Older Adults Testing Assistive Technologies in Living Labs:
Guidelines
Stephanie Lehmann
a
, Esther Ruf and Sabina Misoch
Institute for Ageing Research, FHS St. Gallen University of Applied Sciences,
Rosenbergstrasse 59, 9001 St. Gallen, Switzerland
Keywords: Older Adults, Living Lab, Assistive Technology, Testing, Guideline.
Abstract: Assistive technologies are a promising option for enabling older adults to live independently at home and
therefore to meet the challenges of demographic change. An advantageous way to ensure acceptance and
successful use by end users is a participatory involvement and testing in real-life environment. This position
paper argues for the specific approach of Living Lab testings when testing assistive technologies with older
adults at home. The procedure described is intended as a guideline to adequately consider the specifics of the
test subjects, the older adults, and the special test setting in the real-life environment. Therefore, the guideline
contributes to the quality of future testings.
1 INTRODUCTION
Due to demographic change, caused by the increase
in life expectancy as well as the decline in the birth
rate, the proportion of people aged 65 or over is
steadily increasing in all industrialised countries
(Vaupel, 2000), and due to the increasing number of
people in need of assistance, the effects of the
shortage of nursing staff (Afentakis and Maier, 2010;
Mercay, Burla and Widmer, 2016) will become even
worse. To live at home independently for as long as
possible is preferred by many older adults (Hedtke-
Becker, Hoevels, Otto, Stumpp and Beck, 2012;
Marek and Rantz, 2000), and, apart from a hoped-for
cost saving, it has positive effects on their quality of
life (Sixsmith and Gutmann, 2013).
Assistive technologies have great potential to
meet these challenges. However, many developed
assistive technologies are not satisfactorily used to
support older adults due to lack of acceptance and
other barriers (Pelizäus-Hoffmeister, Birken,
Schweiger and Sontheimer, 2018). Good acceptance
and successful application to generate benefits
requires testing of assistive technologies in a real-
world environment. With that, fear of contact can be
reduced, assistive technologies can be adapted to
actual needs and support can be provided locally
a
https://orcid.org/0000-0002-1086-3075
where it is needed (Liedtke, Welfens, Rohn and
Nordmann, 2012; Pauli, Lehmann and Misoch,
2017a). A promising way to ensure acceptance and
benefits of assistive technologies for older adults is
the participatory involvement of end users and the
testing of these technologies in their real-life
environment. This can be realized within the
framework of Living Labs.
A Living Lab is to be understood as an
infrastructure which enables a user-centered research
methodology (Eriksson, Niitamo and Kulkki, 2005),
whereby users are observed in their interaction with
new technologies. In this position paper, according to
the European view (Schuurman, Evens and De
Marez, 2009), a Living Lab is understood to be the
real, domestic, everyday (living) environment of
users as a testing environment for assistive
technologies (European Network of Living Labs,
2019; Folstad, 2008; Franz, 2014; Lehmann,
Hämmerle, Pauli and Misoch, 2019). The central
focus is on the end user ("user-centred") and the real-
world context is a precondition (Bergvall-Kareborn &
Stahlbröst, 2009; Dell'Era and Landoni, 2014;
Liedtke et al., 2012).
When working with test subjects 65+ and test in
their natural living environment, there are some
special aspects to consider. Conducting studies with
persons must meet the criteria of good research
Lehmann, S., Ruf, E. and Misoch, S.
Older Adults Testing Assistive Technologies in Living Labs: Guidelines.
DOI: 10.5220/0009464100850092
In Proceedings of the 6th International Conference on Information and Communication Technologies for Ageing Well and e-Health (ICT4AWE 2020), pages 85-92
ISBN: 978-989-758-420-6
Copyright
c
2020 by SCITEPRESS Science and Technology Publications, Lda. All rights reserved
85
practice (e.g. guideline "Securing Good Scientific
Practice", Deutsche Forschungsgemeinschaft, 2013;
"European Code of Conduct for Integrity in
Research", ALLEA, 2018). But the elements of the
research process must be adapted to the Living Lab
setting and to the target group 65+ and researchers
must be familiar with the special features of this
group (Turnwald, Frerichs and Prilla, 2011).
2 AIM
The key points presented in the position paper have
been developed and tested within the framework of
various projects of the Institute for Ageing Research.
