Background: The number of older adults in need of care and living at home is increasing in Europe. At the same time, the number of professional caregivers is decreasing. This development reinforces the need for assistive technology to support care recipients in their own homes and promote their independence. One of the main challenges of independent living is the preparation of food. Interactive robots could assist older adults with difficulties performing physically demanding tasks. Within the project AuRorA (full German project title: Wiederverwendbare, interaktive Verhalten für proaktive Roboter im Smart Home), an interactive voice-controlled robot arm was developed as an assistance system in the kitchen. Objective: The aim of the study was to assess how older adults evaluate the AuRorA system and to collect data on actual willingness to use the technology. Older adults were asked to evaluate the system in terms of usefulness, usability, accessibility and intention to use. Material and methods: Due to the ongoing coronavirus disease 2019 (COVID-19) pandemic, the older adults evaluated the system via an online survey. The validated questionnaire Technology Usage Inventory (short: TUI) was used in conjunction with self-developed questionnaires to collect data on study population characteristics. Results: A total of 106 participants were included in the analysis. The acceptance, usability and usefulness of the system were rated as medium, while the intention to use was rated as low. A significant strong correlation was found between the TUI subscales intention to use and usefulness. Conclusion: It can be assumed that the actual need of the individual participant for such a robotic assistive system had an influence on the evaluation of the system. The perceived usefulness may have been a crucial influence on the intention to use and the overall assessment of the system.
Zusammenfassung: Hintergrund: Die Zahl älterer pflegebedürftiger Menschen, die in der eigenen Häuslichkeit leben, nimmt in Europa stetig zu. Gleichzeitig nimmt die Zahl der professionell Pflegenden ab. Assistive Technologien könnten diese Menschen entlasten und ihre Unabhängigkeit fördern. Eine der größten Herausforderungen eines unabhängigen Lebens ist die Zubereitung von Speisen. Bei der Ausführung solch körperlich herausfordernder Tätigkeiten könnten Assistenzroboter unterstützen. Im Rahmen des Projekts AuRorA (vollständiger Projekttitel: Wiederverwendbare, interaktive Verhalten für proaktive Roboter im Smart Home) wurde ein interaktiver, sprachgesteuerter Roboterarm für den Einsatz in der Küche entwickelt. Ziel der Arbeit: Ziel der Studie war es, festzustellen, wie ältere Menschen das AuRorA-System bewerten, und die tatsächliche Bereitschaft zur Nutzung der Technologie zu erheben. Das System wurde von im Hinblick auf Nützlichkeit, Benutzerfreundlichkeit, Zugänglichkeit und Nutzungsabsicht bewertet. Material und Methoden: Aufgrund der andauernden COVID-19-Pandemie wurde die Evaluation des Systems durch ältere Menschen mittels Online-Befragung durchgeführt. Der validierte Fragebogen Technology Usage Inventory (kurz: TUI) wurde gemeinsam mit selbstentwickelten Fragebögen zur Erhebung von Basisdaten verwendet. Ergebnisse: Insgesamt wurden 106 Teilnehmer*innen in die Analyse einbezogen. Die Akzeptanz, Benutzerfreundlichkeit und Nützlichkeit des Systems wurden als mittelhoch eingestuft, während die tatsächliche Nutzungsabsicht als gering eingestuft wurde. Es wurde eine signifikante starke Korrelation zwischen den Subskalen des TUI Nutzungsabsicht und Nützlichkeit festgestellt. Diskussion: Es kann davon ausgegangen werden, dass der tatsächliche Bedarf der einzelnen Befragten an dieser Art robotischen Assistenzsystems einen Einfluss auf die Bewertung hatte. Es wird ebenso vermutet, dass die wahrgenommene Nützlichkeit einen entscheidenden Einfluss auf die Nutzungsabsicht und die Gesamtbewertung des Systems hatte.
Keywords: Assistive technology; Elderly; Meal preparation; Usability; Ageing in place; Assistive Technologie; Ältere Menschen; Nahrungszubereitung; Benutzerfreundlichkeit; Selbstständigkeit
Supplementary Information The online version of this article (https://doi.org/10.1007/s00391-022-02105-8) contains supplementary material, which is available to authorized users.
The majority of older adults in need of care are cared for in their own homes by professional or informal caregivers. The preparation of meals in particular is difficult for people with physical disabilities. Assistive robotic technologies could relieve the burden on caregivers and increase the independence of users; however, there is little research on how older adults evaluate such technologies for home use and on their actual willingness to use them.
