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First steps in designing a videophone for people with dementia: Identification of users' potentials and the requirements of communication technology

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Abstract

Purpose: To identify, based on the literature, people with dementia's potentials to manage an easy-to-use videophone, and to develop a videophone requirement specification for people with dementia. Method: The study is based on the Inclusive Design method, utilising the first two of four phases. Content analyses of literature reviews were used to identify users' potentials for managing a videophone and to gather recommendations regarding communication technology design for the target group. Existing videophones in Sweden were examined regarding potential fit to users with dementia. Findings: This led to detailed identification of cognitive, physical and psychosocial challenges that people with dementia will probably have when using an ordinary telephone or videophone. A requirement specification for videophone design to fit users with dementia was formulated, with the seven principles of Universal Design as a framework. Conclusions: The requirement specification presented here is aimed at designing a videophone but might also facilitate design of other products for people with dementia, particularly in the field of communication technology. Based on this, further work will focus on developing a design concept and a prototype to be empirically tested by people with dementia and their significant others, i.e. the final two design process phases.
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Disability and Rehabilitation: Assistive Technology
2012
7
5
356
363
© 2012 Informa UK, Ltd.
10.3109/17483107.2011.635750
1748-3107
1748-3115
Disability and Rehabilitation: Assistive Technology, 2012; 7(5): 356–363
© 2012 Informa UK, Ltd.
ISSN 1748-3107 print/ISSN 1748-3115 online
DOI: 10.3109/17483107.2011.635750
Purpose: To identify, based on the literature, people with
dementia’s potentials to manage an easy-to-use videophone,
and to develop a videophone requirement specification for
people with dementia. Method: The study is based on the
Inclusive Design method, utilising the first two of four phases.
Content analyses of literature reviews were used to identify
users’ potentials for managing a videophone and to gather
recommendations regarding communication technology
design for the target group. Existing videophones in Sweden
were examined regarding potential fit to users with dementia.
Findings: This led to detailed identification of cognitive, physical
and psychosocial challenges that people with dementia
will probably have when using an ordinary telephone or
videophone. A requirement specification for videophone design
to fit users with dementia was formulated, with the seven
principles of Universal Design as a framework. Conclusions:
The requirement specification presented here is aimed at
designing a videophone but might also facilitate design of
other products for people with dementia, particularly in the
field of communication technology. Based on this, further work
will focus on developing a design concept and a prototype to be
empirically tested by people with dementia and their significant
others, i.e. the final two design process phases.
Keywords: Assistive technology, dementia care,
communication, inclusive design, telephone
Introduction
Technology inuences the everyday lives of most people
and is important for the performance of everyday activi-
ties and participation [1,2]. However, older adults with
cognitive impairment due to dementia or mild cognitive
impairment (MCI) may have diculties in using everyday
technology[2–5] and this might have disabling consequences
in their everyday lives[6,7]. Studies have shown that people
with dementia might have considerable diculties using an
ordinary telephone[8,9]. One problem could be the increased
complexity of new telephones with less intuitive user inter-
faces, requiring previous experience of earlier generation
products in order to understand the current designs [10].
Moreover people with dementia might experience talking
on the telephone as an abstract action that makes it dicult
to relate to the person spoken with, which may cause stress
and confusion[11]. With an ordinary telephone or a mobile
phone people with dementia might also have diculties visu-
alising people who are not present[12]. It can also be dicult
to keep track of the conversation due to working memory
impairment[13]. However, being able to use the telephone
can be very important in order to maintain social network,
RESEARCH PAPER
First steps in designing a videophone for people with dementia:
identification of users’ potentials and the requirements of
communication technology
I.-L. Boman1, L. Rosenberg1, S. Lundberg2 & L. Nygård1
1Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden and 2Royal Institute of Technology,
School of Technology and Health, Handen, Sweden
Correspondence: Inga-Lill Boman, NVS, Division of Occupational erapy, Karolinska Institutet, Fack 2300, Huddinge, S-141 83 Sweden.
E-mail: inga-lill.boman@ki.se
• Before recommending the use of assistive technology
or new products such as a videophone it is important
to examine in detail how well the product can meet
the person’s abilities and needs.
• If people with dementia and their signicant others
receive information about new products or assistive
technology that could be useful for them in an early
stage of the disease process they might be willing to
use it.
• In order to facilitate acceptance and use of new prod-
ucts such as a videophone, the design should aim at
resembling other well known similar products and
people with dementia should be introduced to using
it at an early stage of the disease.