The procedure is suggested as a guideline to support
further research projects and to contribute to an
internal quality control of testings involving people
65+ testing assistive technologies in Living Labs at
home. The recommendations were elaborated in the
context of the IBH Living Lab Active & Assisted
Living consisting of research institutions, care and
nursing facilities as well as technology and service
providers in the Lake Constance region from Austria,
Germany, and Switzerland. The project is funded by
the Interreg V-programme “Alphenrhein-Bodensee-
Hochrhein”.
3 RECRUITMENT–
ACQUISITION OF TEST
SUBJECTS
The selection of suitable test subjects is essential in
Living Lab testing. For technical and organisational
reasons, the number of test subjects in Living Lab
testing is limited (Scherhaufer and Grüneis, 2015), so
that the samples are usually small but time-
consuming to supervise.
As recruiting suitable Living Lab test subjects can
be time-consuming, enough time must be planned for
this phase. Recruiting tests subjects 65+ can be
difficult as the older population group is highly
inhomogeneous (Doyle, Bailey, Scanaill and van den
Berg, 2014; Yang and Lee, 2010). In addition, a
higher dropout rate is to be expected due to increased
morbidity and mortality in persons 65+ (Hoag, 1981;
Menning, 2006). Test subjects must be willing to test
assistive technology in their natural living
environment for a predefined time and be willing and
able to communicate their experiences (Ogonowski,
Ley, Hess, Wan and Wulf, 2013). In order to test
assistive technologies in the real-life environment of
the end users, these must also be willing to invite
researchers and technicians into their homes several
times and accept to integrate a new assistive
technology into their personal interior design.
3.1 Selection of Test Subjects
Selection of test subjects is guided by the research
question and the development-stage the assistive
technology is at. If the usability of the assistive
technology is investigated and initial testing of the
assistive technology (e.g. a prototype) is done with
the aim of discovering possible problems, a smaller,
rather heterogeneously composed sample is chosen
(Nielsen, 2012; Pauli et al., 2017a). The resulting
range of age, affinity for technology, socio-economic
and cultural background should take different
perspectives into consideration. If proof of
effectiveness of the assistive technology is to be
investigated, the sample should be representative of
future users. The goal is not population
representativeness, but to include persons relevant to
the research subject (Kelle and Kluge, 2010). This
can refer to socio-demographic variables as well as
individual aspects of physical or psychological
impairments to get enough test cases. For example,
testing a fall sensor with people who are not at risk of
falling is hardly meaningful, as it cannot be assumed
that the system can be tested at all.
When describing the sample, inclusion and
exclusion criteria must be stated. A basic description
of sociodemographic variables (age, gender,
educational level, etc.) should be provided. If
possible, variables should be collected that are
already known for the general population or target
group through population-based or other
representative studies in order to estimate
representativeness, when this is crucial for
interpretation (Von Geibler et al., 2013). In addition,
specific characteristics of the test subjects in relation
to the research goal must be collected. In order to be
able to compare different Living Lab testings, it is
useful to collect a so-called core data set, e.g. gender,
age, nationality, language, marital status, educational
level, type of housing, household size, residential
area, physical and mental restrictions, technical
experience, existing technical equipment, previous
test experience, user group (primary users are end
users; secondary users are relatives or professional
carers; tertiary users are organizations, communities).
These data can be used for secondary analyses, but
only if prior consent has been obtained.
ICT4AWE 2020 - 6th International Conference on Information and Communication Technologies for Ageing Well and e-Health
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3.2 Recruitment Strategy
The recruitment strategy should be described and
justified in detail at the beginning of the study.
Selective samples can be the result of a specific
recruitment strategy. Often well-integrated, educated
and technology-oriented people are recruited
(Classen, Oswald, Doh, Kleinemas and Wahl, 2014;
Hämmerle, Pauli, Lehmann and Misoch, 2018;
Kubiak, 2015; Lehmann, Pauli and Misoch, 2017)
and further participants recruited via multipliers will
have a similar social status. The recruitment of older
adults for testing of assistive technology is
particularly susceptible to bias e.g. selection bias
(Kleist, 2010), and especially to volunteer bias that
can lead to a non-representative sample (Lehmann et
al., 2017; Von Unger, 2014). In their overview,
Rosenthal and Rosnow (1975) stated that volunteer
test subjects are more likely to be women and more
highly educated. In contrast, experience in testing
assistive technologies shows that men and/or people
with an affinity for technology are more likely to
participate. Experience also shows that people with a
lower educational level or migration background are
usually difficult to reach and motivate (Pauli, Misoch
and Lehmann, 2017b). To be able to interpret the test
results, a description of the procedure and recruitment
strategy is extremely important. Some participatory
research projects offer approaches on how to deal
with this, e.g. by showing test subjects the relevance
of their contribution (Hackl, 2014), or by
emphasizing their "profit" in sense of a direct benefit
(Scherhaufer and Grüneis, 2015).