The continuing growth of the proportion of older adults in European has been accompanied by an increase in the number of people in need of long-term care. At the same time, most older adults wish to remain in their own living situation for as long as possible and without the support of others. Even in the event of them needing care, they often prefer to be cared for at home by outpatient care services [[
These changes in society and the concomitant increased need for home care strengthen the demand for technological assistance systems to enhance the quality of life, health and independence of those in need of care and to relieve the burden on caregivers. The positive effects on health and quality of life resulting from integrating modern technologies into the daily lives of older adults are well documented [[
Klein refers to eating and drinking as "basic activities" that play a central role in every life [[
Against the background of this problem, the AuRorA project was initiated (full German project title: Wiederverwendbare, interaktive Verhalten für proaktive Roboter im Smart Home), which aims to support older adults in preparing food in their own homes by developing an innovative interactive robotic solution.
At the core of the assistance system AuRorA is the lightweight robotic arm Universal-Robot UR5 (Universal Robots, Odense, Denmark) (Fig. 1). The robotic arm can grasp objects with the help of its two-fingered grasping device. According to the systematization of robots for use in healthcare by Kehl, AuRorA can be classified as a robot for personal assistance in everyday tasks [[
Graph: Fig. 1The AuRorA (full German project title: Wiederverwendbare, interaktive Verhalten für proaktive Roboter im Smart Home) system in use (Source: permission for use granted by FZI Forschungszentrum Informatik)
De Graaf et al. stated that in the evaluation of a robotic technology for personal and domestic use, specific emphasis should be placed on exploring the target group's acceptance and intention to use the technology. Acceptance of robotic technologies by older adults has been found to be closely related to the perceived usefulness of these systems [[
We sought to answer the following research questions:
- What are the basic attitudes of older adults towards the technology presented in this study?
- How do older adults evaluate the AuRorA system in terms of accessibility, perceived usability and usefulness?
- How do older adults evaluate the intention to use the robotic assistance system?
Due to the ongoing coronavirus disease 2019 (COVID-19) pandemic, we conducted an online survey so that the study could be carried out without direct face-to-face contact. We created a detailed video of a prototypical cooking process with the AuRorA system to be used in the survey (Fig. 2). We clearly presented the workflow of the interactive cooking process. We showed the resulting video to a number of representatives of the target group before the start of the study and checked it for comprehensibility.
Graph: Fig. 2Screenshots of the video used in the survey, (Source: permission for use granted by FZI Forschungszentrum Informatik)
We used the following questionnaires within the survey:
We collected basic data about the person completing the questionnaire. This information included the subject's age, sex, technology usage and officially recognized degree of disability.
The validated Technology Usage Inventory (short: TUI) was used for the evaluation of the AuRorA system [[
For the development of the digital assessment underlying this study, we used the tool REDCap (Vanderbilt University, Nashville, TN, USA) [[
We sent the survey to the members of the internal database of the Geriatrics Research Group of Charité — Universitätsmedizin Berlin via email. We also contacted various senior citizen facilities that agreed to forward the link. Healthy individuals with a minimum age of 65 years and internet access were included in the study.
We analyzed the data using IBM SPSS Statistics 27 (IBM, Armonk, NY, USA). For all the variables, we calculated mean values and standard deviations. Since ordinal data were present, we calculated the Spearman's rank correlation coefficient to measure the correlation between the key variables of the TUI. We specified a significance level of 0.05 for the analysis. To interpret the calculated Spearman's rank correlation coefficients, we considered the approach and cut-off values by Schober et al. [[
Table 1 shows sociodemographic data as well as further data about the study participants' characteristics.
Table 1 Study population characteristics
Study population characteristics, 73.78 years (SD = 5.138) Male 30.39% Female 69.61% No 70.19% Yes 29.81% Never or rarely 5.8% Occasionally 13.3% Often 81%
SD standard deviation
The results of the TUI questionnaire are presented in Table 2.
Table 2 Results of the Technology Usage Inventory (TUI)
Scales Results Usability (min.: 3, max.: 21), 14.93 (SD = 3.95) Accessibility (min.: 3, max.: 21), 7.29 (SD = 3.46) Curiosity (min.: 4, max.: 28), 16.01 (SD = 6.21) Technology anxiety (min.: 4, max.: 28), 10.55 (SD = 5.45) Skepticism (min.: 4, max.: 28), 14.61 (SD = 5.18) Usefulness (min.: 4, max.: 28), 10.31 (SD = 5.83) Interest (min.: 4, max.: 28), 16.57 (SD = 6.13) Intention to use (scale reversed) (min.: 3, max.: 300), 80.19 (SD = 76.51)
min scale minimum, max scale maximum, SD standard deviation
The average score for accessibility of the AuRorA system was 7.29 (SD = 3.46). A look at the individual items shows that financial accessibility in particular ("I think almost everyone can afford this technology.") was rated critically (mean score = 1.95, SD = 1.22). Similarly, evaluation of the acquisition effort involved ("I think that acquiring this technology does not require much effort.") achieved a low score of 2.29 (SD = 1.65).
The perceived usability of the assistance system achieved a mean score of 14.93 (SD = 3.95), placing it just in the upper third of the scale. Likewise, the scores for individual items showed that application and comprehensibility of the system's operation were rated rather positively (Fig. 3).