Implications for Rehabilitation
(Accepted October 2011)
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Designing a videophone for people with dementia 357
© 2012 Informa UK, Ltd.
receive stimulation and relaxation, and for reaching help
when needed [9,11,14,15]. erefore, people with dementia
might need an easy-to-use videophone to prevent social isola-
tion and to feel safe and independent.
Videophones have been used for video conferencing for a
long time, mostly in business, but nowadays videophones are
becoming more common for personal use. A videophone is a
service or a product that can be used to communicate over a
public communication network, for example an IP network.
e videophone can transmit and receive images and audio
signals for communication between people in real time,
using a camera, communication devices and a screen [16].
Clinical experience suggests that a videophone may be a
good communication tool for people with dementia as video
communication can function not only as a tool to overcome
isolation caused by the disease, but also a way to help people
demonstrate their ideas and understand what is said in a con-
versation with gestures, signs and body language. It has been
pointed out that people with dementia use body language and
concretisation as a strategy to facilitate communication[17].
Videophones can communicate visual nonverbal cues such
as facial expressions, trunk and limb movements and pos-
ture. It can also communicate physical appearance cues such
as clothing and hairstyle, as well as the other’s surrounding
environment.
Even if a videophone could be very useful for persons
with dementia and their families, the existing videophones
and videophone soware in computer systems such as Skype
would very likely be too complicated to be used by persons
with dementia [18]. However, little research has been con-
ducted on the use of videophones for people with dementia.
Most studies in the eld have focused on the use of a video-
phone in Telecare to give advice and support from nurses to
elderly people or their signicant others[14,19]. For example,
in a study by Sävenstedt and colleagues[19], interviews were
conducted with persons with dementia living in a nursing
home and their family members regarding their experience of
using a videophone. e results indicated that in some cases
the videophone conversations were more focused and of bet-
ter quality than face-to-face-conversations. However in order
to be able to use the handset of the videophone most of the
persons with dementia needed assistance from the sta. It has
been shown that signicant others of people with dementia
play crucial roles when everyday technology and assistive
technology are used[6,20]. erefore they should be involved
in the development and design of a new technology such as a
videophone for persons with dementia.
e importance of developing technologies to facilitate and
support communication and maintain relationships between
people with dementia and signicant others is increasingly
recognised[13]. Design concepts such as the Universal Design
and Inclusive Design consider the needs and abilities of people
with disabilities in the design process. e common idea of
Universal Design and Inclusive Design are that products and
environments should be designed to be usable by all people
to the greatest extent possible without the need for adapta-
tions [21,22]. e denitions of these design concepts are
partly overlapping and there is an ongoing discussion about
whether the concepts are synonymous or dierent. Universal
Design is a concept that has its origin in the eld of architec-
ture, but has been quickly expanding into environmental ini-
tiatives, recreation, the arts and health care. Universal Design
was dened by the Center for Universal Design as the design
of products and environments to be usable by all people, to
the greatest extent possible, without the need for adaptation
or specialised design [23]’. e Centre for Universal Design
North Carolina State University has formalised a set of seven
principles that may be used to guide the design process[24].
Inclusive Design shares these principles but it also focuses on
strategies for achieving them[25]. Inclusive Design research
and practice seeks to make work and everyday tasks more
accessible to all. e research is focused on a detailed under-
standing of the functional capability of the users relative to
the particular task demands[26]. Inclusive Design is not so
closely related to a certain principle as is the Universal Design
concept, and its research might thereby permit a broader
approach to the quest.
In this project we intend to develop an easy-to-use video-
phone for persons with dementia using the Inclusive Design
concept[27]. is involves developing and designing an intui-
tive user interface as a mock-up[28] before inviting people
with dementia and their signicant others to test a prototype.
To check the requirements we come up with, we will use the
Universal Design concept’s seven principles as these are easy-
to-follow guidelines. In this paper the rst steps in the process
of developing the user interface are described; i.e. the identi-
cation of these users’ potentials to manage videophones in
terms of challenges they commonly face and a specication of
the requirements of a videophone for people with dementia.
