consumer Electronics, 57,

1607-1611

Peruzzini, M., & Germani, M. (2014). Designing a user-

centred ICT platform for active aging. In 2014

IEEE/ASME 10th International Conference on

Mechatronic and Embedded Systems and Applications

(MESA). doi:10.1109/mesa.2014.6935624

Queirós, A., Cerqueira, M., Martins, A. I., Silva, A. G.,

Alvarelhão, J., Teixeira, A., & Rocha, N. P. (2014).

ICF Inspired Personas to Improve Development for

Usability and Accessibility in Ambient Assisted

Living. In Procedia Computer Science, 27, 409-418.

A Multi-perspective View on AAL Stakeholders’ Needs - A User-centred Requirement Analysis for the Activeadvice European Project

115

Reginatto B.M.B (2012). Understanding barriers to wider

telehealth adoption in the home environment of older

people: An exploratory study in the Irish context. In

Journal of Advanced Life Science, 4(3&4), 63-76.

Rickel, J. & Johnson, W. L. (2000). Task-oriented

collaboration with embodied agents in virtual worlds.

In Cassell, J., Cassell, J., Sullivan, J., Prevost, S. and

Churchill, E.F. (Eds), Embodied Conversational

Agents, MIT Press, Boston, 95-122.

Röcker, C. (2013). User-centered design of intelligent

environments: requirements for designing successful

ambient assisted living systems. In Central European

Conference on Information and Intelligent Systems.

Faculty of Organization and Informatics Varazdin, 4-

11.

Ruscher, S. H., Burger, J., Sauli, E., & Kofler, A. C.

(2016). Implementing WCAG and ISO 9241 in AAL

software applications-A case study. In Technologies

for Active and Assisted Living (TechAAL 2016), 2nd

IET International Conference on, 1-6. IET. doi:

10.1049/ic.2016.0057

Sanders, C., Rogers, A., Bowen, R., Bower, P., Hirani, S.,

Cartwright, M. & Newman, S. P. (2012). Exploring

barriers to participation and adoption of telehealth and

telecare within the Whole System Demonstrator trial:

a qualitative study. In BMC Health Services Research,

12(1). doi:10.1186/1472-6963-12-220

Siegel, C., Prazak-Aram, B., Kropf, J., Kundi, M., &

Dorner, T. (2014). Evaluation of a modular scalable

system for silver-ager located in assisted living homes

in Austria – study protocol of the ModuLAAr ambient

assisted living project. In BMC Public Health, 14(1).

Sponselee, A., Schouten, B., Bouwhuis, D., & Willems, C.

(2007). Smart Home Technology for the Elderly:

Perceptions of Multidisciplinary Stakeholders. In

Constructing Ambient Intelligence, 314-326.

doi:10.1007/978- 3-540-85379-4_37

Van Gemert-Pijnen, J. E., Nijland, N., van Limburg, M.,

Ossebaard, H. C., Kelders, S. M., Eysenbach, G., &

Seydel, E. R. (2011). A Holistic Framework to

Improve the Uptake and Impact of eHealth

Technologies. In Journal of Medical Internet

Research, 13(4), e111.

Van Hoof, J., Kort, H. S. M., Rutten, P. G. S., &

Duijnstee, M. S. H. (2011). Ageing-in-place with the

use of ambient intelligence technology: Perspectives

of older users. In International Journal of Medical

Informatics, 80(5), 310- 331.

doi:10.1016/j.ijmedinf.2011.02.010

Vasunilashorn, S., Steinman, B. A., Liebig, P. S., &

Pynoos, J. (2012). Aging in Place: Evolution of a

Research Topic Whose Time Has Come. In Journal of

Aging Research, 1-6. doi:10.1155/2012/120952

Wright, D. (2010). Structuring stakeholder einclusion

needs. In Journal of Information, Communication and

Ethics in Society, 8(2), 178-205. doi:10.1108/

14779961011040587

Youngtae Ch., and Thoeni, A. (2016). Social media: is this

the new organizational stepchild? In European

Business Review, 28(1), 21-38.

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