Graph: Fig. 3Mean values TUI (Technology Usage Inventory) subscale "usability" with standard deviation (SD)
With respect to the usefulness subscale, study participants' evaluation of the system resulted in a mean overall score of 10.31 (SD = 5.83), which corresponds to a value in the lower third of the scale. Here, a look at the underlying values of individual questions is particularly informative (Fig. 4). The first question refers to evaluation of the expected gain in comfort from using the system. This item achieved a mean score of 3.35 (SD = 1.75). In contrast, the ability of the system to provide support in completing daily tasks was rated with a mean score of 2.43 (SD = 1.74).
Graph: Fig. 4Mean values TUI (Technology Usage Inventory) subscale "usefulness" with standard deviation (SD)
The total score given by the older adults surveyed in this study in relation to their intention to use the system was 80.19 (SD = 76.51). This is in the lower third of the overall scale. The intention to use scale consists of three questions, concerning respondents' actual intention to use, intention to purchase and desire to have access to the technology. The mean scores for all three questions reached the lower third of the scale (Fig. 5). The intention to purchase reached a mean score of 21.22 (SD = 24.09) and the desire to access it a mean score of 31.28 (SD = 30.85).
Graph: Fig. 5Mean values TUI (Technology Usage Inventory) subscale "intention to use" with standard deviation (SD)
For a better understanding of factors which may have an influence the intention to use by the older adults, we calculated correlation coefficients between the intention to use and other factors (Table 3). The interpretation of the Spearman's rank correlation coefficients shows that the greatest correlation is found between the subscales intention to use and usefulness. A strong correlation is present between the variables (Spearman's ρ = 0.742, p < 0.001) with greater perceived usefulness being related to higher intention to use [[
Table 3 Spearman's Rho: correlation between variables and intention to use (ITU)
Variable Curiosity Skepticism Usability Usefulness Accessibility Sex Degree of disability (presence) Technology usage (occasionally/frequently) Correlation coefficient 0.414 −0.45 0.095 0.742 0.171 −0.137 0.085 0.057 Sig. (2-tailed) 0.000* 0.000* 0.389 0.000* 0.112 0.207 0.432 0.595 86 84 85 86 88 87 88 89
ITU intention to use, Sig. statistical significance *p < 0.05
The medium to low evaluation of the AuRorA system in this study is reflected by the results of other studies that have researched the acceptance of older adults regarding robotic assistance systems. Many studies reported a low level of willingness to use and implement robotic solutions for the target group [[
The number of people with an officially recognized degree of disability was relatively small in this study. The medium to low ratings for acceptability and usefulness of the AuRorA system could be due to the lack of the individual need for assistance among the study participants. Heerink et al. described the perceived usefulness as a crucial factor influencing the intention to use an assistance system [[
The eighth Ageing Report of the German Government emphasized the importance of taking ethical considerations into account when exploring the development, distribution and usage of digital technologies for older adults [[
In this context, ethical aspects that are important regarding presented technology should be discussed. First, the aspect of distributive justice needs to be addressed. The AuRorA kitchen system is a functional demonstrator that is not yet ready for introduction into the market. However, it is foreseeable that both acquisition and installation will be very costly. Within this study, the participants critically assessed the affordability of the system. The medium rating for accessibility of the system in this study (particularly evident in relation to the financial accessibility subscale) is in line with the results of other studies. Becker et al. have also emphasized the concern of older adults that due to the unclear financing possibilities of robotics for home use, they are uncertain about the financial feasibility of such a system [[
The low ratings for the perceived usefulness of the AuRorA system may be influenced by the general attitude of older adults towards robotic systems [[
In this study, only an officially recognized degree of disability was queried, which, however, does not necessarily have to imply a limitation in the preparation of food. Thus, as a further evaluation step studies should enroll more participants with support needs in relation to food preparation. Furthermore, the specific needs and technical competencies of especially vulnerable groups, such as people with dementia, should be addressed in the future development of the AuRorA system.
- Less tech-savvy individuals may not have been reached by the online survey. Survey methods like face-to-face interviews are preferable for reaching the target group.
- Mostly healthy older adults were included in this study. The results cannot be generalized to older adults in the need of support for preparing meals.
- There are still barriers to introduction of assistive robotics for older adults, especially financial barriers were considered critically.
- The perceived usefulness may have a crucial influence on the intention to use and the overall evaluation of the system.
Open Access funding enabled and organized by Projekt DEAL.
L. Perotti and N. Strutz declare that they have no competing interests.
All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study. The study was approved by the Ethics Committee of the Charité — Universitätsmedizin Berlin (EA4/101/20) prior to commencement.
Graph: The AuRorA robotic system
Graph: Technology commitment of the study participants
By Luis Perotti and Nicole Strutz
Reported by Author; Author