Method
ere are many aspects to consider when designing a product
such as a videophone for people with dementia, for example
cognitive, physical and psychosocial aspects that can inu-
ence the functioning of a new design [13,29]. It has been
suggested that the development of technology for people with
dementia requires a holistic, person-centred approach with
users involved in order to develop useful and easy-to-use
products[30]. Inclusive Design includes the target users in
the design process so that designers can gain insight into ways
in which the proposed product will be used and the challenges
that might limit use[31]. In this study we have used a modied
Inclusive Design method that comprises four phases. ese
include: (1) To examine the need of the user, (2) To develop a
requirement specication of the design, (3) To create a design
concept, and (4) To develop and evaluate a prototype and dene
a detailed plan for the nal product[21]. In this paper we will
focus on the rst two phases. e rst phase was to examine
the potentials of the users in order to address the right prob-
lem, and to investigate whether the target group would need
an easy-to-use videophone. is phase led to an identication
and a detailed description of challenges in using communi-
cation technology with people with dementia. Secondly, the
description from phase 1 was translated into a requirement
specication on the design. A requirement specication can
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358 I.-L. Boman etal.
Disability and Rehabilitation: Assistive Technology
be dened as a list of all things the new design is required
to do, and all the constraints and features it should take into
account[32]. It provides a checklist against which potential
solutions can be judged as the design progresses. Accordingly,
in this phase we also judged the potential usability of exist-
ing similar products for people with dementia by comparing
their design and functions to the requirement specication.
Later on in the third phase a preliminary design concept will
be created and evaluated against the requirement specica-
tion. Finally, the last phase will be to develop and evaluate a
prototype and dene a detailed plan for the nal product. e
third and fourth phases will be reported on in the future. Even
though this structure was followed there are overlaps between
the phases and to some extent it is a back-and-forth process.
e study was approved by one of the Regional Ethical Review
Boards in Stockholm, Dnr: 2010/1674-31/5.
Phase 1: Identification of users’ potentials
In the rst phase the users’ potential possibilities to manage a
videophone were examined. As no studies were found that had
investigated videophones for people with dementia we have
studied results from research of communication technology
and everyday technology use by people with dementia. We
have also searched publications about the design of technol-
ogy for people with dementia and older adults in the Amed,
Cinahl, OT-seeker, PsycINFO and PubMed databases (and on
the Internet using Google). We also continuously retrieved
other publications based on their references. e collected
publications were reviewed in order to identify challenges
that people with dementia might encounter in using com-
munication technology such as telephones, mobile phones,
videophones, computer programs and computer-based aids
for communication. All data, i.e. the identied challenges,
were then categorised by using content analysis[33]. e col-
lected data led to a description of the challenges that people
with dementia or older adults in general might experience in
using communication technology. is was considered to be
an important point of departure in the process of designing
an easy-to-use videophone for people with dementia, before
investigating available recommendations for design of com-
munication technology for this target group.
Phase 2: Development of a requirement specification
In the next phase, requirements on a videophone for people
with dementia were specied by using the same method of
literature review as described above. Recommendations
regarding the design of communication technology and the
functionality of the design for the target group were gath-
ered from the publications. ese data were summarised and
coded by using content analysis principles [33]. e codes
were then compared with the identied challenges of the
users regarding aspects that were related to the t between
the design and the challenges that these users commonly face.
Aer that the requirements were formulated with descrip-
tions of a suggested design. However, the recommendations
in the literature provided an inconclusive base for the design.
erefore, the specied requirements were analysed and dis-
cussed in the research group in order to reach an agreement
on the aspects that were important for the design for easy use
by people with dementia. e research group consisted of (a)
Occupational therapists with PhD degrees, one professor, and
one engineer with a PhD degree, (b) Doctoral students and (c)
Occupational therapists, all having experience from working
with people with cognitive impairment or dementia. Aer the
discussion, the requirements were revised.
Before designing a new product it is important to be aware
of other similar products that are available or being developed.
In Sweden there are videophones that have been designed for
deaf people or people with hearing impairments. ere are also
television telephones and a videophone for older adults under
development. ese products were examined in order to nd
out if any of them could t users with dementia. Information
concerning these products was collected from the producers
homepages and from meetings with manufacturers. e rst
author gathered the information and presented it in a meeting
with the research group. e functionality of these products
was discussed in detail in order to identify design aspects that
could be useful or challenging for people with dementia.
is examination supported our earlier assumption that
there is a need for an easy-to-use videophone designed for
people with dementia. e videophones examined were
found to be too complex to be used by people with dementia,
as using them requires several steps and some of these steps
are not intuitive for the user. For example, the abundance of
information on the screen was assessed to be too dicult for
people with dementia who have limited ability to process
information[13]. Television telephones such as Ippi[34] and
Myjoice[35] that have been developed to enable communi-
cation for elderly people are less appropriate for people with
dementia, as new learning is required. In order to communi-
cate or send a message, for example, the user has to learn to
use a special remote control. e design of these products was
also compared with the user requirements specication in
order to verify or refuse design aspects and to nd new aspects
to add to the requirement specication. en the requirement
specication was revised and completed with the new aspects.