Recruitment can be done via groups in which
older adults are organised, which work with older
adults, or in which they are overrepresented. For
example, educational institutes for older adults,
community services for older adults, senior citizens'
meetings, senior citizens' representatives at regional
or local level, church associations, social networks or
media such as newspapers or radio (Eisma,
Dickinson, Goodman, Syme, Tiwari and Newell,
2004; Ogonogwski et al., 2013). Recruitment via test
subjects who already recommend the testing to others
and thus act as multipliers is very promising (Hess
and Ogonowski, 2010; Leonardi, Doppio, Lepri,
Zancanaro, Caraviello and Pianesi, 2014; Ogonowski
et al., 2013; Pauli et al., 2017a).
3.3 Recruitment Interview
One interview changes the daily routine of a test
person (Misoch, 2019; Porst and Briel, 1995). Testing
in the daily living environment of the end user
additionally entails an intrusion into the privacy of the
test subjects, which is why sensitive relationship
building is essential for Living Lab testing
(Ogonowski et al., 2013). At least one (recruitment)
interview with the interested person should take place
prior to test enrolment in order to gather socio-
demographic data and needs and to establish a first
personal contact (ibid.). A personal interview and a
visit to the private or institutional residential
environment (Hämmerle et al., 2018) is preferable to
contact by telephone (Ogonowski et al., 2013).
However, since Living Labs usually require large
amounts of time and financial resources (Schuurman
et al., 2009), this is not always possible.
The recruitment interview forms the basis of
successful recruitment. The information and consent
of the test persons should be understood as a
communicative action process that starts even before
the actual consent (Schweizerische Akademie der
Medizinischen Wissenschaften [SAMW], 2015). The
process of information and consent should be fair and
characterized by dialogue, so that people become
aware of what participation in the testing means
(ibid.) In the target group 65+, special attention
should be paid to preparation and sufficient time
resources for the interview.
During the recruitment interview, the end users
must be informed about the general conditions of the
testing, the aim of the testing and the requirements.
Test subjects highly appreciate accurate and detailed
information about the course of the testing (Meurer,
Stein and Stevens, 2013). This verbal information
should be recorded in a written test information
document, in accordance with the rules and templates
of the respective national or regional ethics
commissions, with details of the objective, duration,
procedure, rights, obligations, voluntary nature,
benefits, risks, possibilities of discontinuation,
confidentiality, compensation, liability, assurance of
data protection, financing and contact persons. This is
required by the ethics committees and strengthens the
commitment of the test subjects.
Should a test subject not wish to participate, the
reasons should be clarified as detailed as possible. It
should be determined what the concerns are in order
to be able to make statements about the group of non-
participants, and to understand the motivation for
participation (Meurer et al., 2013). If possible, the
group of non-participants (e.g. persons not reached,
persons inquired about, or persons who left after the
recruitment interview) and the reasons for not taking
part should be described. The proportion of non-
participants should be indicated, and these data
should be considered when interpreting the results
Older Adults Testing Assistive Technologies in Living Labs: Guidelines
87
(Kleist, 2010). It can be assumed that the response
behaviour of participants and non-participants differs
(Groves, 1989; Koch and Blohm, 2015) and can thus
influence validity and reliability (Haunberger, 2011).
In some cases, concerns can be clarified,
intercepted and even eliminated in a recruitment
interview. It is important to address the expectations
of the test persons. If unrealistic expectations are
mentioned by the test persons, they should be
corrected in order to avoid subsequent dropouts. Test
subjects must be able to decide to take part in the
testing voluntarily and without any pressure (König,
2011), as well as having the option to terminate
participation at any time without any disadvantages.