In the nal step, the seven principles for Universal Design[24]
were used as a framework for synthesising our requirement
specication for the design of an easy-to-use videophone for
people with dementia.
Findings
Challenges to using communication technology in
dementia
Cognitive aspects
Analysis of the users’ potentials indicated that it might be di-
cult for people with dementia to use a regular telephone as well
as a videophone because of deteriorating cognitive skills in
areas like attention, executive function, memory, verbal and/or
visuospatial function[36]. ese disabilities might aect users
with dementia’s abilities to remember telephone numbers or
to identify what number to call as well as to sequence neces-
sary actions[9]. ey might also have diculties coping with
many items that require attention, for example to identify the
emergency number among other information[37].
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Designing a videophone for people with dementia 359
© 2012 Informa UK, Ltd.
It has been suggested that technologies for persons with
dementia should not require new learning[6]. However, learn-
ing how to use new technologies (also an easy-to-use video-
phone) always requires some adjustments of habitual patterns
in order to incorporate it into everyday life [38]. Yet, accord-
ing to Orpwood and colleagues[18] and Nygård[7] persons
with mild to moderately severe dementia have a limited but
still promising potential to adapt and to learn new things. It
has been pointed out that in order to facilitate new learning it
is important that the design of the technology is familiar and
as similar as possible to what the person is used to[39,40].
According to Malinowsky and colleagues [41], technology
should be designed to require only easy action skills in order
to be useful for people with dementia. ey presented a hier-
archy of performance action skills that are needed for the use
of everyday technology, where following instructions given
by an automatic telephone service or answering machine was
found to be the most challenging action skill of all. Langdon
and colleagues[42] pointed out that prior experience of using
modern technology is an important aspect of how easy or hard
a new technology is to learn for older adults. erefore it is
important that the design of the videophone is adapted to t
the users’ former experiences in order to be easy to use [43].
Because new learning will be increasingly challenging for peo-
ple with dementia as the disease progresses, it is also important
that such a videophone is introduced at an early stage of the
disease[6,44].
Physical aspects
People with dementia are also likely to have additional age-
related problems such as vision, hearing and/or ne motor
impairments that might become hindrances when using
a videophone [45]. Visual impairments such as decreased
contrast sensitivity and accommodation as well as dicul-
ties with glare need to be considered in design solutions[46].
Changes in hearing are also common with aging as the ability
to discriminate frequencies decreases[47]. Besides impaired
vision and hearing, older adults oen have reduced motor
hand function, for example impaired dexterity, limited range
of movement, muscular tremor or joint rigidity, which impact
on their motor control when using objects[48].
Psychosocial aspects
Aside from cognitive and physical aspects se veral other aspects
might inuence the users’ potential to manage a videophone.
ese include motivation, habits, management strategies and
attitudes on using modern technologies[7,49]. Motivation is
related directly to the persons needs and how well the product
can meet those[49]. Moreover, Goodman and colleagues[50]
found that social aspects inuence older adults’ use of new
technologies. One example of this was that the participants
in their study were less likely to use new technologies as they
did not want to exhibit their lack of understanding of technol-
ogy. Another reason was that they wanted to avoid feelings
of frustration and confusion that could occur if they did not
understand how to use it. Anxiety related to using a new tech-
nology such as a videophone might also be an inuence, if
the person feels “too old to learn how to use a new product”,
and is used to interacting with people face-to-face rather than
with communication technology[51]. Furthermore, assistive
technology that has been developed particularly for disabled
users may be perceived as stigmatising[40]. Consequently,
there is a risk that a videophone might be seen as a stigmatis-
ing reminder of the disability and consequently be avoided or
abandoned. erefore, the design should be unobtrusive and
the users must feel comfortable about using it[52].
User requirements specification
e users’ requirements of a videophone are presented
within the framework of the seven principles for Universal
Design [24] as these principles include the most important
issues in design for all the people with disabilities, including
people with dementia.
Principle 1: Equitable use
Our conclusion was that the design of the videophone, like that
of any technology, should be useful to people with diverse dis-
abilities, as well as to healthy people. Dye and colleagues[37]
and Rosenberg [39] have emphasised that technology for
people with dementia should be aesthetic and appealing to all
users and not draw attention or look like medical equipment
or assistive technology. It is important that the design of the
videophone is age-relevant so that it does not cause embar-
rassment to the users, emphasising their diculties to the
public or making them appear dierent in any way[53].
• e videophone should not be stigmatising
• e design should be age-relevant
• e design should be unobtrusive
• e design should appeal to all users
• e use of the videophone should provide privacy and
security.
Principle 2: Flexibility in use
In the design of an easy-to-use videophone for people with
dementia it is important to take into account the complexity
and individuality of the disease process. erefore the design
needs to be exible, i.e. individually adjustable[13,20,43].
• e design should be exible. It should be possible and
easy to adjust the functions of the videophone to each
user’s needs and skills
• ere should not be too many functions in the video-
phone as these can be confusing and bring about diculty
in choosing those functions that are most appropriate for
the user
• ere should be a user-friendly pre-programmable pro-
gram for signicant others that provides dierent choices
(not visible to user).
Principle 3: Simple and intuitive use
e videophone should be easy and self-instructive
enough to allow intuitive use by people with dementia
as new learning is dicult and new instructions may be
ignored [13,40,43]. e design should hence be easy to
understand, regardless of the user’s experience, knowledge,
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360 I.-L. Boman etal.
Disability and Rehabilitation: Assistive Technology
language skills or current level of concentration. It should
be easy to receive/answer incoming calls and the design
should accept and allow enough time between steps when
making a call. Moreover the videophone should not require
a chain of actions[3,54].
• e videophone should be easy to understand and require
minimal new learning
• e videophone should look familiar i.e. look, feel, and
operate like a regular telephone and be consistent with
familiar symbols and functions
• Only necessary functions that are easy to understand and
recall should be used
• All information that the user needs should be visible on
the screen
• ere should be as few steps as possible to make a call or
answer a call
• e design should give support in how to make or answer
a call
• e design should require minimal user initiation and
maintenance
• e design should not take control away from the user
• e design should provide a feeling of enabling and of
success and independence
• e design of automatic functions must not be confusing
for the user
• e videophone should give feedback on all actions (so that
the user knows that the system has registered an action).
Principle 4: Perceivable information
e design of the videophone should communicate neces-
sary information eectively to the user. e information
should be clear and also meet the special needs associated
with normal aging such as changes in vision and hearing.
It is important to use good contrast as colour perception
declines with age[54]. In addition, people with dementia
may have diculties seeing colours in the blue-violet range
making blue, blue-green and blue-violetall look the same.
Red can make an item stand out more and make it easier to
see for people with dementia[55].
• Information on the screen should be easy to read
• It should be possible to use dierent modes for informa-
tion (sounds, signals, verbal)
• ere should not be any unnecessary decoration on the
videophone
• Important information should be in the middle of the
eld of vision
• e screen should contain as little information as possible
because of the user’s limited ability to process and under-
stand information
• Headlines such as ‘contact list’, ‘call from’ etc. should not
be used
• Colour alone should not carry information.
Principle 5: Tolerance for error
All new technologies must be reliable and this is especially
important for people with disabilities[56]. If the videophone
does not work as expected, this could be very distressing
to people with dementia [43]. In addition, the videophone
should be intelligent, i.e. it should be able to prevent mistakes
and correct errors and risky ways of interacting with it[40].
• ere should not be any loose parts such as an cordless
handset
• e videophone should provide warnings of hazards and
errors
• e videophone should be able to handle errors
• It should be possible to have an automatic search for
alternative telephone numbers if the called contact is not
answering
• If it is possible the videophone should be connected to a
call centre that can give support for various kinds of non-
emergency problems.
Principle 6: Low physical effort
e videophone should be comfortable to use, cause a mini-
mum of fatigue and be easy to handle for people with decreased
physical strength and inferior ne motor coordination[43].
Principle 7: Size and space for approach and use
It should be possible to adjust the font size on the videophone
so that people with vision impairment can read information.
e ring tone should be familiar and must be easy to adjust
and change continually to meet individual needs.
Fonts
• It should be possible to have large font
• Sans-serif fonts such as Helvetica, Arial, or Verdana are
preferred
• Letters should be used rather than symbols
• ere should be clear letter spacing between each character
• Italic fonts should not be used
• Similar text and background colours should not be used
• Patterned backgrounds should not be used
• Shadow eect should not be used.