3.4 Informed Consent
The written consent of the test subject at the
beginning of the test phase is indispensable (Gebel et
al., 2015). It must be written in accordance with
national ethical guidelines and regulations and
communicated to the test persons in an
understandable way.
For test persons 65+, special attention must be
paid to the formal design of the written consent form.
Attention should be paid to layout, understandable
language and brevity, without neglecting the correct
factual content. Guidelines on wording are usually
provided by national ethics committees or
professional associations. For the group of older test
subjects as well as for particularly limited test
subjects, it is also advisable to follow scientific
recommendations for layout as well as formulation of
questions and instructions (Brandt et al., 2018; Lang,
2014).
3.5 Data Handling / Data Protection
In order to ensure the anonymous evaluation and use
of personal data, each test person is assigned a
specific code which links individual data with each
other but gives no indication of the test person
(König, 2011). Only with a separate file, a so-called
code list, collected data can be linked with the
personal data. This code list is to be stored separately
and independently from other (personal) data (König,
2011).
The currently valid basic data protection
regulation is valid throughout Europe and should be
complied with (Akiki, 2019). Data protection and
data security must be observed (Bölscher, 2000;
Epiney, Civitella and Zbinden, 2009; Federrath and
Pfitzmann, 2000; Kühling, Klar and Sackmann, 2018;
SAMW, 2015). Test subjects must be informed of the
contents and procedures and must be given written
assurance that their data (interviews, questionnaires,
technical data) will be treated confidentially. To
protect the privacy of the test subjects, their addresses
will never be passed on to third parties without their
explicit approval. Wherever possible, contact will
only be made via the assigned researcher (Hämmerle
et al., 2018).
4 IMPLEMENTATION– DATA
COLLECTION AND SUPPORT
4.1 Economy of Data Collection
Economic test procedures with a reasonable test
duration should be selected and breaks should be
considered. The researchers in the field should be
familiar with the respective dialects so that the test
subjects can speak in their usual language. Situational
factors should be considered (Kothgassner and
Bertacco, 2011), for example, the test atmosphere
should be made pleasant by eliminating sources of
interference (such as conversations from other
people) and allowing enough time (Felnhofer,
Kothgassner, Hauk, Kastenhofer and Kryspin-Exner,
2013).
4.2 Relationship Building / Trust
At the beginning of the testing, the focus is on
building up a trusting relationship (Ogonowski et al.,
2013), which starts with the initial contact and
enables a long-term commitment. Social skills are
needed for building relationships both among
researchers and test subjects. Establishing a
motivating atmosphere and close interaction with the
test subjects is seen as essential for the success of the
research (Eisma et al., 2004). Regular contact shows
an appreciative attitude towards the test subjects,
enables to address concerns, take statements seriously
(Pauli et al., 2017a), and recognize difficulties at an
early stage. By including all statements, even when
not relevant to the testing, a good feeling is conveyed
(Ogonowski et al., 2013). Researchers should achieve
reciprocity (Smith, 2013) by telling something about
themselves. A relationship based on trust requires a
clearly defined contact person whose tasks and
functions are transparent and who remains the same
throughout the testing, if possible (Georges,
Schuurman, Baccarne and Coorevits, 2015; Hess and
Ogonowski, 2010; Ogonowski et al., 2013). This
proves to be very important especially for people 65+.
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Efficient complaint management must be ensured by
a clear contact person for problems and questions. It
also makes sense to inform test subjects regularly
about the status of the testing, for example by a
newsletter (Ogonowski et al., 2013).
To establish trust, as many individual areas as
possible should be considered (Smith, 2013). For
example, trust in the institution itself, in the software
used, in the individual researchers or in other test
subjects. As trust usually comes through many small
steps, trust in the individual areas can again be
ensured or demonstrated by various factors. For
example, the qualifications of the researchers or their
reputation can be a condition for trust in them.
4.3 Motivation
In order to avoid dropouts, motivation must be
maintained throughout the entire test period, which
can last several months (Smith, 2013). Motivation
depends largely on the expectations of the test
subjects (Meurer et al., 2013) and the reliability of the
research team, which is why the expectations and the
reliability should be actively managed (Ogonowski et
al., 2013). People who have decided to participate are
usually impatient and want to start testing a new
assistive technology immediately (Hess and
Ogonowski, 2010). In order to avoid disappointment
and a lack of motivation, particularly regarding
prototypes that are not yet marketable, it is essential
to communicate clearly what can be expected from
the assistive technology at the respective stage of
development (Georges et al., 2015). Unrealistic
announcements regarding the use of the assistive
technology should be avoided, and longer time
horizons should be preferred.