Sound and volume
• e sound should have good quality (no echo or buer-
ing, no distracting background noise)
• ere should be an inductive connection to a hearing aid
• It should be possible to adjust volume and tone for the
handset and the speaker, and these should be easy to
change later on to meet users’ individual needs
Contrast and colour
• It should be possible to adjust the contrast and colour of
the background to t each user
Concluding comments
Designing a new product is an iterative process with over-
laps between the dierent phases of the entire design pro-
cess [21]. is paper presents the rst two phases in the
development of a videophone for people with dementia,
following an Inclusive Design approach[21]. In reviewing
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Designing a videophone for people with dementia 361
© 2012 Informa UK, Ltd.
publications regarding recommendations of the design
of technology for the target group we identied aspects
that would make a videophone easy to use by meeting the
potentials and requirements of people with dementia. e
aspects we identied in the analysis were found to be close
to the seven principles for Universal Design[24]. is is not
surprising as the principles for Universal Design include
the most important issues in design for all people with
disabilities, including people with dementia. However, when
designing for people with dementia, it is particularly impor-
tant to consider the users’ deteriorating cognitive and physical
functions as well as psychosocial aspects. Principles one and
two in Universal Design state that the design should be use-
ful to people with diverse skills and be exible in use. One
can argue that no design can achieve complete inclusiveness
for all users. Yet it is important that a product can accommo-
date a wide range of abilities by providing a choice of use and
making the design appealing to all users without stigmatising
disabled users[40].
As people with dementia face an increasingly limited abil-
ity to learn how to use new things, our recommendation was
that the videophone should be introduced at an early stage
of the disease. However, people with dementia may prefer
using their familiar and ordinary items as long as possible,
e.g. a telephone, and hesitate to replace them with adapted
equipment, as they fear losing their ability to use the ordinary
item if they stop practicing its use[7,9]. e same tendency
to resist adaptations has also been found in studies of self-
initiated management strategies that people with dementia
have to respond to diculties in everyday life[17,57]. is
suggests that it would be preferable if a videophone such as
the intended one would be conceptualised as an ordinary item
rather than as an assistive device, although it is particularly
designed to t users with dementia. Consequently the design
of the videophone should also include the needs of signicant
others to people with dementia in order to be benecial to
people with and without disabilities. Inclusive Design prod-
ucts aim to be usable without adaptation by as many people as
possible and reduce the need for special equipment. However,
some people will need assistive technology in order to be able
to use mainstream products[27]. As Czaja and colleagues[49]
pointed out, motivation to adjust to new technology is related
to the person’s needs and how well the product can meet
those. Hence it might be dicult to motivate a person with
dementia to start using a videophone in an early stage of the
disease if the need for the product is not experienced by the
person. However if the benets of the product are commu-
nicated to people with dementia and their signicant others,
they might be willing to adjust to it in an early stage of the
disease process. Earlier research has particularly underscored
that to be accepted, the design of the videophone should be
aesthetic and it should not look like an assistive device. For
example, a social alarm could be accepted if it is designed as a
beautiful bracelet[40].
e ndings of this study present a range of detailed chal-
lenges to using a telephone or videophone in dementia, and
similarly detailed requirements for design. Although the
requirement specication presented here is aimed at design-
ing a videophone, we propose that it also can facilitate the
design of other products for people with dementia, particu-
larly in the eld of communication technology. One point
to be noted is that the principles might be contradictory to
each other, and this may need to be considered in further
research. For example; a videophone that is exible and can
be adjusted to individual needs and preferences (principle
2) might be more complex and therefore more dicult to
use, than one that is not as exible. Consequently, principle
2 might be a threat to principle 3 (simple and intuitive use).
Similarly, principle 3 requires that all information that the
user needs should be visible on the screen, while principle
4 (perceivable information) states that the screen should
contain as little information as possible. ese apparent
contradictions remain challenging to designers, but raised
awareness of them is likely to assist in the design process.
Furthermore, even if all principles are taken into account
in the design process we know that the actual interaction
between a person and a piece of technology such as the
videophone is not predictable. is is because it is a com-
plex interaction comprising dierent aspects such as habits,
earlier knowledge, social support etc[2]. erefore it will
be important to evaluate these principles in the forthcoming
empirical research, and to revise them continuously.
One limitation in this study is the lack of direct infor-
mation from people with dementia and their significant
others. However, it has been recommended that research-
ers and designers prepare carefully before turning to users
with cognitive impairment to try out design ideas[45]. As
comprehensive guidelines for design are scarce when it
comes to developing technology for people with dementia,
we chose to start the process by synthesising the state of the
art in the literature. In a forthcoming study we will report
potential users’ views on their eventual need of a product
such as this, and their reflections on a preliminary design
concept that is based on the requirement specifications
presented here.
Acknowledgements
We oer our grateful thanks to research assistants Soa
Starkhammar, Jenny Rahmqvist and Monica Pantzar for
their valuable help during the study, and to all members of
the dementia research group at the Division of Occupational
erapy at Karolinska Institutet. is work was supported by
a grant from the Alzheimer’s Association under the Everyday
Technologies for Alzheimer’s Care program. Swedish
Brainpower also supported the study.
Declaration of Interest: e Principles of Universal Design
were conceived and developed by e Center for Universal
Design at North Carolina State University. Use or application
of the principles in any form by an individual or organisation
is separate and distinct from the principles and does not con-
stitute or imply acceptance or endorsement by e Center for
Universal Design of the use or application. e authors report
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362 I.-L. Boman etal.
Disability and Rehabilitation: Assistive Technology
no conicts of interest. e authors alone are responsible for
the content and writing of the paper.
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... They need to have a user-friendly interface designed specifically for PWD. Assistive ICT devices should also be able to accommodate other age-related impairments such as problems with vision, dexterity and hearing (Boman, Rosenberg, Lundberg, & Nygård, 2012 ...
... However, these devices are generally not adapted to PWD and are not always user friendly (Koumninos, Nicol, Dunlop, 2014). Many programs and applications tailored for PWD were introduced in recent years, however, the usability of these tools with this population has yet to be shown (Boman et al., 2012). ...
... However, to ensure widespread use of touchscreen ICT devices by PWD, there are some adaptations that must be done to cater to this population (Komninos et al., 2014). It has been recommended that the principles of universal design be used for achieving this goal (Boman et al., 2012). According to the principles of universal design, the design of ICT devices should be usable by everyone regardless of their age, abilities or status in life (Joines, 2009). ...
... The idea of person-centered designs, bricolage and collaborative working with participants is increasingly becoming the desired standard in implementation research (Zamir et al., 2018). For technology interventions, a large sum of money is spent on changing the interfaces or key features to better match the userneeds of the older person (Newell et al., 2011;Boman et al., 2012). The current study drew on low-cost materials and techniques (a simple group activity) to allow older people to personalize a new technology (becoming 'bricolers') rather than completely re-designing it. ...
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... There is a little research which indicates that people with dementia may find the additional visual input of body language and facial expression on a video call is helpful in taking part in an interaction (Boman et al., 2014;Meiland et al., 2017;Moyle et al., 2020a) and that such calls can help to reduce isolation and loneliness (Guo et al., 2016). There is some experience that colour contrasts may be perceived differently, and that the light and sound in the environment should be managed to make the screen and the sound as clear as possible for the resident (Boman et al., 2012). Use of the loud-speaker function is helpful. ...
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... Not only does such a view reduce a person to a narrow set of clinical parameters, it also overlooks design opportunities that may otherwise enrich the lived experiences of persons with dementia [27,49]. Research involving persons with dementia has underscored that they can and should be involved in the design process, and suggests that their experiences could be enriched with the continuity of meaningful and enjoyable activities [1,35,57,64]; a greater sense of control and security in their everyday activities [7,41]; and greater social inclusion and social connectedness [2,6,36,38,42,64]. ...
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Persons with dementia and their care partners have been found to adapt their own technological arrangements using commercially-available information and communication technologies (ICTs). Yet, little is known about these processes of technology appropriation and how care practices are impacted. Adopting a relational perspective of care, we longitudinally examined how four family care networks appropriated a new commercial ICT service into their existing technological arrangements and care practices. Cross-case analysis interpreted collaborative appropriation to encompass two interrelated processes of creating and adapting technological practices and negotiating and augmenting care relationships. Four driving forces were also proposed: motivating meanings that actors ascribe to the technology and its use; the learnability of the technology and actors' resourcefulness; the establishment of responsive and cooperative care practices; and the qualities of empathy and shared power in care relationships. The importance of technological literacy, learning, meaning-making, and the nature and quality of care relationships are discussed. Future work is urged to employ longitudinal and naturalistic approaches, and focus design efforts on promoting synergistic care relationships and care practices.