In general, intrinsic motivation, such as general
interest or the desire to learn something, seems to be
more relevant than extrinsic motivation (Leonardi et
al., 2014). This is why social activities are important
for strengthening the sense of community. A financial
incentive to participate does not seem necessary
(Hess and Ogonowski, 2010; Leonardi et al., 2014)
and is also undesirable in research projects due to
selection mechanisms. Otherwise, there would be the
possibility that financially poor people would
participate only because of the financial incentive
(Grün and Haefeli, 2009) and possible risks would not
be sufficiently considered by them (Denny and
Grady, 2007). Moreover, it could lead to an
overrepresentation of people with financially weaker
resources.
4.4 Building a Sense of Community
Real-life meetings, where the test persons can meet
other test subjects, the entire testing team and other
stakeholders, have proven to be a good way to create
a sense of community (Ogonowski et al., 2013; Pauli
et al., 2017a) and increase commitment (Hämmerle et
al., 2018). Aims should be: Community feeling,
exchange among test subjects and with the testing
team, information about the testing, presentation of
results, and the collection of opinions and emotional
situation of the test subjects (Hämmerle et al., 2018).
As in the entire research project, voluntariness is
essential (SAMW, 2015). There should be enough
time for informal exchange (Ogonowski et al., 2013).
As an alternative to the real, very resource-intensive
meetings, a virtual forum can be offered on a
homepage so that test subjects can support each other,
and the researchers are thus relieved (Ogonowski et
al., 2013).
4.5 Involvement of Other Stakeholders
In addition to the primary users (end users), other
stakeholders such as secondary users (relatives or
professionals and service organisations), tertiary
users (politics or institutions) and research or industry
partners must be considered. The participation of
these different user groups and stakeholders can be
very challenging, as different interests and objectives
collide, which cannot always be satisfactorily
considered (Ogonowski et al., 2013).
5 COMPLETION –
TERMINATION OF TESTING
5.1 Dealing with Dropouts
Several factors can cause test subjects to drop out
(Georges, Schuurman and Vervoort, 2016). As the
probability of dropouts is high, particularly due to
rapidly changing (health) conditions of older adults
(Hämmerle et al., 2018; Hoag, 1981), dealing with
dropouts at the beginning of the testing is essential.
As Living Lab testing takes a long time, it is
necessary to define the procedure to be followed
when a dropout occurs, how to handle the data
collected so far, and the possibility of re-recruitment.
With the consent of the test subject, the data collected
so far should continue to be available for analysis. Re-
recruitment does not necessarily have to take place.
However, depending on the research question and
Older Adults Testing Assistive Technologies in Living Labs: Guidelines
89
assistive technology, it should be examined whether
the number of test subjects is still sufficient to answer
the research question.
5.2 Exit Strategy and Compensation
An exit strategy at the end of the testing regarding the
termination of testing and whereabouts of the
assistive technology should be defined at the
beginning of the testing. The assistive technology
may be given to the subjects free of charge, sold to
them at a preferential price, or can be removed.
Compensation can also be defined as part of the exit
strategy. However, the compensation does not have to
be in financial form, as non-monetary motivated
participation seems to work in general (Hess and
Ogonowski, 2010; Leonardi et al., 2014). Experience
from own testings shows that "compensation" by
offering a social event (e.g. a final event with all test
subjects and the researchers) is valued by the test
subjects.
5.3 Feedback of Test Results
If possible, the testing results should be
communicated to all test subjects in an adequate form
(Hämmerle et al., 2018; SAMW, 2015, Chapter 10).
The form in which this takes place should be
communicated early on.
6 CONCLUSIONS
The position paper argues that special considerations
and requirements are needed when dealing with older
adults as test subjects in Living Labs at home and
summarizes the experiences gained so far. It can serve
as a guideline to secure the planning and
implementation of Living Lab studies at home with
older adults qualitatively. The contact with the test
subjects is divided into three phases and enables other
researchers to find answers to relevant topics quickly.
It would be desirable, in the sense of quality
assurance, that future Living Lab testings, especially
with older adults in their homes, are based on these
recommendations.
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