... Not only does such a view reduce a person to a narrow set of clinical parameters, it also overlooks design opportunities that may otherwise enrich the lived experiences of persons with dementia [27,49]. Research involving persons with dementia has underscored that they can and should be involved in the design process, and suggests that their experiences could be enriched with the continuity of meaningful and enjoyable activities [1,35,57,64]; a greater sense of control and security in their everyday activities [7,41]; and greater social inclusion and social connectedness [2,6,36,38,42,64]. ...
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... For instance, external cueing systems can assist people with cognitive disabilities by reminding them to perform a task at the appropriate time (e.g., take their pills), or by providing guidance through a task (291)(292)(293), and sensors recording a patient's position in space may help in navigation through environment (294). Moreover, assistive technologies may help to support decision-making in vocational and personal health domains (295), to read (296), or use the telephone (297). ...
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... The design needs have been well documented and the device can be re-designed using focus groups. The use of focus groups to evaluate internet interventions [39] and video-call technology with older adults has proved advantageous for other researchers [40]. Moreover, a surprising finding about SoW was that although the handset was not used during calls, it still helped to identify that SoW was a tele-service. ...
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Background Older people in care may be lonely with insufficient contact if families are unable to visit. Face-to-face contact through video-calls may help reduce loneliness, but little is known about the processes of engaging people in care environments in using video-calls. We aimed to identify the barriers to and facilitators of implementing video-calls for older people in care environments. MethodsA collaborative action research (CAR) approach was taken to implement a video-call intervention in care environments. We undertook five steps of recruitment, planning, implementation, reflection and re-evaluation, in seven care homes and one hospital in the UK. The video-call intervention ‘Skype on Wheels’ (SoW) comprised a wheeled device that could hold an iPad and handset, and used Skype to provide a free video-call service. Care staff were collaborators who implemented the intervention within the care-setting by agreeing the intervention, recruiting older people and their family, and setting up video-calls. Field notes and reflective diaries on observations and conversations with staff, older people and family were maintained over 15 months, and analysed using thematic analysis. ResultsFour care homes implemented the intervention. Eight older people with their respective social contacts made use of video-calls. Older people were able to use SoW with assistance from staff, and enjoyed the use of video-calls to stay better connected with family. However five barriers towards implementation included staff turnover, risk averseness, the SoW design, lack of family commitment and staff attitudes regarding technology. Conclusions The SoW intervention, or something similar, could aid older people to stay better connected with their families in care environments, but if implemented as part of a rigorous evaluation, then co-production of the intervention at each recruitment site may be needed to overcome barriers and maximise engagement.
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Thesis
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Dementia is on the rise and society faces the challenge of how to manage its impacts. Challenging the biomedical discourse, sociocritical work has underscored relational aspects of caring and promoted 'partnerships' between persons with dementia (PwD), informal care partners, and formal care providers (the 'partners'). Technological research has only begun to explore how innovation may enrich lived experiences with dementia beyond compensating for cognitive deficits or alleviating care 'burdens'. My central thesis aims were to better understand the nature of care partnerships from the perspectives of PwD and family care partners, and to describe how co-creating technological experiences may impact care partnerships. Data were gathered from three qualitative studies. Study I co-designed with family care partners how they support PwD in activities, and how they envision technology complementing their care. Study II employed focus groups with adult children that constructed an understanding of how adult children sustain caring within their family and formal care contexts. Study III used a multiple case study to describe how four care networks adapted to new technologies, and how doing so impacted care practices. Toward my central thesis aims, these findings together demonstrate that care partnerships are comprised of diverse and interdependent care relationships. Partners exercise different forms of knowledge, expertise, and perspectives in ways that may converge, iii complement, or conflict with one another. Partners interact by responding and adapting to care changes, balancing and negotiating with one another, entrusting and diffusing care responsibilities, and learning and growing throughout their care journeys. Whether co-creating technological experiences challenges or enhances care partnerships is influenced by how partners make meaning with technology, learn and foster technological support resources, adapt care practices, and reconfigure their care relationships through technology use. Future work is encouraged to adopt relational approaches to understanding and designing to enrich lives with dementia.
Preprint
A literature review of papers that have explored digital technology user interface design for people with dementia is reported. Only papers that have employed target user input directly or from other works have been included. Twenty four were analysed. Improvements in reporting of studies are recommended. A case is made for considering the population of people with dementia as so heterogeneous that one design does not suit all, this is illustrated through some case study reports from people with dementia. Furthermore it is proposed that by grouping people into functionally similar subgroups interfaces may be designed for these groups that will collectively establish a sequence of 'stepping stone ' interfaces that better address appropriate functioning and maintain self-efficacy.
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